Skipping breakfast sets up a destructive pattern in a person's body rhythm, he said. "The rule of thumb is, don't skip breakfast if you want to lose weight. Eat a breakfast low on carbs and sugar, a modest-sized lunch and a small dinner. Limit eating after dinner." Snack on low-carb and low-calorie foods in between.
Instead, most of his patients go in the other direction. They escalate their eating as the day goes on. They don't eat till lunch, snack in the afternoon, then eat a large dinner. "Then, after dinner, they really start eating, while they watch TV or surf the Web or read.
"They take in 35 to 40 percent of their calories from 8 o'clock to bedtime. People are often surprised at the extent to which they're doing this. Unfortunately, they're often eating something like a Little Debbie cake or high-fat popcorn."
Parents' eating patterns ripple out to their children. If parents skip breakfast, it's likely the kids won't eat much breakfast either, he said. If parents eat after dinner, the kids eat then too. Parents say, 'Oh, our family's all big. That's how we are,' but that may have more to do with eating patterns than with genetics."
One in 4 West Virginia fifth-graders are obese, with high blood pressure and/or cholesterol, according to West Virginia University screening.
The good news is, whole families can improve their health and lose weight by shifting their eating pattern, he said. If mornings are rushed, he said, prepare ahead: hard-boiled eggs, nuts or a banana with peanut butter, things people can grab easily. Another tip: Don't eat in front of the TV or computer.
Trauma can affect a person's weight, but "nobody can predict how," Linton said. One person will eat constantly for comfort, while another resists eating and develops anorexia or bulimia.
"There's research evidence that some women who were sexually traumatized as youngsters may gain weight to avoid being noticed by potential suitors or predators. That definitely happens, but it's important not to generalize." Not all sexually traumatized women become heavy, he said. And all women who are heavy were not sexually abused. "Obese people are already subjected to 'you're stupid, sloppy, lazy, and a drag on society.' We don't need to add a presumption that 'you've probably also been sexually abused.'"
Depression and weight are highly correlated, he said. "When both are there, you can't treat the obesity without treating the depression."
Depression can feed late-night eating too, he said. "As night falls, many people feel lonely and depressed, so they reach for the Cheetos and Cokes that kick up their pleasure chemicals. It makes them feel momentarily better, then they nosedive, so they eat more. So the cycle goes."
Diabetics who are depressed can have an especially hard time losing weight, he said, because they are less likely to do what they need to do to control their diabetes.
Depression medications also can cause people to gain weight. It can be a vicious cycle. Group support and exercise can help people break out of it, he said. "We need more group opportunities," he said.
Doctors, be more thorough
"It's not safe to assume patients know how to help themselves," Linton said. "And research shows that about 50 percent of what a physician tells the patient can be lost by the time they start their car in the parking lot.
Linton's patients often tell him their doctors told them to eat a healthier diet, but they weren't sure what that meant. They don't know, for instance, what foods are carbohydrate and what's protein. Some have never cooked. Others aren't sure how much exercise they can do safely.
Doctor's visits often last about 15 minutes, and "busy clinicians may say, 'I can't sit down with someone for two hours and explain the ins and outs of diabetes,'" Linton said.
Internet sites from the Mayo Clinic and American Diabetes Association can help too, he said. "But we've got to remember to tell patients about them."
Better yet, West Virginia is starting to build a network of multiweek classes in self-management and prevention of chronic disease. "That should help a lot," Linton said. Weekly support groups or self-management classes give a patient step-by-step help, so they're ideal for helping a person change habits, he said.
"If many of the people I interview had had a good self-management class early in the process," he said, "they probably wouldn't be talking to me."
"The bottom line is, change happens only when a person decides to change." But when a person does decide it's time to change, it's more likely to happen if the environment makes it easy or if a self-management class is available, he said.
"City and county government can do many things to help citizens of all weights stay fit or get fit. Charleston needs those kinds of things, more walking and running trails and bike paths, for instance.
"But change takes time. It takes awhile to parallel-park an aircraft carrier. It is increasingly easier to get healthy food at restaurants. You can get oatmeal at McDonald's now. More people are exercising. We're moving in the right direction."
Reach Kate Long at 304-348-1798 or katel...@wvgazette.com.
"The Shape We're In" has been supported by a Dennis A. Hunt Fund for Health Journalism fellowship, administered by the California Endowment Health Journalism Fellowships at the University of Southern California's Annenberg School for Communication and Journalism.