Conclusion: Long-term Sustainability

Conclusion: Long-Term Sustainability


Always dream and shoot higher than you know you can do. Do not bother just to be better than your contemporaries or predecessors. Try to be better than yourself.

—William Faulkner


I am not yet in the best shape of my life.

I have a bucket list, an exercise bucket list. Also, I have a desire to look better. I can see about four abs, but I’m always questing for more. Unfortunately, six-packs of beer and six-pack abs are mutually exclusive.

Life has become a series of physical quests for me. Recall the theory of planned behavior from chapter 7? It’s the one that says having a positive attitude and planning for future accomplishments increases the likelihood of adhering to a new behavior.

I don’t have to worry about going back to the way I was, because I’m always trying to get in better shape. True, one day I will peak, and then all my efforts will be put into a valiant delaying action against age, but that day has not yet come. I am currently training to qualify for the Boston Marathon, and one day I’d like to complete an Ironman triathlon, go helicopter skiing, run a 10K in under 40 minutes and surf a big wave.

Well, maybe not too big a wave.

This thinking needs to become your way too. You need to continuously strive to get better, not because you have to but because you want to. Because you’ve learned to feel the love of your chosen activities. Because the exercise you do has come to define you as a person. Because you’ve embraced your competitive spirit. Because you want to carpemore diems.

When you finish one race, book the next. Think of things you can do that require you to go farther, get faster, be stronger. Pick a race that requires more toughness or is a longer distance. Decide there’s a fitness class that won’t be out of your league for long. Try a new exercise that looks hard and strive to be good at it. Pick a cycling loop that you have to train hard to complete. Learn to walk fast and far enough that you tire the dog out instead of the other way around. Run a marathon, or walk one. Be determined to hold those challenging yoga poses. Swim an extra length. Put some more weight on the barbell …

Do all this, fuel it with good food, and you won’t worry about gaining the weight back.

Life can be stagnation. Life can be a grind. Life can be filled with pain and sickness and sadness.

Or life can be adventure.

It was Helen Keller who said, “Life is either daring adventure or nothing at all.”

I am not yet in the best shape of my life, and neither are you. Just because you can’t do something today doesn’t mean you can’t do it one day.

It’s time to start planning your next adventure. It’s time to seize the day.

Seize it. And kick its ass.


Okay that’s the book. Hope you enjoyed it. Below are three appendices you may also want to check out:


Appendix A: Supplements and Pharmaceuticals

If you’ve tried everything on the exercise and healthy eating front and success still eludes you, there are other options. And there’s some good news about these options.

After a sordid history, a fairly safe and effective weight loss pharmaceutical is finally available. But it is a second-to-last resort. If you are a tough case, you may wish to discuss this with your physician.


Qsymia (phentermine and topiramate)

Obesity expert Dr. Arya Sharma speaks highly of the possibilities for Qsymia, although he doesn’t call it a weight loss drug. “The reason you turn to a medication is to prevent weight regain,” he told me.

And that is the real issue. Many people do the yoyo weight loss. They can lose it, but they can’t keep it off. “The pharmacology blocks the hunger response and can prevent metabolic slowdown,” Sharma said.

He states that the drug is both effective and within tolerable safety parameters because it “is a combination of two drugs that have been around for decades and have been used by millions of people; we know exactly what the side effects are.” He said most people tolerate it well because it’s the unique combination of these drugs that make them effective, and therefore allows for both of them to be at a low dose to minimize side effects.

What’s more, “the testing on these drugs is far more extensive than testing for any weight loss drug ever before.” But there can be side effects. This isn’t a strategy to employ if you’re looking to lean up for the beach; it should be used only if the risks associated with your current weight are higher than the risks of taking the medication. A doctor needs to make this call.

Dr. Yoni Freedhoff is more guarded. “The problem is that the physiology of appetite is so complex,” he said. “You can get a drug to work on one pathway, but rest assured there are many others that will take up the slack.” Evolution programmed these pathways to force us to eat. You know, so we don’t die of starvation.

Again, it’s a discussion to have with your physician.


Weight Loss Supplements

Unlike with pharmaceuticals, we DO make recommendations when it comes to weight loss supplements. Our recommendation is that they suck.

“The best supplements resulted in only two or three pounds of weight lost a year,” Dr. Yoni Freedhoff told me.

A 2008 release from the US Food and Drug Administration sought to recall dozens of weight loss supplements because they were found to be contaminated with harmful substances. This is from the FDA release:


“These tainted weight loss products pose a great risk to public health because they contain undeclared ingredients and, in some cases, contain prescription drugs in amounts that greatly exceed their maximum recommended dosages,” said Janet Woodcock, M.D., director, Center for Drug Evaluation and Research, FDA. “Consumers have no way of knowing that these products contain powerful drugs that could cause serious health consequences.”1


Bad, bad, bad. No, no, no.



Appendix B: Surgical Options

For those who have truly reached their last resort with weight loss, this is the final option.

Society stigmatizes bariatric weight loss surgery as much as it stigmatizes the overweight, and that needs to stop. These procedures can make lives way better. In many cases, they save lives. Yes, bariatric surgery is often a lifesaving procedure that needs to be more available. People who scorn it are jerks.

Obesity expert Dr. Arya Sharma emphasizes that bariatric surgery is not a “cure” for being obese, and that substantial lifestyle changes are still required. What’s more, success is measured in alleviating of comorbidities (negative health consequences) rather than pounds lost.

“The surgery has its risks,” Dr. Sharma told me. “It’s important to balance the risks of having it versus not having it. The more health problems you have, the better idea surgery appears to be.”

And a 2009 analysis out of the Duke University Medical Center shows that the risk is less than previously believed. Dr. Eric DeMaria looked at almost 58,000 patients of bariatric surgery and found that the death rate from surgery was only 0.135 percent—a total of 78 people.

Complication rates were much higher, at 10 percent, with the most common complaint being nausea/vomiting. Over 200,000 people undergo bariatric surgery each year, making it one of the most common procedures performed in the United States.1 Surgical techniques continue to advance to improve safety.

But it’s important to note that this low mortality and complication rate data were accrued from participants in the Bariatric Surgery Centers of Excellence program. Not all surgeons qualify as excellent. Caveat emptor.

If you meet the criteria, if you’ve tried everything and feel that this is your last resort, do your homework and find a reputable clinic to discuss your surgical options. Yes, there are risks, but the benefits can be significant for those who have no other options. “With surgery, four out of five will be successful,” Sharma said. It becomes a question of being in a desperate enough health situation to consider surgery as an option.

There are different types of surgery available, with the more challenging surgeries also being the more effective ones.

“The gold standard is the Roux-en-Y,” Dr. Sharma said, referring to a form of gastric bypass. “It’s more complex but has been around the longest and gets the best results.” He explained that the sleeve gastrectomy is easier to do but less efficacious, and the adjustable gastric band (a lap band) is the easiest but leads to even less weight loss.

“I tell patients, ‘If you want to make the surgeon’s life easier, get a band. If you want to make your life easier, get a bypass,’” Sharma said.

I’m light-years from being an expert on this. Talk to more than one doctor.


Appendix C: Healthy Living for Your Children



All that stuff we wrote in chapter 4 about the benefits of exercise doesn’t just apply to adults. Getting your children excited about physical activity can be one of the most important things you do as a parent. If you are concerned about your children’s activity level, there is one thing you can do that will have a greater effect on their desire to exercise than anything else: you must be a positive role model.

“When children see you exercising, they mirror what you do,” Dr. Teri McCambridge, director of sports medicine at Cincinnati Children’s Hospital, told me. “If they see you get pleasure from it, they will as well.” You need to put a positive spin on your exercise efforts for your children. Don’t moan and groan about it. At least not in front of them.


Tips for Getting Kids Active

  • Play together. Take them to the beach, kick a ball, go for walks, play catch or wrestle. Find creative ways to be active as a family.
  • Remove pressure. If you go drill sergeant on them, they’ll hate it. It’s got to be encouraging and about having fun, because kids don’t exercise, they play.
  • Consider weightlifting. “Obese kids aren’t going to be very good at aerobic activities,” Dr. McCambridge, who also used to be head of the Council of Sport Medicine and Fitness for the American Academy of Pediatrics, told me. “Forcing them to engage in it is hard on their joints and bad for their self-confidence.” Weight training, on the other hand, often leads to a positive-feedback loop, according to Avery Faigenbaum, a pediatric exercise scientist and professor at the College of New Jersey in Ewing, NJ. “These kids are really strong,” Faigenbaum told me. “The skinny kids are always impressed with how much the overweight kids can lift.” Weightlifting will not stunt a child’s growth. “We’ve done a 180-degree turn on this myth,” he told me.




You are in charge. You are a parent first and a friend distant second. You are in charge.

“I don’t hear from parents, ‘My kids really like playing in traffic and I can’t talk them out of it,’ ” Dr. David Katz said. “Letting your kids eat lots of junk food is like letting them play in traffic, only slower. Set the example, and don’t take no for an answer.”

But don’t be an ogre. The kinder, gentler approach is the way to change your children’s eating behaviors.


Tips for Improving Your Children’s Eating Habits

  • Again, be a good role model. In 2000, the Journal of the American Dietetic Association published a report revealing how five-year-old girls’ ideas about dieting are influenced by their mothers’ dieting habits. They found that women who dieted had young daughters who were twice as likely to know about dieting and to have developed ideas about it.1 Throughout children’s growth, parents’ eating behaviors have a profound influence on the approaches their children take to food and diet. For girls this is especially problematic, because by the sixth grade 60 percent of them have been on a diet, and weight loss attempts can have an adverse effect on their physical and psychological health.2
  • Engage them in the process. “You don’t need to be a draconian policeman that always tells their kids what to eat,” Dr. Yoni Freedhoff said..“If they’re old enough to talk about healthy eating, engage them in the process. Don’t talk about body weight and bad foods versus good foods.” Freedhoff likes the idea of having a family cooking night once a week—everyone gets involved and understands the ingredients being used and has a sense of ownership of the meal. It boosts confidence about their ability to eat healthily.
  • Pick your battles. “But cultivate a world where there is less need for battle,” Freedhoff said. Battles damage the parent-child relationship. You don’t want to develop a fear of food in your child by saying things like, “You can’t leave the table until you’ve cleaned your plate,” or, “Eat your vegetables or you’re having them for breakfast tomorrow.”
  • Be honest. Just talk to them. Make your children part of the healthy eating team. Get them to support you in your journey.




Appendix A

  1. “FDA Expands Warning to Consumers about Tainted Weight Loss Pills
List Increases from 28 to 69 Products; Agency Seeking Recalls,” Accessed November 17, 2012.


Appendix B

  1. “Large Scale Analysis Finds Bariatric Surgery Relatively Safe,”


Appendix C

  1. Beth Abramovitz and Leann Birch, “Five-Year-Old Girls’ Ideas about Dieting Are Predicted by Their Mothers’ Dieting,” Journal of the American Dietetic Association 100, no. 10 (October 2000): 1157–63.