January 27

West Virginia obesity solution

24  comments

pto-vallarta-first-tee-blog-size.JPG
Looking down the 1st fairway on the Weiskopf course at Vista Vallarta
I’m in the penultimate day of my all-male golf outing. We’ll be up at the crack of dawn tomorrow, play 18, dash back to the hotel, throw all my crap in the suitcase (where is MD, my packer extraordinairre when I need her?), head to the airport and be back in the late afternoon. When I do get back, I’ll deal with all the comments that have stacked up in my while I’ve been gone. I’ll have them posted with my pithy commentary by noon Monday at the latest. So, if you’ve been waiting and watching, don’t despair.
In roaming through the news today I learned that Medicaid in West Virginia is going to try a different approach to solve the huge obesity problem that afflicts that state. Since the state spends about $140 million per year in health care costs for its heftiest citizens, the powers that be figure that spending a few million on preventative treatment might be a good investment. Problem is, in my opinion, they’re going about it in the wrong way.

Facing more than $100 million in annual costs linked to obesity, the Medicaid program in one of the country’s most overweight states is turning to a familiar name to help residents slim down.
Up to 75,000 West Virginians will soon be eligible for free weight loss courses through Weight Watchers, thanks to an effort by the state Medicaid program and the health benefits group UniCare, the largest provider of Medicaid coverage in the state.

Weight Watchers??!!??
So let me get this straight. We’ve got an enormous number of overweight people, most of whom spend their time face down in the carbohydrates. And we’re going to put them on a low-fat, high-carbohydrate diet–at state expense–to help them lose the weight they’ve put on by eating too many carbohydrates. Have I got that right?
Brilliant!


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  1. Weight Watchers didn’t work for me. I initially lost a little over 50 lbs, but eventually gained it all back. It was enough to make me give up on trying to lose weight until I became diabetic. I paid a lot of money for a weight roller coaster ride. With low carb, I’ve lost more than I ever did on Weight Watchers.
    Hi Dan–

    I suspect the people from West Virginia with discover the same thing.
    Cheers–
    MRE 

  2. One more thought. It’s bad enough that I wasted my own money on Weight Watchers and I certainly don’t want my tax money supporting them.
    In all fairness, I know people who have done very well on Weight Watcher, even keeping the weight off. If Weight Watchers works for them, I won’t argue. However, as I sat in the Weight Watchers meetings, I saw many people like me who didn’t seem to be making any progress.
    I suspect that there are a lot more who don’t make progress than there are those who do.
    Cheers–
    MRE 

  3. Regarding Weight Watchers-they now offer an alternative weight-loss plan which amounts to a version of low-carbing. So, when one joins, there is either the point system (and fat has so many points, one sort of has to do it low-fat to fit into the requirements) or a core plan.
    One of the posters at Dr. Bernstein’s forum lost over 100 pounds in a year (and became a triathlete) by being a Weight Watcher combined with Dr. B’s 6/12/12 regimen.
    Why doesn’t some venture capitalist invest in a low-carb member program with weekly meetings?
    Hi marly–
    I don’t know why someone doesn’t invest in such a deal.  Seems like a sure thing to me.
    Cheers–
    MRE 

  4. A thick fillet was dipped in batter and fried. Here, there’s nothing soggily waiting. It’s all made to order. I had a cup of tea in a Styrofoam cup, brewed from a tea bag that tasted of brown. The vinegar was malt, the ketchup caged in small packets, the mushy peas dyed green. Everything else was as you’d expect from anywhere in England. Except for the fish, which came, eight minutes later, blisteringly hot. The batter had been immolated into a filigree of stalagmites and fans of coral. I broke off a corner. The fish smoked and glistened translucent white.
    What do you fry it in, I asked. “Beef dripping.” Just dripping? “Only dripping.” I doused it in vinegar, sprinkled it with salt and went and sat on the harbour wall, where Cook took out the Endeavour early one morning and the haddock had landed in the dawn. It was stupendous. The chips were pale and crisp, hot and floury. The batter crunched. Beef dripping is everything, in terms of both chemistry and gastronomy. Only animal fat burns hot enough to seal the batter instantly into this light coat. Inside, the fish doesn’t fry — it steams itself in its own hermetic juiciness.
    Fish and chips is a silent meal. You shouldn’t talk and eat. It is a race against falling temperature. You need to be perfectly concentrated, constantly blowing and sucking, wolfing with bared teeth and flared nostrils. But even lukewarm, chips fried in dripping have a delicious, sweet, meaty tang. The faint, fugitive flavour of the bull is the subtle ingredient that makes this perfect.
    That, too, seems a nicely British combination: beefy batter, vinegar and the sea.
    Magpie Cafe
    1 14 Pier Road, Whitby; 01947 602058
    Open daily, 11.30am-9pm
    Five stars
    Hi Simon–
    Enough!!!  I’m starving for some fish and chips now.
    I’m glad to hear that they’re using beef tallow.  Wish we could get it easily over here.  Maybe I’ll start the hunt for a source.
    If you haven’t considered it already, there is probably a career for you as a food writer.
    Cheers–
    MRE 

  5. Dear Dr. MRE
    Thick green grass cut at resort height, flora blooming pink, back-dropping Sierra Madres — damn, that numero uno fairway looks inviting. And to think that you were even par at that point fills me with more envy than I can bear. I know I’m supposed to be happy for my friend’s good fortune, but right now I’m digging deeper than a West Virginia coal mine and happy just isn’t to be found. The best I can come up with is more like, “I hope you had a nice round, you p***k”.
    Sullenly yours,
    James
    Hello James–
    At the moment that photo was snapped I was at even par, but a few moments later I was one under.  A huge drive coupled with an approach shot that hit the pin (and almost dropped in) followed by a tap in bird started the round off right.  That should make you a little more sullen.
    Cheers–
    MRE 

  6. I read somewhere that Weight Watcher’s biggest income is from returning members.
    I tried it several times, but got tired of being hungry all the time.
    Hi Cindy–
    I wouldn’t know, but it I wouldn’t be surprised.
    Cheers–
    MRE 

  7. I got to 473 pounds.
    What people don’t know is that I was a faithful weight Watcher, even losing 66 pounds at one stage. I starved every one of those pounds off.
    I even volunteered at the meetings as a ‘recorder’ (Person who takes the money at the door). As such I was privy to how Weight Watchers works as a business, and how little participants succeeded at their program.
    I asked my former leader, after I had left Weight watchers, ‘Why was I hungry all the time??’ and she just shrugged and said ‘maybe it wasn’t enough food for you?’. She was a qualified Personal Trainer at the time.
    Hi Dave–
    Thanks for the sad story.  I’m glad your now on the right track.
    Cheers–
    MRE 

  8. In the interest of factual fairness, i.e. not all of the “good” foods in the WW food lists are high-carb, I will point out that WW has a number of low-carb items in those lists, most of which count as few or no “points” in their program. The problem, of course, is that the nice healthy meats, nuts and other protein sources, which are as essential to a low-carb lifestyle as the low carb veggies, are higher in points.
    This is primarily because the formula used to calculate points counts fat higher than anything, without regard for the type of fat, and provides “discounts” for the fiber. As most of the low carb items are also low in fat and high in fiber, one can eat, for instance, pretty much all the cauliflower one wants.
    IMO, the real value of an organization such as WW is the camaraderie that comes from having the support and encouragement, not to mention positive example, of the other participants. I’ve often thought that if WW could be convinced to abandon the arbitrary point system and count the much simpler ECC instead, it might even be worth the ten bucks a week.
    Maybe I’ll start “Carb Counters” and see what happens. I’d take dibs on the name, if it weren’t already taken. 🙂
    Brad
    Hi Brad–
    Go for it.  Let me know how ‘Carb Counters’ works out.  I’ll even be a guest speaker.
    Cheers–
    MRE 

  9. About Weight Watchers “alternative weight-loss plan which amounts to a version of low-carbing,” it’s still a low-fat plan. You are allowed to eat “core” foods until satisfied, but the “core” foods are low fat (lean meats, fat free condiments, etc), low sugar (except for the fat free condiments), and limited starch. You only get 2 teaspoons of added oils per day. They also allow you extra points for “non-core” foods. It is “low carb” in that you do have flexibility with carbs and protein, but it doesn’t include enough fat for my likes, unless you use the extra points for more fat. I’ve managed to do just fine with low carb on my own and with info on the web, so I can’t see paying money for it.
    Still, I’m glad to see someone has made it work. It’s their choice and I applaud their success. It would be nice to have a similar low carb organization.

  10. I’ve watch co-workers go through WW and what always bothered me most about the program were the insane things they’d all do on meeting days knowing that they would be weighed. Not eating or drinking anything all day was really common.
    I agree with Brad that the real value of the group is the support and, hey, I’d join Carb Counters if it were to exist. Those of us bucking the low-fat trend really can use the camaraderie that such a group would supply. Lord knows, I sometimes feel like the lone voice in the wilderness in the midst of all my low-fatting friends.

  11. The ironic thing is that 1972 Weight Watchers was carb reduced.
    They allowed two “breads” a day and fruit only at meals.
    And the meal-size protein for women was 4-6 ounces of meat.
    This is what originally worked for so many people, and hasn’t since.
    Hi Connie–
    You’re right that the earlier version of WW was low-carb.  If they had stuck with their guns, they would have done fine.  But when the rest of the world went low-fat, they followed right along.  Now instead of being with the times, they’re behind.
    Cheers–
    MRE 

  12. I’ve got another suggestion instead of Weight Watchers.
    Meter Eaters. I’m starting to think that “eating to the meter” might work even better, as in using personal glucose testing meters to monitor glucose levels in order to lose weight.
    Around Thanksgiving I became concerned when I realized my “high normal” fasting glucose levels around 100 aren’t really normal and that my doctors haven’t really been monitoring my glucose status at all, despite my having gestational diabetes 8 years ago.
    So I got a meter and I’m testing, testing, testing (yes, paying full retail without a Rx for those @%$#@#%^ test strips). The information I’m gathering about where my glucose levels were throughout the day is astounding (& alarming, but that’s another story) but I’m also finding that the instant feedback I get from the meter is great motivation be really strict with my carb intake, to not eat the last three bites of my son’s oatmeal, just a cookie, or whatever. My goal is to have “truly normal” glucose levels most of the time and the meter is helping me get there. To my surprise, when I ate in such a way as to keep my glucose as even (no spikes) and in as normal range as possible, much of my last 10 “stubborn” pounds came off without me even noticing. And this was over the holidays! I had no problem turning down problem foods unless I was truly “testing” my reaction to them. It was quite a different feeling being focused on the meter data rather than the scale. And the meter emphasizes the health aspect, not just the weight or the vanity.
    Then again, that might not be the right motivation for everyone, but I’ll bet it would help some. And the test strips are expensive if one doesn’t have a Dr’s Rx, although folks pay as much or more for some other less effective weight loss methods. But it’s a heck of a lot quicker to check progress than by weighing in once a week. Even with one or two “bad” readings, another opportunity to do better is in just a few hours!
    Cheers,
    Anna
    Hi Anna–
    Interesting.  Meter Eaters.  Hmmm.  I may have to steal it.
    I think you’re probably on to something.  Immediate feedback works much better than delayed feedback, and there’s nothing more immediate than seeing a glucose spike right after consuming a cookie.
    Thanks for filling us in about your experience.
    Best–
    MRE 

  13. Sir hilarious. Thats not me thats AA Gill writing..the Times Food Critic !
    Scuse the analogy but i nearly ‘shot my bolt’ when reading it. And Whitby is really rather charming with or without Dracule !
    My prose is sometimes likened to Hitchens though as a booze addled nicotine sodden former Trotskyite truned pseudo hawk that doesn’t say much for me !
    Esp as i neither tobac nor hocchy hoochy aside from the proverbial blue moon !
    Hi Simon–
    Ah, well…at least I have an ear for good prose.
    Cheers–
    MRE

  14. I think Weight Watchers works pretty well for people who need a lot of structure in their diet plan and work well with handing authority over to a system. Personally, if I’m “put” on any sort of counting calorie or points plan, I know I’m going to rebel in very short order with a very tall order of fries and milkshake.
    I’m disappointed in any “one-size-fits-all” solution, especially an organization that promotes high-carb, low-fat eating. Everyone I know who has “done” Weight Watchers ended up hungry, or storing up points for fast food binges…thinking that it was fine because they only ate carrots for the whole day before that.
    Wouldn’t it be nice if the state could promote eating fresh, healthy, good-for-you foods like meat, fish, eggs and veggies rather than sinking money into an organization that only succeeds for a minority of folks who try it?
    Kate at The Steaks Are High
    Hi Kate–
    It would be nice indeed.  I suspect that West Virginia would find its money much better spent in terms of pounds lost verses dollars spent, but we’re dealing with bureaucrats here, so it’s only right that they get it wrong.
    Cheers–
    MRE 

  15. In all fairness to Weight Watchers (it’s not for me, but does work), my Mom lost 70 pounds on WW and has kept it off. She makes her husband be on the program, too, though he likes to cheat. They keep the weight off by continuing to go to meetings and count their points. It’s not too different than my low-carbing while counting calories and carbs.
    Hi Victoria–
    If it works for someone, far be it from me to be critical. 
    Cheers–
    MRE 

  16. You know, I wonder how much of the Weight Watchers nutritional plan is driven by profit motive. The high-carb/low-fat diet is best for business, since it pretty much guarantees you’ll either return to drop rebound weight, or continue to get the counseling and support you need to fight against the body’s natural desire for optimal nutrition. Several of our neighbors have often uttered the phrase “I need to go back on Weight Watchers”. $Ching-ching$.
    Anna – I love the Meter Eaters idea. I’ve been thinking of getting a glucose meter for exactly the same reason as you did (fasting glucose always tests a little over 100). Now I’m definitely getting one. Any recommendations on model/type? Thanks.
    Dave
    Hi Dave–
    I’ve wondered about the profit motive not only with WW but with many other outfits that support the low-fat diet.  The pharmaceutical companies that sell cholesterol-lowering drugs for one.
    Cheers–
    MRE 

  17. I went to Weight Watchers back in the day, and my overriding memory of it was the total cattiness of the other women (I went for two months and never saw one man). If a weigh-in went well, the whispers instantly started–“she didn’t eat anything, I know.” “I’d lose four pounds too if all I ate was lettuce and water,” etc. Of course, they all had huge fake smiles on their faces as they applauded. And then would come the excuses–“I couldn’t say no, it was her birthday!” “Oh, what’s one piece of cake/fried chicken/(whatever cheat food)?” Whenever I see WW’s preservative-loaded frozen food or snack food, I can only shake my head … and continue on to the frozen veggies.
    Hi Patricia–
    Thanks for the info.  Doesn’t sound like a fun place.
    Cheers–
    MRE 

  18. Thank you Doctor Eades: Your awesome Low Carb Cookworx show has revitalized me (a low-carb follower) and my wife (a type 1 diabetic and low carber). I started days after seeing Dr. Atkins on Larry King Live (Jan 2003) and only months before his tragic accident. I fell from 225 lbs (6’2″) to 185 by the late summer, and am now at 170 lbs (my marriage weight in 1985) and maintain it to plus/minus 5 pounds religiously. Your show addressed so many of the issues that concerned me about the bigger picture (vitamins, minerals, fats, organic dairy and meat) that I simply love your recipes for the feel-good mental picture I have with them – AND they taste good!. The lemon-ricotta pancakes are to kill for. In fact all of your recipes are easy and delicious. We got caught up in a lot of the Atkins products, as well as the soy flour craze, and to me the use of almond meal (and the other flour imposters) opened many doors for us in baking. Bob’s Red Mill (via Amazon) offers many of the necessary cooking ingredients (almond meal in particular). We just obtained some hazelnut meal and coconut flour – do you see that these could be used perhaps as substitutes for flour? For years, I thought coconuts were bad! Once again, thank you for speaking out on this issue. I find that you and your spouse are going to convince many people to change their ways. In fact, after three years of low cholesterol readings, ultra low triglycerides, and elevated HDL combined with much lower LDL, my cardiologist is beginning to believe. Hopefully more will with time. Again, THANK YOU!!
    David and Susan Futoma
    Hi David & Susan–
    Thanks for the kind words.  MD and I are glad you enjoy the show.
    As to the coconut and hazelnut flours…I checked with my bride who said that both those flours should work like the almond flour.  Since they are nut flours they contain more fat than wheat flour, and so you need to cut the amount of butter (or whatever fat you’re using) in the recipe to compensate.
    She’s never used either one, so when you have some experience, drop us a note to let us know how they worked.
    Cheers–
    MRE 

  19. Wow! Thanks Doctor for the incredibly fast response. I found it interesting, and encouraging, to hear your views on coffee. I tried to give it up initially on Atkins, but decided that I just could not. I went back to coffee, and have found that it did not inhibit weight loss. Also, your advice to the effect that some vitamin and mineral uptake requires the fats for absorption has never been clearly brought up in most cooking shows.
    How does a low carb dieter square what they eat with purportedly “high carb”, relatively speaking, foods like bananas, which many doctors tell you are very healthy? Are fruits like mangoes, pineapples, etc, simply off limits?
    I will definitely get back to you about my experience with the hazelnut flour – plan to make a variation of the ricotta pancakes with macadamias (do you consider macs healthy?)
    David and Susan Futoma
    Hi David and Susan–
    Don’t get used to the speedy response.  Your comments came in (both times) as I was going through all the comments on my list and dealing with them.  Depending on how many comments stack up on me, it could take a day or two. 
    All the fruits you mentioned do contain valuable nutrients, but they come at the cost of a fair amount of carbohydrate.  A better way to look at it is the amount of nutrient density per carb.  If you do that, you’ll find that of all the fruits berries have the highest nutritional density per carb.  Bananas, on the other hand, have a low nutritional density per carb.
    I do consider macadamia nuts as healthful. 
    Cheers–
    MRE 

  20. I have been a lifetime member of WW for years, that is how I gained 140 lbs. Thanks to Protein Power I have now lost it. The diet of the early 70’s was low carb and also encouraged 5 fish meals and 1 liver( YUK!) per week. I have tried to find a copy of the early diet, but alas, no where to be found.
    Hi Tess–
    Thanks for the history.  It’s not much of an infomercial for WW.
    Cheers–
    MRE 

  21. Somewhere I remember seeing an interview with the president of Nutrisystem who conceded
    that while the prepackage meals were effective for short term weight loss there was a high recidivism rate
    and that it was good for their balance sheet.The same is obviously true for Weight Watchers.
    Hi Mark–
    I’m sure that the recidivism rate is high with both Nutrisystem and WW.  I can’t believe the president would admit that publicly…unless he was trying to raise money from investors.
    Cheers–
    MRE 

  22. Simon –
    Believe it or not, this Florida girl (soon to be Georgia girl again) has eaten at the Magpie. It was indeed magnificent.
    This is my first post Dr. Eades and in the past week I have spent many, many hours reading your blog and the comments. When I catch up to present, I will start reading your lovely wife’s blog. Thank you – it’s been a joy to read.
    I’m glad you’re enjoying the blog. Welcome aboard.
    I, too, hope to eat at the Magpie someday.
    Cheers–
    MRE

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