The Calorie Creep

But Doctor I am not eating that much…

While there are always exceptions rarely does one become overweight by not eating.

The balancing act of  creating a calorie deficit is key for weight loss.  Please see my prior blog post regarding the fundamentals of weight loss:

Calories Consumed < Calories Expended= Weight Losswtmgt4

It can be one misstep in your day that will sabotage all your good efforts.  Stealing the term introduced to me by an inspiring patient, I would like to bring “the calorie creep” to life in the pictures below:

Keep in mind it does not have to be junk food that can be your calorie creep–avoid the creep in whatever form!

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare


Sun…friend or foe?

So it’s summertime right?  …time for the beach, lake, swimming pool, water park, and baseball games.  You pack up all your gear and head out to have some fun in the sun.  And sometimes it’s hard to remember to pack the sunscreen, apply it, not to mention reapplying it all-day-long.  Then there’s that nice tan glow we all love to have in the summer.  But…..

“More than 3.5 million cases of non-melanoma skin cancer are diagnosed in the US each year, and more than 73,000 cases of melanoma are expected to be diagnosed this year.”

skincancerribbonOne in five Americans will develop skin cancer in their lifetime, melanoma being the most deadly form.  In fact, an estimated 9,940 people will die of melanoma in 2015.  Prevention is obviously key when it comes to skin cancer.  Daily use of a sunscreen with SPF 15 or higher reduces your risk of developing squamous cell carcinoma by 40 percent and melanoma by 50 percent.

skincancerpreventIt’s an easy thing to over-look…I mean it’s the sun, we go outside, we go inside, it’s our world, and therefore easy to forget.  But trust me, for those of you that have been blessed to not have gone through it in your life, there’s nothing scarier than hearing that your best friend, your 36 year old sister, has been diagnosed with Stage II Melanoma.  And there’s no time that is longer or goes by slower than the time it takes for lymph node biopsy results to come back.  There’s no exposure, from the sun or tanning bed that is “better” for you or less harmful than the other.  Sunless or “spray tan” is a good option to consider if you feel like you need some color or that summertime glow.

Skincancer6Another important step is having annual skin checks, as well as watching for any changes to existing or new moles on your body.  This one, to me, is a no-brainer.  Skin cancer is the one form of cancer that allows you to see your tumor…right there, in plain sight, on the outside of your body.  The woman with the lump deep in her breast, guy with a tumor on his kidney or deep in his brain, or child with cancer in their bone marrow didn’t have that chance.  It was hidden inside, not able to be seen, causing harm, just waiting to be found.  So take advantage of the chance to have this particular cancer identified and stopped in its tracks as soon as possible.

“Each year there are more combined incidences of skin cancer than the combined incidence of cancers of the breast, prostate, lung, and colon.”

There are some key characteristics, known as the ABCDEs of skin cancer, that you can look for to help identify a potentially dangerous mole.




  • Asymmetry
  • Border
  • Color
  • Dimension
  • Evolving




So get outside this summer and have a blast enjoying this time of year and all the activities that go along with it!  Just remember to drink plenty of water and make sure to wear sunscreen to protect yourself from the harm that our sun’s rays can cause….and hey, take heart in knowing that you’re preventing all those future wrinkles.


Submitted by Kim Moppin

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

Water Is Your Friend

When patients quote their doctor

I found myself laughing the other day when a patient quoted back to me, “Water is my friend.”

I say it several times a day with a bouncy little cadence, “Water is your friend.  Water is water–not pop, coffee, or tea. Water is water.”

water 9Whether a patient is sick, well, seeking diet advice, or general well-being, the phrase makes its way into my patient interactions multiple times a day.  A very simple concept but so often ignored.

Water is essential

The average person is made up of 55% water–60% in men and 50% in women.  While water is found in all tissue, the bulk of the water is found in your lungs, blood, skin, muscles, brain, and bones.

Water is key in:

  • brain functionwater3
  • lung function
  • muscle function
  • bone health
  • regulating body temperature
  • maintaining weight
  • transporting of blood containing oxygen and nutrients to all tissues
How Much should I drink?

We have probably all heard the eight cups of water a day rule.  While this is a good rule, you may fall short of your body’s daily needs.


A better estimate as depicted in the graphic to the left takes weight into account.  Keep in mind the fitter you are the more water you need as lean tissue contains more water than adipose tissue.

Your activity levels are also going to increase demands on water intake as well.  With every 20 minutes of exercise anticipate a minimum of 6 oz of additional water intake.

Thirst is not a good indicator.  If you are thirsty you are already behind on your water balance.

Your urine is another tip-off to your hydration status.  It should be clear to light yellow.

Why Doesn’t Pop, Coffee, or Tea Count?

water7Pop(or soda), coffee, and tea are traditionally consumed with caffeine.  It is the caffeine that takes them off the list as providing you any hydration.  In fact, the caffeine acts as a diuretic and robs your body of essential water.  Rule of thumb I tell patients is to consume an extra cup of water for every cup of caffeinated beverage or avoid them altogether.


Bottoms up!



Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare



Direct Approach To Weight Loss


The New Year often brings renewed commitment to weight loss or healthier choices.

I spend a lot of my time as a physician counseling patients on how to approach weight loss.

wtmgt4What is the key to successful weight management?  It truly is simple.  You need to have a calorie deficit.   A calorie deficit is when your daily calories burned are greater than your calories consumed.

The difficulty is that the number of calories burned in a day is so variable from person to person.  We each have what is called our basal metabolic rate which is the amount of calories our body uses just sitting around.  A 200 pound muscular male may have a basal metabolic rate of 3000 calories per day while a 200 pound obese male may have a basal metabolic rate of 1200 calories per day.  Comparing diet plans to your neighbor should never be done.  Discovering the calorie deficit for you as an individual to successfully lose weight is the key.

I had a discussion with a registered dietician/personal trainer about a client who was gaining weight despite her great efforts in the gym.  She had her on an 1800 calorie a day diet.  I pointed out that her basal metabolic rate is probably too low to allow for 1800 calories.  If she wtmgt9is working out one hour in the gym and burning 600 calories during that time and her basal metabolic rate is 1000 calories, she will gain weight.  The proof was in her lack of weight loss, but she went ahead and pursued VO2 max testing.  This test evaluates oxygen consumption at rest and estimates your basal metabolic rate.  I was not surprised when her results came back at 800 calories per day.

There are always questions about tools to help with weight loss.  Yes, there are many things that can be used to help aid in weight loss, but they are only tools to help you do the fundamentals. We all know individuals that have had success with surgery or medicine only to regain the weight and more.  If you use the aids to help you eat good food in appropriate portions, you will have success.  When surgery or medicine is used as the solution rather than the aid, failure is likely.

I am a runner and have learned fundamentally that it takes time and energy, methodically wtmgt7putting one foot in front of the other.  I have tools to help make the process easier—good supportive running shoes, inspiring music, and an app on my phone to tell me good job as I go.  The truth is I still have to run.  Weight loss is the same.  You still have to do the fundamentals—remember calorie deficit.

So what should a good diet plan focus on other than the number of calories?    Real food and not processed food which includes fruits, veggies, lean meats, and dairy.   This should be the mainstay of your diet.

weightmgt6Poor diet choices cannot be compensated for by hours in the gym—the math just won’t add up for an appropriate calorie deficit. Exercise is good and necessary for a healthy lifestyle, but it is not the key to good weight management.


Ann Riggs, DO

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Patient-Driven Affordable Healthcare