Lisa Drayer: Diet, nutrition and weight management

Lisa Drayer is the eCounseling Program Director for DietWatch.com, Inc. A member of the American Dietetic Association, Ms. Drayer has appeared frequently on television and radio as an expert in nutrition. She also moderates chat discussions and answers questions on diet, nutrition, and weight management for DietWatch.com and Cyberdiet.com. She joined the CNN.com chat room from New York.

CNN: Thank you for joining us today, Lisa Drayer, and welcome

LISA DRAYER: Hello, everyone, it's a pleasure to be here today to answer your questions on diet and weight loss.

CNN: What are some of the pros and cons of weight loss drugs?

DRAYER: Well, certainly, there is a role for weight loss medications, and they can be beneficial for certain people. The thing to watch for is that you've already tried diet and exercise and behavior modification first. My general rule is that if you've tried diet, exercise and behavior modification for about six months, and you're not seeing any significant weight loss changes -- assuming you're at the appropriate Body Mass Index (BMI) -- then you may want to talk to your doctor about taking a weight loss medication. The good news is that these medications can give you a jump-start to your weight loss. The bad news is that they don't take the place of diet and exercise, so you still need to keep to a healthy regimen of eating healthy, increasing your exercise, so that you're not dependent on the medication.

VIDEO Some have been let down by new diet drugs. CNN's Elizabeth Cohen reports (August 22) Play video (QuickTime, Real or Windows Media)   MORE STORIES Doctors caution use of weight-loss drugs

Now, I also want to point out that the medications aren't indicated for everyone, so in order to be prescribed the weight loss medication by a doctor, you'd have to have a BMI of 27 with existing co-morbidities, existing risk factors, or a BMI of 30 without existing co-morbidities. Basically, to clarify BMI, someone who is 5'4" would have to weigh at least 160 pounds, and have existing risk factors for disease to be considered for medication. If someone didn't have an existing risk factor, they'd have to be 175 pounds at 5'4" to be considered. They're not for someone of average weight, looking to drop five or ten pounds.

CHAT PARTICIPANT: What signal does the brain get when we decide to eat? Are there emotional factors involved?

DRAYER: Definitely, there are emotional factors when we decide to eat. Babies are the only humans that eat in response to real cues for hunger. Once you're past that stage, you engage in disordered eating. Whether it's because you're eating at the right time, or because you're anxious or stressed, emotions play a significant role in when we eat and how much. So, ask yourself if you're really hungry. Do you really want the pretzels or chips? Or is there something else going on? Are you bored, tired, stressed? There are ways to combat those feelings if you feel the urge to binge at a certain moment.

What I recommend is logging on to a diet web site such as dietwatch.com, where you can chat with others who can get you through those difficult moments. That's the beauty of dietwatch.com, we're available 24/7, so if you're craving the cookie jar at 3 a.m., you can log on and get the support you need. I should also say that there are appetite centers in the brain, and there are chemicals in our brain that influence our appetite, so this is a real phenomenon which is affected by the appetite centers in our brain. It's not always hunger, but other reasons that are causing us to eat.

CHAT PARTICIPANT: Lisa, aren't weight loss drugs just a temporary solution, when you stop taking them you gain everything back?

DRAYER: That's definitely true. If you just continue on weight loss medication, you may return to your baseline weight. If you're on a medication, you have to remember it won't take the place of diet and exercise, it can give you a jump-start, but you'd have to stay on the medication for it to have the effects you're getting while on it. Furthermore, you'd have to keep up with your diet, but even when the medications work, if you're overeating, you'll gain the weight back. Another interesting point is that a drug like Xenical® will let you know if you're actually eating too much fat, it's a great behavior modification drug, and you'll get a lot of gas and maybe diarrhea, because the drug works by eliminating 30% of the fat you're eating. If you don't cut back on fat, you'll be very uncomfortable, with lots of side effects like gas and diarrhea.

CNN: What questions should you ask before thinking about taking a weight loss drug?

DRAYER: The first thing is to talk to your doctor, to see if you're even eligible for a weight loss medication. Your doctor should check your history and do a thorough evaluation of your need for the medication. Certain medications are not meant for certain people. For example, Meridia® is not meant for people with existing high blood pressure, because one side effect is that it can increase blood pressure. Make sure your doctor is aware of your medical history before prescribing weight loss medications. So, the first step is an evaluation from your doctor.

The second thing is to really ask yourself if you're viewing the medication as a magic bullet, a quick fix. If you have a tendency to kind of look at things as magic bullets, something to use instead of healthy eating habits, then you may not succeed with your efforts. If you're the type of person with a personality that depends on something, like a crutch, then you may not want to do this, and may not want to engage in behaviors that won't give you long term success.

I also want to make a distinction. There are medications approved by the Food and Drug Administration, like Xenical® and Meridia®, and there are non-prescription weight loss supplements, and those you have to really be careful of, because they can contain dangerous ingredients. For example, Ephedra is a common ingredient in a lot of non-prescription weight loss supplements, and it can have dangerous side effects. In addition, phenylpropanolamine (PPA) is another common ingredient used in some non-prescription weight loss supplements, and PPA has been shown to increase risk of stroke in young women.

So it's important that if you're going to consider taking a pill for weight loss, that you talk to your doctor, get his or her recommendations, and avoid what you're seeing on the shelves in the drug stores. You want to be monitored on these drugs. If you go to the drug store, you might take something and not know the interaction the drugs will have in your body. So it's really, really important to be monitored by your doctor if you're on a weight loss medication, and to avoid the non-prescription medications.

CHAT PARTICIPANT: I read in a study that very frequently your need for water is often confused with hunger, since most people are chronically dehydrated. Can you add to this?

DRAYER: Definitely. That's definitely a true phenomenon. A lot of times, when we're dehydrated, we'll feel hungry. We also may feel hungry when we're fatigued. So if you're hungry, and don't know why, you can take a big glass of water, then wait 15-20 minutes, and then see how you feel. It might be that you were dehydrated or tired. If you're still hungry, try a low calorie snack like baby carrots, pretzels, fruit or low-fat yogurt. Drinking a lot of water is helpful with weight loss. So I recommend getting at least 8 8-ounce glasses of water each day.

CHAT PARTICIPANT: Is there a big difference between off-the-shelf diet products and prescribed diet drugs?

DRAYER: That's what I was getting at earlier. The products on the shelves in the drug stores are non-prescription weight loss supplements, and they often contain ingredients that can be harmful. Ephedra and PPA are just a couple. These ingredients can have harmful side effects, especially if you have existing disease. Ephedra increases heart rate and blood pressure, and can increase your risk of heart attack. Researchers have linked Ephedra use with adverse cardiovascular events. So, it's really a risky behavior to use a product that's not prescribed by your doctor. You can become dehydrated from losing too much fluid. It's not smart to use those products. You may be taking medications, and they could negatively react, and you'd have no idea. I definitely recommend avoiding the weight loss aids that you see on the shelves of the drug stores.

CHAT PARTICIPANT: Are there foods that can increase metabolism?

DRAYER: The best thing to increase metabolism is to eat frequently, meaning to eat whether it's three meals and six snacks or six mini-meals. The more often you eat, the more you're putting your body to work. The more you're eating, the more likely your metabolism will work optimally. The flip side is that if you skip meals, your body slows down. It says, "uh oh, I'm not getting fed, I'd better slow down." The end result is that your metabolism has slowed, and you're less likely to lose weight.

CHAT PARTICIPANT: Why do women have more problem loosing weight than men?

DRAYER: We know a few things. We know that women have more body fat than men, and that's just by nature. That's not something we can control. That means that we have more fat mass as opposed to muscle mass. What we also know is that fat mass is less metabolically active than muscle mass. So, in other words, we have a greater amount of fat mass, which is less metabolically active than muscle, so men have the advantage of having more lean or muscle tissue. They have more metabolically active tissue. So, that's why women often find it harder to lose weight than men. They don't have the muscle mass, they have the fat mass, which isn't as metabolically active as muscle mass.

But that's not to say that there's nothing women can do about it. Eating a healthy diet of fruits and vegetables and high fiber foods, and engaging in a regular exercise program, is the key to shedding the pounds and shedding the fat along with the pounds. If you're really interested in efforts at decreasing the fat mass, you can exercise regularly and build more muscle mass, which will increase your metabolism, because the muscle mass is more metabolically active than the fat mass. So the key for women is to increase the muscle mass through weight bearing exercise.

CHAT PARTICIPANT: Are weight loss drugs the realm of the "lazy"? Isn't improved diet and increased exercise a healthier option than drugs?

DRAYER: Definitely, diet, exercise and behavior modification are the most important factors for weight loss. A medication really should only be considered after you've tried those things for at least six months. So, the reality is that there's no escaping the tried and true, diet and exercise. But if you're struggling with that, and you meet the criteria for a weight loss medication, then it may be a good idea to talk to your doctor about a weight loss medication.

CNN: Do you have any final thoughts to share with us?

DRAYER: I encourage everyone to log on to dietwatch.com. We have terrific e-counseling programs where you can get daily meal plans tailored to your needs, such as vegetarian or low-fat, and weekly progress reports, so if your calories are high, we'll tell you how to cut back. If your calcium is low, we'll tell you how to increase it. You can also chat with other members of our community. This has been helpful to many, to have the support 24/7. We also offer the expertise of registered dieticians. Anyone can be a nutritionist, but only if you meet the criteria established by the American Dietetic Association, can you call yourself a dietician. We have many on our staff, and they'll give you weekly meal plans, progress reports, an initial detailed assessment, and you'll also have the ability to meet with them in a private chat room.

So, wherever you have an Internet connection, you can meet with a dietician on dietwatch.com. There's a lot of good nutrition information on our site, so anyone who is considering a weight loss program should check out www.dietwatch.com. We have a lot of success stories, not just people who have lost 5-10 pounds, but many who have lost 100 or 150 pounds, because they like the tools, information and support they get on dietwatch.com.

CNN: Thank you for joining us today.

DRAYER: Thank you, it was a pleasure to be here.

Lisa Drayer joined the CNN.com chat by telephone and CNN provided a typist. This is an edited transcript of the chat which took place on Wednesday, August 22, 2001.