Beware of Junk Food Under Healthy Disguise

Most people know that French fries are not going to help you meet your health goals, but there are TONS of food products out there that may look or claim to be healthy. If you carefully examine the nutrition label, you’ll find it is really just junk food in disguise. Here are some examples and how you can shop wiser and get healthier.

Granola: Sure, oatmeal is a whole grain, loaded with fiber which helps you stay full and lowers cholesterol but what most people fail to see is how calorie dense granola is, meaning it contains a lot of calories in a small amount. Take a look at a serving size and you will find that a measly ¼ cup (4 tablespoons) contains 120 calories and 3 grams of fat (for Bear Naked Fit granola). Doesn't sound so bad until you take into consideration that people typically eat about 1 cup of cereal, which would be 480 calories and 12 grams of fat. 


Try this instead: 1 cup of plain, cooked oatmeal which is 120 calories and 2 grams of fat. Add some fruit or a drizzle of honey to sweeten it up and pair it with high protein eggs or yogurt to round off the meal.

Diet Juices: While fruit juice contains more vitamins than soda, the sugar content is nearly identical. Anyone that has made fresh-squeezed orange juice knows how many oranges it takes to make just 1 glass. Like granola, a small serving size packs a big calorie punch. So what do food manufacturers do? They make lower sugar versions, which means they take juice and dilute it with water and usually add an artificial sweetener to make up for taste. 


Try this instead: Buy 100% juice and dilute it yourself with water at home, but 1 cup (8 oz) is about as much as the width of 4 fingers. Standard glasses are at least twice the size. Measure it out in a measuring cup to really see how little a serving is. Better yet, at fresh fruit to regular or sparkling water. You will get a different flavor without any additional calories. 

Dried fruit: Hear me when I say that fruit is good for you. It provides necessary vitamins and minerals as well as disease-fighting antioxidants. BUT sugar and extra oils is almost always added to dried fruit. And the rare cases when it is not, the serving size is much smaller than fresh fruit (1/4 cup of raisins = 1 cup of grapes). Sounds like a duh moment, but volume plays a big part in making you feel full. 


Try this instead: Choose fresh fruit over dried and you will feel fuller on fewer calories.

Frozen fruit:  Some frozen fruit, particularly berries, have sugar added to them. Check the ingredients to make sure that all you see listed is just fruit. Sucrose or fructose are different names for sugar, don’t be fooled!


Try this instead: unsweetened, frozen fruit. Or buy fresh fruit when on sale, wash, dry and freeze yourself. 
Wheat bread: Before you gasp and refuse to read anything else, let me clarify: wheat bread is NOT the same as WHOLE WHEAT BREAD. Tricky, little food manufacturing devils cause this confusion. Contrary to popular belief, you cannot tell if your favorite sandwich companion is wheat by its color. White whole wheat bread has similar benefits to whole wheat bread, it is just made from a different type of wheat. However, many companies use enriched flour, made with some wheat and some refined flour to make bread. It has less fiber and vitamins and minerals than whole wheat bread. Before fiber was added to every food under the sun, you could look at the fiber content to recognize which bread was whole wheat and which was enriched/refined, but now fiber is added to enriched products. The only way to be sure what you are getting is whole wheat is to look at the ingredients. The first one item listed should have the word ‘whole’ in it; whole wheat flour or whole grain flour. If it lists enriched flour then put it back on the shelf.


Try this instead: Check out your local farmer's market or natural food store for freshly whole grain bread. It does not last as long as enriched breads, so you may want to refrigerate or freeze part of the loaf depending on how much bread you and your family eat. 
Protein bars: If you haven’t noticed a running theme yet, many processed foods are the culprit in junk food's disguise. Any level of processing has the potential to remove beneficial nutrients and add calories or preservatives. Protein bars are no exception and fall into one of two catagories: nasty tasting cardboard, covered in what appears to be chocolate but tastes like wax; or a candy bar. The former may have a more appealing nutrition facts label, lower in calories, but it tastes horrible. And the latter, well is self-explanatory. Candy and weight loss go together like oil and water. What the two catagories have in common is a host of ingredients you and I can’t pronounce, which equates to heavy food processing and little nutritional benefit. 


Try this instead: Choose a small handful of raw nuts instead when you are pressed for time.

Peanut butter:  I love nut butters, almond is my personal favorite, but many traditional peanut butters are loaded with hydrogenated oils (increases bad cholesterol) and sugar, which take away from what would otherwise be a healthy addition to a meal or snack. You may have tried the ‘natural’ versions, but be sure to read the label and avoid any with hydrogenated oils and lots of extra sugar. 


Try this instead: Natural nut butter without hydrogenated oils or significant amounts of sugar. Store nut butters upside down in your fridge to prevent the oil from separating out.

If you see an item with claims that it is low-fat, low-sugar, low-carb, gluten-free or that something healthy is added to it, like whole grains, fiber, calcium, magic pixie dust… whatever it may be, BE SKEPTICAL. Remember the low-fat craze, when Snack Wells cookies made low-fat cookies? They were loaded with extra sugar. If you are going to take something out of a product, then to make it palatable, something else has to be added. The substitution may impact the nutrition content negatively as can adding something healthy to a product. For instance, when calcium is added to orange juice. Orange juice is thought of as a drink high in vitamin C. SIDENOTE: It’s actually not, because vitamin C is easily oxidized, meaning that as it is exposed to oxygen, the amount of vitamin C decreases. Depending on how it is made, stored and how long the container is open all impacts how much vitamin C is actually available. But that aside, vitamin C and calcium COMPETE for absorption in the body. So, by adding calcium, you are decreasing your ability to absorb either nutrient effectively; making it relatively pointless to consume it at all.

Bottom line: Stick with whole, minimally processed foods as much as possible. Read labels carefully and keep your eye out for health claims that may be too good to be true!

Weigh in on QNEXA

Hopefully, this drug will fail before taking off and making pharmaceutical companies BILLIONS of dollars, but just in case, I am writing this as a warning to those who are considering the drug for personal use. And if you know better, at least illustrate how important it is to research medications, supplements and herbs before you trust regulatory agencies that it is safe.

Contrary to statements made by Vivus, the manufacturer of QNEXA, about their concern on rising obesity rates, their only concern is the bottom line. The more they can cloud the truth and make this drug appear safe, the more money they get in the end. But if you succumb to their deception, the things you are likely to lose is your money and possibly your health, but not excess weight.

I base my position on this from a few different perspectives. First of all, my education. As much as one would like to believe that taking a pill will cure obesity, my two degrees in Nutrition have taught this much - obesity is multi-faceted problem, no one solution will fix it for everyone.  Superseding the body’s natural regulation of hunger (which is the mechanism for QNEXA) will only go so far since there are numerous reasons of why we eat what we do, that go beyond these physiologic cues. Secondly, my experience. I work with patients who have epilepsy and many are on topiramate, one of the drugs used to make QNEXA. I’ve seen the side effects first hand and while it is successful at decreasing appetite and inducing weight loss it comes at a cost. I’ve also worked with adults and children to promote weight management. Everyone is different and success at achieving a healthy weight needs to be addressed as such. Finally, but most important, research. After reviewing the results of the trials and researching the side effects of the drugs used, I’ve concluded that the risks far outweigh the benefits.

QNEXA is described my Vivus as a drug intended to be used by overweight or obese candidates, based on a BMI >27 kg/m² AND also must have co-morbidities associated with obesity such as high blood pressure, type-2 diabetes or abnormal cholesterol levels. While many Americans fall into the category of BMI >27, not all of them have these co-morbidities. The reverse is also true; many people have these conditions but are at a normal weight. According to a recent study published in the International Journal of Obesity, researchers found that 29% of people classified in the “normal” BMI range (<25), have heart disease risk factors similar to people who are obese. So, to say that QNEXA will make a significant difference in obesity risk factors is an overstatement, as its target will be only a portion of the obese population.

The pill itself is a combination of topiramate and phentermine, which are both FDA-approved medications. Topiramate is used for treatment of migraines and seizures and phentermine is a well-known drug for weight loss. The FDA originally denied approval of the QNEXA in 2010, stating that the risks associated with the drug were too high and long term effects were unknown, given that the trial was only 1 year. QNEXA extended the trial and gave the FDA advisory panel 2 years worth of data, which they have now surprisingly endorsed in a 20-2 vote. While the FDA does not have to take the advisory panel's recommendation, it is likely they will. So what changed the panel's mind?

The results of the Vivus trials averaged about a 10% weight loss in a year. For example, a 200 lb individual lost 20 lbs. Research shows that modest weight loss such as 5-10% of your body weight can reduce your risk of chronic disease. What is interesting is the sharpest drop in weight is seen in the first 4 to 8 weeks. The first 4 weeks subjects were being titrated onto the full dose, so they weren't actually receiving the full dose until week 4. Obviously, the subjects were geared up for the weight loss trial and were changing their diets and activity levels which resulted in weight loss. Even the placebo group experienced the same trend of weight loss initially, albeit not as great as the QNEXA group. The graphs of this can be seen on page 67 of the initial report from 2010 to the FDA (link is below). The weight loss continues to trend but begins to plateau after 6 months. Many people who change their lifestyle with the help of dietitians, personal trainers and organized programs such as Weight Watchers experience far greater results in much less time. Even if the weight loss was far greater, that completely avoids the issue of maintaining the weight loss after you stop taking the pill. As far as I could find, no trials have been done to see how long people were able to maintain the weight loss after they stopped taking QNEXA. The positive effects like decreased sleep apnea and lowered blood pressure can be explained by losing weight alone, the pill itself does not reverse those conditions. A magic bullet, QNEXA is not.

As for their risks, the manufacturers state side effects of faster heart rate and incidence of cleft lip or palate in children for women who become pregnant during the trial. They argue, that with education to health care providers to encourage birth control use and monthly pregnancy tests, this is controllable. Sounds reasonable. Except for the part where one of the many side effects of topiramate is that it makes birth control pills LESS effective! I’m curious to know how they justified that to the FDA.

Since we are talking about side-effects of topiramate and phentermine, let’s list them all out. Topiramate can cause decreased appetite and weight loss, but for some also increased appetite and weight gain! It can also lead to nausea, diarrhea, constipation, changes in how food tastes, indigestion, dry mouth, gingivitis, abdominal pain, decreased liver and kidney function, tremors, confusion, mood changes, nervousness, depression, back pain, apathy, fatigue, weakness, muscle pain, edema and menstrual changes. Phentermine can cause nausea, vomiting, diarrhea, constipation, can increase blood pressure and heart rate, tremors, dizziness, headache and insomnia. Phentermine can also be habit-forming and it is recommended to avoid alcohol and caffeine. It is also noted to be used with caution in those with diabetes as it can alter diabetes medications.

I lost my appetite just reading those side-effects.

To sum up, QNEXA claims to reduce risks associated with obesity, yet the two drugs used to make QNEXA are cautioned against being used in that very population! It is targeted to treat people with conditions that are contraindicated (diabetes and high blood pressure). The fact that this was completely disregarded by the FDA is frankly, frightening. Yes, obesity has its risks and treatment is important, but the QNEXA drug has the same risks, if not to an even higher degree. If this were the only option to help people improve their health, then I would understand accepting the risks, but there are other tried and true methods and QNEXA is not one of them. This is plain and simple all about money. And no amount of money is worth your life. 

FDA Bless Weight-Loss Pill http://online.wsj.com/article/SB10001424052970203960804577239642544675320.html

Zaneta M. Pronsky, MS, RD, LDN, FADA . Food Medication Interactions. 13^th Edition, 2004.

Qnexa Advisory Committee Briefing Document. July 2010.
http://www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/drugs/endocrinologicandmetabolicdrugsadvisorycommittee/ucm218821.pdf

Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity. International Journal of Obesity (2012) 36, 286–294; doi:10.1038/ijo.2011.100; published online 17 May 2011 http://www.nature.com/ijo/journal/v36/n2/abs/ijo2011100a.html

Vitamin C Controversy

Feeling sleepy, achy and a tad congested has me at home today. As I sit drinking a cup of tea and resting to prevent whatever my body is fighting off from becoming a full-fledge illness, has me thinking of alternative treatments. I work with children with special health care needs and I regularly hear parents ask what they can do to prevent illness. The common cold or the flu may have the average person feeling miserable for maybe a week, but these sicknesses for a medically compromised child can wind up in a trip to the ER and a hospital admission. Beyond reducing exposure to germs and good hand hygiene, what else can you do?  

The controversy over vitamin C and its benefits in fighting the common cold has dominated since the 1970’s. Studies seem to be split on the ability for vitamin C, taken daily to prevent colds or therapeutically during illness, to be of any benefit. Anecdotally, people claim vitamin C to work wonders even beyond the realm of immune boosting capabilities. It is likely to be one of the most commonly taken supplements aside from a regular multi-vitamin. But do the claims stand up to evidence? And if the research is inconclusive is there really any harm in taking it?

The Cochrane Library published a review of research done on vitamin C and colds and concluded that prophylactic doses, or daily supplementation meant to prevent illness, of 200 mg or more was effective in reducing the duration of illness. The review of 29 studies found that in adults, vitamin C reduced the duration of a cold by an average of 8% and in children 13%. Placebo-controlled studies analyzing the therapeutic effects of vitamin C are few and far between. Only 7 studies were found that compared vitamin C and a placebo to cold symptoms and the results showed no significant differences in the length of illness or severity of symptoms.

While vitamin C may help, but the extent seems minimal. There are a variety of other factors to consider that many research studies do not take into account. Activity level, quality of overall diet and medical conditions all impact one’s immune system. Taking vitamin C supplements will not compensate for a poor diet or sedentary habits. Not to mention that nutrient needs vary for each individual. Lifestyle factors like stress and smoking may increase need for certain nutrients including vitamin C.

But when we look at any potential harm of supplementing vitamin C, aside from the financial cost of supplementing if you really don’t need it, the risks are minimal. Large doses of vitamin C can cause diarrhea, but decreasing the dose solves the problem.

Do I think that vitamin C is the cure-all for the common cold? No. Do I believe it plays a role in our immune systems? Absolutely. But so do vitamin A, D, iron and protein. Besides adequate nutrition, stress management and proper sleep is important as well. For myself, I’ve noticed sleep to be the primary key for staving off illness. So for now, I’ll stick with my routine of healthy eating, exercise and rest and hopefully keep this bug at bay!

References:

Vitamin C for Preventing and Treating Common Cold. Cochrane Library. March 2010.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000980.pub3/abstract

How to boost your immune system. Harvard Health Publications. http://www.health.harvard.edu/flu-resource-center/how-to-boost-your-immune-system.htm

More Reasons to Choose H2O

Drinking 2 glasses (16 oz) of water before meals may help you lose more weight! Dieters who drank 16 oz of water before each meal lost 5 more pounds than those trying to lose weight that did not increase their water intake. The reason being that water takes up more volume in the stomach right before a meal, so less food is eaten overall. http://news.discovery.com/human/glass-water-weight-loss.html

Drinking water instead of carbonated beverages may help you breathe better! Australian researchers linked soft drink consumption to asthma and chronic obstructive pulmonary disorder. This included both diet and regular sodas, the link seems to be related to the carbonation. The higher the intake of carbonated beverages, the higher the likelihood that individual had either asthma or COPD. The study looked at over 16,000 people drinking about 16 oz or more of carbonated drinks per day. http://www.guardian.co.uk/society/2012/feb/07/asthma-connected-fizzy-drinks-study

Take your body weight in pounds, divide it by 2, and that’s how many ounces of water you should be drinking a day. So for a 200 lb person, that’s 100 ounces of water a day, which is about 12 ½ cups. To give you a big picture, there are 120 ounces in a gallon… While any unsweetened beverage counts towards this amount, most people don’t get enough water. The easiest way to increase intake is to keep a water bottle at your desk and with you when running errands. Having one within arms reach will provide a visual reminder to drink more water throughout the day.

Tips to Jazz up Plain Water

1)      Add fresh fruit. Sliced oranges, limes or lemons provide an invigorating twist (pun intended!) to plain water. Even sliced cucumber or herbs like mint, basil or rosemary give a refreshing alternative to traditional water.

2)      Freeze 100% juice ice cubes. Add these cubes to water to slowly melt into plain water and provide a sweet taste without adding a significant amount of calories.

3)      Drink unsweetened tea. With dozens of flavors, unsweetened tea is probably the easiest alternative to plain water and can add beneficial antioxidants and nutrients. Green tea contains ECGC, which increases your body’s natural burn of calories. It may also protect against breast cancer! Black tea also contains antioxidants and there are various types of herbal teas that can provide additional health benefits. CAUTION: The tannins in tea impact the absorption of some nutrients. It’s best not to drink it with supplements or medications just in case.

4)      Try sugar-free, powdered flavors. There are dozens of brands and flavors of sugar-free, powdered drinks that you can add into water. While artificial sweeteners are usually involved, adding a small amount into a bottle of water (use less than indicated) will also help to flavor water and add a negligible amount of sweeteners. Do this in moderation (not every day) and rely on tips #1 #2 and #3 more often to increase your fluid intake.

Grab a glass and drink to your health!

What Food Waste Has to Do with Your Waist

“Clean your plate.” The mantra of parents everywhere. After all, there are starving kids in Africa. Which means you should overeat as way of showing your gratitude?? Ya, I never understood that one either…

Sure, we don’t want food to go to waste. The USDA has calculated that food waste accounts for about 40% of the total supply of food. Now, think about your $100 grocery bill. By these estimates, $40 dollars of that would go to waste!

But, let’s think about it this way; If your body doesn’t need what you are eating, it goes to waste too. Excess carbs, fat and protein will be stored as adipose tissue, your body’s very own landfill!

Here's a couple strategies to avoid wasting food; not just to trim your food bill, but also your body!

1)      Plan ahead! If you make up a menu plan ahead of time, you can determine what you need to buy and when. If today is Sunday and you want to make stir fry on Friday, you probably will not want to buy your produce until Wed or Thurs. Your food likely won’t last. This means you may have to make more shopping trips, but you’ll save money and food in the long run.

2)      Buy less. Ever look in a fridge full of food and say, “There’s nothing to eat”. Or maybe you’ve heard this from a family member. Less, really can be more. You can see more of what you have to eat, less goes to waste and you can stick to your healthy eating plan better.

3)      Get organized. Organize your fridge so you can see what you have and place new items behind old (new gallon of milk behind the one that needs to get used first). Same goes for your pantry, if you have set spots for certain items, you will see your inventory easily.

4)      Freeze more. If you have leftovers that you or your family won’t eat in the next day or two, freeze what is left and save it for a quick meal in the future.

5)      Share. If you throw a party and end up with a lot of leftovers, send people home with food or bring it to work to share. This prevents temptation for party foods you do not usually eat and prevents waste. You can even investigate local food kitchens or programs that you can donate food to.

6)      Make a choice. When all else fails, choose where you want your food to go to waste.

After all, if it’s going to go to waste, better the trash than your waist! :)

Veggies for Breakfast?!

Weekly Tip:

Get a serving of veggies in at breakfast.

We all know that eating more fruits and vegetables is good for us, but getting them in can be the tough part. Current research shows that only 1 in 4 Americans gets more than 5 servings of fruits/vegetables per day. Also, people with a normal BMI consume significantly more fruits and vegetables compared to overweight/obese individuals. Starting your day with a serving of fruits and vegetables is a great way to increase your intake. There are several ways to do this without compromising taste.

1)      Add vegetables to a fruit smoothie. I wash and freeze kale and add a handful to a smoothie with 8 oz of milk (or milk substitute), 1 cup of frozen or fresh fruit, pasteurized egg whites* and/or protein powder,  and 1-2 tsp of orange-flavored fish oil**. Experiment with different fruit/veggie combos and keep in mind that lightly steaming certain vegetables may make them easier to blend (i.e. carrots or broccoli).

2)      Drink 8 oz of low sodium V8. Granted, you’re not getting much, if any fiber from juices but it’s better than nothing!

3)      Make a vegetable omelet. This is a great way to add any type of vegetables that you have sitting in the fridge. Bell peppers and onions from fajitas, spinach and tomatoes from a salad, or steamed vegetables. Add a little cheese and pair with a slice of wheat toast and you’re good to go!

*Pasteurized egg whites can be found in cartons by regular eggs. They pack a protein punch and take on the taste of whatever they are mixed with. ½ cup = 10 grams of protein. There are hundreds of protein powders in all different flavors, just beware of excess sugar or sweeteners. And keep in mind they don’t always taste very good. I like Tera’s Organic Whey Vanilla and mix 1 scoop (11 g protein) with 1/3-1/2 cup of egg whites in my smoothies. No chalky taste like you get from other protein powders.

** Carlson orange flavored fish oil actually adds a great flavor to the smoothie. Plus the omega 3 fats keep inflammation down, normalize cholesterol and keep your hair, skin and nails healthy. You can purchase it at any health food store. Keep it refrigerated.

Here’s more on the health benefits of kale including recipes: http://home.howstuffworks.com/kale3.htm

Think Before You Eat

Our favorite show is on TV and we plop down on the couch with a bag of chips, bowl of ice cream or a stack of cookies. Before we know it, it’s gone and there is little memory of the delicious taste of it on our tongue.


Mindless eating. We’ve all been there.


Most people turn to dieting as a means to lose weight, but this avoids the underlying problem of not taking time to actually enjoy food. Multiple studies analyzing different genders and age groups have concluded that dieting leads to increased likelihood of eating disorders, body dissatisfaction and obesity!

The very thing people are trying to avoid or correct may actually be caused by dieting.
Before you get depressed and run to the freezer for a pint of ice cream... there is a solution.

Stop dieting and make peace with food.

That’s where the principle of intuitive, or mindful eating, comes into play. We have taste buds for a reason! The concept of Intuitive Eating was developed as a means to promote the enjoyment of food while listening to the body’s cues of hunger and satiety.Severe restriction of diet inevitably leads to frustration, deprivation, binging and subsequently guilt and shame. Focusing on enjoying food, allows an individual to enjoy all aspects of food using all the senses (sight, smell touch and taste). This gives time for the body to send signals of fullness. Intuitive eaters tend to have a lower BMI, have better self-esteem, improved cholesterol levels and are less likely to have disordered patterns of eating.

Here is the gist of the 10 principles of Intuitive eating.  (See www.intuitiveeating.org for more details and references) 

Reject dieting. The cycle perpetuated by diet only leads to failure. Never eating dessert again is not realistic. You may stick with it for awhile, but you have one cookie and shame yourself into eating the entire pan, since you "already blew it".

Honor your hunger. If you’re hungry, eat! Don’t focus so much on eating a certain number of calories as this can be flawed. Your body will let you know when to eat and if you pay attention, it will tell you when to stop.

Make peace with food. Food is not the enemy. Think of food as providing nourishment, nutrients and health. But, food is also meant to be enjoyed. Choose foods you know will provide good nutrition, but also something you can enjoy. 

Enjoy food! Take time to savor not just the taste of food but also its sight and smell. Capturing this whole experience takes time, which allows your body to send those signals to your brain telling you when you're full.

Respect your fullness. Eat slowly and only till satisfied. If you stop eating when you feel full, in 20 minutes, you will feel overstuffed. Stop eating at the point of satisfaction and satiety will follow soon thereafter.

Honor your emotions, without food. Don’t stuff your feelings down with food. Explore your feelings and address them in an appropriate way. Journaling is a great way to start this process as is talking with a friend or psychologist.

Love your body, the way it is now. Rolls, cellulite, flab and all! Work towards change but don’t hate! Enjoy what makes you unique and celebrate the changes you see in your body as you pursue healthy eating and exercise.

Exercise for how it makes you feel, not only to lose weight. Exercise can help more than just improve your physical appearance or risk for disease. It also improves mood, sleep and stress. Find an activity you enjoy and do it often!

Respect yourself by honoring your health. Move your body and watch what you eat for your health. Your body will respond in time.

Putting these principles into practice will take time, but a great way to start is to begin journaling. Don't stop just at what and how much you eat. Before a meal ask yourself, "How hungry am I?" Rate your hunger on a scale from 1 to 5, 1 being not at all, 5 being ravenous. As you practice this, you'll find that sometimes you're not actually hungry but something else triggered your desire to eat. Or maybe you went all day without food and now you're at a 5. You can plan better next time to make sure your hunger doesn't get out of control, which will prevent the likelihood of overeating at your next meal.

Then as you sit down to eat, really enjoy your food, with each bite consciously feel the texture in your mouth, the taste and smell. Pause frequently throughout your meal to allow each of your senses to work. Allow your body to tell you when you are full and listen to it. After your meal rate how full you are from 1 to 5, 1 being not at all full (still hungry) and 5 being uncomfortably full. Again, as you track this, you will be able to see the circumstances around eating too little or too much and come up with strategies to fix it.  

I saved the best principle for last: Forget perfection, work towards steady progress. 

The lifestyle you have now didn't happen overnight, so changing it will take time. Small changes add up. It’s what you do MOST of the time that counts BIG.