Questions and Answers About Nutrition
'Our idea of what a portion size is has become quite distorted.'
–Debbie Hicks, Med, RD, LDN
According to Dietary Guidelines for Americans 2010, adult women should consume 1,600 to 2,400 calories a day and adult men 2,000 to 3,000 calories a day. However, calorie needs for men, women and children vary greatly depending on several factors-age, gender, weight, height, medical history, level of physical activity or exercise, and whether you are trying to lose, gain or maintain your weight. A dietitian can help determine an appropriate calorie level.
Debbie Hicks, the outpatient clinical nutritionist at Wake Forest Baptist Health, helps people to improve their diet habits. She discusses some of the major nutrition problems she's seen over the years.
Tell us about "portion distortion.''
Portions of food have gotten ridiculously huge. Our idea of what a portion size is has become quite distorted. When people come to see me, we discuss their current dietary habits. Occasionally someone will tell me "I feel like I eat healthy, so I don't know why I'm overweight."
When we get into the details of their eating habits, they may say "I bake my pork chops" but then they tell me that they eat two to three of them. Or if they have potatoes with their meal, they'll have a huge plate full; even if the potatoes are just boiled with no fat added, that's still too large of a serving.
In restaurants with salad bars, I've seen people use two to three ladles of dressing on their salads; that much dressing has the same fat and calories of six chicken nuggets. A frequent question I get is "OK, exactly how many calories am I supposed to be eating?" Most people really don't know.
How did things get this way?
I think some restaurants have contributed to the large portion sizes. Most people eat out way too much, and depending on where they go, the portion size they receive may be too large. For example, if someone goes to a pizza buffet … they will probably eat as much pizza as they can eat, to feel like they are getting their "money's-worth."
But if that same person orders delivery pizza or makes pizza at home, they will eat less, because the quantity is not unlimited and possibly because they didn't spend as much money.
Also, the consumption of sodas and sweetened iced tea is another huge problem that I typically see. People have a tendency to drink way too much of these beverages. I've had a few patients that were drinking 1,000 calories in soda each day and that's too much.
Does a person's body get used to having more calories?
Sort of. Your body gets accustomed to the large amount that you are eating, so you need more to fill yourself up. And that's not a good thing.
How do you get people to change?
The main thing is you have to want to change. Willpower is half the battle; you have to be at a point in your life where you are willing to make changes. As you were gaining weight, you got accustomed to eating a lot of extra food. You have to learn to be happy with smaller portions.
Adding more fiber (in the form of fruits and vegetables) to your diet will help; the fiber content and water content really helps fill you up. For example, let's say half of your meal is pot roast and the other half is rice; if you throw in a salad or some other kind of vegetable and fruit, you will eat less of the meat and rice because the vegetable and fruit helped to make you feel full.
So there's no special secret?
It has to be lifestyle changes. Exercise is very important, also. Someone who is a "picky" eater needs to try to expand their variety, especially of fruits and vegetables. I've known people that have made healthy dietary changes and lost, say, 20 to 30 pounds.
But the minute they got down to the weight they were happy with, they changed back to some of their old bad habits, such as drinking regular sodas, and slowly the weight crept back up. Whatever works, you have to stick to that.
How many people that you see lose weight?
It's hard to say. Most people have good intentions in the beginning, then get off track and either plateau or gain weight back. This is why I recommend they come back for follow-up visits with me once a month. I feel like the people that don't keep their return appointment are probably the ones that weren't successful.
So you like to see people once a month for six months. And you weigh them when they visit you? Are they pleased?
I typically weigh each weight-loss patient that I see (at the initial visit and at each follow-up). Sometimes people have lost a lot of weight and are very happy, while some people may have only lost 1 pound or maybe just maintained. I tell them not to be discouraged by that … the fact that they maintained or lost just a small amount is considered a success.
In the months prior to seeing me, they may have gained 20 pounds, so compared to that, it's actually a success. Sometimes I tell them they need to focus a little more closely on making healthy diet changes. Or occasionally someone will tell me "I'm doing everything I can," but then when we sit down and review the diet, it shows that they're really not (maybe they are doing well during the week, but blowing it on the weekends). So we'll review that weight loss meal plan together and see where changes can be made.
Do kids and adults have different nutrition problems?
Yes and no. I've seen both adults and children that have terrible eating habits … too much soda, too many desserts/sweets, too much pizza and eating out. Lack of activity is a problem with all age groups, but seems to be more prevalent in children than adults.
Some children have learned to be very sedentary… they spend too much time playing video games, computers, watching TV, etc. They need to get up and move. I typically give these children a handout called "Kid's Activity Pyramid," which is a list of activities they could do to get them moving.
Visits to a dietitian are typically arranged through a primary care physician. People with questions or who would like to schedule an appointment may call 336-713-3043.