Getting Back on Track with Healthy Eating

Spotlight: Nancy Oliveira, MS, RD, LDN, CDCES, Brigham and Women’s Hospital

The EAP turned to Nancy Oliveira, nutrition expert from BWH Faulkner, to better understand the factors related to weight fluctuation, and how to establish and maintain a plan for healthy eating.

Nancy has seen patients in her clinic with 20-30 extra pounds from the last year. She shares some helpful guidance and tools for getting back on track.

What does it mean to have a healthy diet?

It may sound “old-school” but the most successful way to achieve optimal weight is to focus on healthy but realistic eating and life-style habits.

• Resources for general healthy eating:

USDA – My Plate
USDA – My Plate – Widget
Harvard Chan – Nutrition Source – Healthy Eating Plate
American Diabetes Association – Eating Well

• Maintain your blood sugar with the right combination of proteins (good fats), vegetables, and healthy grains.
• Avoid too many sugars/refined carbs or heavily processed foods that can lead to elevated blood sugar, even more cravings, appetite deregulation and mood issues.
• Be mindful to choose “real food” (whole/minimally processed) when possible.
• Be careful not to overeat trendy “ultra-processed” snacks that make health claims (such as being “high protein” or “all natural”), as these are not a good substitute for whole foods. They may still contain added salt or sugar and unhealthy fats that can have an addicted quality in some people.

How can you eat healthy when you are eating out or busy?

• Make informed choices by researching menu nutrition information, such as calories and sodium; some places list this on their menu.
• Preview the menu online (if available), and choose what you plan to eat in advance. Otherwise, it may be too tempting to not choose those loaded nachos or basket of fries!
• Look for healthier choice options that many restaurants now offer.
• Assume that restaurant portions will be large, so plan to share with a friend, or eat half (or less), and save the leftovers for another meal.

• Don’t be fooled by the “health halo” in restaurants, e.g. assuming everything at a certain restaurant, such as a salad place, is healthy. This is not the case if you choose high-calorie toppings/dressings or aren’t mindful of portion sizes, even for salads.
• To reduce reliance on take-out,  it’s helpful to have healthy and easy choices available at home. When you are very hungry, the tendency is to choose whatever, (chips or cookies for example), is ready to eat and right in front of you.
  – Try batch-cooking to prepare several healthy meals in advance, one day per week.
  – Divide portions of meals into food storage containers and freeze for later use.
  – Keep a supply of healthy snacks (washed fresh fruit, nuts, string cheese, low sugar yogurt), and limit the amount of unhealthy options in the house.

What about diets, “trendy” weight loss programs and influencers?

Unless a person has special medical needs, Nancy does not recommend commercial diets. They may provide quick weight loss, but many are too strict, negatively impact metabolism, and are not sustainable options for the long-term. Research shows that many people gain the weight back in time. It is important to understand that one size doesn’t fit all. Each person has a unique set of health circumstances and goals, and a weight management program should take this into account.

A few considerations:

• Focus on goals related to healthy eating or exercise, rather than weight loss, which leads to a lifestyle that supports a healthy weight into the future. “Slow and steady” still wins the race.
• Avoid the scale for the first 3-4 weeks of a new program, so that you can put all your efforts on achieving healthy lifestyle goals.
• After the first month, limit weighing yourself to once a week. That is frequent enough to show true body fat loss.
• Remember that a weight loss program that worked for you 5, 10 or 20 years ago may not be a good fit today. Your body chemistry and metabolism change throughout the years.
• Nancy does not rule out the possible benefits of Ketogenic diets (low carb, high fat, moderate protein) or intermittent fasting, for some, but cautions that these should be considered and implemented in consultation with a registered dietitian to avoid developing nutrient deficiencies.
• Be wary of programs and diets endorsed by social media (TikTok, Instagram) influencers, which may be helpful for some but can cause anxiety and disordered eating patterns for others.

Which apps or programs might be useful for those who want some structure or coaching?

These programs are popular and generally provide sound nutrition guidance if one does not have access to a registered dietitian:

• My Fitness Pal (basic functions are free) 
• Noom (requires membership fee)
• Weight Watchers (requires membership fee)

What does sleep have to do with food?

Sleep habits can influence food cravings and even food choices. When we are sleep-deprived and fatigued, our energy level drops and hormones that regulate appetite are disrupted. This can result in craving carbs and sugar, which provides a quick but short-lived energy boost. Eating too many refined carbs and not enough other nutrients makes us crave even more sugars and carbs. If this becomes a cycle, weight gain, constant cravings and inevitably, sub-par sleep may result.

How does exercise fit into a healthy eating plan?

Exercise is a key component of a healthy lifestyle. It helps to decrease body fat, especially harmful abdominal fat, reduce high blood pressure and blood sugar, and maintain weight loss. However, Nancy does not recommend exercising for the sole purpose of weight loss. People usually overestimate how many calories they expend with exercise and then consume too many calories.

Still, exercise  helps to regulate many things that impact weight management, including:

• Hormone levels (reducing cortisol)
• Improved mood/stress
• Increased energy
• Controlled appetite
• Deeper sleep

How does someone begin the process of getting weight under control?

The best way is to look back and see why weight gain occurred. During the quarantine, what changed (work situation, eating habits, sleep, physical activity)? Were there healthy habits you started (less take-out, more home cooking, doing meditation)? From there, write down 1-2 goals (aside from just weight loss) and outline a plan to achieve these goals. Avoid the temptation to jump into a fad diet or get a recommendation from a friend who lost weight. Consider these factors when creating goals:

• Meal planning and eating times
• Late-night eating
• Snacking habits
• Drinking behaviors
• Sleep habits
• Stress & mental health
• Exercise patterns

How do you keep on track with a healthy eating plan?

The best program is one that you will stick with and that builds your self-esteem. When feelings of guilt or failure accompany an eating plan, you are more likely to overeat or stop the program.  This means that your plan should fit your lifestyle and food preferences and should not cause feelings of deprivation.

• Aim for an “80-20” mix for the best chance of maintaining your plan. This means you abide by the program 80% of the time, leaving room for special meals and treats the other times.
• Keep a journal, even though it requires work and commitment, especially at the beginning of your process.
• Research shows that accountability leads to successful behavior modification.
  – Keep track of both positive and negative habits.
  – Take stock of the measures that do and don’t work for you and adjust as needed.
• Stop judging yourself.
• Accept that lasting results take time.
• If you occasionally veer off the plan, consider this a normal part of the process, rather than “cheating”.

What advice do you have for those who need to gain weight?

Although society doesn’t always understand that this is a health problem, there are those who have lost weight due to the stress of the Pandemic. Just like those who want to lose weight, these individuals should utilize the healthy plate options, such as the Harvard Chan – Nutrition Source- Healthy Eating Plate, referenced above. Otherwise, Nancy recommends:

• A focus on high-calorie healthy fats, such as nuts, nut or seed butters, avocado, or adding a little more olive oil to meals.
• Home-made or ready-to-drink shakes, are easy to digest and provide extra calories, protein and fluid.
• Avoid too many high calorie, ultra-processed food items, (such as high sugar/fat cookies, ice-cream, chips, soda and fried food), that negatively impact health.

When to seek professional help?

Many people can manage their own healthy eating or weight management program, but some might benefit from input from a professional, such as a registered dietitian, PCP, health coach, or even a fitness trainer. People who might benefit from guidance and monitoring include those:

• Not knowledgeable about nutrition.
• With medical conditions.
  – Dietitians can offer specialized expertise for many conditions, including eating disorders, digestive problems, diabetes, and heart disease.
• Who need assistance with accountability.

What can providers do to support those who are candidates for healthier eating habits?

Clinicians, like patients, should focus on health, rather than weight as a barometer. As mentioned earlier in this article, stigmatizing weight will deter people from coming forward for help to achieve better health or addressing other medical issues. The fear of being chastised or shamed can represent a significant barrier. Instead of discussing weight, try:

• Setting a goal of lowering blood  pressure or cholesterol, rather than stating “you must lose 50 pounds.” Usually weight loss must occur to achieve these goals but you will remove the weight stigma.
• Not using body mass index as a sole indicator for chronic illness. Because it is based only on height and weight, it does not paint an accurate picture of a patient’s health.