The Doctor Weighs In

by Pat Salber, MD

While not nearly as high profile as TV’s “The Biggest Loser,” the National Weight Control Registry has helped researchers gain a better understanding of what it takes to lose a significant amount of weight (at least 30 pounds) and keep it off (for at least a year).

The Registry was started in 1994 by Rena Wing, Ph.D. from Brown Medical School, and James O. Hill, Ph.D. from the University of Colorado. According to the NWCR website, it is the largest prospective investigation of long-term successful weight loss maintenance in the country.  Individuals who meet the criteria of “successful losers” self-report information about their dietary, exercise, and other lifestyle habits. Although not a randomized, controlled clinical study (the “gold standard” in research), there is nevertheless some valuable information to be gleaned from this weight control registry.

According to results reported by lead investigator, Suzanne Phelan, PhD, at the June 2-5, 2007 Endocrine Society meetings in Toronto, 89% of 4,200 registry participants lost weight with diet and exercise. Ten percent used diet alone and 1% exercise alone. The average age of the losers was 47 years old; 77% were female, 95% Caucasian, 64% married and 82% college-educated.

Nearly half the registrants lost weight on their own, not relying on outside help such as weight loss programs or counselors. Strategies included restricting certain foods, such as deserts (87%), portion control (44%); counting calories (43%), counting fat grams (25%), and using liquid meal-replacements (20%).

The August 2007 issues of DOC News, a publication of the American Diabetes Association, reports that Phelan and her team identified a number of other key strategies:

• Low cal, low fat. Participants reported an average energy intake of about 1,300 calories per day with about 20-30% of those calories from fat. To put this in perspective, this is about the amount of calories you get when you lunch on a Big Mac with medium fries and a Coke.
• Lots of physical activity. These losers reported burning about 2,600 calories per week (walking 5 miles or engaging in 30-90 minutes of physical activity per day).
• Limited TV viewing. More than half of the participants watched fewer than 10 hours of TV per week. Only 21% watched more than 21 hours weekly. The average American watches about 28 hours/week. [Note: Not only did these folks have more time to exercise, they also may have been able to avoid the compulsive eating associated with eating while viewing.]
• Frequent self-weighing. Seventy-five percent reported weighing at least once a week. Forty-four percent weighed daily and 31% weekly.   Click here for more information on this important weight control behavior.
• Dietary consistency. Participant tended to eat the same type and amount of food on weekends and holidays as during the work week.
• Limited dietary variety. Many participants restricted their choices within food groups.
• Don’t skip breakfast. Almost 80% of participants reported eating breakfast every day.
• Limited fast food. Participants rarely ate fast food – consuming less than one such meal per week (see bullet one to see why this is important!)

National Weight Control Registry participants did not take their weight loss and maintenance for granted. They had to work at it. But they did report that the perception of the effort required decreased over time. It becomes a way of life.

If you are interested in learning more about the National Weight Control Registry visit www.nwcr.ws/ . If you are a successful loser, consider becoming a registrant - help contribute to our national knowledgebase of what it takes to take it off and keep it off.

by Pat Salber, MD

The cabbie who drove me from the airport to the hotel on my last business trip probably weighed 400 pounds.  We made small talk during the trip.  He told me he was hoping to leave Nevada soon and move to Oregon.  But, he said, it was tough getting the time and resources to make the move.

He works 12 hours days, six days a week.  The cab company deducts chunks of his pay  for their share of his revenues and to cover his health insurance premium and a tax on his tips.  His take home pay is $500 every two week pay period.

As we started talking about his health insurance, the conversation naturally drifted to health.  He is prediabetic, he told me, and his brother is a type 2 diabetic who has already had some toes amputated.  He knows he is facing the same future if he doesn't lose weight, but how can he do it?

When you drive a cab 12 hours a day, you often eat on the run.  That means fast food, high fat, and lots of calories.  Also, how do you fit in exercise?  Should he try to walk before the 12 hour shift or, perhaps, go out in the middle of the night when his shift is over? 

I found myself wondering what I would do if I were his doctor.  Of course, I would recommend he lose weight, alot of it.  And, I would tell him to get moderate to vigorous exercise 30 to 60 minutes a day.  I would prescribe any needed medications.  And, I would tell him to join WeightWatchers, or better yet an on-line weight loss support program, like PEERtrainer (www.peertrainer.com).

Chances are, in my 15 minute office visit, I wouldn't have learned about the challenges presented by his daily schedule.  I wouldn't understand that my recommendations were unlikely to be followed -- not because he wouldn't, but rather because he couldn't.

If something doesn't change, his prediabetes will most likely become diabetes.  He will probably have a heart attack or stroke or maybe, like his brother, he will end up with toes or feet amputated -- all potentially preventable if he could change his lifestyle.

At the end of the ride, all I could think of to say was that he needed to get a new job -- one that is less stressful and would allow him to exercise and eat better.  But I knew this too would be a daunting task given the long hours he already works and the meagerness of his financial resources.

I keep mulling over his story and wondering, how could you help this man?  I haven't come up with an answer.  Can you?

This is an oldie, but goodie, first published on TDWI September 15, 2006

The results of the 2007  Food and Health Survey* are in and they show…guess what? Most people want to lose weight. Seventy-five percent of individuals surveyed said they are concerned with their weight. This is up from 66% in 2006. 70% said their reason for making dietary changes is “to lose weight,” and 56% said they are actively trying to lose weight. This is interesting as it seems to reflect reality.  According to the latest scientific evidence, 66% of Americans are overweight or obese.

Where there is a disconnect, however, is people’s knowledge of the relationship between "calories in" and "fat on."  Although 60% of Americans who are trying to lose weight say they are doing so by reducing the number of calories they consume, only 11 percent were able to correctly estimate the number of calories they should consume in order to accomplish that goal. Interestingly, most people underestimated the number of calories they thought they should consume, but that was offset by the 34% of Americans who admitted they actually consume more than they estimated they needed.

It was heartening to learn that most people (69%) say they use food and beverage packaging elements when deciding whether or not to buy and eat food products. However, the most commonly used element was the expiration date. Sixty-six percent said they used the Nutrition Facts Panel (aka the Nutrition Label) and most used the calorie information and the information about fats, particularly Trans fats. The problem is they are not paying attention to serving size – only 49% did so, down from 63% in 2006. Knowing the calories per serving does not translate into decreased caloric consumption if you do not understand serving size.  And, as I have pointed out before, serving size is not intuitive or even easy to understand (how many of us can estimate 1 oz of cashews or 30 grams of Bran Buds?).

Of the 56% of people surveyed who said they were trying to lose weight, 79% said they had increased or began to engage in physical activity; 69% had reduced portion sizes of meals and/or snacks, and 60% had reduced the number of calories. But snacking remains a national pastime with about half of those surveyed saying snacks are an important part of an overall healthful diet. Almost all Americans (93%) eat at least one snack per day with the mean number of snacks being 2.5 per day. Ten percent of those surveyed said they ate 4-5 snacks per day and 7% ate 6-7 per day. Two percent admitted to eating 8 or more snacks per day (how do they have time for anything else??).

Many people perceived foods and beverages to have health benefits, often beyond what medical evidence supports. Specifically, the following percentages of the surveyed population strongly or somewhat agree with the following statements:

• Specific foods improve heart health – 80%
• Specific foods improve physical energy or stamina – 76%
• Specific foods improve immune system function – 71%
• Specific foods improve mental performance – 66%
• Specific foods improve the risk of getting specific diseases – 65%

Can’t you just see the glint in the food manufacturers’ eyes (and the banners proclaiming health benefits plastered all over our food packages)? Food lies masquerading as food science – but, you will have to wait for that is the subject of a post yet to come.

The last item from this survey that I want to mention is that American’s perceived their health to be better in 2007 than in 2006. Thirty-nine percent of those surveyed said their health was “excellent” or “very good” compared to only 33% in 2006. And even more people (58%) said they were “extremely satisfied” or “somewhat satisfied” with their health status – this is somewhat puzzling since that means some people are satisfied with health that is less than “very good.”

So there you have it – a glimpse into how we perceive food, fat, and facts.

*The Survey, sponsored by the International Food Information Council (IFIC) Foundation and organization affiliated and supported by “the broad-based food, beverage, and agricultural industries.” The first survey was produced in 2006 based on a telephone survey of Americans performed in November 2006. The 2007 Survey is based on a telephone survey in March of 07.

Pat Salber, MD

If you liked this post, you may also enjoy reading:

We are fat and getting fatter

Big meals lead to big mistakes in calorie estimation

Living with diabetes can be tough. There is so much stuff to learn and so many things to do. It can be hard to keep track of everything. And, it can seem overwhelming, particularly around the time you are first diagnosed.

That’s why I am recommending if you have diabetes or if you know someone who has diabetes, get your hands on a great little book, "Know your Numbers, Outlive your Diabetes.” It is written by Richard Jackson, MD, a doc at the world famous Joslin Diabetes Center and Amy Tenderich, a professional journalist who also happens to have diabetes (check out her website: www.DiabetesMine.com).

Five Numbers to Know

This book points out that there are five essential tests everyone with diabetes should have:

• Hemoglobin A1c (often just called A1c). This is a measure of the average blood glucose levels over the previous two to three months
• Blood pressure
• A full lipid profile – not just a total cholesterol, but a full panel that determines LDL, HDL (often called good cholesterol), and triglycerides (blood fats that go up after we eat)
• Microalbumin: a test of whether diabetes has cause kidney damage
• A Retinal Eye Exam to asses whether there is any evidence of eye damage

The authors explain what these tests mean and how often you should get them. What I particularly like is that they stress that you need to be the owner of these numbers:

“These numbers belong to you, and knowing them is your right, as well as critical to your health – just like the numbers in your bank account.”

They even give you advice on how to get your hands on these numbers:

“It is your right to request them, so don’t feel intimidated about speaking up….A call to the office should suffice…” but they recommend, “make the call at a time when you have some other paperwork to do, and use a speakerphone so that you don’t get too frustrated trying to get through or waiting on the line.”  It seems like they may have had some first hand experience calling doctors' offices.

Don’t feel like you have to do everything at once

There is a chart in the book that the authors titled “Your Diabetes Health Account.” Using it, you can compare your numbers to the certain targets in order to determine how well you are doing. For example, if all of your numbers are at optimal targets, you can see that you have five “bags of money” in your diabetes account. These are your health assets. If your tests are past due or way out of whack, then you have health debts which should be paid off as soon as you can. By taking a close look at your diabetes health account, you can pinpoint your focus of what you need to do to get your health account back in balance.

They counsel, “Rather than depressing you, knowing your priorities should boost your confidence; you have learned exactly which health factors are most important for you right now and which may not need attention on an everyday basis."

Take Action

Once you learned your numbers and assessed your diabetes health account, it is time to take action. The book provides strategies for how to improve every one of the five essential factors. The tips provided are practical, but detailed enough to help even a novice diabetes-self-manager get started.

The first part of the book lays out the strategies for improvement and the second part dives deeper into the diabetes toolkit they are helping your prepare. Advice on diet and exercise are clear and easy to follow. For example, one strategy for portion control, an important element of a weight loss diet, is to share a meal. Pretty simple, huh? Or you can divide your food before you start to eat and have it put into a “doggie bag” before it automatically goes into your mouth to end up around your middle. Avoid buffets. We all know we eat too much at buffets…it is simply too easy to pile it on the plate.

Other good information

There are chapters on diabetes drugs and diabetes devices as well as information about low and high blood sugar. The chapters are well laid out with important information placed in boxes.

Sprinkled through the book are stories of real people living with diabetes, like Loretta, a kindly grandmother with type 2 diabetes who lost weight and brought her hemoglobin A1c into control or Marci, a “high-powered New York City account executive" who enlisted her husband to help her deal with “diabetes frustration.”

Empowerment

Yeah, I know, some of you hate the “empowerment” word. But that is what this book sets out to do. It arms you with information. It helps you understand your particular needs and challenges. And it provides guidance on how to go, one step at a time, from where you are now to where you want to be in terms of diabetes health.

So, there you go. If you have diabetes, if someone you care about has diabetes, or if you are a health professional working with people with diabetes, then buy (and read) this book. You will be glad you did.

Pat Salber, MD

If you are like many Americans, you spend more of your “awake” time at work than you do at home. At home, I can control my environment. I don’t keep calorie dense foods in the house. I read food labels and use a food scale to help me determine portion sizes. I have a personal trainer who comes to my house five days a week – rain or shine, whether I am in the mood or not. And, I have my husband – a guy who is religious about good nutrition and physical fitness – to serve as my live-in health coach.

But, at heart, I am weak. I love, love, love to eat, eat, eat. I eat when I am stressed out and I eat when I am relaxed. Eating right does not come naturally to me. I have to work at it. I do like to exercise, but when I get busy, it is usually the first thing to fall off of my “to do” list.

Sometimes, I spend long periods of time working out of my home. During those times, I am physically fit. Sometimes, I travel to work long hours in remote workplaces. What I have learned is this type of work-life makes me fat. Let me give you some recent examples:

• I travel to a different time zone to work on a fascinating and challenging assignment. The flight is delayed. I am hungry. I am in the Continental Airlines lounge. They have cheese and crackers. So, I eat cheese -- lots of it. Why, because it is there.
• My flight is delayed. I arrive at the hotel after 11 pm and, guess what, I am hungry again. There is nothing to eat at 11 pm except what is in the mini-bar. Hmmm. What’s there? A container of cashews and a container of peanuts. I choose the cashews. It is only after I have shoveled many dozens of the tasty nuts into my mouth that I read the label: 90 calories per portion - a portion is 5 (that’s right 5) cashews. OMG
• I give myself permission not to work out on the first travel day, after all I can only get 7 hours of sleep and I need eight hours minimum to feel even remotely human.
• I have 30 minutes to get ready in the morning. I ordered oatmeal – pretty healthy? But it came with (and I ate) milk and brown sugar.
• Now, I am at the office. It is 11 am. It is too early for lunch, but I am hungry. So, I go to the vending machine. Here are my choices:
• The top two rows are various types of potato and corn chips
• The next couple of rows are cookies and sweet rolls.
• At the bottom are some corn nuts (I love corn nuts), and some candy bars.

Really?

• Ok, I am good. I didn’t get anything from the vending machine…do I get any points for that? Probably not because the company has arranged a “potato bar” for lunch. The potato was, no question, the biggest Idaho potato I have ever seen in my life—this was a potato on steroids or maybe it was genetically engineered to be humongous. I bet it weighed 2 pounds. The toppings were all in trays. They included huge mounds of butter and sour cream (not low cal, low fat). There were also containers of (the most delicious) shredded beef, Tex-Mex beans, and shredded cheese. And, just in case you couldn’t ingest enough carbs via the potatoes and toppings, there was also a bowl of potato chips and dip. Now, I must admit there was a bowl of raw veggies. It was sitting on a counter behind the table with the potato bar.
• I would like to use the stairs to go to meetings on different floors, but there is a sign by the staircase warning that you can’t exit the stairwell once you have entered it except on level one….some sort of security thing (definitely not a health thing).  Maybe there is a way around this, but I am too busy to find out.
• It’s close to 7 pm when I leave work. I am tired and I am hungry. I call room service. Do I need to tell you the rest of the story?

Sound familiar?  If so, I am not surprised.  The typical American workplace is not designed to keep us healthy. Our workplaces and our work habits are making us fat:

• We work obscenely long hours
• We have long commutes
• We are surrounded in the workplace by high energy density foods
• We have no time to exercise – before, during or after work
• Doesn’t matter because we are too tired to exercise anyway
• We have workplaces that are designed to help us avoid any type of physical activity (except for our typing fingers – mine, by the way, are quite thin)
• When we fly across time zones for work, we have an excuse to eat more and exercise less – we are tired and the airlines treat us like cattle – which, by the way, also eat too much and exercise too little.

There are better scenarios our there. In a post to follow, I will explore the concept of a workplace that is healthy by design. This is a workplace where it is easier to walk up the stairs than take the elevator.  There are apples and carrots in the vending machine instead of candy bars and potato chips.  In this type of workplace, "work-life balance" is an expectation, not a slogan.

Lest you think it is too expensive or too inefficient for American companies to have a healthy work place, let me remind you that those of us susceptible to developing diabetes, heart disease and other related conditions when we get fat and out of shape will cost you a ton of money.  We are a part of the reason why your health insurance costs are so high. And you know what that does to the bottom line.

Perhaps a little less productivity, a little less stress, and a little more work-related body movement might be cheaper in the long run. Think about it.

Pat Salber, MD, MBA

Cheerios for breakfast?  The box says only 110 calories per serving.  But, that is without milk or sugar or fruit. 
An official Cheerios "portion"

So when I say, "I only had a bowl of Cheerios for breakfast.".  You may think.  She had a serving.  That's only 110 calories.  Very good! 

If you remember to add in the skim milk calories, it is still a reasonable 150 calories.  But one cup of Cheerios is a pretty small portion and it is pretty boring with out the fruit.

So, here's is what I really eat.  I fill the bowl up.  It is a small bowl after all.  Then I put in some fruit (4 medium sized strawberries in this case).  Finally, a sprinkle or two (or three) of brown sugar.  Then I pour on enough milk to moisten it all (a full cup) and what do I have? 

What I really eatHmmmm.  Let's add it up:

      2 cups of Cheerios               = 220 cal

      1 cup of skim milk              =   80 cal

      4 medium strawberries   =   25 cal

      2 loosely packed teaspoons of brown sugar (yum)  =  34 calories

      for a GRAND TOTAL OF 359 calories, triple the amount of a "serving." 

Portion wise?  or portion lies?

We have known for a long time that the distribution of fat in the body is important in determining important health risks, such as type 2 diabetes and cardiovascular disease. “Apples” (or the abdominally obese) are at much greater risk than pear-shaped people who tend to deposit their fat in the hips, thighs and butts.

More recently, researchers have determined that one type of belly fat, called visceral fat, is worse than belly fat just below skin.  Visceral fat is deposited the omentum, the tissue that drapes around the intestines and other abdominal cavity organs (or viscera). You don’t have to be obese to have visceral fat. One the other hand, not all people who are obese develop significant amounts of this “bad fat.”

An article in the San Francisco Chronicle reports that recent research suggests that abdominal fat is related to the release of the stress hormone, cortisol. According to UCSF’s assistant professor of psychiatry, Elissa Epel, an expert on the physiological effects of stress, cortisol which is released when people are under stress, seems to interact with the pancreatic hormone, insulin, to create visceral fat. At the same time, cortisol stimulates a craving for “comfort foods” – the sweet stuff and the stuff high in fat. This is a double whammy – you desire and, as a result, often consume high calorie foods and you deposit those excess calories as bad fat in your belly.

To test the hypothesis that stress is related the deposition of visceral fat, researchers at the University of California San Francisco are recruiting 50 overweight women to participate in a study on the impact of stress relief techniques on body fat, particularly visceral fat. The study is not designed to help the participants lose weight per se, rather it is designed to reduce stress and stress-related eating.

The 50 women will be divided into two groups. One group will start stress reduction classes right away, the other won’t start these classes until after 6 months have passed. The classes will teach women stress reduction techniques and will also teach them how to recognize triggers that prompt stress-related eating. They will also be taught “mindful eating.”

I described mindful eating in my recent post “Getting in touch with your feelings…about raisins.” In that post, I describe a “raisin exercise” developed by the author of Soul-Full Eating, Maureen Whitehouse. This approach to eating involves really engaging with the foods you eat. As opposed to gulping them down as many of us do in the course of our hectic lives, you are taught to visually examine the food and then explore it with your fingers and hands. When you put it in your mouth, you explore it with your tongue and chew it, ever so slowly, letting the flavors linger in your mouth and in your mind.

According to a co-researcher on the UCSF study, Jennifer Daubenmier, a postdoctoral fellow with the UCSF Center for Obesity Assesment, Study and Treatment, mindful eating helps participants to think about how and why they eat. The goal of the UCSF program is to ultimately help the participants make better, smarter food choices. Although weight loss is not the goal, it is hoped that the program will result in a reduction of bad belly fat.

To qualify for the study, women must weigh less than 300 pounds and have apple-shaped figures. They must be between 21 and 50 years old. They must not be recently pregnant, diabetic or have heart disease. If you fit these criteria and are interesting in participating in the study, send an email to ucsfcalmmstudy@yahoo.com. If you want to learn more about what it means to participate in a clinical trial, click here.

Two tablespoons of peanut butter with jelly on toastI write in my daily food log that I had "some peanut butter and jelly on one slice of whole wheat toast."

You think:  2 tablespoons of peanut butter and a little (say a tablespoon of jelly).  That's 90 calories for the whole wheat bread, 200 calories for the peanut butter (maybe I should cut it down to a tablespoon), and 50 calories for the jelly.  340 calories.  Well, if that's all you had for breakfast, not too bad (but not too good, either).

Here it is with four tbs of peanut butter!But what you don't know is I slathered the bread with 4 tablespoons of peanut butter and topped it with 2 of jelly for a whopping 590 calories-- half of a day's calories allowed on a 1200 calories weight loss diet.

Then, I complain, it doesn't matter what I eat, I just can't seem to lose weight. 

Uh, oh, you caught me in another portion lie.

This one is perfect for New Year's Eve as many of us prepare for the biggest drinking night of the year.

I tell you I had "one glass of white wine" with dinner.
4 oz white wine

You think:   4 oz, 80 calories...not too bad.

8 oz white wine

But, what I really drank was "one glass of white wine" filled to the brim.  8 oz, 160 (empty) calories.  

Uh oh, I told a portion lie.

Best wishes for a very Happy (and safe) New Year's eve.

My local newspaper, the San Francisco Chronicle, has a hysterical article about a restaurant in Arizona named “The Heart Attack Grill.”

The restaurant specializes in serving food that is really, really bad for you. Here’s what’s on the menu:

• The Quadruple Bypass Burger (also available in a Single, Double or Triple Bypass version)
• Flatliner Fries (the restaurant’s website boasts that these are fried in pure lard!)

They also sell beer and soda as well as cigarettes. Cigarettes? Yep, cigarettes are on the menu being promoted with the tagline: “When you’re in the mood to be bad, add cigarettes to your meal.

If you are able to finish a Triple or a Quadruple Bypass Burger, you can get pushed to your car in a wheelchair. Squadnillion calories burgers, lard-fried fries and cigarettes: no wonder the registered tagline for the restaurant is

“A Taste Worth Dying For”

The waitresses, designated as “nurses,” are dressed in Hooter-like cleavage and bun-baring outfits. Although the owner, Jon Basso, calls his food “nutritional pornography,” the controversy surrounding this restaurant is not the food, but the sexy imitation nurses. Basso and his restaurant are evidently under threat of a lawsuit by the Arizona Board of Nursing for using the word “nurse” at his restaurant and on his website.

BTW, the Heart Attack Grill concept is available for franshising if you are "Man Enough."  As the website states, a Heart Attack Grill could be coming soon to an artery near you!

This is truly an “only in America story.” Enjoy.

I did not eat celery sticks before Thanksgiving dinner. I ate fresh French bread that I "dipped" in spinach dip made from mayonnaise and sour cream (OMG! Thank you, Amy, it was delicious). I did not drink sparkling water. (I drank Edna Valley Chardonney-heck, I live in California). Then, I ate alot of turkey--mainly dark meat... a bit of stuffing, a few scoops of mashed potatoes and gravy, a big spoonful of sweet potatoes topped with coconut ( thank you, Karen) and some home-made apple pie (Karen, these calories are from you too, thanks an awful lot). I didn't bother with the green beans or the salad. This was a night of serious carb-loading. Quite a few of my loved ones felt compelled to remind me of my pre-Thanksgiving blog. "Hey, why are you eating brie instead of celery sticks?" "That looks like wine, not sparking water." How could they say these things to me right when I am enjoying the "cocktail" hour? The morning after the Thanksgiving feast, the scale proclaimed that I had gained 3 pounds. I am not sure these are "real pounds," if you know what I mean. At least not yet---real pounds are the ones that just keep hanging around even if you starve, starve, starve yourself for the next two to three days. I think of these initial pounds as indulgence pounds...the type of pounds that pile on just when you are having some fun.

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Thanksgiving is one of my favorite holidays. The whole family travels from all over the country to our house in Larkspur, California. There are adult children, their children, cousins, cousin-in-laws, parents, parents-in-laws, and friends and friends’ friends. It is a big gathering for the Michaeli-Salber clan. It is also, hands down, the biggest eating day of the year. Let’s take a quick inventory of the typical (when you are really honest) adult Thanksgiving plate:

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Multiple choice - What is the leading source of saturated fat in American diets? a. Beef b. Milk c. Cheese The answer is cheese according to Marion Nestle, a university based nutritionist, in her recently published book "What to Eat." She goes on to explain that a hard cheese, like cheddar, may be one-third fat by weight (oh my!). Close to two-thirds of the fat in cheddar is saturated (bad fat). A slice of cheddar cheese or a few small cubes can have 120 calories and about 10 grams of fat, 6 grams of which are saturated. Hmmm...my recipe for macaroni and cheese uses a pound of cheddar....it is so good that (in the old days) my husband and I could eat the "whole thing." No wonder I was fat.

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