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Focus on behavior, not scale
For third food diarist, health problems make it tough to lose weight

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Date published: 4/30/2006

R ACHAEL CUBBAGE is a 61-year- old retiree with multiple health problems who is trying to lose weight.

She lost 32 pounds not long ago and hopes to lose 10 more. But she recently started needing an oxygen tank to help her breathe. Walking--much less losing weight--has become difficult.

Cubbage, who lives by herself in Stafford County, stands 5-foot-6 and weighs 210 pounds. She has diabetes, high cholesterol and blood pressure. She suffered a heart attack last year, and also battles depression, arthritis and fibromyalgia.

Although she loves old-fashioned Southern cooking, Cubbage has taken diabetes management classes and made a huge effort to eat less salt and lard. She also quit smoking years ago.

Cubbage should be proud of the changes she's made, while also considering other changes she can make to feel better.

Food diary

On the day she kept a food diary for me, Cubbage started off well, with cereal, soy milk and water.

At lunch at the International House of Pancakes, though, she ate quite a few eggs, pancakes and sausage patties, and neglected to balance her meal with fruit or veggies.

Cubbage had a modest, healthy dinner. And the rest of the day, she snacked--often healthfully, but in a way that made it a challenge to keep her blood sugar balanced.

Small, frequent meals such as the snacks Cubbage ate can be a good thing, but it's important that they have some structure. That's because spreading carbohydrate foods throughout the day helps balance blood sugar. Cubbage ate most of her carbohydrates at midday, and then grazed until 1 a.m.

Overall, Cubbage kept calories around 1,700, which is good for most women. But it's possibly a bit high for her because she has difficulty being active. It might help her to stay closer to 1,500 calories.

Rather than counting calories, though, it may be easier to concentrate on what to eat. She got plenty of protein but fell short of the 1.5 cups of fruit and 2.5 cups of veggies recommended for her height.

Eating more fruits and veggies would not affect calories much but would boost her fiber intake. (She took in 17 grams, short of the minimum of 25 grams recommended to reduce cholesterol and regulate digestion.) Many fruits and veggies have vitamin C, of which she also fell short.


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Breakfast, 10 a.m.: cereal with cup soy milk, and flavored water

Lunch, 12:30 p.m., at International House of Pancakes: three scrambled eggs, three turkey sausage patties, 3 pancakes, cup sugar-free syrup, some butter, three cups of coffee, three containers of half-and-half, and six packets of Splenda

Snack, 2:45 p.m.: 32-ounce caffeine-free Diet Pepsi

Dinnertime: a 17-ounce bottle of flavored water at 5:30 p.m., followed a half-hour later with half a sandwich of soy cheese on wheat bread, cup pickled beets, cup three-bean salad, 1 teaspoon of mustard and bottle of flavored water. An hour later, she drank another bottle of flavored water.

Evening snacks: an apple at 8 p.m., two large, sugar-free cookies at 9 p.m., a bottle of flavored water, and at 10 p.m., six crackers with hummus. At midnight and at 1 a.m., she drank a bottle of flavored water.