Interview With Mayo Clinic Nutritionist Dr. Donald Hensrud
We interviewed Dr. Donald Hensrud, nutritionist physician at the Mayo Clinic in Rochester, MN, for today's TV story. Since we didn't have time to include all his helpful information in that story, we wanted to provide you an extended look at Dr. Hensrud's interview.
Does the Mayo Clinic have a diet?
So what is the Mayo philosophy?
Are there ups and downs to yo-yo dieting? What is your advice if just thinking about losing weight weighs heavy on my mind?
Where do I start?
Is America really obese?
Why is "long term" so important?
What's most important when trying to tackle a weight problem?
Is it really dangerous to be overweight?
What about dietary supplements?
Is it really just about changing my behavior?
What if I feel the need to weigh myself every day?
What about these popular diets? Do they work?
How helpful is a support system?
Does the Mayo Clinic have a diet?
Dr. Hensrud: There isn't a Mayo Clinic diet and there never has been a Mayo Clinic Diet. This is a myth that's been haunting us for years and nobody knows how it started but it has a life of its own. There never has been and never will be a Mayo Clinic Diet.
So what is the Mayo philosophy?
Dr. Hensrud: It does get down to the basics. Everybody knows it's "eat less and exercise more". The challenge is applying the basics. There are general things that apply to everyone regarding diet, exercise, behavioral modification.
If we see a patient in our clinic we look at the individual factors from that patient. Do they have specific dietary issues that are making it difficult to manage their weight? Activity issues?
Dr. Hensrud: We use a common sense approach and apply that to the individual person; moderation. We live in a society that makes it difficult to incorporate moderation.
Are there ups and downs to yo-yo dieting?
Dr. Hensrud: There are a lot of beliefs out there that yo-yo dieting has harmful health consequences or that it can result in sustained depression of metabolic rate. In other words, you burn less calories after you yo-yo diet so that makes it easier to gain calories. It really isn't true.
If people look closely at the studies that have been done, overall, it doesn't seem to have a lot of negative health consequences. And it doesn't seem to predispose to weight gain. It can be frustrating to gain and lose weight over and over again. But it doesn't necessarily set someone up for failure or for negative health consequences.
What is your advice if just thinking about losing weight weighs heavy on my mind?
Dr. Hensrud: Weight management certainly has a lot of psychological implications. Over half of the population right now is classified as overweight. And it can be very frustrating to manage weight. It's a difficult problem. If it were easy, we wouldn't have that many people who are struggling with it.
From a psychological standpoint, if people attempt something over and over and they're not successful, it can be frustrating. But, we try to encourage people; don't give up. We encourage lifestyle changes. We encourage positive changes. And I would suggest that managing weight, believe it or not, can be an enjoyable process.
It doesn't have to be a negative or restrictive experience. Let me give you a couple of examples:
So if people are going to try and manage their weight, they have to almost go against the grain and society. But I think with some moderate changes, making some initial efforts and focusing on it in a positive way, it certainly isn't insurmountable.
Is America really obese?
Dr. Hensrud: Over half the population is classified as over weight. And that's a body mass index of more than 25... approximately 20 percent overweight. One of four people is classified as obese. The prevalence of obesity is increased by about one third over the past fifteen to twenty years. That's ? not genetic factors that has caused that change.
One of the strongest candidates is less activity throughout our day. One of the messages to people is, exercise is great. If you can do exercise, wonderful. Even if you can't, try and do more activity throughout the day. It can burn more calories than what people realize and it can be incorporated in our daily schedule.
Taking the stairs instead of the elevator, parking a few blocks away. It's human nature to try to conserve energy and do step saving activities. We should be doing just the opposite; looking for excuses to burn a few more calories.
Why is "long term" so important?
Dr. Hensrud: In order for someone to manage weight long term, whatever changes they make in their lifestyle have to be done over a long period of time. They have to approach it as if this is just the way it's going to be indefinitely.
So, in terms of diet, it does get down to basics. People need to reduce their calorie intake. For some people it may be portion size. For others it may be the types of food they're eating.
In general, what we would encourage is decrease the intake of high energy-dense foods. And what I mean by energy-dense foods is not only foods that are high in fat but for other foods that are also high in concentrated calories such as foods that contain a lot of sugar.
In terms of physical activity, it has to become another lifestyle change. Getting activity throughout the day. Making an effort to try and incorporate some exercise at various times of the week. The more those can become permanent lifestyle changes, the much better chance someone has at managing their weight long term and most importantly, improving their health.
What's most important when trying to tackle a weight problem?
Dr. Hensrud: The number one goal is to improve people's health. Certainly losing weight for cosmetic reasons is appropriate. I understand that.
From a medical perspective, it's extremely important that we do that (tackle a weight problem) to prevent the long-term complications of increased weight which include high blood pressure, diabetes melodes, obstructive sleep apnea which is a disordered respiratory condition (where people tend to hold their breath at night - it's very under-diagnosed), high tri-glycerides, and low good cholesterol, and degenerative arthritis. There are a number of complications that occur over a long period of time.
Is it really dangerous to be overweight?
Dr. Hensrud: The longer people are overweight, the more they increase their risk of developing those conditions (listed above). The more people can change their lifestyle, not only to prevent the long-term health consequences but to feel better on an everyday basis, it'll benefit them as well.
If you look at the studies on weight management, overall the results aren't that great. 90-95% of the weight that's lost is regained within four to five years regardless of the program.
If you look at people who have lost weight and kept it off long term, there are some common factors. One is a commitment to lose weight. Not only to lose weight, but a commitment to change lifestyle.
Another factor that is common among people who have successfully lost and maintained is dietary change; that's no surprise, either portion control or decreasing the fat or, most importantly, overall calories in the diet.
And third, that's no surprise, regular, physical activity. In some cases, a lot of activity is required to maintain weight. In fact, regular physical activity is the most important factor to maintaining weight long term. It works best in conjunction with dietary changes as well as changes in physical activity.
What about dietary supplements?
Dr. Hensrud: The bottom line is people aren't going to lose a lot of weight using supplements and probably aren't going to keep it off long term. And there are some risks. Euphedra, for example, is an herbal preparation that's in a lot of weight loss medications available over the counter. There have been many adverse affects from Eufedra including deaths. So people need to be careful about what supplements they're taking and what methods they're using to lose weights.
We use some prescription medications in our nutrition clinic. We try and reserve the prescription medications for people who have health complications from their weight such as high blood pressure, diabetes, obstructive sleep apnea, and need to lose weight for some medical reasons.
Is it really just about changing my behavior?
Dr. Hensrud: There is a genetic factor to weight, as well. Some people, in their genes, may be large boned. Their parents may be large and it does make it more challenging for them to manage their weight. Again, it's not impossible.
The way I look at genetics versus environment, it's like a card game. If you're playing five-card poker, the genetics are like the hand that you're dealt. But how you play those cards, that's the environment. And most people can improve on the cards they're dealt; both in terms of weight and in terms of health.
What if I feel the need to weigh myself every day?
Dr. Hensrud: People should not weigh themselves every day. There are fluid fluctuations in the body that can change from a pound or two on a daily basis. That isn't indicative of fat weight or stable weight. I advise people not to weigh more than once a week. And even on a week to week basis, don't focus too much on the changes from week to week but the trend over time.
What about these popular diets? Do they work?
Dr. Hensrud: There are many different ways to lose weight. Some are healthier than others. There are many different books and programs out there. The reason we emphasize positive lifestyle changes over a long period of time is, it will improve health; it's achievable to keep up over a long period of time.
If people are going to undertake extremely vigorous or compulsive programs, I think in the long run it makes them less likely to be able to stay on that long term. And depending on what type of program, it may not even improve their health if it's a non-safe manner of weight loss. I think people really need to evaluate carefully.
There are a number of popular fad diet books out there on the market nowadays people can lose weight on but I have two questions: Number one, can people stay on them long term? And number two, if they stay on them long term, will their health improve as well as their ability to lose weight?
And with many programs on the market, there is no scientific evidence it will improve their health long term. Some of the programs will restrict carbohydrates to the point people are eating less fruits and vegetables. The number one dietary guideline from the American Cancer Society is to eat more plant products, specifically fruits and vegetables. If people are excluding them from their diet, they may be able to lose some weight over the short term but what is that doing for their long-term health? Theoretically, it could be increasing their risk of cancer. I think people need to look carefully at the different programs and choose a method that is sustainable over time and healthy.
How helpful is a support system?
Dr. Hensrud: Many people find it helpful to have some type of support as they go through their weight management programs. And this can be support from families, from friends, or from a professional group. And there are many good groups out there who can offer professional support.
It could be on the internet. People need to be aware that not everything on the internet are legitimate and they need to be careful about what sites they choose to get their health information from. It could be an E-mail support system. Many studies have shown that when people follow up with a program - whatever the program - over a long period of time, they're more successful in managing their weight long term.
It is a good idea to have some type of support that people can rely on.
Dr. Donald Hensrud is a nutritionist physician with the Mayo Clinic in Rochester, MN.
If we see a patient in our clinic we look at the individual factors from that patient. Do they have specific dietary issues that are making it difficult to manage their weight? Activity issues?
Dr. Hensrud: We use a common sense approach and apply that to the individual person; moderation. We live in a society that makes it difficult to incorporate moderation.
Are there ups and downs to yo-yo dieting?
Dr. Hensrud: There are a lot of beliefs out there that yo-yo dieting has harmful health consequences or that it can result in sustained depression of metabolic rate. In other words, you burn less calories after you yo-yo diet so that makes it easier to gain calories. It really isn't true.
If people look closely at the studies that have been done, overall, it doesn't seem to have a lot of negative health consequences. And it doesn't seem to predispose to weight gain. It can be frustrating to gain and lose weight over and over again. But it doesn't necessarily set someone up for failure or for negative health consequences.
What is your advice if just thinking about losing weight weighs heavy on my mind?
Dr. Hensrud: Weight management certainly has a lot of psychological implications. Over half of the population right now is classified as overweight. And it can be very frustrating to manage weight. It's a difficult problem. If it were easy, we wouldn't have that many people who are struggling with it.
From a psychological standpoint, if people attempt something over and over and they're not successful, it can be frustrating. But, we try to encourage people; don't give up. We encourage lifestyle changes. We encourage positive changes. And I would suggest that managing weight, believe it or not, can be an enjoyable process.
It doesn't have to be a negative or restrictive experience. Let me give you a couple of examples:
- If people would use a more lifestyle change a approach; don't make any changes they can't keep up long term; look at what you can eat instead of what you can't. There's a lot of enjoyable food out there.
- Similarly with exercise; how many times have you heard someone say, "Oh, I feel good after I did some exercise, but I just don't get in enough" ? People need to keep reinforcing that over and over again. It is an enjoyable process. If they incorporate healthy lifestyle changes, they feel better and in the end will have better health, which is our main goal, and they make it easier to perpetuate over time.
So if people are going to try and manage their weight, they have to almost go against the grain and society. But I think with some moderate changes, making some initial efforts and focusing on it in a positive way, it certainly isn't insurmountable.
Is America really obese?
Dr. Hensrud: Over half the population is classified as over weight. And that's a body mass index of more than 25... approximately 20 percent overweight. One of four people is classified as obese. The prevalence of obesity is increased by about one third over the past fifteen to twenty years. That's ? not genetic factors that has caused that change.
One of the strongest candidates is less activity throughout our day. One of the messages to people is, exercise is great. If you can do exercise, wonderful. Even if you can't, try and do more activity throughout the day. It can burn more calories than what people realize and it can be incorporated in our daily schedule.
Taking the stairs instead of the elevator, parking a few blocks away. It's human nature to try to conserve energy and do step saving activities. We should be doing just the opposite; looking for excuses to burn a few more calories.
Why is "long term" so important?
Dr. Hensrud: In order for someone to manage weight long term, whatever changes they make in their lifestyle have to be done over a long period of time. They have to approach it as if this is just the way it's going to be indefinitely.
So, in terms of diet, it does get down to basics. People need to reduce their calorie intake. For some people it may be portion size. For others it may be the types of food they're eating.
In general, what we would encourage is decrease the intake of high energy-dense foods. And what I mean by energy-dense foods is not only foods that are high in fat but for other foods that are also high in concentrated calories such as foods that contain a lot of sugar.
In terms of physical activity, it has to become another lifestyle change. Getting activity throughout the day. Making an effort to try and incorporate some exercise at various times of the week. The more those can become permanent lifestyle changes, the much better chance someone has at managing their weight long term and most importantly, improving their health.
What's most important when trying to tackle a weight problem?
Dr. Hensrud: The number one goal is to improve people's health. Certainly losing weight for cosmetic reasons is appropriate. I understand that.
From a medical perspective, it's extremely important that we do that (tackle a weight problem) to prevent the long-term complications of increased weight which include high blood pressure, diabetes melodes, obstructive sleep apnea which is a disordered respiratory condition (where people tend to hold their breath at night - it's very under-diagnosed), high tri-glycerides, and low good cholesterol, and degenerative arthritis. There are a number of complications that occur over a long period of time.
Is it really dangerous to be overweight?
Dr. Hensrud: The longer people are overweight, the more they increase their risk of developing those conditions (listed above). The more people can change their lifestyle, not only to prevent the long-term health consequences but to feel better on an everyday basis, it'll benefit them as well.
If you look at the studies on weight management, overall the results aren't that great. 90-95% of the weight that's lost is regained within four to five years regardless of the program.
If you look at people who have lost weight and kept it off long term, there are some common factors. One is a commitment to lose weight. Not only to lose weight, but a commitment to change lifestyle.
Another factor that is common among people who have successfully lost and maintained is dietary change; that's no surprise, either portion control or decreasing the fat or, most importantly, overall calories in the diet.
And third, that's no surprise, regular, physical activity. In some cases, a lot of activity is required to maintain weight. In fact, regular physical activity is the most important factor to maintaining weight long term. It works best in conjunction with dietary changes as well as changes in physical activity.
What about dietary supplements?
Dr. Hensrud: The bottom line is people aren't going to lose a lot of weight using supplements and probably aren't going to keep it off long term. And there are some risks. Euphedra, for example, is an herbal preparation that's in a lot of weight loss medications available over the counter. There have been many adverse affects from Eufedra including deaths. So people need to be careful about what supplements they're taking and what methods they're using to lose weights.
We use some prescription medications in our nutrition clinic. We try and reserve the prescription medications for people who have health complications from their weight such as high blood pressure, diabetes, obstructive sleep apnea, and need to lose weight for some medical reasons.
Is it really just about changing my behavior?
Dr. Hensrud: There is a genetic factor to weight, as well. Some people, in their genes, may be large boned. Their parents may be large and it does make it more challenging for them to manage their weight. Again, it's not impossible.
The way I look at genetics versus environment, it's like a card game. If you're playing five-card poker, the genetics are like the hand that you're dealt. But how you play those cards, that's the environment. And most people can improve on the cards they're dealt; both in terms of weight and in terms of health.
What if I feel the need to weigh myself every day?
Dr. Hensrud: People should not weigh themselves every day. There are fluid fluctuations in the body that can change from a pound or two on a daily basis. That isn't indicative of fat weight or stable weight. I advise people not to weigh more than once a week. And even on a week to week basis, don't focus too much on the changes from week to week but the trend over time.
What about these popular diets? Do they work?
Dr. Hensrud: There are many different ways to lose weight. Some are healthier than others. There are many different books and programs out there. The reason we emphasize positive lifestyle changes over a long period of time is, it will improve health; it's achievable to keep up over a long period of time.
If people are going to undertake extremely vigorous or compulsive programs, I think in the long run it makes them less likely to be able to stay on that long term. And depending on what type of program, it may not even improve their health if it's a non-safe manner of weight loss. I think people really need to evaluate carefully.
There are a number of popular fad diet books out there on the market nowadays people can lose weight on but I have two questions: Number one, can people stay on them long term? And number two, if they stay on them long term, will their health improve as well as their ability to lose weight?
And with many programs on the market, there is no scientific evidence it will improve their health long term. Some of the programs will restrict carbohydrates to the point people are eating less fruits and vegetables. The number one dietary guideline from the American Cancer Society is to eat more plant products, specifically fruits and vegetables. If people are excluding them from their diet, they may be able to lose some weight over the short term but what is that doing for their long-term health? Theoretically, it could be increasing their risk of cancer. I think people need to look carefully at the different programs and choose a method that is sustainable over time and healthy.
How helpful is a support system?
Dr. Hensrud: Many people find it helpful to have some type of support as they go through their weight management programs. And this can be support from families, from friends, or from a professional group. And there are many good groups out there who can offer professional support.
It could be on the internet. People need to be aware that not everything on the internet are legitimate and they need to be careful about what sites they choose to get their health information from. It could be an E-mail support system. Many studies have shown that when people follow up with a program - whatever the program - over a long period of time, they're more successful in managing their weight long term.
It is a good idea to have some type of support that people can rely on.
Dr. Donald Hensrud is a nutritionist physician with the Mayo Clinic in Rochester, MN.Copyright 2003 by Lifewhile.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
