This week's focus is on the Grocery Store.  You've been challenged to post some of your secrets to success and share some of your "go to" food items with the group.  Please feel free to post below and check back during the week, as we'll be asking past Largest Losers to "weigh in" with some of their recommendations as well.

Tom Jordan, RD

Fall 2009 competitors, we urged you to make your thoughts public this week.  Please post your thoughts, comments, and suggestions below to those following along at home or anyone on the sidelines thinking about jumping in to the next session.

Tom Jordan, RD, LDN

This weeks discussion focused on using food labels as a guide for healthy food choices.  This triggered several important questions, so feel free to post these questions below or add tips and suggestions for other challengers.

Tom Jordan, RD

Now that you have all made big changes in WHAT you are eating, now it's time to focus on WHEN you are eating.  Our discussion this week aimed at taking advantage of times when your body is more metabolically active (post workout) and coined the phrase "Feed your muscles, starve your fat!"  Please comment below on how you're incorporating these principles.

Tom Jordan, RD, LDN

Week 3:  Expanding Exercise

Anybody can start off big with exercising, but often times we start fast and burn out faster.  The keys to a successful exercise program are developing workouts that are safe, effective, and FUN!  We want to know what tips you have for your teammates on how to keep mixing things up.

Tom Jordarn, RD, LDN

By now you should be getting used to logging your food either by hand or by using sparkpeople.  Please add comments and questions below about your experience." 

Tom Jordan, RD, LDN

This program is tough!  Weight loss is tough!  Believe it or not, the mental piece is harder than the physical piece.  Use this thread to post inspirational tips for our participants, and communicate your struggles--and what you've learned to help overcome them.

Tom-

From personal experience I understand how difficult it is to get a healthy meal.  Much less 3 meals, AND SNACKS!
The supplements are awesome, but I really feel that those should be used more in case of emergency.  If you're stuck in traffic for 3 hours, you know you will be at a whole day meeting, you absolutely have nothing in the kitchen worth eating and cannot get to the grocery store.  For those situations, having a protein bar, or meal replacement shake can be a real life-saver. For the rest of our lives, our normal, everyday lives, we should not be drinking shakes or relying on bars.  Here are some tips to help prevent the need for supplements:

#1 - Menu planning
Think 3-4 days ahead.  Plan your protein first.  Here's an example:

Monday
breakfast: oatmeal
lunch: turkey sandwich
snack: hummus and veg
dinner: Salmon

Tuesday
breakfast: yogurt and fruit with cereal
lunch: tuna salad
snack: peanut butter and jelly on English muffin
dinner: Chicken

Wednesday
breakfast: whole wheat waffles and fruit
lunch: green salad with chicken
snack: almonds, raisins and yogurt
dinner: Tuna Steaks

That took me about 2 minutes to write.  I was also helping my daughter and letting the dog outside.  It still only took 2 minutes.  If you need help making a menu, talk to me or Tom (preferably Tom).  Want to make it go even faster?  Make flashcards!  Make 10 flashcards for every meal.  Look through them and pick out 3-4 days worth.  It might take you 30 minutes to write out all the cards to start with, but from then on, menus are a snap!

That was just the protein.  For produce turn to your grocery store and see what looks good.  Tomatoes look horrible, but cucumbers look great?  Get cucumbers and make a little side salad with fresh dill, green onion and a little dressing.  You hate corn, but love peas?  Well, get some fresh pea pods and snack on those with your dinner.

#2 - Pantry staples
There are some things that should always be in the kitchen.  Make a list with a box next to each item.  Photocopy it 50 times and put those in a folder in a drawer, or take one copy and keep it on the fridge.  When you are almost out, put a check next to something.  Everybody's staples will vary based on preferences, but here are mine to give you an idea:

Baby carrots
Celery
Pea Pods
Apples
Onions
Green onions
Egg Whites in a carton
Granola bars
Cereal - cheerios for me, frosted flakes for kids Whole wheat/grain bread Mustard etc.

I am not buying pickles at every trip to the store.  But I do always want to have some in the fridge.  A few times a year we run out and I go get more.  The list is long, but every trip to the store I am only getting a few items.
Sort your list according to how your grocery store is set up.  It will make things go WAY faster.  Group things into categories: Produce, Bakery, etc, just like the titles of the isles in the store.

#3 - Short trips to the grocery store
In the long run this will keep you sane.  You are better off going to the store and getting 4 days worth of protein, produce and check a few staples than waiting till Sunday and getting everything.  Stopping at the store on the way home from work, or from the gym, or from First Health will be worth it.  Making that extra trip on the weekend is usually a huge waste of time.  I usually spend 20 minutes at the store 2-3 times a week.  It feels WAY better than going for 60 minutes on Sunday.  Also, my protein and produce last longer.

#4 - Prepare food ahead.
Cutting up veggies for a day or two supply (long for some veg).  
Starting dinner before you leave for work (putting chicken in marinade for example).  
Using leftover protein for the following day's lunch.
Be careful, not everything can get prepared ahead of time, just learn which are which and things can go fast!

Jason

Hey everybody!
There are so many great thoughts that I hear from our team members, that I wanted to create an open forum for people to ask questions, make suggestions and ask for help.  The First Health Largest Loser Team will be lurking in the forums every day, so feel free to give us feedback, encouragement and anything!

Jason

I was a little worried that altering my diet to lose weight would basically be denying myself food.  That's what I thought a 'diet' was.  It turns out that the 1700 calories a day I should be eating is pretty easy to do.  The biggest change is altering my meals so that I eat a little less at any given meal, but end up eating 4-5 times per day.  That change has been awesome.  As Tom taught us, since you are always slowly releasing energy in to your bloodstream this way, you feel less hungry.  I actually feel MUCH LESS hungry on the diet than i did when I was eating 1000-1500 more calories.  Altering what I eat has not been too bad either.  We have many resources to help us find lean protein at every meal, increase dietary fiber and eat the proper amount of fat.  Another change has been a little weird: PAYING ATTENTION to what I eat.  Typically, 90% of my calories had just been shoveled into my mouth while I was doing something else.  Now 75% of my  calories go in while I am really focusing on eating.  With every bite I think a little bit about what I'm eating.  The times I eat that way are much more satisfying than the 25% of my calories that just get shoveled in while I'm driving or doing something else.

Overall, the starting weight loss has been slow, but the changes I am making as easy to do, therefore easy to maintain.  They are not a burden in any way, and I am sure that I will continue these changes forever.  So even though I only lost 1 pound this week - with my new diet, I see that 1 pound happening EVERY WEEK until I reach my goal!

Dr Jason

I am thrilled that we have this blog space.  We can add recipes and other nutritional hints and ideas in here.  Frankly, if we had to eat terrible food for this program, I don't think I could succeed.  Having the availability to eat anything we can make - as long as it's healthy, makes it much easier for me to ENJOY what we're doing.

I will be putting recipes in this section.  If you have feedback, recipes of your own, or even requests, please let us know!

Dr. Jason

I've been overweight nearly my entire life.  There are plenty of reasons for this: my family, both genetics and environment, my lifestyle as a child and teen, my habits as an adult, stress. . . There are always excuses if you are looking for them.  Recently, my wife and I had our 10-year anniversary and I realized that I have gained weight EVERY YEAR since we've been married.  I thought, "What am I going to look like at our 20th anniversary?"  I have never been able to make the commitment to losing weight.  I would go to the gym for a week or so.  I would try to diet for a few weeks.  Nothing really worked.  I needed to make a permanent change in my behavior regarding food and activity.  Something needs to change and it needs to change forever.   

We've started the Largest Loser challenge at First Health Associates and I am involved as a doctor, but I knew from the moment I heard about the program that I wanted to be involved as a participant too.  It's been two days.  My diet has changed a lot.  I have had only 1 diet soda per day.  I have really increased my intake of fresh produce and decreased my intake of red meat and fatty foods like mayonaise.  I'm measuring everything and thinking ahead.  Planning what I'm going to eat, and only eating what I scheduled is a real change for me.  I have not been to the gym yet.  That is for Tuesday.  But everyday I am walking for 1-2 miles extra.  I take the dog for a long walk every night.  I know I need to get in more calorie-burning time.  I plan on doing more tonight.  I want to jog half of the time I'm walking the dog.  Maybe go 2-3 miles walk/run, instead of 1-2.  There's nothing stopping me, except my own will to change.

Dr Jason

Whether or not you’re a fan of the Reality TV series Biggest Loser, nearly all of us have heard of the show. I managed to avoid it for the first 6 full seasons but have recently become intrigued. What interests me isn’t the massive weight loss numbers participants put up, but the fact that they become so committed and excited about changing the way they live their lives.

Weight loss secondary to lifestyle changes is important to us as a clinic since losing (and maintaining) weight is a key component in the prevention of heart disease, high cholesterol, diabetes, and even cancer. A healthy weight also becomes important for preventing the stress on the knees and back that can lead to degenerative joint disease and osteoarthritis.

Our interest in long lasting lifestyle changes has led to the development of our own program titled “The Largest Loser Fitness Challenge".” Again, the goal of the program is centered on losing weight and keeping it off, but unlike dieting our focus is on making lifestyle changes that you can maintain for the rest of your life.

Our program includes:

· Initial Medical Exam and Blood Work
.Initial Behavioral and Lifestyle Therapy session
· Consultations with Dietitian
· Personal Training
· Weekly Nutrition classes and group exercise
· Dietary Supplement Recommendations (optional)

To make the program fun, exciting, and challenging, we will be taking a group of participants who will be competing for various prizes. Prizes are yet to be determined but the overall winner can expect a substantial reward for their efforts.

Please chime in with any questions, thoughts, or recommendations about this program. We are very excited to kick it off and can’t wait to see some big HEALTH numbers.

Are you part of the 80% of the population who suffers from lower back pain? Pain that makes getting out of bed difficult? Pain that prevents you from enjoying the activities that you love? Pain that just won't seem to go away no matter what approach you take to treat it? If so, then I truly feel your pain. Well not really, that would be kind of weird if I could, but I can definitely relate because years ago I was just like you. My story is not much different than the same one most of my patients tell me on a daily basis (or at least three times a week-that's my work schedule-jealous?). There is one significant difference though: I found the answer to my back pain and it only had a little to do with my lower back! Let me explain.

As a teenage athlete back in the day I was susceptible to ankle sprains. This began when I was around age 15 and continued for many years until I finally got too busy, and hate to admit it too old, to abuse my body year-round. At the time I figured that spraining my ankles was a "rite of passage" to being an "elite" athlete (all 5'8" and 135 pounds of me soaking wet). It wasn't until I looked around and noticed that not a single one of my fellow athletic friends had similiar problems did I realize that this was not a normal result of being a so-called "jock". In fact, if it was, there are millions of better athletes out there than me who never sprained an ankle. Then, around age 19, the lower back problems kicked in. What began as extreme stiffness when getting out of bed that made it difficult slipping on socks eventually became so disabling that I avoided playing pick-up basketball or lifting weights just to get a good night's sleep, despite knowing that it was going to hurt in the morning anyways. This continued throughout my graduate school training and into the early years of professional practice. Imagine that, a chiropractor with a bad back! Oh the irony.

So, exactly how did I come to write this entry with my lower back problems in the past?  For one, I forced myself to sleep on my back instead of my stomach, something I advocate for most of my patients (but not all-more to come on this later). Secondly, I began to focus on my poor posture and adapted my workouts more to core strengthening rather than obsessing about having a "six-pack". Finally, and most importantly, I was introduced to the amazing capabilities of foot orthotics. These custom-molded, plastic inserts have not only had a profound affect on my health but have also transformed the results I get in treating my patients. Little did I know way back when that my ankle sprains were directly related to the bowed-legs my father so graciously bestowed upon me and that the same poor mechanics which caused those injuries also played a part in my lower back pain. In a nutshell, the instability from my structural "defects" (bowed-legs) leads me to overcompensate in order to avoid rolling my ankles with every step I take (ouch) and eventually finds its way all the way up to my lower back. And to think, if I had only figured this out years ago I may have actually lived up to my potential (once again all 5'8" and 135 pounds soaking wet) as an aspiring professional athlete (name the sport...I was going to be the next Bo Jackson). Guess it was my destiny to end up doing what I do (all 5'7" and 165 pounds of me now...I've lost an inch and put on a little weight...more on that later).

That's all for now folks,

Dr. Joe Musolino

As a physiatrist, I am always working with medical specialists from all different backgrounds.  While I was in training at Schwab Rehabilitation Hospital, I had the chance to train with Physical Therapists, Occupational Therapists, Speech Therapists, Psychologists, Life-Care Planners, Nurses and many other rehab related specialists.  Most of the patients I worked with, in the beginning of my training, had permanent disabilities like strokes, spinal cord injuries and other dangerous medical conditions.  These patient's used to stay in the hospital getting rehab for 2-4 months while their strength returned and they learned to live with their profound new disability.  They spent hundreds of hours with their therapy team, and the staff that would help plan their discharge.  We all had to work together to make sure that the patient had what they would need on the day they returned home.  How can you send somebody home in a wheelchair if they live on the third floor and do not have an elevator???  It was complicated, but rewarding.  Each specialist had a different approach to the patient, and would usually think of things in a different way.  By using our combined knowledge we were able to supply the patient with ample resources.

Later in training I worked as a resident on the consultation team at University of Chicago Hospital. This is a world class institution, with some of the foremost physicians in the world.  As a consultant, I would be asked to give an opinion and give recommendations for other people's patients from a Physiatrists perspective.  The most common question we were asked is, "Where should this patient go when they are discharged?"  Home? Rehab? Nursing home?  The approach to asking this question nearly always involved me talking to all the doctors treating the patient, to determine how medically stable the patient was, and how much medical care they would need on discharge.  I would also talk to the therapists at the hospital who were working with the patient, to be sure that the patient would be able to handle the work of full-time rehab after discharge from the medical hospital to the rehab hospital.  In this service, I was talking to dozens of doctors and therapists, as well as discharge planners who were seeing what the patient's insurance would allow.  

The different settings above are common for physiatrists to encounter during their training.  The different ways to approach rehab are clear, inpatient/outpatient/nursing home. . . Regardless of the setting, working TOGETHER, with different specialists, was the only way to provide thorough care for the patient.

Here at First Health Associates, our team shares that approach.  We are routinely asking one another about the various questions, conditions and concerns our patients have.  "What would YOU do about this kind of headache?"  "Do you think this back pain is from the disc, or more from the muscle?"  "Do you think Patient X is ready for therapy or does he need more time to let the pain subside?"  Because we are all part of the same team we are able to provide support to one another, not just on a regular basis, but on a CONSTANT basis.  Having all these experts under one roof gives us a unique set of resources.  Patients always tell us, "Dr. Paul said that to me yesterday." "Emery said that too" "Dr. Zhu thought that would help too"  By working as a team, with all of our focus on the patient, we can support one another, provide another point of view and another set of treatment options, everything our patient might need!

 In Health and Wellness,

Dr Jason Gruss

As many of you know, I am a physiatrist.  I help patients with disabilities.  Pain can be profoundly disabling and many physiatrists specialize in treating pain. 

Pain is tricky.  It is a perception, a sensation.  I cannot accurately measure how much pain someone is in; they have to tell me.  I cannot see through a patient’s eyes, or hear sounds the way they do, nor can I feel their pain.  We have to rely on words and understanding one another to really identify pain.

I ask about pain, and I KNOW that the questions can be frustrating. “I understand that it is painful, but what KIND of pain?”  That question bothers me as much as it bothers my patients.  I spend lots of time explaining what I mean and defending that silly question, because the information can be helpful.  Sore muscles feel different than pinched nerves, but both hurt.  Getting hit with a hammer feels different than getting stabbed with a knife, but both hurt.

Because pain is a particular sensation, and can only be experienced by the patient, we rely on that persons perception of pain.  The trick is that people sense all sorts of things differently.  Some people prefer chocolate to strawberry ice cream – their perception of one is superior.  Some people like different music or fabric or aromas.  Perception varies.  Pain is no different. 

Pain is in your head.  So is your sight, sound, flavor, texture.  Understanding that everyone’s perceptions are different is essential for good communication between me and my patients.  The only way to achieve that is to take the time and patiently work through all aspects of their experience with pain.  To find out what this is like – try to explain to someone what chocolate tastes like, or what cotton feels like, or what smoke smells like. 

Dr Jason