Cheese is one of the most frequently eaten foods in America, the home of obesity and overweight. For health reasons, many individuals are decreasing their meat intake but when it comes to cheese, “no way”! What makes cheese so difficult to eat in moderation or to avoid? It provides the combination of fat which helps you feel satisfied and salt which tantalizes your taste buds. It also contains compounds called casomorphins which are derived from the protein found in milk called casein. Casomorphins attach to the opiate receptors in the brain and trigger the brain to release dopamine, which leads to feelings of reward and pleasure. It is no surprise that cheese consumption has sky rocketed. In 1909 the average American ate less than 4 pounds of cheese per year. Today, an American eats more than 33 pounds annually. It has become a multi-million dollar industry to promote tasty and cheesy high fat foods to the public.
The rising amount of cheese consumed in the United States is directly associated with the obesity epidemic and leading cause of death, heart disease. Cheese is very calorie dense and the majority of calories come from fat. Most of the fat is saturated fat which leads to insulin resistance and elevated cholesterol levels. The typical sodium content per ounce ranges from 175 mg (cheddar) to 450 mg (parmesan) for those concerned about their blood pressure. So why do we eat it? If you are eating cheese for the protein or calcium content, choose healthier choices such as nuts.
Interested in alternatives to cheese?
• Try sprinkling roasted sunflower seeds or chick peas on your salad
• Mix nutritional yeast into your pasta sauces or meat-less meatball recipes
• Find a recipe for cashew cheese or try vegan cheese
• Squeeze fresh lemon on your cooked vegetables for flavor
• Take cheese out of your sandwich and add avocado, roasted red peppers or hummus
It is still important to watch the calorie content when choosing your foods. Good luck!
Carol Penfield MS, NPc is a nurse practitioner and certified personal trainer who specializes in Lifestyle Medicine at Emerald Physicians in Yarmouth. She offers private appointments as well as shared medical appointments for weight loss, which are covered by insurance.

Want to know the “key” to successful weight loss?

Step by step approach to permanent weight loss.

What is the secret to successful weight loss and what does it take to keep from re-gaining? The answer is at Chatham Health and Swim Club, where participants have literally lost a ton of weight. Carol Penfield, owner of the Chatham Health & Swim Club, has applied her specialized medical expertise to help both members and non-members successfully lose weight. Her unique “Weigh to Better Health” team weight loss program not only works; it has also led to a healthier community. Since 2010, during three 6-week programs, 293 participants have lost 1,956 pounds while simultaneously raising over $38,000 to support primary care at Fontaine Medical Center. The enrollment fees for all the participants have been donated to the Cape Cod Healthcare Foundation in order to benefit the health of others in the community.

Carol Penfield, who is an independent nurse practitioner, applies the fundamental principles of a new medical specialty called “Lifestyle Medicine”. Lifestyle medicine offers proven strategies for converting knowledge “I know I need to lose weight” to action “here is my plan”. Solutions to changing exercise and eating habits must be very individualized. For example, a person who enjoys crunchy foods will not be satisfied with a low fat yogurt, or someone who grew up eating comfort foods will not adhere to eating celery!

Three [out of many] principles of the Lifestyle Medicine approach specific to treating obesity are as follows:
First, you must set appropriate goals by asking yourself the following questions:

• Why do I want to lose weight? Choose health-related goals that are achievable and measurable; rather than “because I want to look good” since only 1% of our population is ever truly satisfied with their appearance.

• How important is it, and how motivated am I? You should objectify your answer by using a scale of 1 – 10 (1 = not confident and 10 = very confident). If your confidence level is below 5, then the goals should stay small and be made weekly.

Second, routine exercise MUST be practiced. 95% of people who lose weight and keep it off exercise at least 5 times weekly for an accumulated amount of 60 minutes. Addressing specific barriers to exercise such as pain, time, or finances is critical in order to attain exercise adherence.

Third is accountability. Most individuals underestimate their daily dietary intake and overestimate their activity level, leading to gradual weight gain over the years.
Diet logs and the use of pedometers are excellent examples of objective recording. Reporting in to a group, coach, or medical professional such as Carol Penfield has been documented to improve outcomes.

Most New Year resolutions start to dwindle by the end of February. Successful gains in health will not be sustained by just a resolution once a year. There is another answer…Lifestyle Medicine. Lifestyle Medicine practices have been proven to be extremely successful nationwide by achieving measurable gains in health [including weight loss] over time. Common and critical conditions are treated, such as heart disease, diabetes, hypertension, arthritis, and back pain, as well as obesity. Carol Penfield’s Lifestyle Medicine practice, located on the campus of the Chatham Health and Swim Club, is the first such program on Cape Cod. She helps her patients find that delicate balance when creating attainable goals, in order to minimize discouragement and build confidence. The practice offers on-going individual and group support as well as weekly on-site or electronic check-in options, and is covered by most medical insurances.



Lifestyle Medicine is now on Cape Cod. This new approach to medical care has been proven to benefit the health of the community, as well as being a paradigm shift that creates true health care reform.

What is Lifestyle Medicine? According to the American College of Preventive Medicine, it is the use of lifestyle interventions within conventional medicine to lower the risk for a number of lifestyle-related diseases; or if such conditions are already present, to serve as an adjunct to the management plan.

The desired goal of health care reform is to improve health outcomes and control costs. The problems that continue to plague health care in the United States remain challenging. More than two-thirds of the adult population in the U.S. are overweight or obese, less than 25% get adequate servings of fruits and vegetables, more than 20% continue to smoke and less than 30% achieve enough physical activity for health benefits. Health care professionals must focus on helping individuals understand that their daily habits and actions profoundly affect all aspects of their health. Health care dollars continue to be spent on treatment of disease rather than prevention. Chronic diseases account for 78% of our annual health care costs. Lifestyle and environmental factors such as diet, sedentary lifestyle, smoking and chronic stress are significant underlying causes of these diseases.

So why is health care so expensive while our outcomes remain relatively poor? Presently “prevention” therapies are defined as early detection of disease, such as screening tests, mammograms, or colonoscopies. Although important, these costly procedures do not actually prevent the disease from occurring. Lifestyle medicine plays a critical role in management and prevention of chronic diseases. It includes a patient centered approach with interventions tailored to each patient’s unique medical, psychological and socio-cultural situation. The treatment plans focus on the entire risk factor profile rather than on isolated illnesses.

The predominant lifestyle-related medical conditions seen in primary care include obesity, hypertension, diabetes, elevated lipids, metabolic syndrome, cardiovascular disease, arthritis and osteoporosis.
According to the American College of Preventive Medicine:
3 out of 4 do not get enough physical activity,
4 out of 5 need to significantly improve their diet,
2 out of 3 need to lose weight,
1 out of 3 adults age 30 – 64 average less than 6 hours of sleep per day.

To further analyze a specific condition, heart disease remains the number 1 killer in America today. A comprehensive review of the largest national studies has shown that four lifestyle changes in patients with cardiovascular disease can affect the risk of death as follows:
36% reduction with smoking cessation
24% reduction with regular physical activity
20% reduction with moderating alcohol use
44% reduction with dietary changes

If patients are told by their primary care provider to lose weight, quit smoking, exercise more and follow a healthy diet, the patient is more likely to comply. However, the resources including time and support to guide individuals on how to do it are lacking. It takes more than simple advice to change behaviors. The challenge is to convert awareness into behavior change. Lifestyle medicine techniques provide that missing link, using patient education and behavioral science methodology.

Delivery of care currently is based on medication and surgery and there are no incentives to treat disease with lifestyle medicine. A change in emphasis is critical to the future of health care reform. According to an analysis by the Cleveland Clinic, enrolling patients with heart disease, diabetes, metabolic syndrome and certain cancers into a lifestyle medicine program could reduce net health care expenditures by $930 billion over 5 years. It would also result in dramatically improved health and quality of life for Americans. There is pending legislation addressing interventional lifestyle treatment. It will support the development of a health-based economy rather than one based on illness. If lifestyle medicine takes hold, our “sick care system” will be transformed into a “health care system”.

On November 19th, 2011, Carol Penfield M.S., NPc, Nurse Practitioner will be opening her private medical practice specializing in lifestyle medicine, which will be accepting most insurances. The office is located beneath the Chatham Health & Swim Club. Please feel free to call: 508-945-7761 for more information or to book an appointment.


By Carol Penfield M.S. Nurse Practitioner, Certified Personal Trainer, Nutritionist
Owner of Chatham Health & Swim Club

The average American gains 10 pounds during the holiday season from Halloween to New Years. Fifty percent of an individual’s yearly weight gain occurs during this festive time. WHY? Social gatherings often include more food choices, larger portions and alcohol that weaken “willpower”. Healthy eating patterns become difficult to maintain. The people who gain the most weight during the holidays are those who abandon their exercise routines.

It is important to first focus your mind on trying to only lose the new weight gained. Dieters often get overwhelmed with an unrealistic long-term goal and therefore prematurely give up on a weight loss regime. Staying consistent and working on a 500-calorie deficit per day will lead to reducing your body fat by one pound per week. This can be achieved through eating 250 calories less and burning 250 calories through exercise daily.

Take the pressure off yourself. Fat does not disappear overnight. Making small changes such as eating one less donut per week can lead to a loss of 3 pounds in a year. Consider walking 8 minutes extra each day and in one year you will lose 4 pounds.

Trying to get your motivation back during the holiday season is another challenge. The following are a few tricks to try.

1) Minimize your choices.
Freeze or give away your leftovers. Consider periodically trying meal replacements such as a Slim Fast shake, nutrition bar, or Weight Watchers meal. With meal replacements, your portions are defined for you and temptation is minimized.

2) Tricks for overeaters used to “volume”.
People who are used to eating large portions can try increasing their vegetable intake. Fill yourself with low calorie vegetables, rather than other calorie dense foods. It has been shown in studies that successful dieters consume greater that 20 vegetable servings per week. Drinking a large glass of water before your meal can also trick your stomach into feeling full.

3) Train your body to be satisfied with smaller portions.
One technique is to try small frequent snacking. Snacking during the day may keep you from getting too hungry and eating more than necessary at the next meal. Fueling your body with small meals will help boost your metabolism. Eating a large volume of food at once, such as more that 1000 calories, will lead to storing the excess as fat. It is important to stay within your total daily calorie allowance when planning snacks. Most individuals will lose weight on an intake of 1500 calories per day.

4) Don’t stop exercising or you will not lose the weight!
Schedule time during your busy day to exercise above your usual activity. Walking is the most common form of exercise chosen. Walking will improve your health and fitness level but many are not exercising at the level it takes to lose weight. Consider trying interval exercises. Interval exercise groups have shown to lose fat at a higher rate than endurance exercise groups. Walking and other endurance exercises do effectively burn calories, but interval exercises have shown to not only burn calories but also boost your metabolism after the exercise regime.
Interval exercising involves alternating between high and low intensity exercises for a specific short length of time. For example, changing the speed of your activity, doing exercise stations or light weight lifting. The exercise to recovery ratio should be 2:1. For instance, if you walk up stairs for 30 seconds your rest portion would be twice as long or 60 seconds before repeating the activity. When doing interval exercises it is important to exercise at an intensity level that you feel is “somewhat hard” or 60-80% of your maximum heart rate.

5) Be accountable.
It is hard to lose weight on your own. Over 100 studies have indicated that people
who join groups or seek periodic professional consults for diet and exercise show the greatest weight loss success. Checking your weight only once a week is recommended.

6) Recognizing stress and depression.
Family and social issues often arise during the holidays. Many individuals overeat or binge-eat to relieve stress. Depression can potentially interfere with motivation to lose weight and it can be treated. Consider seeking professional help to assist in recognizing and possibly treating depression.

Losing weight during the holiday season becomes a “growing” challenge every year. Developing healthy eating patterns, routine exercise and making modest behavioral changes will lead to success. It is difficult to stay motivated and lose weight on your own. Do not give up on trying, your health depends on it!

If you are interested in learning more about losing weight, controlling overeating and fat burning circuit exercises, come to a free workshop on Saturday, January 2th, 10 –11 am, at the Chatham Health & Swim Club, 251 Crowell Rd., Chatham.
Call 508-945-3555 to reserve a seat.
If you are unable to attend, and are interested in a 6-week weight loss challenge starting Jan. 4th with Carol Penfield, Nurse Practitioner and Program Director, call her office at 508-945-7761.

Nutrition and the Skin

Choices in nutrition may help slow down the skin’s aging process from the inside, however, it does little to protect from the damaging factors of the outside world. The sun’s harmful UVA and UVB rays cause wrinkles by speeding up the skin’s aging process. This is why it is very important to always wear a sunscreen with SPF 30, or higher, no matter where you live or what the weather is like outside. Smoking speeds up the skin’s aging process as well, also creating wrinkles. It is important that you drink plenty of water in order to keep your skin hydrated, 6 to 8 (8 oz.) glasses daily has been recommended. Vitamins, minerals, and essential fatty-acids help keep the skin healthy and rejuvenated. They can be obtained by eating fresh fruits and vegetables.