New York City Mayor Michael Bloomberg recently announced a plan to forbid the sale within the city of sugar-sweetened drinks larger than 16 ounces. The limit, which excludes juice-based, artificially-sweetened, and alcoholic drinks, as well as drinks sold at convenience or grocery stores, is his latest contribution to the effort to combat obesity and associated chronic diseases. Fines of $200 may be instituted as soon as March 2013.

Critics maintain that this approach will not decrease obesity because nothing will prevent those who desire from simply stopping at a local convenience store to purchase the drink of their choice before proceeding to their destination. 

These people miss the point. Mayor Bloomberg is not saying you can’t drink as much soda as you want. He’s saying it can’t be your default setting when you make a stop for a fast food meal. He’s saying you can’t buy it all in a single cup.

This reminds me of the time my two young sons threatened to eat white bread at school. I listened solemnly, and replied that they could still eat anything they wanted anywhere they wanted, like at school or a friend’s house. I was not saying they could no longer eat white bread. I was saying was that they could count on the fact that the available options in our home would consist of nutritious, whole foods. Of course my new plan would simultaneously decrease opportunities for choosing empty calories. 

I have heard people say that Mayor Bloomberg’s policy interferes with their freedom to indulge personal appetites (that will significantly increase their risk of becoming sick and/or handicapped). So many years later, I still remember the sign that hung on the front wall of my ninth grade Civics class: “The right to swing my fist ends where the other man’s nose begins.” – Oliver Wendell Holmes. 

Are buckets of soda the only cause of obesity?  Of course not. Insufficient activity, giant bagels, overwhelming stress, chronic exhaustion, gargantuan servings of chips and fries in place of fruits and vegetables, and triple-sized burgers all contribute their fair share, not to mention smoking and trans fats.

The obesity epidemic is no longer just an epidemic, but rather a catastrophe. Either we invest in prevention or we pay the consequences. One issue at a time. All roads lead to Medicare, and we will fund the consequences. We’re all in this together. 

Today I’m talking about how words are employed with regard to fat, because the term “healthy fats” annoys me.

Fats are one of three (or four) macronutrients: protein, fat, and fiber (plus water).  Some folks call those three categories protein, fat, and carbohydrate, but that makes it permissible to consider stripped (refined carbohydrate) a macronutrient and that is not the case.  Stripped carbohydrates aren’t food; they’re manufactured calories, and manufactured calories aren’t food.

If, on the other hand, we call that class of macronutrient “fiber,” then you know I’m talking about the carbohydrate that comes up out of the ground and is always, always rich in fiber.  Remember that, with the exception of milk and honey, carbohydrate doesn’t exist in nature without the fiber.  So whenever you come across carbohydrate without fiber attached, we humans probably made it that way.

Well then, what’s wrong with the term “healthy fats?”  Well, we don’t use the adjective “healthy” in front of protein or carbohydrates.  We assume that when you mention them in a blog about good health that you’re talking about the healthy kind.  Yes there are unhealthy carbs, loads of them in fact, yet we don’t feel the need to keep reminding ourselves.  So why do people persist in distinguishing fats as “healthy?”

A couple of reasons, I think.  The main one is that we spent the last few decades being trained (by the advertising industry, under direction from the manufactured-calorie industry), to consider fats unhealthy.  We have heard, over and over, that if you eat fat you’ll get fat.  We internalized this message so successfully that we began to wrinkle our noses and stick out our tongues when we said the word “fat.”  Not funny.

It turned out that the message was wrong.  We looked around and noticed that the less fat people ate, and the more refined carbohydrate they were taught to substitute, the more overweight they became.  Yes, it took a couple of decades to realize, but it’s no longer impossible to ignore.  We have an enormous weight problem in this country and it’s not because of fat.

We are, finally, realizing that fat is good for us, and we’ve identified a few kinds of fat that seem to be particularly good for us, such as olives, avocadoes, nuts, peanuts, and deep-sea fish like tuna or salmon.  In order to distinguish these from what we consider the gross, disgusting, fat-causing types of fat, we started to call these fats “healthy” fats, as if the fats themselves are healthy.  But they’re not.  They’re just chemical compounds that break down into fatty acids of a certain configuration that happen to serve one or another beneficial purposes once we consume them.

These are fats that nourish us, or that provide us with beneficial nutrients.  So from here on in, I’m going to call them nourishing fats, or nutritious fats.  There’s no reason for me to call them healthy; if you read about them on my blog, you already know how I feel about them.

Do we now know everything we need to know, everything we’re ever going to need to know, about nutrition?  Definitely not.  But I do believe that there are some important things about which we can all agree.  And one of them is that nutritious fats play an important role in our diets.

All kinds of behaviors can have an effect on your weight, and the solution to each is different.  

Maybe portion size is your biggest issue.  Maybe it’s hard to get moving, even though you know you need to get some exercise.  Maybe you have a sweet tooth that you can’t shake.  Maybe you’re completely stressed out, and you never get a decent night’s sleep.  Maybe you are a nighttime snacker.  Or maybe it’s some combination of these.

How do you know which of these applies to you?  Be honest with yourself.  Check the ingredient list of everything you eat, and keep a log for a week.  Can you actually say that there is very little sugar or virtually no corn syrup in your diet?  It may be hard to believe, but it’s in yogurt, breads, ice cream, salad dressings, sodas and sports drinks, muffins, non-dairy coffee whiteners, and even some kinds of dark chocolate.  If you’re doing a fairly good job avoiding it, then it’s not number one.  But maybe it’s number two.  I have no problem with a treat now and then, but I want to know when I choose it, and I don’t want to eat “hidden sugar.”  It spikes your insulin levels, packs on the fat, and makes you crave more.

American portions are out of control, and not just yours.  Bagels have tripled in size since the 1960s.  There’s always room for dessert.  You can get a bucket of soda for ten cents more, so why wouldn’t you?   Just super size me, you know?   But I don’t want people to feel hungry, or denied.  Eating well and being satisfied are synonymous.  Luckily, there are good solutions to hunger, and they are called fiber, fat, and protein.  Fruits and vegetables and beans are delicious and filling.  Fat is flavorful and satisfying.  Protein keeps you going.      

Exercising your right to free speech more than anything else?  Getting exercise can be difficult, but it’s not impossible.  First, remove as many obstacles as possible:  Sleep in your T shirt and shorts, and put the gym shoes by your bed so you have to step over them to get up.  Ride an exercise bike at home instead of having to drive to the gym.  Commit to meet a friend and walk together, so you don’t keep one another waiting.  Secondly, reward yourself, with a chart and gold stars if necessary, and then redeem those gold stars for something you’ve been dreaming about.  Think about what it will take to get you moving, and do whatever it takes.  Make it worth your while.  If your knees bother you, then take a Tylenol beforehand.  As I tell my patients, “I’ll pay any price to keep you mobile.”

On a scale of one (always relaxed and focused) to ten (frighteningly freaked out and finding it hard to think), how stressed out are you most of the time?  Know that a very important part of being healthy is relaxation, in both daytime and nighttime.  If you rate your stress level almost always as lower than four, keep up the good work, and continue to work on protecting your relaxation time.  If it’s higher than four, you may find that walking helps, or meditation, or yoga, or talking about it with friends.  If your stress level is higher than six, you may want to schedule an appointment to talk about it with your doctor.  Your doctor should be able to refer you to a professional with expertise in stress management.

If you’re having difficulty sleeping, learn about “sleep hygiene” and see if you are doing something that is actually making it worse.  Are you finding it hard to fall asleep because you can’t turn off your mind?  Do you wake up in the early morning hours and have difficulty returning to sleep?  Maybe you aren’t getting enough sleep, period.  Any of these can derail weight loss efforts.

Have you been eating a big bowl of cereal before you go to bed?  A peanut butter sandwich or a candy bar?  That’s a problem.  Start working on this issue by trying to eat a bigger breakfast and lunch, thereby getting in more calories earlier in the day.  You may still want a nighttime snack, but it can be a healthier one.  Eat berries, for example, which are sweet and satisfying, but low in practically everything else (except fiber).  

See how these apply to you, and start thinking about the one that resonates most with you.  One step at a time, one day at a time, one issue at a time.  I don’t believe in quick fixes.  I believe in slow, sustainable progress, so that someday you can say, “Wow, I really eat differently than I used to.”

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