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Thursday, April 18, 2019

Quitting smoking doesn’t have to mean big weight gain

Confession: I’m a little obsessed with the pedometer in my smartphone. It’s fun to carry it with me and see how many steps I take when exercising or grocery shopping or carrying laundry across my house. I aim for 10,000 steps per day, but I don’t always hit the mark, and I’ve wondered if switching to a digital fitness tracker would push me to go the extra mile. So a small study published in the September American Journal of Preventive Medicine (AJPM) caught my attention.

The study’s researchers wanted to see if digital fitness trackers would increase physical activity among older women. The trackers are tiny gadgets that come in wearable styles such as wristbands, watches, and pendants, as well as hand-held versions you can clip onto a sleeve or slip into a pocket. In addition to the number of steps you take, a digital fitness tracker can also measure and record how fast you walk and how far, for how long, and at what intensity. In the AJPM study, the researchers used a brand of tracker called Fitbit and an accompanying web application that evaluates and even graphs recorded information.

How they did it

The study involved 51 overweight postmenopausal women who had been getting about 33 minutes per week of moderate to vigorous physical activity. The researchers divided them into two groups. The women in the first group each received a standard pedometer. Women in the second group each received a Fitbit, an instructional session, and a follow-up call after four weeks. Both groups were asked to perform at least 150 minutes of moderate or vigorous physical activity each week and to walk 10,000 steps a day. All the women used an additional gadget called an accelerometer to track their movements.

After 16 weeks, neither group had reached its fitness goals. The pedometer-only group did not have a significant increase in their physical activity levels. But the fitness-tracker group increased physical activity by an additional 38 minutes per week.

Accountability, accuracy, and motivation

The study didn’t prove that the fitness trackers caused the women to exercise more, or that pedometers aren’t great tools. (And it may have only shown that 51 older women couldn’t reach their fitness goals, even with the help of fitness tools.) But it does beg the question: do fitness trackers get you to do a little more? “I believe they may be helpful,” says Linda Arslanian, director of rehabilitation services at Harvard-affiliated Brigham and Women’s Hospital. She points to three major factors: accountability, accuracy, and motivation.

“When you can see what your activity levels are, and you know that someone is checking them, there’s accountability, and you’re motivated to work harder because you want to comply,” she explains. In the AJPM study, participants knew that researchers were looking at their results. (You can achieve a similar degree of accountability by using a tracker and asking a partner to look at your results.) “We use similar strategies with our patients and clients. We often have them fill out activity journals or log their exercise programs, and we review those logs with them on their follow-up visits. This helps establish a degree of accountability because they know we’re checking them.”

But an activity journal can’t capture what you’re doing as accurately as a fitness tracker, points out Arslanian. Unlike logs, journals, or standard pedometers, the trackers accurately record objective data about your workout, including the pace, distance, intensity, and duration of your exercise, and can track your progress on those measures. “When you can see all of those things, especially your progress, it motivates you to keep building on what you’ve accomplished,” says Arslanian.

Another benefit

Some fitness trackers can also record your heart rate, which is important for determining the intensity of your workout. “If you’re doing aerobic exercise, you want to exercise at 60% to 80% of your maximum heart rate for at least half an hour, three to five times per week,” says Arslanian. “Do that, and your endurance will improve.” Having a device that gives you that information, or alerts you if you’re below or over your established training heart rate, can make workouts more effective. It can also make them safer, especially if you have heart problems or other medical conditions.

The most accurate way to determine your maximum heart rate is to undergo a stress test. But for healthy individuals, it is possible to estimate your maximum heart rate. To calculate an estimated maximum heart rate, subtract your age from 220. (For example, if you’re 60 years old, your maximum heart rate is 160 beats per minute.) You’ll want to exercise at 60% to 80% of that number:

    60% of 160 (0.60 x 160 = 96) is 96 beats per minute.
    80% of 160 (0.80 x 160 = 128) is 128 beats per minute.

So when exercising, you’d want to keep your heart rate between 96 and 128 beats per minute.

But Arslanian warns that you shouldn’t embark on an exercise program without advice. “You need the okay from your doctor first, and you need someone to craft an exercise program that is in your training range and your safety zone, with a range of intensity and duration that will have the greatest chance of being effective,” she says. Using a device like the Fitbit can make it easier to stay within that training range.

That’s advice that can help us all go the extra mile, whether we’re using a fitness tracker, a pedometer, or even a smartphone as an exercise tool. Autism isn’t exactly something parents want to find in their child, so it’s understandable that parents might feel uneasy about looking for it. But looking for autism is important — and something that has become part of routine pediatric care.

Currently, one out of every 59 children has been diagnosed with autism spectrum disorder. That means autism is really common. And — this is what’s really important — getting help early makes all the difference.

At every single visit in the early years, pediatricians carefully follow the development of children. We ask about how they are learning to move and use their hands and walk and talk and play. We aren’t looking just for autism, of course; there are many reasons why some children may have delays or problems with their development, and we want to catch all of them.

When we see that a child is late to talk, or doesn’t relate to other people or play in ways we might normally expect for his or her age, we do think about autism. Many practices give parents questionnaires to fill out that ask about symptoms of autism. This allows us to get more detailed information than we might get just from talking to parents.

The good news is that most children don’t have autism. Being a bit late to talk, or being shy, or just being quirky are all more common than autism. But getting help early can make a difference no matter what is going on, so whenever we see something that concerns us, we want to take a closer look.

There are a few ways to look more closely. Children from birth to three years old can be evaluated and get services from Early Intervention, a program for children with any developmental risks or concerns. Most of the services are done at home (or at daycare, or any other location that works for the family) and at no cost to the family. Children who are older than three years can get an evaluation and services through the local public schools.

Parents can call Early Intervention or reach out to their local public schools on their own, but it can be useful when the doctor helps with the referral. That way, the concern gets relayed more clearly, we can stay on top of the referral and make sure the follow-through happens, and it helps build a team — which is a wonderful thing for any child to have.

The other way that we can look more closely at a child who is developing more slowly or differently than others is through an appointment with a specialist, usually a developmental pediatrician (a pediatrician who has had extra training in child development) or a neurologist. Very often, we will do a referral to a specialist along with the referral to Early Intervention or the schools to get the fullest picture possible.

It’s always tempting to say, “Oh, she’s just a late bloomer,” and not do anything at all. And actually, there are lots of late bloomers out there. But even late bloomers can bloom faster with a little help. Every child deserves a little help, I think.

For information on what milestones your child should be achieving at different ages, check out the Act Early page on the Centers for Disease Control and Prevention website. And please, if you have any worries at all, talk to your doctor. We’re here to help. Many people put off quitting smoking because they’re worried about gaining weight. Not only do they want to avoid having to buy bigger pants, they also might believe that the extra pounds would be worse for their health than smoking. The good news is that kicking the habit doesn’t have to mean a bigger waistline.

Multiple studies confirm that, when comparing the health effects of smoking against weight gain, it’s much better for your health to quit smoking. A few extra pounds won’t hurt your health as much as smoking will. For example, quitting smoking lowers your risk of cardiovascular disease despite any subsequent weight gain. Researchers say quitters who gain a few pounds still have about a 50% lower risk of heart disease than smokers. The same reduction in risk holds true for people with diabetes. That’s surprising, given that gaining weight can worsen diabetes — which increases the risk for cardiovascular disease on its own.

Typically, people gain about 5 to 10 pounds in the six months after they quit smoking. But what happens over the 10 years after that? To answer this question, researchers at the Penn State College of Medicine used data gathered from the long-running National Health and Nutrition Examination Survey (NHANES).

They looked at the amount of weight gained over 10 years in three groups of people: recent quitters who had been heavy smokers, recent quitters who had been light smokers, and continuing smokers. They also looked at whether a person’s body weight at the time he or she quit made a difference in the pounds added over the following decade.

All smokers that quit gained an average of 18 pounds over 10 years. People that continued to smoke also gained weight over the long term — 8 pounds on average. So the average amount of weight gain related to quitting smoking was 10 pounds over 10 years. That’s not much more than the initial weight gain during the first six months after quitting.

Interestingly, quitters who had been light smokers (those who had 1–14 cigarettes per day) had similar long-term weight gain as those who continued to smoke. However, quitters who had been heavy smokers (those who had more than 24 cigarettes daily) put on significantly more weight than either the continuing smokers or the light-smoking quitters.

Body weight at the time smokers quit also makes a difference. In this study, people who were obese at the time they quit were more likely to gain the most weight after quitting.

If you’re a smoker and want to quit, you might want to have a plan to keep potential weight gain in check. Start a new exercise program before you quit. If you are overweight already, change your diet now to eat healthier and cut down on total daily calories. Making these healthy changes before you quit smoking can help minimize weight gain.

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