How to Be Healthy Without Really Trying

By Kathleen Zelman, MPH, RD, LD
WebMD Weight Loss Clinic - Live Events Transcript
Event Date: Sept. 7, 2005

Can we really improve our health without a total lifestyle overhaul? David L. Katz MD, MPH, author of Stealth Health: How to Sneak Age-Defying, Disease-Fighting Habits Into Your Life Without Really Trying, chatted with Kathleen Zelman, director of nutrition for the WebMD Weight Loss Clinic, explaining how to eat smart, improve blood pressure, get better sleep, and reduce cholesterol by making simple changes in your day-to-day routine. They talked Sept. 7, 2005.

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR: Welcome to WebMD Live. Joining us is David L. Katz MD, MPH, author of Stealth Health: How to Sneak Age-Defying, Disease-Fighting Habits Into Your Life Without Really Trying. He chats with Kathleen Zelman, director of nutrition for the WebMD Weight Loss Clinic.

Welcome, Dr. Katz and Kathleen. Thank you for joining us.

ZELMAN: The book is Stealth Health: How to Sneak Age-Defying, Disease-Fighting Habits Into Your Life Without Really Trying. Hot off the press by Reader's Digest. It is a great compilation of small things to work into habits for better health.

KATZ: Kathleen, I really have to give credit to my colleagues at Reader's Digest and in particular, Neal Wertheimer, editor in chief there, for representing the interests of the general public in the power of prevention.

We have long said that an ounce of prevention is worth a pound of cure. However, we recognized that for many, the ounces added up and became quite heavy, and the pounds of benefit were often rather elusive.

Putting our heads together, along with my co-author Deb Borden, we came up with this plan to put those ounces on a diet and make the pounds of benefit more readily accessible. I must say, as a specialist in preventive medicine, I was completely won over by the idea and very pleased with the outcome of the collaborative effort.

ZELMAN: Readers Digest has published many reliable and credible stories on good health.

KATZ: I agree. I have a relationship with Reader's Digest now, as this is my second book with them. The prior book, called Cut Your Cholesterol, addressed comprehensive strategies for lowering heart disease risk. I felt they approached that book very responsibly as well, striking a balance between the presentation of good science and an engaging, reader-friendly tone.

ZELMAN: The book claims to be the simplest plan -- how so?

KATZ: In Stealth Health, every tweak of one's daily routine that is recommended is truly just that: a small tweak. We recognize that for many people eating well, being physically active, making major changes in their daily routine to pursue health, can seem quite daunting. So we reduced it to small daily tweaks that anyone can do.

We then suggest that you adopt three very small and easy adjustments to your daily routine and simply maintain them until they become habits. Once those three are habits, we advise adding three more. The intent here is for significant health-promoting change to almost effortlessly build up over time.

ZELMAN: Getting into routines and developing habits appears to be one of the more effective tools to improve your health. But as you know, old habits die hard and it is not that easy to create new habits. How can this book make routines easier to adopt?

KATZ: I think the easiest way to change behavior is to have lots of options. In Stealth Health I think we provide over 2,500 potential tweaks to one's daily routine. When I am providing lifestyle counseling to my patients, one of the things I invariably remind them is that they are the boss. My job is to empower them with enough options so that some of them sound appealing.

Stealth Health puts that same philosophy into print. Somewhere within the more than 2,500 options you will find something you won't mind doing. Even if you are ambivalent about making changes in your routine because they do come hard, you can find a small change that comes relatively easy.

Our advice is to start with that change and let the positive effects encourage you to make another small change, and another, and another. Eventually, the changes that intimidated you at first will stop looking scary and unappealing and you may well find you're ready for them, too.

ZELMAN: Dietitians have promoted small changes for years. Yet if you look at the percentage of obesity and overweight, our message has not resonated with consumers. How do you think Stealth Health will inspire consumers to change behaviors?

KATZ: I'm enough of a realist to recognize that no one book can hope to fix everything that's wrong with health-related behavior for a large and complex population, but what's novel here is the effort to make health promotion and disease prevention about fun. It's one thing to advocate small changes; it's another to provide enough of them spelled out in explicit terms that the invitation becomes almost irresistible.

Today we should perhaps talk about Stealth Health approaches to improving diet and nutritional health, though in the book you'll also find sections devoted to:

  • Quality sleep
  • Controlling stress
  • Improving mental health
  • Improving relationships
  • Health and beauty tips

The idea here, again, is to empower the reader with enough options so that some are downright appealing. Our hope is that with one foot on a slippery slope leading toward better health, our readers will slide on down. It's our philosophy that health can be habit forming; you just have to acquire the habit. We're trying to help, and I sure hope it works.

ZELMAN: Fun speaks volumes to everyone and if we can make losing weight fun it will be effective. At the WebMD Weight Loss Clinic our members tell us once you get into a groove it can be easy and fun.

How do you keep you and your family in good health and great shape?

KATZ: I take pride in practicing what I preach. I would find it awkward to recommend healthful eating and regular physical activity if I couldn't make it work for myself.

When I say myself, it's a bit misleading, because I come along with a whole brood. My wife Catherine and I have five children: Corinda, Rebecca, Valerie, Natalia, and Gabriel, ranging in age from 17 down to 6. We make healthful practices work for all of us.

I think this is vitally important in two ways. First, parents have a responsibility to model health-promoting behavior to their children. But second -- and here's the selfish part -- in unity there is strength. Many of the tips in Stealth Health relate to such things as stocking your pantry or refrigerator; these are changes that affect your whole household, your whole family. That is by design.

If you "go on a diet" but your family does not, you have added the difficulty of juggling multiple diets to your already hectic routine. If you take a stealth-health approach to improving nutrition for your whole household, you find you're in it together, supporting one another's efforts towards lasting good health.

That's what I do. I live in a home where all the nutritional choices are good ones. I live in a home where a fair amount of physical activity each day is simply part of the routine. I think supporting one another in health-promoting behaviors is a great way to show love.

What we do is emphasize the best possible choice in every food category, and this is addressed in Stealth Health with food recommendations and tips on label reading and addressed extensively in one of my prior books, called The Way to Eat.

For example, my kids, like everybody's kids, like to eat chips, crackers and cookies. Using stealthy healthy techniques to make such choices, we choose the best crackers, such as Kashi TLC, which are very tasty and rich in whole-grain goodness and fiber, and the best chips, such as Guiltless Gourmet, which are low in added fat and salt, and the best cookies, such as Barbara's and Cathy's brands. So we have all of the variety in the house required to keep everyone satisfied, but without compromising health.

It is my contention that in every food category from bread to breakfast cereal, dairy products to pasta sauce, there are good and not-so-good choices in every supermarket. Making the better choices can add up to a huge difference in the quality of your overall diet without the need for any major sacrifices.

ZELMAN: That's great and you make it simple and easy for the whole family to enjoy the taste of eating right because as you know, good food can taste delicious. Let's talk about some of the targeted recommendations for weight loss because it is clearly the focus of many Americans' interest in health.

KATZ: There are small adjustments you can make to the calories you take in and the calories you burn up each day to influence your weight.

Let's start first with calories you burn up. Everyone has heard of a pedometer, and we recommend using one. At first, simply learn what your average daily step count is without committing to increasing it. Once you have established your baseline, try to add 500 steps a day. Then 1,000, and then 1,500, gradually building. Where do you put those steps? That's up to you. Stealth Health always respects the fact that only you are the master of your daily routine.

You can add steps by:

  • Exercising
  • Going for a walk
  • Playing
  • Walking your dog
  • House or yard work

By knowing where you're starting and tracking your progress, you can easily find the best way to increase your daily step count and as a result, the calories you're burning.

A stealth-healthy tip on calories would be to start every dinner with a large tossed green salad. This should not be too great a hardship for anyone. What are the benefits? A salad of mixed greens with a light dressing, such as vinaigrette, is very low in calories, very rich in nutrients, and rather filling because vegetables are bulk.

By filling up with such nutrient-rich, low-calorie food at the start of a meal, you are likely to wind up eating fewer calories over the course of that meal. Small reductions in "calories in" and small increases in "calories out" each day can add up to the difference between steady weight gain or lasting weight control.

ZELMAN: We have all heard the advice to just walk, walk, walk as a great form of exercise. Some new guidelines recommend an hour a day of rigorous exercise for weight loss. Do you think it is enough to strap on the pedometer and get out there for 30 minutes each day?

"Make time each day to have some physically active recreation with your family."

KATZ: It is generally unwise to rely on exercise alone to lose weight, because tasty calories are so readily available to us all, that it's quite easy to eat back the benefits of physical activity. Consequently, it is advisable to combine strategies for increasing physical activity with strategies for controlling calorie intake.

But any physical activity you add to your day will likely do you good, whether or not it leads directly to weight loss. First, physical activity promotes health. This is clearly desirable, independent of weight loss. Second, the more active you become, the more appealing further additions of physical activity tend to become.

If you are sedentary the idea of going for a long walk on the beach or a hike or a bike ride when you are on vacation might be rather intimidating. If you routinely have added 1,000 or 2,000 steps to your daily routine, your level of fitness might now make those activities look more appealing.

As a result, physical activity tends to be habit forming, and the more you do the more you can do. Your energy level tends to rise, your interest in your health tends to increase, and the next thing you know you're paying more attention to the fuel that powers that physical activity -- namely, your dietary choices.

People who become more active generally improve their diet as well, acquiring an overall interest in their health and vitality along the way. So 500 steps a day is not the solution to losing a significant amount of weight, but it is the start of something much bigger that can achieve both weight loss and health promotion.

MEMBER QUESTION: How do you fit in exercise when you have limitations or have lost weight due to disease?

KATZ: Unless you are severely disabled by illness or injury, there is almost always some way to be physically active.

For example, if you have arthritis-related trouble with your joints, swimming might be both good for fitness and somewhat therapeutic. If you have limitations in the use of your legs, there are aerobic activities designed exclusively for the upper body. For example, there's a stationary bicycle designed to be pedaled with your arms rather than your legs.

There are many other options, as well. There is also the opportunity to simply tense the muscles around your body for brief periods involving no equipment and no stress to the joints. This approach, discussed in Stealth Health, is referred to as isometric exercise.

In general, I recommend to my patients who have significant physical challenges of any kind to confer with a physical therapist or trainer to get individualized recommendations for fitting physical activity into their lives. This is one of those things when if there is will, there is almost always a way.

ZELMAN: How does stress impact energy, weight, and immunity -- three areas the book claims to improve if you follow the daily tips?

KATZ: There is a new branch of medicine rapidly evolving called "psychoneuroimmunology." This branch of medicine is testimony to the powerful effects of stress and mental health in general on physical well-being.

We know that stress directly influences the levels of many powerful hormones in the body. Among these, are cortisol, adrenaline, noradrenaline, and even insulin. Hormone levels, in turn, have effect on both the nervous system and the immune system. As a result, there is rather convincing evidence that people with high levels of stress tend to get more heart disease, may be at increased risk of cancer, and are likely subject to more frequent infections.

The study of these interactions between stress, immunity, hormones, and nervous system function, is still in its infancy. But even so, the evidence is already compelling that stress is on the short list of major health influences.

ZELMAN: It must have been hard to select the top ten tip list. How and why did you choose these ten:

  1. Drink a cup of tea in the morning.
  2. Walk 30 minutes daily.
  3. Quit smoking.
  4. Enjoy a glass of wine each evening.
  5. Take five minutes daily to close your eyes and breathe deeply.
  6. Talk to a friend.
  7. Eat fish twice a week.
  8. Take a multivitamin daily.
  9. Eat whole foods rather than processed.
  10. Get a good night's rest.

KATZ: It was tough to choose. What we were looking for was a combination of: relatively easy to do; strongly supported by science; multiple benefits.

For example, we recommend moderate consumption of wine. This clearly can offer multiple benefits to those for whom alcohol does not pose a health hazard. Wine can be quite pleasurable, can enhance appreciation of a meal, and can directly lower heart disease risk by two well-established mechanisms.

In each case, we were looking for tips that conferred multiple benefits as a way of rewarding the stealth-health approach.

MEMBER QUESTION: I feel so overwhelmed with the changes I need to make for myself and my family. Where do you suggest I start?

KATZ: I would be inclined to choose physical activity as the initial focus. This, despite the fact that I am a dedicated nutritionist. The reason is, if you are feeling overwhelmed, adding physical activity to your daily routine is simple, and likely to be immediately rewarding.

You mention a family. Permit me to suggest that you make some time. Don't find time, but make time each day to have some physically active recreation with them.

I could provide many examples, but here is a simple one from the Katz family repertoire. Take turns choosing your favorite music and put it on for half an hour in the evening and dance. All of a sudden, what seemed overwhelming has turned into a bit of family fun. Starting your quest toward better health can be as simple as that.

Once you have energized yourself, whether it's from walking or dancing, you can start accumulating other stealth-health tips into your life. Don't overshoot and don't get intimidated. Remember, you are the boss. Make small changes that are acceptable to you. Slow and steady progress is fine, as long as you move in the right direction. You can do it. Good luck.

ZELMAN: Your pearls of wisdom are so profound and hopefully ones our readers will find inspirational, like your book. You inspired me to go out and buy a bean-grinding coffee maker with a timer; it is a great tip to "wake up and smell the coffee." Coffee has gotten good press lately yet your first top ten tip is to drink tea.

KATZ: This is an instance where I don't consistently practice what I preach, and those are quite rare. I tend to drink coffee. And I confess I have to work at incorporating more tea, specifically green tea, into my diet. My wife is French, and unlike the English or the Asians, the French are quite dedicated to their coffee. So we enjoy a cup of French roast side by side every morning.

This is a case, though, where both options are quite acceptable. The caffeine in coffee is a mild stimulant that can help jump-start your day and enhance the clarity of your thinking. It has also been shown to have some appetite-suppressing effects and can assist with weight control. Coffee is also a moderately good source of antioxidants, a benefit most people know little about.

But the reason for recommending tea specifically is that green tea is a more concentrated source of antioxidants, while still providing a lower dose of caffeine.

Unlike coffee, green tea, in large studies, has been associated with reduced risk of heart disease and possibly cancer. So strictly on the merits of available science with health as the goal, the laurels must go to green tea. But again, it's nice to know that in this case the runner-up, namely coffee, is a perfectly acceptable alternative. As I noted, it tends to be my preferred choice.

ZELMAN: You appear to be a soy fan, recommending soy milk, soy butter, etc. throughout the book. Is there any reason why we should drink soy milk instead of cow's milk?

KATZ: I don't have strong feelings about replacing standard dairy products with soy products. However, many adults are intolerant of lactose, the sugar found in cow's milk. As a result, they avoid dairy altogether. In these cases, alternative products made from soy can substitute as good sources of high-quality protein and -- if fortified -- of calcium, as well.

I am more of a proponent of using soy as an at least an occasional alternative to meat. Soy is one of the plant sources of complete protein, meaning it provides all of the amino acids required for human health. Unlike meat of most varieties, soy is quite rich in a number of nutrients, low in saturated fats, and rich in healthful unsaturated oils.

So the overall health profile of soy makes it quite appealing. Add to that the benefit of what you are taking out of your diet, namely, meats that may be rich in saturated fat, and you have a strong argument to work soy into your dietary routine.

ZELMAN: You are a well-respected leader in the medical and nutrition community and I appreciate the fact that you continue to write books to dispel myths and help Americans become healthier. Stealth Health is a "must read" and I highly recommend it. Thank you kindly for taking out time to be with us today and shedding more light on how to sneak health into everyday activities.

KATZ: Thank you so much for having me. I appreciate the kind word. It was my pleasure.


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