From Barnes & Noble

Dr. Howard Shapiro has taken the weight-loss world by storm with his innovative Food Awareness Training, utilizing visual guides to help dieters make informed and intelligent eating choices. Rather than forbidding certain foods, Dr. Shapiro's Picture Perfect Weight Loss focuses on portions and reinforces healthy choices by presenting images that readers won't soon forget.

From the Publisher

Dr. Shapiro has been featured in the New York Times, New York Daily News, New Woman and Vogue, because he has helped hundreds of celebrity, executive, and model clients successfully lose weight. In 1998, he designed a weight-loss program the New York Police Department that was so successful, he is now creating a program for the Fire Department.

Dr. Shapiro believes that many people with weight problems are visually motivated. With this in mind, he created an innovative diet book that utilizes more than 170 full-color photographs of food equations. On each page spread, readers actually see what they are tempted to eat. Next to this is an abundance of alternative options-for the same total calories. With only a fraction of the choices from the second column, a dieter will be completely sated--and will have consumed fewer calories. Nothing is forbidden--dieters can even eat restaurant and airplane food! Without memorizing complicated lists or counting calories, Dr. Shapiro's images leave a lasting impact, allowing dieters to make intelligent food choices for a lifetime.

: Howard M. Shapiro, M.D. has had a successful holistic weight loss practice in Manhattan for more than 20 years.

Publishers Weekly

A New York-based physician specializing in weight control, Shapiro will no doubt startle many lifelong dieters and experts with his approach to eating. There are no "correct" portions and there are no bad foods. Instead, he insists that people must become aware of what they're consuming. To illustrate this principle, the book is filled with color photographs of different foods. For example, one page shows a handful of mixed nuts, potato chips and vegetable crisps: these three portions have 400 calories each, but 10 cups of popcorn has the same number of calories as the rest. A one-cup serving of Quaker Natural Cereal has 540 calories, but that same number of calories is found in 16 low-cal Fudgsicles. Shapiro uses real-life examples of people with weight problems and includes practical advice, albeit in brief chapters, on exercise and the psychological reasons why people become overweight. However, the power of this book is clearly the illustrations showing the "right" and "wrong" food choices. Shapiro walks readers through ethnic menus (Chinese, Greek, etc.), explaining which choices make the most sense healthwise. This is a smart approach to dieting from which everyone, regardless of their weight, will benefit. Copyright 2000 Cahners Business Information.|

Product Details

• Table of Contents
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• Read a Sample Chapter

Table of Contents

Read an Excerpt

Dr. Shapiro's Picture Perfect Weight Loss

Warner Books

Chapter One

Seeing Is Believing:
The Core Of Food
Awareness Training

Does it seem to you that everywhere you go, people are talking about their diets?

    It's true. One-third of Americans are overweight, while another third struggle constantly not to be. In 150 million homes each day, clock radios go off and people get out of bed, go into the bathroom, look in the mirror, and think about a diet.

    But only about 9.5 million people are actually dieting at any given time.

    What happens to the 140 million other promises? They're broken as soon as the man in the too-tight vest reaches for that piece of Danish pastry in the bustle of the morning meeting. For the mom who's at home with the kids, the diet promise ends as soon as she takes a few more nibbles of the kids' snack foods because she needs energy. For the person who has been chained to a desk all day, trying hard not to think about food, the diet promise comes to a crashing end with a late-night bowl of ice cream.

    Everyone knows that being overweight isn't good for you. The insurance companies certainly know it: To determine risk groups, they have gathered masses of statistics about what happens to people who are overweight. They've realized that if you're overweight, you're more prone to diseases such as heart disease, diabetes, stroke, and high blood pressure. People who are overweight are more likely to need surgery, and once they've had the surgery, they're more likely to develop complications. Being overweight even affects your buying power: Those who weigh more are likely to earn less money, especially if they're executives.

Enough Incentives?

    Better health and more prosperity are fine motivators. But even with these incentives, the thought of going on a diet is difficult to contemplate.

    A diet is rigid. A diet is boring. A diet means giving up all the foods you like. A diet means changing your lifestyle. A diet means feeling hungry. And many people have discovered something else that's incredibly discouraging about diets: Once they're over, you usually begin to gain back the weight.

    Before you take the first steps toward Food Awareness Training, I want you to get rid of all those thoughts about dieting. This is not like any diet you may have known. Food Awareness Training is flexible, not boring. You do not have to give up the food you love or change your lifestyle. You will never feel hungry. You will change your entire relationship with food so you need never be on the same up-and-down weight cycle again.

    This is not a "diet book" in any conventional sense. Start with the fact that it is not just for dieters. You won't have to rely on prescriptions, diet gurus, or prepared meals. While this book will help anyone who is trying to lose weight, either through an individualized or group program or with the help of a doctor, it is also meant to help people who are trying to maintain weight, eat in a healthier way, or make better choices for their children.

Who Are You?

    To be sure, the way you approach Food Awareness Training is likely to be influenced by experiences that you've had with diet or weight-loss programs in the past. Fortunately, the program has worked for a wide range of people--from those who have never tried diets to those who have been through numerous plans and programs that were designed to help them lose weight. And there's a reason why Food Awareness Training is just as effective for men as it is for women, and just as effective for young people as it is for those who are middle-age or older.

    If you've never been concerned with weight loss, but you are now, Food Awareness Training can help you make food choices that assure you'll never have to go on a drastic weight-loss program. In fact, many people who come to see me are experiencing a weight problem for the first time.

    Among the first-timers are women who notice small to moderate weight gain with the onset of menopause. The extra weight isn't a problem, and they want to make sure it doesn't become one. They feel like there are certain things that they can do now to lose some weight and avoid a lot of weight gain in the future. And they're right.

    Some men meet their first challenge with weight gain just as they're reaching middle age. That's to be expected. Metabolism changes as we get older, and the food that we consume doesn't get burned up as quickly. Even if our eating habits don't change, it's easy to put on a few pounds--and much harder to take them off. In fact, by the time you're a mature adult, you need 100 fewer daily calories than you needed when you were growing up.

    Some people who have never had weight problems in the past find that a new medication can have side effects. People often gain weight if they start taking drugs that contain steroids. And some people gain weight when they have hormone therapy or take psychotropic medications such as antidepressants.

    Other factors that can cause weight gain? Maybe you've put on a few pounds because you've started traveling for business a lot more than you used to. Or perhaps you have young children who tie you to the home front and kitchen much more than you used to be. Working odd shifts, changing jobs, or going through a relocation can also initiate weight gain.

The Quick-Fix Lure

    For anyone who starts to put on weight, a gimmick diet might appear to offer a quick fix. My advice: Stay away from those diets.

    You need practical, easy-to-understand advice to make some healthful and easy adjustments in the way you choose food. With my program, you can continue to eat real food, and you don't have to follow a set routine of eating a certain amount at a particular time. Also, you don't have to deal with control and deprivation. While you're eating healthier food--for some people, the best food they've ever had in their lives--you'll also be controlling your weight, as long as you have Food Awareness Training to guide the hand that feeds you.

* If you have gone on diets many times during your life, you'll be relieved to discover that Food Awareness doesn't involve unusual regimes and extremes of deprivation.

I know how extraordinary those programs can be, having met people who have tried everything from pills and injections to elaborate rituals that involve weighing each portion of food. Food Awareness Training will teach you how to make food choices for a lifetime. With this plan, you have the very best chance of losing weight and keeping it off--without ever feeling deprived.

Most important, you won't have to go through the heartbreaking cycle of losing and gaining weight again. You will never again have to see a diet doctor or join a program. Why? Because you will be dealing with food in a totally different way than you ever have before.

* If you're particularly concerned about fitness and nutrition, Food Awareness Training will help guide you through the maze of information and apparent contradictions that relate to reduced-fat or low-calorie foods and beverages. Which of these foods really do make sense? Are there some low-fat or "light" foods that are nutritionally barren? With Food Awareness Training, you'll find out which of the diet foods are nutritional booby traps and learn to make other choices automatically. You'll also discover some of the nutritional superstars that can help you maintain a well-balanced, healthful diet even if you're trying to maintain or lose weight.

* If you're a teenager or college student, you may already think a lot about being overweight. But even if you know that certain foods should be avoided, you may not always find it convenient to sit down to a regular meal. Also, you may not be sure which foods are good choices for meals or snacking.

With Food Awareness Training, you can pick up knowledge of your food choices with minimum effort. This book presents that kind of information in a memorable and easy-to-understand way. You can start to develop automatic eating habits that will help you for the rest of your life.

The Key to Weight Loss

    When I was beginning my practice, I prescribed many different approaches to losing weight that were tailored to individual needs. I discovered that calorie reduction is the key.

    On a long-term basis, there is only one safe, effective, foolproof way to get yourself down to a lower weight and keep off the extra pounds. That is to eat a healthy, reduced-calorie diet and get enough exercise.

    But the really good news is that eating fewer calories does not necessarily mean eating less food. And it definitely doesn't mean that you have to walk around in a constant state of deprivation. After all, a feeling of deprivation is the surest way to make your weight-loss plan fail. Instead, you may be eating even more food. You will certainly feel satisfied.

    I also found that most people don't enjoy counting calories. First-time dieters quickly discover that it's a time-consuming and complicated chore. Calorie counting almost always goes hand in hand with the feeling of being deprived that spells doom to a diet.

    And that led to the next important step in my program: developing food demonstrations.

The Look of Knowledge

    You've already seen one food demonstration on page 4. Coming up in this book are scores of others.

    These are exactly the kinds of food demonstrations I use in my practice. The "demos" are a powerful, effective tool for teaching people to look at food in a different way.

    We see so much information about fat and calories that this information may seem like first-grade stuff to most of us. But it's not always easy to judge the information given to you.

    For instance, if you read a package label, you may register the fact that a food is "high in fat" or "low in fat," but you're less likely to pay much attention to serving size.

    Just for fun, you might want to test some of the assumptions you have about different types of food. The food quiz on page 12 will help you do that.

    One thing is certain about taking this quiz: Once you've seen the answers, you're unlikely to forget them. Seeing the actual food--and understanding how many calories are in that food--is a far more powerful message than reading a list of words and numbers.

    These demonstrations--like the many in chapter 6 of this book--are likely to challenge many of your assumptions. Looking at their choices, people often say, "That can't be true! How can one little fat-free muffin have as many calories as all that fruit?"

    But there's no trick to these demonstrations. Before preparing any visual display of food, my staff nutritionist checks food values with statistical tables provided by the USDA. If we're using packaged foods, we use the nutritional information on the packages, paying special attention to the serving sizes. And for some of the prepared dishes in the food demonstrations, we calculated the calories for the recipes using the USDA handbooks.

    Each food demonstration has been carefully checked, using all the information that we have about calorie counts, nutritional values, and serving sizes, to make sure that the portions and amounts are accurate. Since you're always making choices about what foods you eat and don't eat, I want to make sure that what you see is what you get.

Help from the Demos

    The food demonstrations not only help you choose wisely but also help you interpret nutritional information correctly. Here, too, the advice of dietitians and nutritionists is extremely valuable. We find, for example, that many people have mistaken beliefs about what they should and should not eat.

    Take the term fat-free. Thinking that fats should be avoided, many people believe that they can lose weight if they simply eliminate butter and oil from their diets.

    What happens if you eat fat-free cakes and cookies instead of the conventional fat-filled kind? What if you eat bagels instead of croissants? What if you have jelly beans for a sweet instead of a chocolate bar, or pasta instead of a burger? Isn't weight loss guaranteed for people who adopt these fat-cutting strategies?

    If that's what you've heard, and you've moved over to a low-fat or fat-free diet, then you may wonder why the scale isn't moving downward. Where's the flaw in the low-fat reasoning?

    Here's the problem: A fat-free cake, as advertised, is probably free of fat, but it is high in refined carbohydrates. And the carbohydrates that it contains can easily turn to body fat.

    Carbohydrate calories are very real calories. Like fat calories, they can either turn into energy when you exercise, or they can go to the fat cells in your body, where they're stored away. That's why food products that are advertised as "fat-free" do not by themselves help you get thin.

    When I speak with people who have had lifelong struggles with weight control, I tell them that the program they will begin is not a short-term effort but the beginning of a journey during which their relationship with food will change. Even experienced dieters are surprised to discover that they don't have to stick with the foods that they thought were "good" for them--foods they might not even like--but that they can eat a wide array of foods that they really enjoy. Nothing I can say, however, drives home these points as powerfully as the food demonstrations.

A Male Message, Too

    In the past, the overwhelming majority of people who came to see me about weight control were women. Their number one concern was appearance. Many women just didn't like how they looked in jeans or bathing suits, and they wanted to change that.

    Few men seemed to share the same concerns. But that's starting to change.

    Several years back, most of the men who came to see me were concerned about some health problem associated with weight. Some had heart problems, and their doctors had told them that they absolutely had to lose weight to help prevent future heart attacks. Others were threatened by what they found out about their family histories, which suggested that they might be in line for future health problems such as atherosclerosis (hardening of the arteries), diabetes, or other weight-related problems. Again, their doctors' warnings gave them an urgent nudge toward my office.

    These days, more men are concerned with appearance. Yes, health concerns are still the dominant issues, but I am seeing many more men than I used to, and they have other issues. Some top executives, for instance, now make room in their crowded calendars to visit my office to deal with their weight.

The Costs of
Being Overweight

    Why are more men visiting me than before? Well, for one thing, there's been a change in our society, and men are no longer embarrassed to admit that they care about how they look. I see a lot more men working out, going to spas, coloring their hair, having cosmetic surgery--and coming to me to deal with their bodies.

    The appearance factor is more than skin deep. Many male professionals have learned--sometimes the hard way--that no one has a lifetime guarantee of employment. It is not unusual for a top executive and even a CEO to be let go. If you are in the position of having to present yourself as a job candidate in competition with young people in good shape, you want to look as youthful, fit, and healthy as possible.

    Fair or not, in many competitive business environments, people who are trim and in good shape are perceived as being disciplined. Being overweight is more often seen as having a lack of willpower.

    I've seen many men and women who were extremely talented, well-paid, and promotable. But they understood that they could go even farther in their careers if they were more "presentable." Many of my patients--both men and women--tell me that once they lost weight, they were suddenly treated differently at work.

    One woman who holds a very high position at a global firm estimates that being severely overweight has probably cost her several million dollars in lost compensation. Men are beginning to realize that the same may be true for them--but having been less sensitive about weight, some have been slower to understand the professional and economic cost of being overweight. When they come to the door of my office, however, they're prepared to make some weight-loss choices that they feel will keep their options open.

    As you begin using the information here, you may be facing similar issues in your professional life.

Meet Your Challenges

    Over the course of my career, having interviewed thousands of people who are concerned with weight loss, I have discovered that each individual faces different challenges. But many are in similar situations in terms of their lifestyles and schedules. Here are the four lifestyle situations that seem to pose the most problems.

1. Tied to a desk. Let's face it: Many people who spend a lot of time in the office have fairly sedentary lifestyles. Lunch may be catch-as-catch-can from a vending machine, the office cafeteria, the local sandwich shop, or some other source. Often, food choices are limited, and snacks are all too available--no farther away than the desk drawer or office refrigerator.

    If you're in this situation, you may find that you have a low-energy period in the late afternoon. The temptation is to remedy the problem with a "sugar fix." And, of course, if you're in an office all day, your responsibilities don't end there. Pressured by family demands or other obligations, you may be tempted to pick up convenience foods for breakfast or dinner. Again, your options may be limited because you need to act fast to get food on the table.

2. Home with the family. Stay-at-home moms (and dads) often have big snacking problems. When kids leave food on their plates, parents naturally hate to see it go to waste. So they take a bite here, a bite there, and it all adds up.

    Also, in many families with children, it's likely there will be more junk food around. Chips and cookies find their way in, and when you have easy access, that's another problem. When you're spending a lot of time near "kid food," it's all too easy to grab a handful while you're taking care of the family.

3. Eating on the run. Young, single students are typical on-the-run eaters. But you may have the same eating pattern if you're so busy that you rarely cook. If you have little time to eat, you may be picking up practically all your meals. You get breakfast from a deli or coffee shop. Lunch may be fast food or whatever the nearest street vendor has to offer. Dinner ends up being takeout. It's not uncommon to skip a meal or two, then eat as much as necessary to fill yourself up.

    Often, this eating style is driven by necessity, and in some professions, nearly everyone eats this way. Police officers, for instance, rarely have time for sit-down meals, except when they're off duty. Department store clerks and other retail personnel have irregular breaks, so they can't count on fixed schedules. In fact, anyone who has to eat out most of the week is likely to have an eating-on-the-run lifestyle.

4. Wined and dined around the clock. Executives who spend a lot of time doing business in social situations are likely to eat well but rarely on the same schedule. They may start their days with a "power breakfast," hold a meeting at lunch, and go to a social event for dinner. If your lifestyle is like this, you're probably traveling a great deal, often grabbing a bite while you're on the road, in an airport, on a plane, or in a hotel.

    Each one of these lifestyle situations makes different kinds of demands on us, and in each case, your food choices vary. That's why I do food demonstrations with so many different kinds of foods--not just things that you'll find in the cupboard or refrigerator but also with fast foods, street-vendor foods, take-out and restaurant foods, and common snacks.

    In other words, I understand that you can't change your lifestyle just because you've decided to lose weight. Your lifestyle depends on such a wide range of factors--family, location, profession--that you need food choices that fit your lifestyle, rather than the other way around.

    The idea is to help you see your choices, no matter what circumstances you're in or what lifestyle you follow. The right solution is the one that helps you eat healthfully, lose weight, and not feel deprived.

The Stress Connection

    Do you eat more or more erratically when you're feeling a lot of stress?

    For so many people, food is a stress reliever. And from what I have seen, people these days are under a lot more stress than they were in the past.

    More women are juggling jobs and families. Men and women are spending more hours on the job. Of course, it's true that my office is located in New York City, one of the stress capitals of the world. But I think that what I see is replicated in many other places in this country.

    Americans as a whole tend to be workaholics. Many people work two jobs to maintain the high standard of living to which they aspire. And in many two-career families, time is at a premium.

    Not long ago, I began working with a group of police officers who were just starting Food Awareness Training as part of a health-improvement program.

    We all know about big-city cops. Can you imagine a higher-stress job? But I was interested to learn that on-the-job stress wasn't necessarily their biggest concern. For many of them, the stress that they reported came from being so busy.

    Many have spouses who also work. So a typical off-duty police officer has to take on a large share of household responsibilities. After they get home, they have to look after home maintenance, cleaning, cooking, and child care. For them--as for so many of us--these are the stresses that really add up.

    The result? To many of these cops, food was a comfort and a reward. One officer told me that his biggest problem was snacking after 11:00 P.M. Not until then--after his workday was over and the domestic duties were taken care of--could he kick back and relax. And that's when he reached for snack foods.

    I could not only sympathize but also empathize. For me, too, that's a time of day when I can wind down and when I am most tempted by food.

    So what can we do?

    In my view, late-night snacking is not necessarily bad. If that's the only time of day when you can get a break, why not enjoy it? But I helped the policeman by showing him that there are a number of satisfying and delicious snacks lower in calories than what he was eating. When he felt like sitting down for a snack, he could eat foods like pretzel rods, fruit, low-calorie frozen fudge bars, or Creamsicles.

    I didn't tell him not to eat. I didn't tell him that he was eating for the wrong reasons. I just helped him make some different choices--equally satisfying and enjoyable, but for just a fraction of the calories.

Why You Gain Weight

    As your own tastebuds will tell you again and again, food is not a villain.

    Most of us love it. And that's a good thing because we need food for growth and repair of tissues. We need all that pent-up nutritional power to help meet our energy needs.

    It's not the food itself but the storage process that makes us unhappy. If we eat more than we need for immediate use, our bodies put it into cozy, comfortable storage cells. Where are those cells located? You already know the answer. Most of the plump fat cells are located in the trouble spots that we know about--bellies, hips, thighs, buttocks, and all the other areas that have fat-holding cells.

    People who tend to be overweight have bodies that scientists would describe as efficient. At first blush, efficiency might sound like a good thing, but in the modern world, it's a liability. If your body uses food efficiently, you get the energy you need immediately, and then store the excess.

    For some people, that's fine. Their bodies, almost mysteriously, don't store much of the food they eat. You know who I'm talking about--those few people who seem to be able to eat anything and still stay thin.

    For the vast majority of us, however, the fat that we store just keeps hanging around. If only there were some way to reset the controls on our bodies. If we could do that, maybe we could turn the storage function from high to low.

    Of course, as you know, scientists have not quite figured out a way. Until they do, some people will be more likely to gain weight than others. The reasons have to do with body chemistry.

    On the other hand, that doesn't mean your body is going to fight you all the way. Many people can maintain a significant degree of weight loss, but that's easiest to do when you don't feel deprived.

Bon Hunger

    For many years, we were fed the myth that there was a difference between genuine hunger and mere appetite. Hunger was supposed to be a good or normal sensation that came after prolonged periods without food.

    For years, we believed the myth that you could actually tell the difference between appetite and hunger. Experts said that if you hadn't eaten food for hours and were genuinely hungry, you would know it. Dizziness, weakness, or acid stomach are the symptoms of real hunger.

     Appetite, they claimed, was something different. Appetite was the result of out-of-control impulse. Your appetite, not hunger, made you head for a box of cookies despite the fact that you had just finished dinner. If you polished off a whole bowl of peanuts while chatting with your friend at the bar, that was the fault of your appetite again.

    By this reasoning, the hunger-versus-appetite dichotomy was black and white. If you were legitimately hungry, that was okay. But if your appetite was making you eat, well, that was deemed less okay, even shameful.

    Appetite, we were told, was an emotional response rather than a biological one. Appetite led you to eat out of boredom or frustration or anger. Eating for emotional reasons sounds like a wrong reason to eat.

    But as scientists have begun to unlock the secrets of weight gain and weight loss, they have learned that people's reasons for eating can't be labeled in such neat and precise ways. The difference between hunger and appetite is hazy. Researchers have discovered that there are several hormones and neurochemicals in the body that have a profound effect on your life.

Listening to
Your Chemicals

    There are at least six body chemicals that have a profound effect on your life--and your weight. Their names are strange, and there's no reason to memorize them. But as weight-loss research continues, it's likely that you'll see these chemicals mentioned again and again. They are cholecystokinin, cortisol, dopamine, leptin, neuropeptide Y, and serotonin.

    At the moment, there are no adequate explanations about how each of these affects your weight individually. What researchers do know, however, is that these substances relay messages to your fat cells, blood, brain, and intestines. They play a role in regulating body weight, appetite, eating behaviors, and even the way we think about food.

    This is not to say that we are automatons programmed by chemicals. Our eating is also affected by other factors, from psyche to circumstances. Since the whole issue of eating is so complex, no researcher can tell you with absolute certainty why someone can resist the temptation of the bread basket one day but lust helplessly after chocolate cake the next day.

    While it's nearly impossible to know the reasons why you need to eat a particular food at a particular time, it's very important to be in touch with that desire. You can't understand all the ways in which chemicals work, but you must listen when they talk to you. Most dieters have not learned to do this.

    The urge to eat is a need that must be filled.

    If we don't respond to that urge, the need-to-eat feelings--call them hunger, appetite, or anything else--will get the upper hand. And here's the irony: As a result of trying not to respond to the need to eat, there's a good chance that you won't be able to lose weight or maintain weight loss.

Beyond Good and Bad

    Most dieters have built-in defenses. A statement as simple as "I'm hungry!" is unacceptable. Before acknowledging something that simple, dieters are already worrying about how that hungry feeling can lead them into going astray, going out of control, or messing up. People who have been on diets tell me that they constantly feel either good or bad, in control or out of control.

    But you can't repress a feeling that says, quite simply, "I want to eat that." You might try to keep that chemically driven impulse in check, but it's sure to get the upper hand.

    Overweight individuals typically have so much anxiety about the urge to eat that their bodies operate defensively. They don't even allow the hunger to come to consciousness. They find all kinds of rationalizations.

    A person may come home from the supermarket with a cake. She says, "I bought it to serve to company." But lying just below the surface of that statement is the real reason, which is simply the desire to eat cake. The chemicals are talking. But what happens when we don't allow the chemicals to be heard?

    What I'm telling you is something that you may have always suspected if you've struggled repeatedly with your weight. That struggle is caused by something other than lack of determination. It's not being caused by a deficit in willpower. By identifying the chemicals that play a role in your hunger, we're beginning to get to the real causes. Soon we should have the information that proves your suspicions are true: Gaining and losing weight are not matters of self-control, determination, or other intangible factors.

    In the meantime, that doesn't mean that your only choice is to throw up your hands and say, "Well, it's fate. I was born to be overweight." That is definitely not the case. You can reshape (literally) your destiny--or at least you can achieve a more modest goal of just taking a few pounds off.

    I like to think of a person's underlying body chemistry as a kind of metabolic hand of cards that he is dealt at birth. Maybe, when it comes to weight issues, you weren't dealt the genetic equivalent of four aces, but I can tell you that if you play your cards right, you can still come up a winner.

Continues...

---

Excerpted from Dr. Shapiro's Picture Perfect Weight Loss by Howard M. Shapiro Copyright © 2003 by Howard M. Shapiro. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

---

Read a Sample Chapter

Chapter One

Seeing Is Believing:
The Core Of Food
Awareness Training

Does it seem to you that everywhere you go, people are talking about their diets?

    It's true. One-third of Americans are overweight, while another third struggle constantly not to be. In 150 million homes each day, clock radios go off and people get out of bed, go into the bathroom, look in the mirror, and think about a diet.

    But only about 9.5 million people are actually dieting at any given time.

    What happens to the 140 million other promises? They're broken as soon as the man in the too-tight vest reaches for that piece of Danish pastry in the bustle of the morning meeting. For the mom who's at home with the kids, the diet promise ends as soon as she takes a few more nibbles of the kids' snack foods because she needs energy. For the person who has been chained to a desk all day, trying hard not to think about food, the diet promise comes to a crashing end with a late-night bowl of ice cream.

    Everyone knows that being overweight isn't good for you. The insurance companies certainly know it: To determine risk groups, they have gathered masses of statistics about what happens to people who are overweight. They've realized that if you're overweight, you're more prone to diseases such as heart disease, diabetes, stroke, and high blood pressure. People who are overweight are more likely to need surgery, and once they've had the surgery, they're more likely to develop complications. Being overweight even affects yourbuying power: Those who weigh more are likely to earn less money, especially if they're executives.

Enough Incentives?

    Better health and more prosperity are fine motivators. But even with these incentives, the thought of going on a diet is difficult to contemplate.

    A diet is rigid. A diet is boring. A diet means giving up all the foods you like. A diet means changing your lifestyle. A diet means feeling hungry. And many people have discovered something else that's incredibly discouraging about diets: Once they're over, you usually begin to gain back the weight.

    Before you take the first steps toward Food Awareness Training, I want you to get rid of all those thoughts about dieting. This is not like any diet you may have known. Food Awareness Training is flexible, not boring. You do not have to give up the food you love or change your lifestyle. You will never feel hungry. You will change your entire relationship with food so you need never be on the same up-and-down weight cycle again.

    This is not a "diet book" in any conventional sense. Start with the fact that it is not just for dieters. You won't have to rely on prescriptions, diet gurus, or prepared meals. While this book will help anyone who is trying to lose weight, either through an individualized or group program or with the help of a doctor, it is also meant to help people who are trying to maintain weight, eat in a healthier way, or make better choices for their children.

Who Are You?

    To be sure, the way you approach Food Awareness Training is likely to be influenced by experiences that you've had with diet or weight-loss programs in the past. Fortunately, the program has worked for a wide range of people—from those who have never tried diets to those who have been through numerous plans and programs that were designed to help them lose weight. And there's a reason why Food Awareness Training is just as effective for men as it is for women, and just as effective for young people as it is for those who are middle-age or older.

    If you've never been concerned with weight loss, but you are now, Food Awareness Training can help you make food choices that assure you'll never have to go on a drastic weight-loss program. In fact, many people who come to see me are experiencing a weight problem for the first time.

    Among the first-timers are women who notice small to moderate weight gain with the onset of menopause. The extra weight isn't a problem, and they want to make sure it doesn't become one. They feel like there are certain things that they can do now to lose some weight and avoid a lot of weight gain in the future. And they're right.

    Some men meet their first challenge with weight gain just as they're reaching middle age. That's to be expected. Metabolism changes as we get older, and the food that we consume doesn't get burned up as quickly. Even if our eating habits don't change, it's easy to put on a few pounds—and much harder to take them off. In fact, by the time you're a mature adult, you need 100 fewer daily calories than you needed when you were growing up.

    Some people who have never had weight problems in the past find that a new medication can have side effects. People often gain weight if they start taking drugs that contain steroids. And some people gain weight when they have hormone therapy or take psychotropic medications such as antidepressants.

    Other factors that can cause weight gain? Maybe you've put on a few pounds because you've started traveling for business a lot more than you used to. Or perhaps you have young children who tie you to the home front and kitchen much more than you used to be. Working odd shifts, changing jobs, or going through a relocation can also initiate weight gain.

The Quick-Fix Lure

    For anyone who starts to put on weight, a gimmick diet might appear to offer a quick fix. My advice: Stay away from those diets.

    You need practical, easy-to-understand advice to make some healthful and easy adjustments in the way you choose food. With my program, you can continue to eat real food, and you don't have to follow a set routine of eating a certain amount at a particular time. Also, you don't have to deal with control and deprivation. While you're eating healthier food—for some people, the best food they've ever had in their lives—you'll also be controlling your weight, as long as you have Food Awareness Training to guide the hand that feeds you.

• If you have gone on diets many times during your life, you'll be relieved to discover that Food Awareness doesn't involve unusual regimes and extremes of deprivation.

I know how extraordinary those programs can be, having met people who have tried everything from pills and injections to elaborate rituals that involve weighing each portion of food. Food Awareness Training will teach you how to make food choices for a lifetime. With this plan, you have the very best chance of losing weight and keeping it off—without ever feeling deprived.

Most important, you won't have to go through the heartbreaking cycle of losing and gaining weight again. You will never again have to see a diet doctor or join a program. Why? Because you will be dealing with food in a totally different way than you ever have before.

• If you're particularly concerned about fitness and nutrition, Food Awareness Training will help guide you through the maze of information and apparent contradictions that relate to reduced-fat or low-calorie foods and beverages. Which of these foods really do make sense? Are there some low-fat or "light" foods that are nutritionally barren? With Food Awareness Training, you'll find out which of the diet foods are nutritional booby traps and learn to make other choices automatically. You'll also discover some of the nutritional superstars that can help you maintain a well-balanced, healthful diet even if you're trying to maintain or lose weight.

• If you're a teenager or college student, you may already think a lot about being overweight. But even if you know that certain foods should be avoided, you may not always find it convenient to sit down to a regular meal. Also, you may not be sure which foods are good choices for meals or snacking.

With Food Awareness Training, you can pick up knowledge of your food choices with minimum effort. This book presents that kind of information in a memorable and easy-to-understand way. You can start to develop automatic eating habits that will help you for the rest of your life.

The Key to Weight Loss

    When I was beginning my practice, I prescribed many different approaches to losing weight that were tailored to individual needs. I discovered that calorie reduction is the key.

    On a long-term basis, there is only one safe, effective, foolproof way to get yourself down to a lower weight and keep off the extra pounds. That is to eat a healthy, reduced-calorie diet and get enough exercise.

    But the really good news is that eating fewer calories does not necessarily mean eating less food. And it definitely doesn't mean that you have to walk around in a constant state of deprivation. After all, a feeling of deprivation is the surest way to make your weight-loss plan fail. Instead, you may be eating even more food. You will certainly feel satisfied.

    I also found that most people don't enjoy counting calories. First-time dieters quickly discover that it's a time-consuming and complicated chore. Calorie counting almost always goes hand in hand with the feeling of being deprived that spells doom to a diet.

    And that led to the next important step in my program: developing food demonstrations.

The Look of Knowledge

    You've already seen one food demonstration on page 4. Coming up in this book are scores of others.

    These are exactly the kinds of food demonstrations I use in my practice. The "demos" are a powerful, effective tool for teaching people to look at food in a different way.

    We see so much information about fat and calories that this information may seem like first-grade stuff to most of us. But it's not always easy to judge the information given to you.

    For instance, if you read a package label, you may register the fact that a food is "high in fat" or "low in fat," but you're less likely to pay much attention to serving size.

    Just for fun, you might want to test some of the assumptions you have about different types of food. The food quiz on page 12 will help you do that.

    One thing is certain about taking this quiz: Once you've seen the answers, you're unlikely to forget them. Seeing the actual food—and understanding how many calories are in that food—is a far more powerful message than reading a list of words and numbers.

    These demonstrations—like the many in chapter 6 of this book—are likely to challenge many of your assumptions. Looking at their choices, people often say, "That can't be true! How can one little fat-free muffin have as many calories as all that fruit?"

    But there's no trick to these demonstrations. Before preparing any visual display of food, my staff nutritionist checks food values with statistical tables provided by the USDA. If we're using packaged foods, we use the nutritional information on the packages, paying special attention to the serving sizes. And for some of the prepared dishes in the food demonstrations, we calculated the calories for the recipes using the USDA handbooks.

    Each food demonstration has been carefully checked, using all the information that we have about calorie counts, nutritional values, and serving sizes, to make sure that the portions and amounts are accurate. Since you're always making choices about what foods you eat and don't eat, I want to make sure that what you see is what you get.

Help from the Demos

    The food demonstrations not only help you choose wisely but also help you interpret nutritional information correctly. Here, too, the advice of dietitians and nutritionists is extremely valuable. We find, for example, that many people have mistaken beliefs about what they should and should not eat.

    Take the term fat-free. Thinking that fats should be avoided, many people believe that they can lose weight if they simply eliminate butter and oil from their diets.

    What happens if you eat fat-free cakes and cookies instead of the conventional fat-filled kind? What if you eat bagels instead of croissants? What if you have jelly beans for a sweet instead of a chocolate bar, or pasta instead of a burger? Isn't weight loss guaranteed for people who adopt these fat-cutting strategies?

    If that's what you've heard, and you've moved over to a low-fat or fat-free diet, then you may wonder why the scale isn't moving downward. Where's the flaw in the low-fat reasoning?

    Here's the problem: A fat-free cake, as advertised, is probably free of fat, but it is high in refined carbohydrates. And the carbohydrates that it contains can easily turn to body fat.

    Carbohydrate calories are very real calories. Like fat calories, they can either turn into energy when you exercise, or they can go to the fat cells in your body, where they're stored away. That's why food products that are advertised as "fat-free" do not by themselves help you get thin.

    When I speak with people who have had lifelong struggles with weight control, I tell them that the program they will begin is not a short-term effort but the beginning of a journey during which their relationship with food will change. Even experienced dieters are surprised to discover that they don't have to stick with the foods that they thought were "good" for them—foods they might not even like—but that they can eat a wide array of foods that they really enjoy. Nothing I can say, however, drives home these points as powerfully as the food demonstrations.

A Male Message, Too

    In the past, the overwhelming majority of people who came to see me about weight control were women. Their number one concern was appearance. Many women just didn't like how they looked in jeans or bathing suits, and they wanted to change that.

    Few men seemed to share the same concerns. But that's starting to change.

    Several years back, most of the men who came to see me were concerned about some health problem associated with weight. Some had heart problems, and their doctors had told them that they absolutely had to lose weight to help prevent future heart attacks. Others were threatened by what they found out about their family histories, which suggested that they might be in line for future health problems such as atherosclerosis (hardening of the arteries), diabetes, or other weight-related problems. Again, their doctors' warnings gave them an urgent nudge toward my office.

    These days, more men are concerned with appearance. Yes, health concerns are still the dominant issues, but I am seeing many more men than I used to, and they have other issues. Some top executives, for instance, now make room in their crowded calendars to visit my office to deal with their weight.

The Costs of
Being Overweight

    Why are more men visiting me than before? Well, for one thing, there's been a change in our society, and men are no longer embarrassed to admit that they care about how they look. I see a lot more men working out, going to spas, coloring their hair, having cosmetic surgery—and coming to me to deal with their bodies.

    The appearance factor is more than skin deep. Many male professionals have learned—sometimes the hard way—that no one has a lifetime guarantee of employment. It is not unusual for a top executive and even a CEO to be let go. If you are in the position of having to present yourself as a job candidate in competition with young people in good shape, you want to look as youthful, fit, and healthy as possible.

    Fair or not, in many competitive business environments, people who are trim and in good shape are perceived as being disciplined. Being overweight is more often seen as having a lack of willpower.

    I've seen many men and women who were extremely talented, well-paid, and promotable. But they understood that they could go even farther in their careers if they were more "presentable." Many of my patients—both men and women—tell me that once they lost weight, they were suddenly treated differently at work.

    One woman who holds a very high position at a global firm estimates that being severely overweight has probably cost her several million dollars in lost compensation. Men are beginning to realize that the same may be true for them—but having been less sensitive about weight, some have been slower to understand the professional and economic cost of being overweight. When they come to the door of my office, however, they're prepared to make some weight-loss choices that they feel will keep their options open.

    As you begin using the information here, you may be facing similar issues in your professional life.

Meet Your Challenges

    Over the course of my career, having interviewed thousands of people who are concerned with weight loss, I have discovered that each individual faces different challenges. But many are in similar situations in terms of their lifestyles and schedules. Here are the four lifestyle situations that seem to pose the most problems.

1. Tied to a desk. Let's face it: Many people who spend a lot of time in the office have fairly sedentary lifestyles. Lunch may be catch-as-catch-can from a vending machine, the office cafeteria, the local sandwich shop, or some other source. Often, food choices are limited, and snacks are all too available—no farther away than the desk drawer or office refrigerator.

    If you're in this situation, you may find that you have a low-energy period in the late afternoon. The temptation is to remedy the problem with a "sugar fix." And, of course, if you're in an office all day, your responsibilities don't end there. Pressured by family demands or other obligations, you may be tempted to pick up convenience foods for breakfast or dinner. Again, your options may be limited because you need to act fast to get food on the table.

2. Home with the family. Stay-at-home moms (and dads) often have big snacking problems. When kids leave food on their plates, parents naturally hate to see it go to waste. So they take a bite here, a bite there, and it all adds up.

    Also, in many families with children, it's likely there will be more junk food around. Chips and cookies find their way in, and when you have easy access, that's another problem. When you're spending a lot of time near "kid food," it's all too easy to grab a handful while you're taking care of the family.

3. Eating on the run. Young, single students are typical on-the-run eaters. But you may have the same eating pattern if you're so busy that you rarely cook. If you have little time to eat, you may be picking up practically all your meals. You get breakfast from a deli or coffee shop. Lunch may be fast food or whatever the nearest street vendor has to offer. Dinner ends up being takeout. It's not uncommon to skip a meal or two, then eat as much as necessary to fill yourself up.

    Often, this eating style is driven by necessity, and in some professions, nearly everyone eats this way. Police officers, for instance, rarely have time for sit-down meals, except when they're off duty. Department store clerks and other retail personnel have irregular breaks, so they can't count on fixed schedules. In fact, anyone who has to eat out most of the week is likely to have an eating-on-the-run lifestyle.

4. Wined and dined around the clock. Executives who spend a lot of time doing business in social situations are likely to eat well but rarely on the same schedule. They may start their days with a "power breakfast," hold a meeting at lunch, and go to a social event for dinner. If your lifestyle is like this, you're probably traveling a great deal, often grabbing a bite while you're on the road, in an airport, on a plane, or in a hotel.

    Each one of these lifestyle situations makes different kinds of demands on us, and in each case, your food choices vary. That's why I do food demonstrations with so many different kinds of foods—not just things that you'll find in the cupboard or refrigerator but also with fast foods, street-vendor foods, take-out and restaurant foods, and common snacks.

    In other words, I understand that you can't change your lifestyle just because you've decided to lose weight. Your lifestyle depends on such a wide range of factors—family, location, profession—that you need food choices that fit your lifestyle, rather than the other way around.

    The idea is to help you see your choices, no matter what circumstances you're in or what lifestyle you follow. The right solution is the one that helps you eat healthfully, lose weight, and not feel deprived.

The Stress Connection

    Do you eat more or more erratically when you're feeling a lot of stress?

    For so many people, food is a stress reliever. And from what I have seen, people these days are under a lot more stress than they were in the past.

    More women are juggling jobs and families. Men and women are spending more hours on the job. Of course, it's true that my office is located in New York City, one of the stress capitals of the world. But I think that what I see is replicated in many other places in this country.

    Americans as a whole tend to be workaholics. Many people work two jobs to maintain the high standard of living to which they aspire. And in many two-career families, time is at a premium.

    Not long ago, I began working with a group of police officers who were just starting Food Awareness Training as part of a health-improvement program.

    We all know about big-city cops. Can you imagine a higher-stress job? But I was interested to learn that on-the-job stress wasn't necessarily their biggest concern. For many of them, the stress that they reported came from being so busy.

    Many have spouses who also work. So a typical off-duty police officer has to take on a large share of household responsibilities. After they get home, they have to look after home maintenance, cleaning, cooking, and child care. For them—as for so many of us—these are the stresses that really add up.

    The result? To many of these cops, food was a comfort and a reward. One officer told me that his biggest problem was snacking after 11:00 P.M. Not until then—after his workday was over and the domestic duties were taken care of—could he kick back and relax. And that's when he reached for snack foods.

    I could not only sympathize but also empathize. For me, too, that's a time of day when I can wind down and when I am most tempted by food.

    So what can we do?

    In my view, late-night snacking is not necessarily bad. If that's the only time of day when you can get a break, why not enjoy it? But I helped the policeman by showing him that there are a number of satisfying and delicious snacks lower in calories than what he was eating. When he felt like sitting down for a snack, he could eat foods like pretzel rods, fruit, low-calorie frozen fudge bars, or Creamsicles.

    I didn't tell him not to eat. I didn't tell him that he was eating for the wrong reasons. I just helped him make some different choices—equally satisfying and enjoyable, but for just a fraction of the calories.

Why You Gain Weight

    As your own tastebuds will tell you again and again, food is not a villain.

    Most of us love it. And that's a good thing because we need food for growth and repair of tissues. We need all that pent-up nutritional power to help meet our energy needs.

    It's not the food itself but the storage process that makes us unhappy. If we eat more than we need for immediate use, our bodies put it into cozy, comfortable storage cells. Where are those cells located? You already know the answer. Most of the plump fat cells are located in the trouble spots that we know about—bellies, hips, thighs, buttocks, and all the other areas that have fat-holding cells.

    People who tend to be overweight have bodies that scientists would describe as efficient. At first blush, efficiency might sound like a good thing, but in the modern world, it's a liability. If your body uses food efficiently, you get the energy you need immediately, and then store the excess.

    For some people, that's fine. Their bodies, almost mysteriously, don't store much of the food they eat. You know who I'm talking about—those few people who seem to be able to eat anything and still stay thin.

    For the vast majority of us, however, the fat that we store just keeps hanging around. If only there were some way to reset the controls on our bodies. If we could do that, maybe we could turn the storage function from high to low.

    Of course, as you know, scientists have not quite figured out a way. Until they do, some people will be more likely to gain weight than others. The reasons have to do with body chemistry.

    On the other hand, that doesn't mean your body is going to fight you all the way. Many people can maintain a significant degree of weight loss, but that's easiest to do when you don't feel deprived.

Bon Hunger

    For many years, we were fed the myth that there was a difference between genuine hunger and mere appetite. Hunger was supposed to be a good or normal sensation that came after prolonged periods without food.

    For years, we believed the myth that you could actually tell the difference between appetite and hunger. Experts said that if you hadn't eaten food for hours and were genuinely hungry, you would know it. Dizziness, weakness, or acid stomach are the symptoms of real hunger.

    Appetite, they claimed, was something different. Appetite was the result of out-of-control impulse. Your appetite, not hunger, made you head for a box of cookies despite the fact that you had just finished dinner. If you polished off a whole bowl of peanuts while chatting with your friend at the bar, that was the fault of your appetite again.

    By this reasoning, the hunger-versus-appetite dichotomy was black and white. If you were legitimately hungry, that was okay. But if your appetite was making you eat, well, that was deemed less okay, even shameful.

    Appetite, we were told, was an emotional response rather than a biological one. Appetite led you to eat out of boredom or frustration or anger. Eating for emotional reasons sounds like a wrong reason to eat.

    But as scientists have begun to unlock the secrets of weight gain and weight loss, they have learned that people's reasons for eating can't be labeled in such neat and precise ways. The difference between hunger and appetite is hazy. Researchers have discovered that there are several hormones and neurochemicals in the body that have a profound effect on your life.

Listening to
Your Chemicals

    There are at least six body chemicals that have a profound effect on your life—and your weight. Their names are strange, and there's no reason to memorize them. But as weight-loss research continues, it's likely that you'll see these chemicals mentioned again and again. They are cholecystokinin, cortisol, dopamine, leptin, neuropeptide Y, and serotonin.

    At the moment, there are no adequate explanations about how each of these affects your weight individually. What researchers do know, however, is that these substances relay messages to your fat cells, blood, brain, and intestines. They play a role in regulating body weight, appetite, eating behaviors, and even the way we think about food.

    This is not to say that we are automatons programmed by chemicals. Our eating is also affected by other factors, from psyche to circumstances. Since the whole issue of eating is so complex, no researcher can tell you with absolute certainty why someone can resist the temptation of the bread basket one day but lust helplessly after chocolate cake the next day.

    While it's nearly impossible to know the reasons why you need to eat a particular food at a particular time, it's very important to be in touch with that desire. You can't understand all the ways in which chemicals work, but you must listen when they talk to you. Most dieters have not learned to do this.

    The urge to eat is a need that must be filled.

    If we don't respond to that urge, the need-to-eat feelings—call them hunger, appetite, or anything else—will get the upper hand. And here's the irony: As a result of trying not to respond to the need to eat, there's a good chance that you won't be able to lose weight or maintain weight loss.

Beyond Good and Bad

    Most dieters have built-in defenses. A statement as simple as "I'm hungry!" is unacceptable. Before acknowledging something that simple, dieters are already worrying about how that hungry feeling can lead them into going astray, going out of control, or messing up. People who have been on diets tell me that they constantly feel either good or bad, in control or out of control.

    But you can't repress a feeling that says, quite simply, "I want to eat that." You might try to keep that chemically driven impulse in check, but it's sure to get the upper hand.

    Overweight individuals typically have so much anxiety about the urge to eat that their bodies operate defensively. They don't even allow the hunger to come to consciousness. They find all kinds of rationalizations.

    A person may come home from the supermarket with a cake. She says, "I bought it to serve to company." But lying just below the surface of that statement is the real reason, which is simply the desire to eat cake. The chemicals are talking. But what happens when we don't allow the chemicals to be heard?

    What I'm telling you is something that you may have always suspected if you've struggled repeatedly with your weight. That struggle is caused by something other than lack of determination. It's not being caused by a deficit in willpower. By identifying the chemicals that play a role in your hunger, we're beginning to get to the real causes. Soon we should have the information that proves your suspicions are true: Gaining and losing weight are not matters of self-control, determination, or other intangible factors.

    In the meantime, that doesn't mean that your only choice is to throw up your hands and say, "Well, it's fate. I was born to be overweight." That is definitely not the case. You can reshape (literally) your destiny—or at least you can achieve a more modest goal of just taking a few pounds off.

    I like to think of a person's underlying body chemistry as a kind of metabolic hand of cards that he is dealt at birth. Maybe, when it comes to weight issues, you weren't dealt the genetic equivalent of four aces, but I can tell you that if you play your cards right, you can still come up a winner.

(Continues...)