Many dietitians and diabetes educators use the exchange lists as a guideline for meal planning, and so does your book. How does the No Time to Lose Diet book differ from the standard exchange list approach to meal planning for weight loss?

I use the exchanges just as a teaching tool. I would say my recommendations differ from those of the government in two ways. First, my approach is a more moderate one when it comes to carbohydrates. I think that when you look at the obese population in this country, seventy percent of them have metabolic syndrome. I think the recommendations for carbohydrates and starchy carbohydrate levels in traditional teaching are excessive when you consider our less than adequate activity level. So I would call my book a more moderate approach with regards to carbohydrates. Secondly, I try to customize the exchange lists a little bit. In the book I tried to simulate what I do in the office. I have a carbohydrate calculator that factors in age, height, weight, sex (some of the defining characteristics of metabolic syndrome and activity level) to really help people find the appropriate level of starchy carbohydrate servings for them. I think it is much better than counting calories or grams or points. It is kind of more of a big picture approach.

You are one of less than two hundred nutrition specialist physicians in the country. What was your impetus for seeking a career in the weight loss industry?

I knew I never really wanted to practice internal medicine. I just did not feel like I was making a profound difference in people's lives putting them on medications and not really doing much of anything else. I happened to get a part-time job at a weight loss clinic and I very quickly saw the profound impact that I could have on people's lives, it was like a light bulb went off in my head. I said "This is what I need to be doing." I did not agree with certain aspects of the weight loss clinic approach because they used diet pills and shakes, and I just think of that as a quick fix and not really a permanent solution. So after working there for about six months, I set up my own office. I then found out about the new board certification [nutrition specialist], which is a sub-specialty. I said, you know what if I am going to do this, I am going to do it the right way and I should be appropriately credentialed as well. I wanted to differentiate myself from other people who may just label themselves as experts in nutrition. And so, I went ahead and trained myself through reading and going to meetings and also through seeing patients all day, everyday-you learn a lot that way. I get joy from having a profound impact on people's lives and getting them off of medicine.

How do you teach exchanges to low-literacy level patients?

Again, I really focus more on the big picture. I try to emphasize basic principles. I think what is most important in the exchange system from a weight-loss standpoint is the serving sizes of starches and fat. I think people eat too many of those foods. I mostly emphasize finding the hidden fats in your diet as well as being more aware of serving sizes of fats, salad dressings, etc. Everybody knows what salad dressing is, I just need to show them a tablespoon and say you know what, if you subtracted this everyday, you could lose six pounds in one year. I do more dramatic, applicable things like that so that it sticks with them.

You encourage your patients and readers to approach each day with a "plan." What type of plan do you find is most important for successful weight loss?

A time-efficient plan that is an overall plan for your approach. Knowing what fast food options you have, if that has to be the case. Knowing that if you have a business lunch you might want to have a lighter breakfast because you might eat a little heavier at lunch if it is out. Having the planned snacks in the car so that if you are driving the kids around in the carpool you have got a bottle of water and a protein bar or an apple and almonds. My patients are too busy to sit down and write out a plan everyday. I just want them to have the basic infrastructure of a strategy, so that the good food is in the house, and if they know it is going to be a long day, foods are already planned and in the fridge, and they do not have to get home and say, "Oh, I am just going to order a pizza because I do not have time to deal with this." It is more a big picture plan and an approach to building the infrastructure of a healthy eating lifestyle.

For overweight people with very limited time for exercise, what do you emphasize more: cardiovascular exercise or strength training and why?

Absolutely cardiovascular exercise. I think the majority of overweight people, just by nature of being overweight, probably have enough lean body mass. Strength training is great to get more lean body mass, but if it is a matter of time, they are going to burn more calories with fat-burning potential from the cardiovascular exercise. As people progress in their weight loss, I really encourage them to find the time to add in resistance training because I do not want them to be losing muscle. But if it is a time standpoint, absolutely the cardio for fat burning.

If someone has almost one hour per day, five days a week to dedicate the exercise, what strategies do you recommend to help him or her stay on track with an exercise plan?

If they have an hour a day, they are doing better than, I would say, ninety-five percent of the country. The most important thing is to make exercise fun and to mix it up. If you were to walk the same mile everyday along the same course, you would burn fewer and fewer calories because you are in better shape, you are losing weight, and your muscles are more conditioned. So you have to change things up. If somebody was really consistently doing five days a week, one hour a day, I would say variety would probably be the most important thing so that they keep benefiting from exercise as much in progressive weeks.

Okay. You advise your readers to write down goals and barriers to weight loss at various points throughout the book. How are these goals intended to be revised throughout the weight loss process?

Writing goals down helps you keep track of your accomplishments. I write down my patients' goals in my medical chart because they forget. They say "Oh god, I really have not done that much," and I say, "Look at all these milestones that you've hit." I write them down for encouragement...it helps with confidence. Certainly goals would need to be revised or altered. Writing helps you be aware of barriers and think about strategies to overcome them. And then when you do that, it is another accomplishment. I am big about discouraging my patients from coming into my office to say what they did wrong this week. I want to know what they did right, first, because I want them to see the positive, not the negative.

As most sensible weight-loss programs do, your book emphasizes the importance of vegetables. What tips do you have for readers who may not love vegetables as much as they should?

Figure out a way to get them in. I do with my patients who say that they do not like any vegetables. I give them a list of vegetables, and say there has got to be something here that you like or maybe you have to make vegetables taste better. I would rather a person add a little fat to the vegetables to make them taste better than not eat them at all. I sprinkle some freshly grated cheese or get pre-made sauces that enhance the vegetables. You can transform broccoli from boring steamed broccoli into a gourmet meal. I encourage people to be creative with low-calorie options such as salsa, which count as vegetables but help to season other foods without fat.

Your book cites a number of published weight-loss studies and other diet books. What are your most recommended popular diet plans or components of these plans, and why?

From a psychological standpoint, I think Weight Watchers is good because it helps dieters really understand their mentality. I like the sense of community with the program. I think they fall short with the point system that may allow for too much flexibility. You could eat ten Twinkies a day and still be within your point limit, and that is obviously not good nutrition. From a nutrition and health standpoint, I think phase three of the South Beach Diet is good. My program is probably most similar to this maintenance phase of South Beach. The first two phases are overkill and too restrictive with carbohydrates. I think the South Beach program is good from a health and cardiovascular standpoint.

I was intrigued that you recommended FAGE Total Greek yoghurt with sixteen grams to eighteen grams of saturated fat per container. I am curious as to how this is part of a successful weight loss plan?

No, not the full-fat brand. My recommendation was intended to be for the low-fat or fat-free versions. I have a shopping list in the Appendix and recommend there that FAGE has zero percent or two percent is ok if you have to add some fat.

What behavior change strategies do you recommend for people struggling with binge eating disorder?

That is a tough one for me because I am not a trained psychologist. I do see binge eating disorder a lot in my office, though. I think it is important to figure out the triggers, both behavior and environmental triggers. Triggers can put you in an emotional situation that causes bingeing. I find that other binges are people just trying to eat around their cravings. Sometimes, if someone is craving a Hershey bar, instead of trying to eat a cup of yogurt with granola or fruit, the person might really be better off just having what they know they really wanted in the first place, because deprivation can be a stronger trigger for binge eating than initial cravings are. I believe that the more you know about you and what triggers your behaviors, the more you can avoid certain situations that promote that.

Your book has a number of interesting case studies with weight-loss stories from your practice. Who has been your most inspiring patient recently, and what tips were the most helpful in getting this person to lose weight?

My most inspiring patient recently is a woman who initially came to me four years ago. She had lost about one hundred pounds, and unfortunately regained those one hundred pounds and another fifty pounds back. When she came to me, we were struggling mentally to get her back on track. She decided that doing a modified fast would help her get going. She successfully lost about half of the weight on her own and came to me to learn how to eat again. She knew she could not continue the fast. I just said, "You have got to trust me that eating real food in moderate portions is going to be okay, and that you can have a nice dinner out with your fiancée every once in a while." I helped her build exercise into her life because she was very all-or-nothing when it came to the gym. She was the perfect example of the notion that failure is not in the falling down, but it is in staying down. The fact that she lost one hundred pounds, regained it, and then recommitted and lost one hundred and fifty pounds, showed me that sticking with it and never giving up can be successful, and definitely inspiring.