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Health care reform is an unreliable weight loss counselor

With two-thirds of Americans overweight or obese, health care reform law is dishing out new rules to help us slim down.

For example, chain restaurants with 20 or more locations must post nutritional information and calorie counts on their menus. And new health insurance plans must cover certain preventive care 100 percent, including weight screening for everybody and weight-loss health counseling for obese adults and obese children age 6 and older. That means you don't have to pay a deductible or copay if you qualify.

These measures could serve as helpful tools if you're serious about shedding pounds – or they could backfire.

1. Know how many calories you need

health care reformThe U.S. Food and Drug Administration is charged with creating rules implement an Affordable Care Act provision requiring chain restaurants to post nutritional information. Under the proposed rules, restaurant menus must also post a statement that says a typical daily diet consists of 2,000 calories.

Making nutritional information readily available is a good step, says Dr. Christina Scirica, a Harvard Medical School faculty member and a pediatric pulmonologist at Massachusetts General Hospital. But  she fears the statement about a typical daily diet consisting of 2,000 calories could be misleading to many consumers.

Using that as her guide, she says, she would eat 250 to 450 more calories per day than she needs. "I could gain as much as 46 pounds in a year."

If you're going to count calories, Scirica says, talk to a medical professional to learn how many calories you need each day. Remember, 2,000 is just an average.

2. Count munchies at the movies

Under proposed FDA rules, health care reform’s nutritional labeling requirement for chain restaurants and retail food outlets applies only to businesses whose primary purpose is to sell food. That means movie theaters, airplanes, bowling alleys and a host of other places wouldn’t have to post calorie counts.

That’s a problem for two reasons, Sciraca says. First, many of the foods sold by exempted establishments have a notoriously high number of calories. A medium popcorn and soda combo at leading theaters packs about 1,500 calories, according to the Center for Science in the Public Interest.

Second, she says, research shows people underestimate the number of calories in foods they eat, and they tend to eat more when distracted by other activities.

“Thus, for the FDA to exempt establishments whose ‘primary purpose … is not to sell food’ leaves out some of the very places where people are most likely to overeat,” she stated in a letter to the FDA.  

Bottom line: Be mindful of what you eat regardless of whether the establishment posts nutritional information.

3. Beware of the boomerang

Health care reform’s requirement for chain restaurants to post nutritional information might motivate some folks to choose lighter meals, says Karen R. Koenig, a Sarasota, Fla., psychotherapist and author of "The Rules of 'Normal' Eating."

If you're among them, you might see the 2,210-calorie Jalapeno Smokehouse Burger with Ranch and fries on the Chili's menu and choose the 550-calorie Margarita Grilled Chicken instead.

But if you're not, you might mutter, "Nobody tells me what to do," and order the burger, 145-calorie Budweiser, and 1,250-calorie Chocolate Chip Paradise Pie. Grand total: 3,605 calories.

"People are tired of being lectured," Koenig says. "They already know a lot of this stuff."

The rebellion is known as the boomerang effect, and it's one with which most dieters are all too familiar. A similar phenomenon is rebound eating, Koenig says -- overeating to compensate for deprivation.

If you’re not a fan of the Affordable Care Act and resent in-your-face nutritional information, you might be especially prone to the boomerang effect.

If you're about to rebel by overeating, Koenig suggests you acknowledge your feelings and ask yourself, "Who am I hurting?"

Also, keep in mind you don't have to give up eating out to manage weight.

"Every food fits into a healthy eating plan, even the worst of the worst," says Yvonne Quiones Syto, a registered dietitian in Stanhope, N.J., and author of "Nutrition Map: Your Guide to Eating Healthy in the Real World."

"You have to juggle," she advises.

She suggests looking up nutritional information online to plan how to accommodate your favorite restaurant fare into your eating plan. Want to splurge? Think portion control. Ask for a to-go box as soon as the meal arrives, and immediately put away a portion or split an order. Don't be afraid to ask for substitutions, Syto says.

4. Get expert help for weight loss

Under health care reform, new insurance plans must cover weight loss counseling for obese adults and obese children 6 and older. The U.S. Centers for Disease Control defines an obese adult as anyone over age 20 with a body mass index (BMI) of 30 and above. About a third of U.S. adults are obese. An obese child is one whose weight is at the 95th percentile for BMI-for-age-and-sex charts for children.

Talk to your child’s pediatrician If you’re concerned about your child’s weight.

A primary-care doctor may provide weight loss counseling or refer to you to a specialist, such as a registered dietition.

More from Barbara Marquand here

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