Chat transcript: Dr. Pamela Peeke on nutrition, body image and obesity

(CNN) -- Dr. Pamela Peeke of the National Institutes of Health joined CNN.com on October 8, 1999, to chat about nutrition, body image and obesity. Peeke joined us from Maryland, and CNN.com provided a typist. The following is an edited transcript of the chat.

Chat Moderator: Welcome, Dr. Pamela Peeke! Dr. Peeke is joining us today from Maryland.

Dr. Pamela Peeke: Glad to be here!

Chat Moderator: Why do we eat junk food when we know better?

Dr. Pamela Peeke: Because it is easily accessible, it is cheap, and we rarely ever plan our meals. We grab and gulp!

Question from Allen: Dr. Peeke, would you agree that obesity, for most, has more behavioral causes than pathological?

Dr. Pamela Peeke: Thirty to 40 percent of obesity is genetic. The majority, therefore, is environmental. So we are talking about behavior, environment and habits.

Chat Moderator: Why do restaurants and manufacturers sell junk food?

Dr. Pamela Peeke: They sell junk food because the grand majority of people continue to eat it. It is cheap to make, very palatable because of the high amounts of fat and sugar, which drives up interest in eating more of it. Also it is cheap.

Question from mary: Dr. Peeke, I have been trying to lose weight all my life. I've tried everything now. When I don't get enough sugar, I get the shakes and have to lie down for awhile. What should I do?

Dr. Pamela Peeke: You are eating the wrong kind of sugar. You need the same release sugar, which comes from grains as well as vegetables. Cheap refined and processed sugar, which is found in dessert items, drives blood sugar immediately up and immediately down. You need a form of complex sugar, which keeps blood sugar levels normal for a much longer period of time. Choose sugars wisely.

Question from mary: What kind of sugar should I eat? Sometimes this happens when I don't eat at all. I know I should not go without eating, but I can't seem to lose weight if I take in more than 1,000 calories per day. And I do exercise. I ride my bike five miles per day What else can I do?

Dr. Pamela Peeke: The grand majority of people with this problem need to eat small meals throughout the day. If 1,000 calories is all you can eat, divide it by five and eat roughly every three hours. In the best of all worlds, have some form of protein with high-grade carbohydrates, such as grain or vegetables or cereal. An example would be to have a fat-free yogurt with two teaspoons of GrapeNuts or fat-free granola combined. Another example, fat-free or low-fat cottage cheese with fruit.

Question from Tami: Dr. Peeke, what do you think the best (and still healthy) way to lose a few pounds is?

Dr. Pamela Peeke: The key here is remembering that you want to shed excess fat weight while you are building more precious muscle weight. You must be patient and remember that it involves two primary objectives:

1.) Be physically active absolutely every day. That means to accrue over the day at least 45 minutes of getting up and moving, whether it is stairs, walking, biking, whatever. It doesn't matter ... MOVE!

2.) Take the total number of calories you eat now and simply cut it by about 20 percent. Try to get in the majority of your eating before 5 p.m., and keep dinner light. It is a play between what you eat and how you use that food fuel.

Question from Squid: Where do you start to find out how to become a healthy eater and not a binge eater?

Dr. Pamela Peeke: Squid, log on to www.shapeup.org. You will find the only cyberkitchen on the Web that I helped devise. This will help you begin the journey.

Question from ROHO: Dr. Peeke, what do you think about drugs such as Xenical and Meridia? Thank you.

Dr. Pamela Peeke: Meridia has been out for two years and has been shown to help a few people begin to shed excess fat weight. It is not, by any means, an answer. Just a potential helper. Personally, I have not found it to be very effective. Better to take a healthy walk and to watch your portions.

Xenical is a brand new drug, which will decrease by 30 percent the fat in a meal you eat. If you eat more than that in terms of fat, you will have painful abdominal cramps, bloating, and potential anal leakage of fatty stools, which become loose. Therefore this drug acts as a reminder not to eat more than 30 percent fat in your diet. Many people have problems with the side effects.

Question from JamieLynn: Dr. Peeke, I'm female 38, 6'1" and weigh 150. I have high blood pressure. It has been suggested to me that being tall and thin could cause this. Could you comment?

Dr. Pamela Peeke: Being tall and thin generally does not contribute to high blood pressure. Instead, to have high blood pressure at such an early age is usually genetic or part of a rare medical syndrome. The best way to treat this is close follow up with your doctor, medications if needed for the BP, and a regular schedule of aerobic physical activity.

Question from Superkittn: Is there a chance that we can get fen-phen back??

Dr. Pamela Peeke: Phentermine has been on the market for 25 years and continues to be prescribed today. Fenfluramine has been taken off the market and will not be reintroduced.

Question from flubber: For Dr. Peeke: Please comment on the safety and effectiveness of the Heller's Carbohydrate Addiction diet. Thanks.

Dr. Pamela Peeke: There is absolutely nothing wrong with eating high-grade healthy carbohydrates, which include fruit, vegetables, grains and cereal. The problem is with refined, processed sugars that we find in dessert items primarily. We need to decrease the intake of the refined sugars to no more than 5 percent of our total calories daily. The Hellers make a point of stating that the grand majority of carbohydrates can stimulate out-of-control appetites in people. It is not that simple. Each person's response to carbohydrates is unique.

By trial and error, each person must find whether or not any kind of carbohydrate such as pasta, rice, potatoes or the refined form as in candy will set them off to a binge or overeating. I would advise that people avoid most refined sugars and stick with vegetables and fruit and make their lives easier by decreasing the starches to at least half what they are eating now. This will help decrease bingeing.

Question from stan: Is a high-protein, low-carbohydrate diet a healthy way to keep your body fat down?

Dr. Pamela Peeke: The best way to keep your body fat down is to work with a percentage of fat, protein and carbohydrate which is healthy. I would recommend that the primary source of carbohydrate be vegetables and fruit and some starch for a total of about 50 percent of your diet. And protein should not exceed 25 percent for the average individual, and it would be healthy to keep fat at roughly at 25 percent. The majority of the high-protein, high-fat, low-carbohydrate diets available are unhealthy because they de-emphasize the fruit and vegetables, which are magnificent banks of anti-oxidants as well as bulk and fiber. And high levels of protein and fat with no carbohydrates predispose to weakened bones, kidney damage and, potentially, colon cancer.

Question from mary: Dr. Peeke, what do you think of Dr. Atkins' "new diet revolution"?

Dr. Pamela Peeke: The same thing I just said about the Heller diet.

Question from Mags: Do you have any good news about obesity for us? Are Americans more fit today than in the past?

Dr. Pamela Peeke: Mags, unfortunately Americans are more unfit today than they ever have been. We have been singing the fitness song to the same 12 percent of the population over the past 30 years. That population is very fit. The rest of the 80 percent of America is very unfit. People, regardless of size, need to be moving more to combust and use the food fuel they eat every day. Thank you, Mags :)

Question from AC: Is there any help for people who may possess a thrifty gene, and where can I find more information?

Dr. Pamela Peeke: The information about the thrifty gene means that there is an assumption that some people simply store fat more avidly than others. This was found in the study of the obesity gene, where there is no question that we recognize that some people can do this with great ease. Information about this can be obtained by contacting the National Library of Medicine at the National Institutes of Health. You can access through Internet Grateful Med in the search engine at the key word prompt.

Question from stan: What is your opinion on the use of creatine for better athletic performance?

Dr. Pamela Peeke: Presently creatine has been studied by several research facilities, which have found no significant change in physical performance by its use.

Question from Cyber_Wolf: Dr Peeke, is it better to be a bit overweight or a bit underweight?

Dr. Pamela Peeke: It is better to be a bit FIT than a bit UNFIT! You can be thin and completely unfit and unhealthy, or you can be slightly overweight and very fit and vice versa. The point is not the weight; the point is the level of fitness.

Question from JOEY: I'm a little lost, doctor. Are you saying that this low-carbohydrate, hi-protein plan doesn't work, but in fact can be dangerous?

Dr. Pamela Peeke: The answer is you will lose weight, but in a dangerous way. Weight comes off because you are eating fewer calories, less carbohydrates, and the main fuel is coming from fat. Fat, when broken down, forms ketones. Ketones are toxic to most body tissues, since the body would rather use carbohydrates as its primary source of fuel. In actuality, you need a balance of fat and carbohydrates together for optimum fuel to live out your daily activities. Too much fat fuel and too little carbohydrate fuel keeps you unbalanced.

Question from JamieLynn: Dr Peeke: Do you have any thoughts about using pseudoephedrine hydrochloride (over-the-counter "stay awake" pills) for weight loss. They certainly kill your appetite.

Dr. Pamela Peeke: So does napalm!!!! LOL! Pseudoephedrine is speed! It gives you a temporary high as well as appetite suppressant effect, which you become very resistant to very quickly. This is a dangerous drug, as it also raises blood pressure, heart rate, and if you have underlying heart disease, may harm you. My recommendation: Don't go there!

Question from judy: Is 1,200 calories per day an unsafe way to diet? Can you fit your daily allowances within 1,200 calories?

Dr. Pamela Peeke: Every person is different. It is important to understand that if you wish to decrease your total daily calories, you must customize it to yourself. Therefore, I would recommend that you log on to www.shapeup.org, which has a built-in calculation that you will make for yourself on the cyberkitchen to determine the exact number of calories that you need to accomplish your health goal. That site I did in conjunction with C. Everett Koop. It is interactive, you put in all your stats, and it will help you!

Question from Mags: Hey, doc, do you have a Web site?

Dr. Pamela Peeke: My own Web site is under construction and will be up in April 2000 in conjunction with my new book, which will be released the same month. It will be called www.askdrpeeke.com.

Question from Matt: Do you have a book you'd recommend for people to become more educated on fitness?

Dr. Pamela Peeke: Matt, log on to the American College of Sports Medicine (www.acsm.org/). They have everything. It is the gold standard organization on how to get the journey going. Also, check out the books by Kenneth Cooper at the Cooper Institute of Aerobics in Dallas, Texas.

Question from bobc: Why did the recent ACS study utilize BMI (body mass index) rather than body-fat percentage? BMI would label Arnold S. as dangerously overweight.

Dr. Pamela Peeke: Body fat percentage is impossible to determine by our current technology when it begins to exceed 30 to 35 percent. Therefore, BMI has been used as a direct reference. You are right in that BMI does not consider muscle mass. However, the only real exception to BMI are elite athletes, and that is a small portion of the American population.

Question from Cyber_Wolf: Dr. Peeke, are any of the Web sites you mentioned used in schools?

Dr. Pamela Peeke: What kind of schools?

Cyber_Wolf Public schools.

Dr. Pamela Peeke: Cyberwolf, the answer is the majority of public schools lack this type of information. The good news is we are pushing forward to have campaigns like Shape Up America! instituted in schools around this country.

Question from flubber: If customization is important, then is a service like Jenny Craig wise?

Dr. Pamela Peeke: It is important to sit down with a knowledgeable credentialed individual who can customize for you. I would recommend a registered dietitian or nutritionist who is licensed and has gone through professional school to help guide you. Some medical centers also have obesity institutes with helpful professionals from the academic world as well.

Question from Mags: What about the "thin" image in our culture? Are eating disorder cases up or down in recent years?

Dr. Pamela Peeke: The majority of the thin image is affecting women starting with childhood. Hollywood and the media have maintained the interest in this type of appearance. It is up to all of us to realize what a facade this truly is. The answer is found by taking young girls and boys and teaching them sports and team play at school and to direct their attention away from thinness and toward personal achievement in fitness.

Question from happy: Dr.Peeke, do you foresee a future where Hollywood will settle for a more realistic body size, one which teens can view as the norm?

Dr. Pamela Peeke: My answer is yes, I feel more positive, especially since Hollywood is embracing the new image of women over 40.

Dr. Pamela Peeke: We now have more images and examples of healthy, fit, older women who will help bring the message that thinness did not help them achieve that goal. Tina Turner is not thin; she is beautiful and fit and joyful about it. These women need to teach the younger ones that through their example, fitness and beauty from curves in the woman's body, and from direction changed in Hollywood from appearance to talent is what counts.

Question from JamieLynn: Dr. Peeke: I read somewhere (and I don't remember the source) that if you eat less than 800 calories/day your body actually slows down and you gain weight. Is this true?

Dr. Pamela Peeke: The majority of people of average size in America usually require between 1,200 to 2,000 calories per day, depending on physical activity level. Dietary intakes below 1,000 calories definitely reduce basal metabolism, and if done routinely, are very dangerous to the individual.

Question from randy: I don't believe that science yet knows the mechanisms of obesity. I eat low fat and exercise vigorously, and I'm still fat (but with good blood pressure and low cholesterol). Why aren't there studies of WHY some people get fatter than others?

Dr. Pamela Peeke: We have those studies, and what we have found is that there are people who gain weight very easily despite eating decreased calories and exercising. My recommendation for people with this genetic and biological tendency is to make certain to include weight lifting at least twice a week to increase metabolism by building muscle, which will help lose excess fat weight with greater ease. The problem is that you may be doing only aerobic exercise; you need weight lifting.

Question from Mags: If someone had an eating disorder, and wanted help, where wold you refer them to?

Dr. Pamela Peeke: Eating disorder specialists are usually therapists who are social workers or psychologists found in every city. Institutions can help refer you. One of the best is The Renfrew Center. It is on the Web, or you may call their central facility in Philadelphia.

Question from How: Is their a jump-start diet out there that gives you high energy?

Dr. Pamela Peeke: The way to be able to achieve better energy immediately is to combine physical activity with decreasing your total calories, decreasing the amount of refined sugar in your diet to 5 percent or less. With that combination of physical activity as well as changes in dietary intake, you will feel more energy. There is no magic energy food.

Question from Guest01728: At what rate should you exercise? A very high rate, or a lower rate for longer periods of time?

Dr. Pamela Peeke: If you are beginning your exercise journey and are presently unfit, I would recommend walking at approximately 3 to 3.5 miles per hour for 45 minutes or as tolerated until you can reach 45 minutes. After about six weeks, try to increase the pace to about 4 miles per hour, because now you are trained and will not hurt yourself.

Chat Moderator: Any final thoughts?

Dr. Pamela Peeke: I stand by my recommendation that fitness and not thinness should be your goal and objective. Avoid fads that promise instant results when you know that this is going to take a lifetime to perfect.

Chat Moderator: Thank you, Dr. Pamela Peeke, for joining us!

Dr. Pamela Peeke: Thanks. Bye!