UNDERSTAND AND PRACTICES

OF

WE GHT

MANAGEMENT

By

Dr.Amaresh Mohan

OnlineGatha The Endless Tale

OnlineGatha The Endless Tale

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PREFACE
The primary goals of this book is to help you for management of
Weight without drugs, supplements or gimmicks and to educate you in
the Weight Management. In other words, my goal is to turn you into a
Weight Management Expert. This book was written for you in simple
step-by- step instructions: Do this, dont do that, eat this, dont eat that,
and so on. This is not just an informational book it is a complete
system that will take you from where you are now to where you want to
be in the shortest possible period of time.
Our modern way of living has largely eliminated physical activity
as one of the fundamental stimuli from our lives. The growth of noncommunicable lifestyle diseases and the epidemic increase in obesity
provide clear evidence of this imbalance between our lifestyles and our
physical requirements. Physical inactivity has become a major risk
factor for chronic non-communicable diseases in populations.
Physical activity, exercise, health and quality of life are closely
interconnected. The human body was designed to move and therefore
needs regular physical activity in order to function optimally and avoid
illness. Furthermore, living an active life brings many other social and
psychological benefits and there is a direct link between physical activity
and life expectancy, so that physically active populations tend to live
longer than inactive ones. Sedentary people who become more physically
active report feeling better from both a physical and a mental point of
view, and enjoy a better quality of life.
Overweight and obesity are defined as abnormal or excessive fat
accumulation that may impair health. Especially obesity is a medical
condition that it may have an adverse effect on health, leading to
reduced life expectancy and/or increased health problems. Obesity is a
leading preventable cause of death worldwide, with increasing
prevalence in adults and children, and authorities view it as one of the
most serious public health problems of the 21st century. A systematic
healthy diet and customized physical exercise with supervision consist
the mainstays of treatment obesity and weight management generally.

[ ABOUT THE AUTHOR

Dr. Amaresh Mohan is an Asst. Professor
in the Department of
Paramedical
Sciences
IAAT
Group of Institution
and
Consultant
Physiotherapist at
Physio Care Clinic
Gomti Nagar, Lko.
Dr.
Amaresh
received
Bachelor
of
Physiotherapy degree from AAIDU Allahabad.
He obtained his Master in Physiotherapy
(Orthopedics) from Meerut University Utter
Pradesh, & Master in Community Medicine &
Public Health from Lucknow University. He is
involved in teaching students of Paramedical
Sciences. Dr. Amaresh Mohan attended many
national and International Conferences and
Workshops. Presently he is a Life Member of
Indian Association Of Physiotherapists. He has
published several books and articles on Health
Concerns Issues.

ACKNOWLEDGEMENT
AND
DEDICATION

This book is dedicated to My Grand

Mother & Grand Father.
Thanks to The God, My Father,My Relatives
Specially My Mother, who has taken a big part
of that sacrifice.
I would like to thank my wife Dr. Anubha for
standing beside me throughout my career and
writing this book. She has been my inspiration
and motivation for continuing to improve my
knowledge and move my career forward and the
rest of my family members, who supported and
encouraged me in spite of all the time it took me
away from them.
Thanks to all my friends for sharing my
happiness when starting this Book and following
with encouragement when it seemed too
difficult to be completed.
I would like to thank Online Gatha.com for
enabling me to publish this book.

08-49

PART I
Understanding Body Weight
Introduction and Components of Body Weight
Regulation of body weight
Concepts of underweight, overweight and obesity
understanding weight loss and fat loss

50-160

Part II
Understanding Obesity/Overview of Obesity
An Obesity
Assessment Tools and Strategies
Causes of Weight imbalance/obesity
Risk Factors of Weight Imbalance
Dietary Habits that Increase Risk
Complications of Weight Imbalance
Obesity in Children

161-378

Part III
Weight Loss and Maintenance strategies
Weight Management and its benefits
Essential Nutrients and Healthy Eating
Key Components of a Lifestyle Change Program
Liquid Meal Replacements
Support Groups and Behavioral Modifications
Changing Sedentary Habits and Exercise
Balancing Calories and Exercise
Exercises Technique and Program Design
Herbal and Natural Weight Regulators
Nutritional Supplements and Fad diets
Medications
6

 Bariatric Surgery and Restrictive Banding Procedures

379-392

Part IV
Leanness and eating disorder
Weight imbalance: Excessive leanness
Nutrition in Eating Disorders

393-410

Part V
Diet Planning
Planning Diet to Weight manage

411-416

Part VI
Energy Expenditure
Understanding of 24- hour energy expenditure- useful
in diet and exercise plan for weight loss, gain or
maintenance

PART VII

417-420

Weight Loss Services

Different Barriers to weight loss

PART VIII

421-444

Weight Management for Special Populations

Pregnant and Postpartum Women
Weight Management for Seniors
Weight Management for Persons with Disabilities
Establishing a Weight Loss Business

REFERENCES

445

PART I
UNDERSTANDING
BODY WEIGHT

INTRODUCTION AND COMPONENTS

OF BODY WEIGHT
INTRODUCTION OF BODY WEIGHT

The term body weight is used in the biological and medical

sciences to refer to a person's mass or weight. Body weight is
measured in kilograms (kg), a measure of mass, throughout the
world, although in some countries such as the United States it is
measured in pounds, or as in the United Kingdom, stones and
pounds. Most hospitals, even in the United States, now use
kilograms for calculations, but use kilograms and pounds together
for other purposes. The body weight is the weight of the person
without any items on, but practically body weight is taken with
clothes on but often without the shoes and heavy accessories like
mobile phones and belts, wallets. The Body weight is one way of
determining a person's health.
Ideal Body Weight (IBW)
A weight that is believed to be maximally healthful for a person,
based chiefly on height but modified by factors such as age,
gender, build, and degree of muscular development.
The ideal body weight historically is a subject to study that
raises more questions than answers, i.e. is obesity linked with
morbidity.
So ideal body weightfor men and women is based on weight,
height and body frame. However, co-morbid factors such as
smoking and family history for diseases are not considered as
variables in this survey. Today, ideal body weight remains
controversial.
It is generally acknowledged that obesity may increases the risk
of many diseases, including diabetes mellitus, hypertension,
coronary heart disease (CHD), cancer of the endometrium, colon
and kidney, stroke, osteoarthritis and infertility. These risks
9

become more evident as the BMI increases. Yet the definition of

obesity has varied by age and sex and is generally not clear.
The Body Mass Index (BMI)
The Body Mass Index (BMI) is also known as Quetelet index, is a
measure of relative weight based on an individual's mass and
height.
BMI is defined as the individual's body mass divided by the
square of their height with the value universally being given in
units of kg/m2.
BMI = mass (Kg)/(height (m))2
= mass (Ib) x 703/(height (in))2
BMI can also be determined using a table or from a chart which
displays BMI as a function of mass and height using contour lines,
or colors for different BMI categories.
Body mass index (BMI) is categorized by the International Obesity
Task Force as:

18.524.9 = Healthy weight

25.029.9 = Overweight
30.034.9 = Class I obesity
35.039.9 = Class II obesity
>40.0 = Class III obesity

The BMI is used in a wide variety of contexts as a simple

method to assess that how much an individual's body weight
departs from what is normal or desirable for a person of his or her
height. There is however often vigorous debate, particularly
10

regarding at which value of the BMI scale the threshold for

overweight and obese should be set, but also about a range of
perceived limitations and problems with the BMI.
The Body Volume Index (BVI)
It is a new measurement for obesity, proposed as an alternative to
the Body Mass Index (BMI).BMI is based on a measurement of
total mass, irrespective of the location of the mass, but BVI looks
at the relationship between mass and volume distribution (i.e.
where different body mass is located on the body). People of
different age, gender or ethnicity will have different body shapes
and recent studies have highlighted the limitations of BMI as an
indicator of individual health risk.
Lean Body Mass (LBM)
The LBM is a component of body composition, calculated by
subtracting body fat weight from total body weight: total body
weight is lean plus fat.
In equations:

LBM = BW BF

Lean Body Mass equals Body Weight minus Body Fat

LBM + BF = BW
Lean Body Mass plus Body Fat equals Body Weight
The percentage of total body mass that is lean is usually not
quoted it would typically be 6090%. Instead, the body fat
percentage, which is the complement, is computed, and is typically
1040%. The Lean body mass (LBM) has been described as an
index superior to total body weight for prescribing proper levels of
medications and for assessing metabolic disorders, as body fat is
less relevant for metabolism.
The terms "lean body mass" and "fat-free mass" are used to
describe body composition. Although they may be used
interchangeably, they are not the same. Lean body mass includes
11

fat that acts as fuel for energy production and other processes that
are part of normal metabolism. On the other hand, fat-free mass
does not include any fat.
Lean Body Mass(LBM)
Lean body mass includes the combined weight of the internal
organs, bones, muscles, water ligaments and tendons, Included in
this mass is the weight of the essential fat in the organs, central
nervous system, and bone marrow. The weight of nonessential or
storage fat, which is present in the subcutaneous adipose tissue
underlying the skin and also surrounds internal organs, is not a
constituent of lean body mass.
In equations:

LBM = BW BF

Lean Body Mass equals Body Weight minus Body Fat

LBM + BF = BW
Lean Body Mass plus Body Fat equals Body Weight
Fat-Free Body Mass (FFM)
To obtain the fat-free mass, the weight of the essential fat is
subtracted from lean body mass, according to professor of
kinesiology Dr. Sue Beckham at the University of Texas at
Arlington. Essential fat cannot be differentiated from storage fat.
Estimates vary, but there is about a 2 to 3 percent difference
between lean body mass and fat-free mass in males and a 5 to 12
percent difference in females.
ADIPOSE TISSUE

Adipose tissue, or fat, is an anatomical term for loose connective

tissue composed of adipocytes.
Its main role is to store energy in the form of fat, although it also
cushions and insulates the body.
There are two types of adipose tissues :
-White adipose tissue (WAT)
-Brown adipose tissue (BAT).
12

Adipose tissue is primarily located beneath the skin, but is also

found around internal organs.
In the integumentary system, which includes the skin, it
accumulates in the deepest level, the subcutaneous layer, providing
insulation from heat and cold. It also functions as a reserve of
nutrients. Around organs, it provides protective padding.
WATER

The Water is a transparent fluid which forms the world's streams,

lakes, oceans and rain, and is the major constituent of the fluids of
living things.
Water covers71% of the Earth's surface. It is vital for all known
forms of life. On Earth, 96.56% of the planet's water is found in
seas and oceans, 1.7% in groundwater, 1.7% in glaciers and the ice
caps of Antarctica and Greenland, a small fraction in other large
water bodies, and 0.001% in the air as vapour, clouds (formed of
solid and liquid water particles suspended in air), and precipitation.
Only 2.5% of the Earth's water is freshwater, and 98.87% of that
water is in ice and groundwater. Less than 0.3% of all freshwater is
in rivers, lakes, and the atmosphere, and an even smaller amount of
the Earth's freshwater (0.003%) is contained within biological
bodies and manufactured products.
A healthy sedentary adult living in a temperate climate should
drink 1.5 litres of water per day. Water is a major constituent of
our bodies and vital organs. This threshold of drinking water
enables to balance water losses and keep ones body properly
hydrated.
Chemical Composition of water:
Water is made up from the two molecules of hydrogen and one
molecule of oxygen i.e.
(H+H) + o = WATER or H2O

13

The functions of water:

Water is involved in many of our bodys vital functions:
1. Cell life
The Water is a carrier of distributing essential nutrients to cells,
such as minerals, vitamins and glucose.
2. Body temperature regulation
Water has a large heat capacity which helps to limit changes in
body temperature in a warm or a cold environment. Water allows
the body to release heat, when ambient temperature is higher than
body temperature. When the body begins to sweat,and the water is
evaporated from the skin, then its surface efficiently cools the
body.
3. Chemical and metabolic reactions
Water removes waste products including toxins that the organs
cells reject, and removes them through urines and faeces.
4. Transportation of nutrients
Water helps to participates in the biochemical break-down of what
we eat.
5. Elimination of water
Water is an effective lubricant around joints and also acts as a
shock absorber for eyes, brain, spinal cord and even for the foetus
through amniotic fluid.Water is at the center of life. This is why
nobody can live more than 3 to 5 days without any water intake.
Hypertrophy
Hypertrophy is an enlargement or overgrowth of any organ or body
part due to the increased size of the constituent cells.
Muscular hypertrophy is a multidimensional process, with
numerous factors involved i.e. it involves a complex interaction of
satellite cells, the immune system, growth factors, and hormones
with the individual muscle fibers of each muscle.
14

Types of muscle hypertrophy

There are two types of hypertrophy:
1-Myofibrillar hypertrophy
2-Sarcoplasmic hypertrophy

Myofibrillarhypertrophy refers to an actual increase in size of the

muscle fibers (myo means muscle and a fibril is a threadlike
cellular structure).
Sarcoplasmic hypertrophyrefersto an increase in the volume of the
fluid, non-contractile components of the muscle (glycogen, water,
minerals, etc.).
The word Sarco means flesh and plasmic refers to plasma,
which is a gel-like material in a cell containing various important
particles for life. For e.g., if we look at rep ranges on a continuum
going from very heavy weight for 1 rep to very light weights for
40+ reps, the following generally holds true:
heavier weightlifting preferentially increases power and induces
myofibrillar hypertrophy, and lighter weightlifting preferentially
increases endurance and induces sarcoplasmic hypertrophy.
Researchers call this the strength-endurance continuum.
Heavier lifting does result in some sarcoplasmic hypertrophy
and lighter lifting some myofibrillar hypertrophy, but the former
induces more myofibrillar than sarcoplasmic, and the latter vice
versa.
Hyperplasia (or "hypergenesis")

It is a general term for an increase in the number of the cells of an

organ or tissue causing it to increase in size. This may be due to
any number of causes including (but not limited to) increased
demand, chronic inflammatory response, hormonal dysfunctions,
or neoplasia.
The different types of Hyperplasia conditions are endometrial,
adrenal, parathyroid and prostatic.
Hyperplasia is classified as:
15

Simple Hyperplasia, complex Hyperplasia, simple with atypia,

meaning cell abnormality; or complex with atypia.
In simple hyperplasia without atypia, there is proliferation of
cells, but the basic structure of the endometrium is relatively
unchanged. This is considered to be the least dangerous type of
hyperplasia. Other terms that are approximately the same as
simple hyperplasia are mild, cystic, or Swiss-cheese hyperplasia.
In complex hyperplasia without atypia, the individual cells may
be enlarged, but, as in simple hyperplasia, the internal makeup of
the cells is considered to be normal. However, the cells have
proliferated to the point where the normal structure of the
endometrium is interfered with Glands crowd each other, and
under a microscope the architecture is jumbled and less regular.
Other descriptors in this general category are adenomatous,
moderate, or glandular hyperplasia.

16

REGULATION OF BODY WEIGHT

Understanding the physiology behind the regulation of body
weight can help to treat and educate obese patients. This current
knowledge of body weight regulation and the metabolic changes
that occur in the body in response to weight loss.The physiological
basis for the difficult nature of weight loss, and especially
maintenance of lost weight.
The Weight management is a long-term approach to a healthy
lifestyle. It includes a balance of healthy eating and physical
exercise to equate energy expenditure and energy intake. To
develop the healthy eating habits while using tips that will keep us
fuller longer can be useful tools in weight management. The body
needs is important to weight management and can control overconsumption and under-consumption of food.
Weight management does not include to the fad diets that
promote quick, temporary weight loss. It focuses on the long-term
results that are achieved through slow weight loss, followed by
retention of an ideal body weight for age, sex and height.
THEORIES RELATED TO WEIGHT MANAGEMENT

Weight gain resulting from excess storage of fat is ultimately

explained by an intake of calories that exceeds those expended.
However, the physiological mechanisms that govern to the
metabolic balance of food consumption and energy extraction with
the energy costs of basal metabolism, digestion, and physical
exertion are complex and incompletely understood. The factors
that influence the behaviors of eating and physical activity, which
determine energy balance and gains or loss of body fat, are even
less well understood. Two common theories about the etiology of
overweight and obesity, set point and settling point, address how
physical activity can play a role in the treatment or prevention of
overweight and obesity.

17

The Fat Cell Theory

The idea behind the fat cell theory is that each body is programmed
to have a basic set number of fat cells. The theory states that the
creation of new fat cells is far easier than losing old ones, a fact
that plays an important role in adult weight loss.
According to the fat cell theory, the set point for your body's
number of fat cells was determined during puberty. Fat cells grow
quickly in children, but as we become adults, the body determines
the current number of fat cells as our adult set point and
significantly slows the creation new ones. Because, according to
the theory, the number of fat cells present in your body during
puberty will determine the ease or difficulty of weight loss as an
adult, adolescent nutrition becomes even more important. While it
is not impossible for an overweight child to lose weight as an adult,
it will be far more difficult.
In the early years of the fat cell theory, scientists were certain
that the body could not gain more fat cells after puberty; however,
in recent years the theory has changed. Studies have shown that
individuals who are sedentary and eat poor diets actually gain fat
cells over time, making weight loss even more difficult.
Dieting can be frustrating for those with a higher fat cell set
point, as the fat cells in body are programmed to fill. During a diet,
the body's fat cells shrink, that is how we lose weight. However, as
soon as you return to your regular eating habits, like magnets, the
fat cells in your body begin to attract fat and soon you are back at
your weight set point. While dieting can be a great tool for people
who had a healthy weight in their adolescence.
The long term studies on fat cell theory have proven that the
body can in fact lose fat cells; however, the process isn't easy and
can take years.While fat cells shrink during a few weeks or months
of traditional dieting, if you change your lifestyle habits for good,
your body will begin to slowly eliminate fat cells as they become
unnecessary. That is, if there is no excess fat to store in a cell for a
18

sufficient amount of time, the body will let it go. While long-term
weight loss and elimination of excess fat cells will take years and
permanent changes.
The Set Point Theory
According to set point theory the body maintains its normal weight
and body fat level with internal regulatory controls that dictate how
much fat one has. In this theory, some individuals have a high
setting, meaning they tend to have a naturally higher weight as a
set point, and others have a low set point, and therefore a naturally
lower body weight.
The set point theory suggests that despite dieting efforts, the
body tends to return to its set point weight, however regular,
consistent exercise may help to adjust the natural set point. Some
refer to the set point theory as an internal "thermostat" that
regulates body fat.
In this theory, the body regulates energy and subsequently body
weight.The Body weight may fluctuate around a predetermined
set-point through variations in food intake and energy expenditure.
Obesity can be explained in this model as having an elevated setpoint. In this model, it is also possible for environmental influences
such as food intake or energy expenditure to alter the set-point.
The set point theory hypothesizes that the body has an internal
control mechanism, that is, a set point, located in the lateral
hypothalamus of the brain that regulates metabolism to maintain a
certain level of body fat. Though evidence in rats has supported the
theory, there is no scientific consensus that such a metabolic set
point exists in humans for fat maintenance. Though weight losses
after the use of stimulant drugs, nicotine, and exercise seem
consistent with the concept of an altered set point, these effects can
also be explained by the alteration of basal metabolism in ways
that do not require a change in the set point. Studies using mainly
dietary restriction have shown that weight loss is accompanied by a
decrease in fat-free body mass and basal energy expenditure.
19

Severe caloric restriction has been shown to depress resting

metabolism by as much as 45%.
FACTORS REGULATING ENERGY INTAKE

Energy intake should be seen as a behaviour which is mainly

influenced by social, environmental, and psychological factors.
The interaction between peripheral organs and the hypothalamus
has an impact on hunger, motivation to eat, satiety, and energy
balance.
Intake of food is controlled by a number of biological and
external factors. External factors that regulate appetite (and food
intake) include cultural and psychological influences such as
economic background, education, learned experiences,portion size,
cognitive effects and, especially, food palatability. Given that a
variety of outside influences affect ones eating habits, eating (and
not eating) can be seen as a kind of behaviour in which individual
and environmental factors influence the amount of energy ingested.
The hectic food patterns are known to be a significant cause of
obesity in individuals with eating disorders. They have also many
metabolic and peripheral pathways that are part of the human
appetite and satiety system.
This complex system governs energy intake and expenditure
and is responsible for feeding and satiety. Disturbances to in this
system can affect energy balance and cause weight gain (in most
cases) or weight loss. Many sites are involved in the appetite
system, and the brain (especially the hypothalamic region) is one
of the centres where information (signals) from tissues is analyzed
and orders (other signals) are sent to the system controlling
appetite and eating. The gastro-intestinal (GI) tract, liver, pancreas,
and adipose tissue therefore engage in a cross-talk between
peripheral organs and the central nervous system (CNS). In
response to peripheral signals, the CNS secretes numerous
hypothalamic peptides (neuropeptides) that play a role between
food intake and energy balance.

20

The chemical composition of food and its relative macronutrient

content played a critical role in regulating food intake. For
instance, unlike carbohydrates and dietary fat, proteins are thought
to reduce spontaneous food intake by promoting satiety. The amino
acid composition of ingested proteins may also be an important
regulator of satiety. Fat and alcohol consumption seems to increase
energy intake whereas carbohydrate ingestion does not, although
there is evidence to suggest that complex carbohydrates (with a
low-glycemic index) may induce satiety similar to proteins.
The Carbohydrates comprise 45 to 60% of a standard diet and
are thought to be the central macronutrient regulating energy
balance. Carbohydrates vary widely with respect to chemical
composition, absorption, and palatability. Dietary fibres and
starches are not absorbed quickly and therefore induce satiety
faster than carbohydrates with a high-glycemic index such as
sucrose, fructose, and sweeteners. The latter three are absorbed
quickly and released in the circulation, thereby playing a critical
role in food intake, especially in the intake of high-fat, energydense foods.
High-fat foods are generally quite palatable, and when humans are
allowed to eat high-fat foods without restriction, they often eat
more of these foods than when asked to eat low-fat foods under the
same conditions in a controlled environment. Because of factors
such as palatability and energy density, a high fat diet may
therefore promote a positive energy balance and weight gain .
Provided that fat is not replaced by refined sugar, low-fat diets can
induce a negative energy balance and are recommended by
healthcare professionals to treatobecity and overweight.
The chemical composition of lipids is another factor that can
affect energy intake. It has been shown that substituting mediumchain triglycerides for long-chain triglycerides can promote weight
loss in men when energy intake is constant. More importantly,
21

polyunsaturated fats have been shown to decrease the activity of

certain lipogenic enzymes and increase fatty acid oxidation in
mice. It has also been shown that polyunsaturated fatty acids,
unlike saturated fatty acids, promote insulin sensitivity and prevent
adipocyte enlargement, which is a sign of fat accumulation.
The factors (both environmental and biological) that influence
energy intake are quite heterogeneous and may vary considerably
among individuals. In order to stem the obesity epidemic and
lessen its growing burden, additional research is needed to better
understand and integrate determinants of energy intake, from social
and environmental factors to biological and neuroendocrine
factors.
FACTORS REGULATING BODY WEIGHT

A constellation of clinical studies has established the close link

between the obesity and type 2 diabetes, however is not perfect,
many diabetic patients are not obese, and many obese individuals
are perfectly responsive to insulin. Regardless of whether a causal
relationship exists between obesity and the body's response to
insulin, beneficial effects of weight loss on the metabolic
parameters of many diabetic patients are well documented. Thus, it
is not surprising that a combination of weight loss and exercise is
an effective treatment for many diabetic patients.
The American Diabetes Association and the National Institutes
of Health have recommended that health care professionals advise
obese diabetic patients to lose weight. However, while losing
weight in the short term is achievable, maintaining reduced body
weight over the long term has proven to be exceedingly difficult
for most people. At least part of the reason behind the difficulty of
maintaining a reduced body weight is the body's ability to activate
adaptive mechanisms that act to minimize weight loss.
To describe the physiological basis of body weight maintenance
and the metabolic changes that occur in the body in response to
weight loss. Understanding the inherent difficulties associated with
22

maintaining long-term weight loss may allow patients and those

with the responsibility of managing their diseases to appreciate the
obstacles. It does not minimize the role of personal will and
commitment in achieving long-term weight loss by emphasizing
the role of physiology and genetics.
In contrast, combined with the message that long-term weight
loss is difficult but achievable, a realistic assessment and
acknowledgement of the contribution of genetics in weight
maintenance may help to overcome the perception that obesity is
exclusively caused by over-indulgence. A deeper understanding of
the complex nature of body weight regulation may induce more
individuals to become committed to making lasting lifestyle
changes to achieve and maintain a healthy weight.
ABILITY TO MAINTAIN BODY WEIGHT

The body weight is determined by energy intake on one hand and

energy expenditure on the other. Imbalance between energy intake
and expenditure results in a change in body weight. Organisms
expend energy to perform daily work required for survival, such as
finding food or evading predators.The Metabolic efficiency refers
to the amount of energy an organism has to exert to perform a
given amount of work.
Metabolic efficiency varies among different species of
organisms and among different individuals within a species. An
individual with high metabolic efficiency will expend less energy
to perform a specific task, such as climbing a set of stairs, than an
individual with low metabolic efficiency. Compared with an
individual with low metabolic efficiency, an individual with high
metabolic efficiency is better able to preserve body weight during
negative daily energy balance (expenditure exceeding intake), but
likely to gain more weight during positive energy balance (intake
exceeding expenditure). The ability of an organism to minimize
reduction in body weight during long periods of starvation is likely
associated with its survival.

23

The organisms are very adept at acquiring and storing energy.In

most of vertebrates energy reserve exists in the form of fat. One
pound of fat contains more energy than one pound of dynamite.
Complicating matters is the fact that we gravitate toward our food
sources. It would be much easier to achieve and maintain weight
loss if we treated our daily sustenance with the same disgust as we
do cough syrup. In fact, it's just the opposite, foods with high
energy density, such as sugar and fat, tend to be more palatable.
Perhaps the human association of eating with pleasure may have an
evolutionary origin similar to our aversion to the bitter taste of
toxic plant compounds.
Genetic Contribution To Metabolic Efficiency And Regulation
Of Body Weight
Lifestyle (sedentary or active) has a clear influence on body
weight. The rapid rise in the incidence of obesity in recent decades,
with the percentage of overweight or obese adults reaching 66% in
the United States according to the Center for Disease Control and
Prevention, cannot be attributed to genetics alone. However, results
of many studies indicate that genetic factors do play an important
role. In rare cases, obesity has been traced to mutations in single
genes.
Usually, these genes code for proteins involved in the regulation
of satiety and food intake, such as leptin (Ob), the leptin receptor
(Ob-R), pro-opiomelanocortin (POMC), and the melanocortin 4
receptor (MC4R). Although these mutations have so far been
attributed to only a few isolated families, the observation that
virtually all of the affected genes play a role in the neuronal control
of satiety suggest food intake rather than metabolic efficiency as a
prime driver in the body weight regulation.
Many different types of studies have demonstrated the
importance of genetic factors in the maintenance of body weight,
and detailed reviews are available. Just a few of these studies are
described here. To assess the relative contribution of genetics and
family environment to body weight in the wider population.
24

Although there was a positive correlation in BMI between the

adoptees and their biological parents, no relationship was found
between adoptees and their adoptive parents.
The Metabolic studies of monozygotic twins have also provided
compelling evidence for the role of genetics in determining body
weight. One study examined the effects of overfeeding on weight
gain in pairs of monozygotic twins.
All of the individuals in the study consumed the same amount of
calories for the same amount of time (approximately 3 months),
there was a large variation in the degree of weight gain, from 8.8 to
29.3 lb, among different individuals. However, the amount of
weight gain was very similar within each twin pair.
The reverse also holds true. When moderately obese
monozygotic twins were kept on a low-calorie diet, the amount of
weight loss varied greatly among different pairs of twins.
However, within each pair of twins, the amount of weight loss was
quite similar. These results indicate that the body's response to
changes in caloric intake is dictated at least in part by genetics.
Another line of evidence supporting the role of genetics in body
weight regulation came from comparison of metabolic differences
in individuals belonging to different ethnicities. In one study, a
group of overweight women (average BMI 29 kg/m2) were kept
on a low-calorie diet for a period of time until their BMI decreased
to < 25 kg/m2, the defined upper range of what is considered
normal weight. When these age-, weight-, and BMI-matched
women were separated based on ethnicity, differences in resting
energy expenditure were apparent before and after weight loss.
Interestingly, the women had larger decreases in resting energy
expenditure after weight loss, suggesting that they may be at higher
risk to regain the lost weight. In addition, children belonging to
different ethnicities also have different resting energy
expenditures.

25

CONTROL OF BODY WEIGHT AT THE MOLECULAR LEVEL

The regulation of body weight and energy homeostasis is

controlled by a myriad of metabolic pathway intermediates and
endocrine control systems. Food intake is under the control of the
central nervous system through many interconnected
neuroendocrine and neurotransmitter circuits. Energy expenditure
is regulated by the autonomic nervous system and numerous
endocrine hormones, the most prominent of which are the thyroid
hormone system. This will focus on one endocrine hormone with
particular relevance to patients with type 2 diabetes: insulin.
An Insulin likely predates leptin as an ancestral energy
homeostasis hormone. Insulin and insulin-like growth factor 1
(IGF-1) signalling systems are involved in the regulation of life
span, reproductive maturity, and body size in the nematode
Caenorhabditiselegans and the fly Drosophila melanogaster, two
organisms that do not have leptin. In vertebrates, insulin regulates
energy homeostasis and body weight through both the central
nervous system and through its effects on lipid and glucose
metabolism.
In healthy individuals, insulin levels rise after a meal. Insulin
readily crosses the blood-brain barrier33 to enter the central
nervous system and bind to receptors located in the hypothalamus,
the area of the brain that controls feeding behavior and energy
homeostasis. Insulin is known to inhibit food intake by decreasing
the expression of the orexigenic neurotransmitter neuropeptide Y.
These scientific findings are in contrast to a number of recent
popular nutrition recommendations that suggest the rise in
endogenous plasma insulin during the postprandial period is
correlated with an increase in subsequent appetite.
Insulin has profound metabolic effects in the determination of
body weight that are independent of its neuroendocrine action in
the central nervous system. Insulin is an anabolic hormone that
promotes storage of glucose and fat. Weight loss is often seen in
diabetic patients with poorly controlled blood glucose because of a
26

near complete lack of insulin. Without insulin to inhibit hormonesensitive lipase, internal adipocyte triglyceride stores are
hydrolyzed to fatty acids and glycerol and released into the
circulation, causing the blood to become lipemic and take on a
cloudy appearance. In diabetic patients the lacking of insulin, body
weight is reduced as triglyceride stores become depleted.
An opposite phenomenon often occurs in patients taking the
thiazolidinedione (TZD) class of insulin sensitizers. This class of
peroxisome proliferator-activator receptor- (PPAR-) agonist
drugs include pioglitazone and rosiglitazone. One of the common
side effects of these drugs is weight gain resulting from expansion
of adipose tissue.This effect is likely associated with the welldocumented effect of PPAR- activation in inducing adipocyte
differentiation. In obese and insulin-resistant Zucker rats,
administration of a TZD compound led to decreased plasma
glucose, insulin, and triglyceride levels that were associated with a
fourfold increase in the number of small adipocytes.
Thus, it appears that the insulin-sensitizing effect of TZD
treatment is closely tied to the expansion of adipose tissue and
weight gain. Indeed, it has been proposed that insulin resistance
and type 2 diabetes is, in part, caused by the inability of adipose
tissue to expand. High levels of circulating free fatty acids and
triglyceride content in liver and muscle have all been linked to the
development of insulin resistance. The mechanism by which
adipose tissue expansion improves whole body insulin action is
thought to be twofold: 1) triglycerides in liver and muscle and
circulating free fatty acids are transferred and sequestered in
adipose tissue where they can be properly stored, and 2) those
adipocyte hormones with insulin-sensitizing effects are restored to
normal levels.
The close association between insulin sensitivity and adipose
tissue expansion reflects the fact that improved insulin
responsiveness in adipose tissue, the culprit behind increased fat
deposition in adipose tissue, is coupled to enhanced insulin action
27

in muscle and liver. The connection between insulin action and

body weight has in fact led to the proposal that insulin resistance
develops as an adaptive physiological mechanism to prevent
additional weight gain. The evolution may have selected for
organisms that are metabolically efficient and can buffer reduction
in their body weight. However, there is an equally good argument
for evolution to select for organisms that can prevent their body
size from becoming too large.
An oversized organism may have difficulty catching prey or
evading predators. Organisms that have evolved a regulatory
system to maintain a set weight may have a selective advantage.
Decreased responsiveness to insulin in adipose tissue will lead to a
propensity to reduce fat deposition, resulting in elevated fatty acid
levels and triglyceride content in muscle and liver, and whole body
insulin resistance. This situation essentially allows an organism to
buy extra time, avoiding imminent demise at the mouth of a
predator but risking diabetes and its complications in the future
years.
The possibility of insulin resistance being tied to the prevention
of additional weight gain holds serious implications for therapeutic
modalities aimed at improving insulin action in type 2 diabetic
patients. If the hypothesis stated above is true, it may be next to
impossible to separate weight gain from improving insulin
sensitivity in the absence of a persistent and aggressive exercise
regimen.
PHYSIOLOGICAL
WEIGHT

BASIS

FOR

DIFFICULTY

TO

LOSE

It is well documented that, although most people participating in

weight-loss programs can successfully lose weight in the short
term, the majority of them cannot sustain the reduced body weight
in the long run. A plausible hypothesis that can account for the
body's tendency to return to its prior weight can be stated as
follows: body weight is maintained at a set level, and deviations

28

from the preferred set point are resisted and minimized by a

feedback control system.
This so-called set-point theory of body weight regulation has
been slowly developed over a number of years and backed by a
plethora of experimental approaches. First, many species of
mammals, including humans, whose body weights were altered by
over-nutrition or under-nutrition will eventually return to their
original weight once the normal feeding pattern is resumed.
Second, lesions in the ventromedial hypothalamus of rodents
caused by gold thioglucose administration or surgery led to
overfeeding and obesity.
These experiments established an anatomical location of one
hypothetical regulatory feedback mechanism predicted by the setpoint theory. Third, parabiosis experiments in which the
circulatory system of a normal or an ob/ob mouse was allowed to
slowly exchange with that of a db/db mouse demonstrated the
presence of a soluble, circulating factor that can inhibit feeding. In
these experiments, abnormally high levels of leptin are produced
from the db/db mouse, which lacks the receptor for leptin. The
leptin then travels through the parabiotic junction into either an
ob/ob or a normal mouse. Having functional receptors for the high
levels of leptin coming from the db/db mouse, the ob/ob or the
normal parabiotic pair soon stops eating and dies within a month
from starvation. These experiments demonstrated the existence of a
molecule that can act as a signal in the weight-maintaining
feedback control system.
These early experiments predicted the role of leptin and its
receptor as one feedback control loop that regulates body weight in
rodents. Produced by adipocytes, leptin levels rise or fall
depending on the size of the adipose depot. When the size of the
adipose depot is sufficient, elevated levels of leptin travel to the
ventromedial hypothalamus, where the leptin receptor is rather
abundant, and initiates a series of events that result in aversion to
feeding.
29

In addition to food intake, leptin plays a permissive role in the

immune response and reproduction. Although the leptinsignaling
system can dictate body weight in rodents, its significance in
regulating body weight in humans remains unclear. Obese humans
already have high levels of leptin; they are refractory to the effects
of leptin, a condition called leptin resistant. In fact, one study in
obese rats demonstrated that the anorexic and subsequent weight
loss effects of metformin may be related to the amelioration of
leptin resistance in the hypothalamus.
It is unclear whether metformin treatment improves leptin
sensitivity in humans. In any case, with the discovery of additional
signalling systems that can fulfill the functional requirement of the
feedback control loop, we now understand that leptin is just one of
many systems capable of influencing body weight.
Although we are getting an everclearer picture of the feedback
control mechanisms predicted by the set-point theory at a
molecular level, it is necessary to measure energy intake and
expenditure before and after weight change to understand why
long-term changes in body weight are difficult to maintain. In
1995, Leibel et al. A study that examined energy expenditure in
healthy nonobese and obese volunteers who either gained or lost
10% of their initial body weight through over- or underfeeding.
After a 10% weight gain, total energy expenditure increased as
expected. However, the magnitude of the increase in energy
expenditure was more than what was expected based on the 10%
increase in body weight. Interestingly, resting energy expenditure
did not change much for either the non-obese or the obese group.
It was an increase in the non-resting energy expenditure that
accounted for most of the difference in total energy expenditure. A
major component of non-resting energy expenditure is accounted
for by skeletal muscle. Increased non-resting energy expenditure in
the absence of increased activity (a value that normally varies but
was kept constant in this study) suggests that, after weight gain,
muscle expends more energy to accomplish the same task.It
30

becomes less metabolically efficient. This has the effect of

buffering against further weight gain.
In contrast to weight gain, a 10% weight loss resulted in
decreased energy expenditure beyond what was expected of a 10%
loss in body weight. Also different from weight gain, both resting
and non-resting energy expenditure decreased after weight loss.
With the 10% loss, the body is now more metabolically efficient,
requiring less energy than before at rest, as well as expending less
energy during exercise. This protects against additional weight
loss.
This finding can explain many people's experience of not being
able to lose the last few pounds of a set weight-loss goal. It can
also provide a potential explanation for why it is relatively
effortless to gain lost weight back. With the body being more
metabolically efficient than before, a return to the original feeding
level after a period of weight loss through decreased caloric intake
would regain the lost weight. For individuals who are particularly
efficient, it may even lead to net weight gain.
It is unclear at present how long the larger-than-expected
decrease in energy expenditure will persist after weight loss.
Perhaps the body will eventually adjust to the new weight, and it
will be easier to maintain the reduced weight. Indeed, some
investigators have reported that, in sustained weight loss, changes
in energy expenditure eventually stabilized and were not larger
than expected.
In addition to decreasing energy expenditure, weight loss is also
associated with an increase in appetite. The increased hunger in
these subjects was associated with higher levels of fasting cortisol.
Diet-induced weight loss is also associated with increased basal
and postprandial ghrelin levels.Ghrelin is an orexigenic hormone
that is secreted primarily by the stomach and duodenum. Normally,
ghrelin levels rise before meals (associated with the urge to eat)
and are suppressed after eating. In addition to appetite stimulation,
31

the administration of exogenous ghrelin is associated with a

decrease in metabolic rate and fat catabolism. Thus, higher levels
of ghrelin after weight loss promote weight regain by two
mechanisms: an increase in energy intake combined with a
decrease in energy expenditure.
The regulation of body weight involves complex signalling
systems and compensatory changes in appetite and metabolic
efficiency. Current evidence points to the existence of a set point
that makes weight loss or gain progressively difficult. However, as
with most biological systems, there is likely to be an upper and a
lower limit for how much metabolic efficiency can change. As
long as energy expenditure exceeds that of intake, a decrease in
body weight must occur.
CENTRAL REGULATOR OF WEIGHT- BRAIN

An increasing recognition that a complex interplay exists between

the Central Nervous System (CNS) and the activity of numerous
organs involved in energy homeostasis. This requires the
transmission of key information to the brain, and control of food
intake is one component of energy balance where endocrine
signalling from the periphery to the CNS has a particularly
important role. Considered broadly, energy homeostasis consists of
the interrelated processes integrated by the brain to maintain
energy stores at appropriate levels for given environmental
conditions. Energy homeostasis thus includes the regulation of
nutrient levels in key storage organs (e.g. fat in adipose tissue and
glycogen in the liver and elsewhere) as well as in the blood (e.g.
blood glucose).
To accomplish this, the brain receives continuous information
about energy stores and fluxes in critical organs, about food that is
being eaten and absorbed, and about basal and situational energy
needs by tissues. The brain in turn controls tissues that have
important roles in energy homeostasis, like the liver and
musculoskeletal system, as well as the secretion of key
metabolically active hormones, primarily through the autonomic
32

nervous system. The brain is thus able to respond to ongoing as

well as unanticipated demands via well-coordinated responses to
prevent shortfalls in energy stores while maintaining biochemical
homeostasis. This review focuses on hormonal and related signals
that inform the brain of energy levels, thereby influencing energy
intake and ultimately body weight.
As a general rule, signals arising in the periphery that influence
food intake and energy expenditure can be partitioned into two
broad categories. One comprises the signals generated during
meals that cause satiation (i.e. feelings of fullness that contribute to
the decision to stop eating) and/or satiety (i.e. prolongation of the
interval until hunger or a drive to eat reappears). The prototypical
satiation signal is the duodenal peptide cholecystokinin (CCK),
which is secreted in response to dietary lipid or protein and which
activates receptors on local sensory nerves in the duodenum,
sending a message to the brain via the vagus nerve that contributes
to satiation.
The second category includes hormones such as insulin and
leptin that are secreted in proportion to the amount of fat in the
body. These adiposity hormones enter the brain by transport
through the blood-brain barrier and interact with specific neuronal
receptors primarily in the hypothalamus to affect energy balance.
Satiation and adiposity signals interact with other factors in the
hypothalamus and elsewhere in the brain to control appetite and
body weight.
Body weight (adiposity) is a homeostatically regulated variable,
and its long-term maintenance can only occur via a close linkage of
energy intake to energy expenditure. This means that over long
intervals, the amount of food consumed must provide energy
equivalent to the amount of energy expended. Humans and most
mammals acquire energy in discrete episodes or meals. For many
modern-day humans, the impetus to begin a meal is rarely if ever
based on a biological deficit or need such as insufficient glucose.
Rather, appetite and hunger occur, and meals are initiated
33

based on habit, time of day, specific social situations, convenience,

or stress, factors that are not linked to energy needs and so are
nonhomeostatic.
Arguably, this has been the case throughout human evolution as
well, with the initiation of feeding governed by nonhomeostatic
factors such as food availability or having a safe haven to eat.
Thus, the homeostatic influence over food intake is often left to the
control over how many calories are consumed once a meal begins;
i.e. on meal size. Consistent with this, many of the secretions of the
gastrointestinal (GI) tract during a meal, such as CCK, are
proportional to the number of calories consumed, and some of
these secretions function as satiation signals to the CNS to help
limit meal size.
In contrast to satiation signals that are physically secreted
during meals, adiposity signals are more tonically active, providing
an ongoing message to the brain proportional to total body fat.
Insulin is tonically secreted in basal amounts, with phasic
increments occurring during meals, and both components of total
insulin secretion (i.e. basal and meal-stimulated) are directly
proportional to body fat. Leptin is secreted in direct proportion to
body adiposity, following a diurnal pattern with less direct
connection to meals than insulin.
As an individual changes body weight through caloric
restriction or overeating, the amounts of insulin and leptin secreted
into the blood change in parallel, and this in turn is reflected as an
altered signal of body fatness, tantamount to body energy stores,
reaching the brain. These adiposity signals interact with anabolic
and catabolic neural circuits, causing a change in sensitivity of the
brain to satiation signals. For example, during food deprivation or
dieting, reduced brain insulin/leptin signalling renders neural
circuits controlling meal size less sensitive to satiation signals such
as CCK. As a consequence, the homeostatic setting is geared for
the intake of larger meals because more food must be consumed
before a sufficient satiation signal is generated to stop eating.
34

This situation of extra-large meals persists until body weight

(and hence the insulin/leptin signal) returns to normal. Conversely,
after excessive weight gain, the increased insulin/leptin brain
signal results in increased sensitivity to satiation signals, and
smaller meals are consumed until the excess weight is lost.

35

CONCEPTS OF UNDERWEIGHT:
OVERWEIGHT AND OBESITY
A majority of people in the world are considered underweight,
overweight and obese. With processed foods, people not exercising
and certain eating disorders, we as humans are on a path of
developing diseases that affect the health of our body
systems. The body mass index indicates what bracket a person
falls in, which is calculated by dividing a person's weight by the
square of the person's height. If a body weight is above a healthy
weight this person is considered to be overweight. Vice versa, if a
person's body weight is below a healthy weight that person is
considered underweight.
Body Mass Index (BMI) is a simple index of weight-for-height
that is commonly used to classify underweight, overweight and
obesity in adults. It is defined as the weight in kilograms divided
by the square of the height in metres (kg/m2).BMI still does not
give us information about the total fat or how the fat is distributed
in our body, which is important as abdominal excess of fat can
have consequences in terms of health problems.
A way to measure fat distribution is the circumference of the
waist. Waist circumference is unrelated to height and provides a
simple and practical method of identifying overweight people who
are at increased risk of obesity-related conditions. If waist
circumference is greater than 94-102 cm for men and 80-88 cm for
women, it means they have excess abdominal fat, which puts them
at greater risk of health problems, even if their BMI is about right.
The waist circumference measurement divides people into two
categories: individuals with an android fat distribution (often called
apple shape), meaning that most of their body fat is intraabdominal and distributed around their stomach and chest and puts
them at a greater risk of developing obesity-related diseases.
Individuals with a gynoid fat distribution (often called pear
36

shape), meaning that most of their body fat is distributed around

their hips, thighs and bottom are at greater risk of mechanical
problems (e.g. joints, thighs). Obese men are more likely to be
apples while women are more likely to be pears.
THE DYNAMICS OF ENERGY BALANCE:

The fundamental principle of energy balance is:

Changes in energy (fat) stores = energy (calorie) intake energy expenditure

Overweight and obesity are influenced by many factors including

hereditary tendencies, environmental and behavioural factors,
ageing and pregnancies. What is clear is that obesity is not always
simply a result of overindulgence in highly palatable foods or of a
lack of physical activity. Biological factors (hormones, genetics),
stress, drugs and ageing also play a role.
However, dietary factors and physical activity patterns strongly
influence the energy balance equation and they are also the major
modifiable factors. Indeed, high-fat, energy-dense diets and
sedentary lifestyles are the characteristics most strongly associated
with the increased prevalence of obesity world-wide. Conversely,
weight loss occurs when energy intake is less than energy
expenditure over an extended period of time. A restricted calorie
diet combined with increased physical activity is generally the
advice proffered by dieticians for sustained weight loss.
Miracle or wonder diets that severely limit calories or restrict
food groups should be avoided as they are often limiting in
important nutrients and/or cannot be sustained for prolonged
periods. Besides, they do not teach correct eating habits and can
result in yo-yo dieting (the gain and loss of weight in cycles
resulting from dieting followed by over-eating). This so called yoyo dieting may be dangerous to long-term physical and mental
health. Individuals should not be over ambitious with their goal
setting as a loss of just 10% of initial weight will bring measurable
health benefits.

37

THE TRENDS IN OBESITY AND OVERWEIGHT

Evidence suggesting that the prevalence of overweight and obesity

is rising dramatically worldwide and that the problem appears to be
increasing rapidly in children as well as in adults.
The most comprehensive data on the prevalence of obesity
worldwide are those of the World Health Organisation MONICA
project
(MONItoring
of
trends
and
determinants
in CArdiovascular diseases study). Together with information from
national surveys, the data show that the prevalence of obesity in
most European countries has increased by about 10-40% in the
past 10 years, ranging from 10-20% in men and 10-25% in women.
The most alarming increase has been observed in the Great Britain,
where nearly two thirds of adult men and over half of adult women
are overweight or obese. Between 1995 and 2002, obesity doubled
among boys in England from 2.9% of the population to 5.7%, and
amongst girls increased from 4.9% to 7.8%. One in 5 boys and one
in 4 girls is overweight or obese. Among young men, aged 16 to 24
years, obesity increased from 5.7% to 9.3% and among young
women increased from 7.7% to 11.6%.
THE HEALTH
OVERWEIGHT

CONSEQUENCES

OF

OBESITY

AND

The health consequences of obesity and overweight are many and

varied, ranging from an increased risk of premature death to
several non-fatal but debilitating and psychological complaints that
can have an adverse effect on quality of life.
The major health problems associated with obesity and
overweight are:
Type 2 diabetes
Cardiovascular diseases and hypertension
Respiratory diseases (sleep apnea syndrome)
Some cancers
Osteoarthritis
Psychological problems
38

A decrease in perceived quality of life

The degree of risk is influenced for example, by the relative
amount of excess body weight, the location of the body fat, the
extent of weight gain during adulthood and amount of physical
activity. Most of these problems can be improved with relatively
modest weight loss (10 to 15%), especially if physical activity is
increased too.
Type 2 diabetes
Of all serious diseases, it is Type 2 diabetes (the type of diabetes
which normally develops in adulthood and is associated with
overweight) or non-insulin-dependent diabetes mellitus (NIDDM),
which has the strongest association with obesity and overweight.
Indeed, the risk of developing Type 2 diabetes rises with a BMI
that is well below the cut-off point for obesity (BMI of 30).
Women who are obese are more than 12 times more likely to
develop Type 2 diabetes than women of healthy weight. The risk
of Type 2 diabetes increases with BMI, especially in those with a
family history of diabetes, and decreases with weightloss.
Cardiovascular Disease and Hypertension
Cardiovascular disease (CVD) includes coronary heart disease
(CHD), stroke and peripheral vascular disease. These diseases
account for a large proportion (up to one third) of deaths in men
and women in most industrialised countries and their incidence is
increasing in developing countries.
Obesity predisposes an individual to a number of cardiovascular
risk factors, including hypertension and elevated blood cholesterol.
In women, obesity is the third most powerful predictor of CVD
after age and blood pressure. The risk of heart attack for an obese
woman is about three times that of a lean woman of the same age.
Obese individuals are more likely to have elevated blood
triglycerides (blood fats), low density lipoprotein (LDL)
cholesterol ("bad cholesterol") and decreased high density
lipoprotein (HDL) cholesterol (good cholesterol). This metabolic
39

profile is most often seen in obese people with a high accumulation

of intra-abdominal fat ("apples") and has consistently been related
to an increased risk of CHD. With weight loss, the levels of
triglycerides can be expected to improve. A 10 kg weight loss can
produce a 15% decrease in LDL cholesterol levels and an 8%
increase in HDL cholesterol.
The association between hypertension (high blood pressure) and
obesity is well documented and the proportion of hypertension
attributable to obesity has been estimated to be 30-65% in Western
populations. In fact, blood pressure increases with BMI; for every
10 kg increase in weight, blood pressure rises by 2-3mm Hg.
Conversely, weight loss induces a fall in blood pressure and
typically, for each 1% reduction in body weight, blood pressure
falls by 1-2mm Hg.
The prevalence of hypertension in overweight individuals is
nearly three times higher than in non-overweight adults and the
risk in overweight individuals aged 20-44 years of hypertension is
nearly six times greater than in non-overweight adults.
Cancer
Although the link between obesity and cancer is less well defined,
several studies have found an association between overweight and
the incidence of certain cancers, particularly of hormonedependent and gastrointestinal cancers. Greater risks of breast,
endometrial, ovarian and cervical cancers have been documented
for obese women, and there is some evidence of increased risk of
prostate and rectal cancer in men. The clearest association is with
cancer of the colon, for which obesity increases the risk by nearly
three times in both men and women.
Osteoarthritis
Degenerative diseases of the weight-bearing joints, such as the
knee, are very common complications of obesity and overweight.
Mechanical damage to joints resulting from excess weight is
generally thought to be the cause. Pain in the lower back is also
40

more common in obese people and may be one of the major

contributors to obesity-related absenteeism from work.
Psychological Aspects
Obesity is highly stigmatised in many European countries in terms
of both perceived undesirable bodily appearance and of the
character defects that it is supposed to indicate. Even children as
young as six perceive obese children as lazy, dirty, stupid, ugly,
liars and cheats.
Obese people have to contend with discrimination. A study of
overweight young women in the USA showed that they earn
significantly less than healthy women who are not overweight or
than women with other chronic health problems.Compulsive
overeating also occurs with increased frequency among obese
people and many people with this eating disorder have a long
history of bingeing and weight fluctuations .
THE ECONOMIC COST OF OBESITY AND OVERWEIGHT

International studies on the economic costs of obesity have shown

that they account for between 2% and 7% of total health care costs,
the level depending on the way the analysis is undertaken. For
example, the direct cost of obesity-related diseases (including the
costs of personal health care, hospital care, physician services and
drugs for diseases with a well established relationship with obesity)
amounted to about 2% of total health care expenditure. In The
Netherlands, the proportion of the countrys total general
practitioner expenditure attributable to obesity and overweight is
around 34%.In Europe, the estimated annual financial cost of
obesity is 0.5 billion in treatment costs to the National Health
Service and the impact on the economy is estimated to be around
2 billion. The estimated human cost of obesity is 18 million sick
days a year; 30 000 deaths a year, resulting in 40 000 lost years of
working life and a shortened lifespan of nine years on average.

41

RESPONSIBLE
LIFESTYLES

FACTORS

FOR

PROMOTING

HEALTHY

Promoting healthy diets and increased levels of physical activity to

control overweight and obesity must involve the active
participation of many groups including governments, health
professionals, the food industry, the media and consumers. Their
shared responsibility is to help promote healthy diets that are low
in fat, high in complex carbohydrates and which contain large
amounts of fresh fruits and vegetables.
Greater emphasis on improved opportunities for physical
activity is clearly needed, especially with increased urbanisation,
the ageing of the population and the parallel increase in time
devoted to sedentary pursuits.
People who are obese usually over eat so when planning a diet
they should use portion controls to help measure the amount of
food they are putting into their systems. People who are
overweight and obese should not go straight into a strict diet
because that can put their body in shock and the outcome won't be
healthy. Here are a couple of things that people should do to get
fit:

1. Eat periodically
2. Stop eating a few hours before bed
3. Exercise-even walking is better than doing nothing
With setting goals, aiming for a target, limit calories and reducing
alcohol intake you can be on your way to a healthy stage. The
problem with diets is that people will lose weight and will gain
back immediately. If you just watch what you eat and exercise, in
time you will get healthy.
There are a number of risks associated with underweight,
overweight and obese people. People who are underweight
experience a complete lack of nutrients, they deteriorate a lot
quicker without food because of the lack of nutrients and
energy. Another effect of underweight people is that when they get
42

cancer they end up dying from starvation. On the other side of the
spectrum, overweight and obese people experience risks such as:
increase risk of heart attack, diabetes, hypertension, kidney stones
and a great deal more.
WEIGHT LOSS

Calories are found in most foods. When you consume calories

your body uses them as fuel. The leftover calories that your body
doesn't use are stored as fat.

One pound of fat is roughly 3,500 calories.

The BMR, also known as Basal Metabolic Rate, is the number
of calories your body burns in a single day from performing basic
functions like breathing and pumping blood.When you create a
deficit your body will turn to the in your fat stores to function
properly -- burning those unwanted pounds away.In order to lose
one pound of fat you need to create a caloric deficit of 3,500
calories. This means youneed a deficit of around 500 calories per
day in order to lose one pound per week.
TO CREATE A CALORIE DEFICIT

Change your diet and eat fewer calories than you burn each day. If
you eat 500 fewer calories than your BMR each day for a week,
you'll lose about one pound of fat.
Introducing physical activity and burning more calories than
you consume:If you eat enough calories to support your BMR, but
exercise more, you'll create a caloric deficit simply by burning
extra calories.
A combination of eating fewer calories and exercising to burn
more calories: If you cut just 200 calories a day from your diet
and burned just 300 extra calories a day by exercising, you'd lose
about one pound per week.A combination of diet and exercise is
the easiest way to lose weight because it requires only small
tweaks to your lifestyle.
For exampleEliminate Calories
43

1 Can of Soda = 140 Calories

1 TBSP of Butter = 102 Calories
Add Physical Activity
20 Minutes of Circuit Training = 113 Calories
30 Minutes of Walking = 179 Calories
___________________________
Total Deficit: 525 Calories
Understanding how calorie deficit works, is just the first step to
finding and sticking to a weight loss program that works for you.
FAT LOSS

The fat loss has become important for all of us, whether were
losing weight for our health, the beach, or a contest, we follow all
kinds of diets and workout routines in an attempt to lose fat. This is
strange considering that if you grasp an understanding for how fat
is stored and utilized you will increase your chances of losing it
and seeing the errors in a diet.
MEAL TIMING

The reasoning behind having anywhere from 5-7 meals a day is not
to speed up your metabolism but to provide proper insulin control.
Insulin is responsible for pulling amino acids, glucose, and
triglycerides from the blood and shuttling them where necessary. If
your cells are active (working muscle, recovering muscle cells)
they will be used for fuel; if they are dormant (adipose tissue), they
will be stored as fat. Now to time your meals properly, you must
understand the timing behind fat; triglyceride levels peak at about
4 hours after a meal, so your largest meal of the day should be
early or around lunch time, and not late at night if your goal is to
reduce body fat.
Knowing the timing behind insulin is important as well, insulin
tends to remain elevated after a meal anywhere between 90
minutes to 4 hours after a meal, and so reducing carbohydrates up
to 4 hours pre-exercise would be optimal. Exercising on an empty
stomach or starvation cardio as it is called before breakfast in the
44

morning is not recommended. The body uses fuel based on what it

can generate ATP (energy) with the fastest.
It begins with creatine phosphate, then glycogen, protein, then
fat. Fat takes the longest to generate energy (this is the reasoning
behind low-intensity steady state cardio to use fat as a fuel source)
but it provides the most ATP (it contains the most energy, which is
why it is 9 calories per gram as opposed to 4 like carbohydrates or
fat). So based on this, if you begin doing cardio while levels of
glycogen (the storage form of carbohydrates in the body) are low,
your body will begin to pull amino acids from muscle to use as
fuel; only after this happens will your body begin to utilize fat.
Here are two sample macronutrient schedules based on morning
training and evening training to maximizefat loss. The actual
macronutrient amounts are relative based on weight and will be
discussed later in this article. When zero carbohydrates are
referenced, a lean animal meat source (fish, chicken breast, turkey
breast) or protein powder is suggested. When low fat is being
referenced, then it is best to only have your fats come from the
meat in your protein source.
It is advantageous to utilize a low carbohydrate diet that
employs more fats. However, for natural weightlifters
the protein sparing and glycogen replenishing effects of
carbohydrates are necessary to maintain muscle mass and the
volume of exercise needed to burn the necessary amount of
calories. Despite the abundance of calories contained in fat
however, there is no conclusive research that shows a link between
fat and improved performance.
Morning Workout Plan
Breakfast: protein, 0 carbs, low fat
Training and Cardio
Post-exercise: protein, carbohydrates, 0 fat
Lunch: protein, carbs, fat
Snack: protein, carbs, low fat
45

Dinner: protein, carbs, low fat

Bedtime snack: protein, 0 carbs, 0 fat
Evening Workout Plan
Breakfast: protein, carbs, low fat
Snack: protein, carbs, low fat
Lunch: protein, carbs, fat
Pre-exercise: protein, 0 carbs, low fat
Training and Cardio
Post-exercise: protein, carbohydrates, 0 fat
Bedtime snack: protein, 0 carbs, 0 fat
TOTAL MACRONUTRIENTS FOR THE DAY

As far as dividing up your total macronutrients for the day, a

relatively higher carbohydrate, moderate protein, low fat diet is
coming back into style for natural bodybuilders. To optimize fat
loss, a low carbohydrate or carbohydrate cycling phase is still best
when coming into the final weeks to optimize conditioning and
take advantage of carbohydrate loading. However, continuing a
low carbohydrate diet for extended periods of time for a natural
lifter will almost always lead to large amounts of muscle wasting
as your body will breakdown muscle for fuel.
Fat is still required in the diet to maintain healthy levels
of testosterone and your dietary fat will come from your chicken,
fish, and red meat once or twice a week. Natural bodybuilder Alex
Stewart currently has a thread on his current progress with this
style of dieting.
The reason for having a higher ratio of carbohydrates is
important when being involved in caloric restriction is that it can
reduce oxidative stress and increase your lifespan. This is
important because this is evidence that it is a diet that can be
maintained for extended periods of time without the stress, fatigue,
and cardiovascular damage of a high fat low carbohydrate diet.

46

Imagine if you were a natural bodybuilder preparing for a show,

what would you prefer: 8-12 weeks of stressful low carbohydrate
diet, or 12-16 weeks of a diet that provides you with plenty of
energy, easy to find foods, and now stress until the final 4 weeks
when carbohydrate cycling is incorporated. This macronutrient
profile is especially effective for those who arent bodybuilders
since finding low fat, carbohydrate foods and snacks are much
easier than having low carbohydrate meals or snacks on the go.
Carbohydrates are proven for providing satiation and the feeling
of fullness, however there is not enough evidence to prove that the
high caloric count of fat provides the necessary feeling of fullness
required for a diet. At 9 calories per gram it is too easy to
overshoot the amount of calories you plan to provide yourself for
the day, while at 4 calories per gram you could have almost twice
as much carbohydrate. Anyone who has been on a calorically
restricted diet that incorporated fats outside of what was naturally
occurring in their foods can attest to how hard it is to stop eating
nuts, or to limit their scoops of peanut butter.
To calculate the number of calories to take in and the ratio of
macronutrients, use a calorie calculator to determine the number of
calories you require for maintenance and reduce that number by
about 600 calories or by about 20%.
The diet itself will be broken up into 50% carbohydrates,
35% protein, and 15% fat. While dieting you will only need
enough protein every 3 hours to maintain a positive nitrogen
balance, the relatively high ratio of carbohydrates will spare
muscle protein during caloric restriction and provide energy for
your workouts. The timing of your carbohydrate intake will allow
insulin levels to subside before your workout allowing for more fat
utilization during the workout itself and the subsequent cardio.
SUPPLEMENTATION

A supplement that has much research to support its acute (shortterm, usually 2 weeks or less) effectives are the Medium Chain
47

Triglycerides. They are a form of fat this is broken down quickly

and used readily as fuel. It was suspected that athletes with a
higher fat utilization like long distance runners could benefit from
supplementing with this fat but the results were inconclusive .
However, they are research proven to provide a thermogenic
effect as a result of fat oxidation and increase fat utilization. This
fits perfectly into the diet during the final weeks when you take
advantage of the rapid, short term fat loss associated with low
carbohydrate dieting. Because the effects last less than 2 weeks it
is best used in conjunction with carbohydrate cycling during the
low or no carbohydrate days as your supplementary fat.
DIFFERENCE BETWEEN WEIGHT LOSS AND FAT LOSS

There is a big difference between losing weight and losing fat. The

goal should never be to loseweight, but instead should always be to

lose fat. When you lose weight, you lose a little bit of everything-fat, muscle, fluids, organ size. You want the majority of your
weight loss to come from fat, not the other stuff. If you are only
concerned with seeing a smaller number on the scale, you may be
losing valuable muscle instead, which will result in long-term
weight--meaning fat--gain.
BODY FAT TESTING

To determine whether youre losing weight or fat, perform a body

fat test. If youre a female who weighs 150 pounds, with 35
percent fat, youre carrying around more than 52 pounds of fat.
Ideally, a healthy woman will be around 25 percent fat, or about 37
pounds, so a loss of 15 pounds of fat would be required to reach a
healthier level. Say you lost 20 pounds total, but only 10 pounds of
it came from fat stores. You would still be at an unhealthy 32
percent fat. To reach the 25 percent body fat level, all 20 pounds
must come from fat.
DEHYDRATION IS NOT REAL WEIGHT LOSS

One of the quickest weight loss tricks that has nothing to do with
fat loss is from being dehydrated. If you lose weight because
48

youre dehydrated, youve only lost water, and those pounds will
come right back. Dont fool yourself into thinking those pounds are
really gone. You still have just as much fat on your body as before.
In fact, without hydration, the muscles will shrivel up because
water keeps them plump and vital, leaving you lighter, but without
any energy or strength.
When losing weight, the way to lose just fat is by adding
strength training into fitness program. Dont try to lose weight
simply by performing cardio. The pounds you lose through cardio
will come right back if you stop the cardio, without muscle mass to
keep the weight off. Dont worry about bulking up or gaining too
much muscle. For the majority of the population, its simply not a
concern. When you add muscle, you improve the body fat
composition ratio, which is the main goal.
LOSING MUSCLE SLOWS METABOLISM

Losing weight other than fat is unavoidable, but the loss of muscle
mass will cause a rebound effect that leads to weight gain. Muscle
is metabolically active and lights your furnace, keeping your
metabolism brisk and burning calories. Even when youre sitting
on the couch, you burn more calories if you have more muscle
mass on your frame. So losing muscle means your furnace slows
down, your metabolism gets sluggish and the weight keeps on
coming.
LOSE FAT TO GET HEALTHY

Losing weight can leave you looking like a smaller version of a fat
person because you have no muscle tone underneath your skin. To
look like a fit, healthy person, losing fat and having muscle is
absolutely necessary. Hit the weights. If you dont know what
youre doing, get some help because its important to do strength
training properly to avoid injury.

49

PART II
UNDERSTANDING
OBESITY/OVERVIEW
OF OBESITY

50

OBESITY
WHAT IS OBESITY?

Obese people accumulate so much of body fat that it might have a

negative effect on their health. If a person's bodyweight is at least
20% higher than it should be, he or she is consideredobese. If your
Body Mass Index (BMI) is between 25 and 29.9 you are
considered overweight. If your BMI is 30 or over you are
considered obese.
WHY DO PEOPLE BECOME OBESE?
People become obese for several reasons, including:

-Body mass measurement

-Consuming too many calories
People are eating much more than they used to. This used to be the
case just in developed nations- however, the trend has spread
worldwide. Despite billions of dollars being spent on public
awareness campaigns that attempt to encourage people to eat
healthily, the majority of us continue to overeat.Most people would
expect this increase in calories to consist of fat - not so! Most of
the increased food consumption has consisted of carbohydrates
(sugars). Increased consumption of sweetened drinks has
contributed significantly to the raised carbohydrate intake of most
young American adults over the last three decades. The
consumption of fast-foods has tripled over the same period.
Various other factors also may have contributed to Indias
increased calorie and carbohydrate intake:
Agricultural policies in most of the developed world have led
to much cheaper foods.
The Indian Agricultural Bill meant that the source of processed
foods came from subsidized wheat, corn and rice. Corn, wheat
and rice became much cheaper than fruit and vegetables.
Leading a sedentary lifestyle:With the arrival of televisions,
computers, video games, remote controls, washing machines,
51

dish washers and other modern convenience devices, the

majority of people are leading a much more sedentary lifestyle
compared to their parents and grandparents. Some decades ago
shopping consisted of walking down the road to the high street
where one could find the grocers, bakers, banks, etc. As large
out-of-town supermarkets and shopping malls started to appear,
people moved from using their feet to driving their cars to get
their provisions. In some countries, such as the USA,
dependence on the car has become so strong that many people
will drive even if their destination is only half-a-mile away.The
less you move around the fewer calories you burn. However,
this is not only a question of calories. Physical activity has an
effect on how your hormones work, and hormones have an
effect on how your body deals with food. Several studies have
shown that physical activity has a beneficial effect on your
insulin levels - keeping them stable. Unstable insulin levels are
closely associated with weight gain. Children who have a
television in their bedroom are much more likely to be obese or
overweight than kids who do not.
Not sleeping enough:If you do not sleep enough your risk of
becoming obese doubles, according to research carried out at
Warwick Medical School at the University of Warwick. The
risk applies to both adults and children. Professor Francesco
Cappuccio and team reviewed evidence in over 28,000 children
and 15,000 adults. Their evidence clearly showed that sleep
deprivation significantly increased obesity risk in both groups.
Cappuccio said, "The 'epidemic' of obesity is paralleled by a
'silent epidemic' of reduced sleep duration with short sleep
duration linked to increased risk of obesity both in adults and in
children. These trends are detectable in adults as well as in
children as young as 5 years."Professor Cappuccio explains
that sleep deprivation may lead to obesity through increased
appetite as a result of hormonal changes. If you do not sleep
enough you produce Ghrelin, a hormone that stimulates
appetite. Lack of sleep also results in your body producing less
Leptin, a hormone that suppresses appetite.
52

Endocrine disruptors, such as some foods that interfere

with lipid metabolism:A team from the University of
Barcelona (UB) led by Dr Juan Carlos Laguna published a
study in the journal Hepatology that provides clues to the
molecular mechanism through which fructose (a type of sugar)
in beverages may alter lipid energy metabolism and cause fatty
liver and metabolic syndrome.Fructose is mainly metabolized
in the liver, the target organ of the metabolic alterations caused
by the consumption of this sugar. In this study, rats receiving
fructose-containing beverages presented a pathology similar to
metabolic syndrome, which in the short term causes lipid
accumulation (hypertriglyceridemia) and fatty liver, and
eventually leads to hypertension, resistance to insulin, diabetes
and obesity.Poorly balanced diets and the lack of physical
exercise are key factors in the increase of obesity and other
metabolic diseases in modern societies.
Although there appears to be a consensus on the negative
effects of fructose-sweetened beverages, there is still some
debate over the effects of fructose versus high fructose corn
syrup - two studies are worth to be mentioned here:
"IMA Finds High Fructose Syrup Unlikely To Be More
Harmful To Health Than Other Caloric Sweeteners" and
"Fructose Sweetened Drinks Increase Nonfasting Triglycerides
In Obese Adults".Fructose effect on the brain may promote
obesity - researchers from Yale University School of Medicine
compared the effects of fructose and glucose on the brain with
MRI scans and found that high fructose diets may be behind
the current obesity epidemic.
Lower rates of smoking (smoking suppresses appetite):
According to the National Institutes of Health (NIH) "Not
everyone gains weight when they stop smoking. Among people
who do, the average weight gain is between 6 and 8 pounds.
Roughly 10 percent of people who stop smoking gain a large
amount of weight - 30 pounds or more."
Medications that make patients put on weight:According to
an article in Annals of Pharmacotherapy, some medications
53

cause weight gain. "Clinically significant weight gain is

associated with some commonly prescribed medicines. There is
wide inter-individual variation in response and variation of the
degree of weight gain within drug classes. Where possible,
alternative therapy should be selected, especially for
individuals predisposed to overweight and obesity."
The longer a person is overweight, the harder it becomes
for them to lose weight: Many have wondered whether obesity
itself becomes a permanent state, i.e. does obesity promote
obesity? Researchers from the University of Michigan and the
National Council of Science and Technology (COINCET) in
Argentina, reported in the Journal of Clinical Investigation that
in animal experiments, obesity seems to become a selfperpetuating state.
They found that the normal body weight of mice that become
obese starts going up; their bodies perception of normal
weight becomes a heavier than before, regardless of whether
they are made to go on diets which had made them lose weight.
Senior author, Malcolm J. Low, M.D., Ph.D., said "Our model
demonstrates that obesity is in part a self-perpetuating disorder
and the results further emphasize the importance of early
intervention in childhood to try to prevent the condition whose
effects can last a lifetime. Our new animal model will be used
in pinpointing the reasons why most adults find it exceedingly
difficult to maintain meaningful weight loss from dieting and
exercise alone."Lead researcher, RacherBatterham, explained
that people who carry the FTO gene variant tend to eat too
much, prefer high-energy, fatty foods, and are usually obese.
They also appear to take much longer to reach satiety (feeling
of being full).
TYPES OF OBESITY

Type-1 and Type-2 Obesity

Type-1 obesity is not caused by a disease and, in most cases, it is
caused by excessive eating habits and lack of exercise. Type-1
54

obesity can be treated with general obesity treatment methods like

simultaneous dietetic treatment and exercise. But type-2 obesity
requires that the underlying disease be treated first. Usually,
obesity goes away naturally after the underlying disease has been
treated.
Type-2 obesity accounts for less than 1% of obesity cases and is
caused by a disease; abnormal weight gains occur with type-2
obesity even when little is eaten. Cushing syndrome,
hypothyroidism, polycystic ovarian disease, and insulinoma, are
some internal secretion diseases that cause type-2 obesity. Cushing
syndrome is characterized by thinning arms and legs and
abdominal obesity, whereby fat gathers around the body, and in
some instances, the hypodermis cracks from sudden weight gain
causing line marks on the abdomen, groin, underarm, and back.
Persons with hypothyroidism experience a drop in their
metabolism, and weight gain occurs as a result of low calorie
consumption.
Child-type and Adult-type Obesity
Although obesity may look same from outside, a full examination
reveals that there's a considerable amount of personal difference in
the number and size of fat cells. According to the size and number
of fat cells, obesity can be divided into adult-type, where only the
size of fat cells is increased, and child-type, where the number of
fat cells is increased.
The number of fat cells increases the most during the year after
birth. People who have always been obese since childhood, have 34 times more fat cells than people who became obese as adults.
With adult-type obesity, the number of fat cells is close to normal,
but the size increases. This happens mostly after middle age. But
generally, the reason child-type obesity is more dangerous and
important than adult-type obesity is because it is extremely
difficult to reduce the number of fat cells already made. Therefore,
treatment is much more effective for adult-type obesity, where the

55

enlarged fat cells just have to be returned to their original state,

than for child-type obesity.
Abdominal Obesity and Limb Obesity
Depending on where fat is stored on the body, obesity can be
divided into abdominal obesity and limb obesity. Abdominal
obesity is when fat is mostly distributed over the abdomen and
back, and limb obesity is when fat is concentrated around the
thighs, arms, legs, and buttocks. Abdominal obesity occurs mainly
in men; limb obesity occurs primarily in women.

The reason the distribution of fat is significant is because

depending on where it's concentrated the danger level for adult
diseases changes. So with abdominal obesity there's a higher
danger of ischemic heart disease, diabetes, and hyperlipidemia.
This is because low protein steatolytic enzymes, which breakdown
nutrients into triglycerides and store them in fat cells, are very
active within abdominal fat.
METABOLISM AND OBESITY

Over the long-term, most adult humans are able to maintain their
body energy stores through the process of energy balance, which
regulateshow much energy is consumed to match how much
energy is expended.The expenditure of energy is required for
resting metabolic rate to maintainbasic physiologic functions (e.g.,
heartbeat, muscle function, respiration)and metabolize, digest, and
store food that is consumed as well as forphysical activity.
A Resting metabolic rate is the largest component of
dailyenergy expenditure, and physical activity-related energy
expenditure isthe most variable,but some longitudinal studies
support the idea that reduced energyexpenditure is a risk factor for
the development of obesity.
There are several possibilities that could account for such
discrepantfindings.

56

First, the ambiguous findings in the literature might be explained

by the possibility that differences in energy expenditure
andphysical activity and their impact on the development of
obesity aredifferent at the various stages of maturation.
Second, there could beindividual differences in the impact of
altered energy expenditure onthe regulation of energy balance. The
impact of energy expenditure onthe cause of obesity could vary
among different subgroups of the population (e.g., boys versus
girls and different ethnic groups) and couldhave a differential
effect within individuals at different stages of development.
Third, given that obesity can arise as aresult of a small energy
balance over time, it is unlikely that existingtechniques are capable
of measuring such small differences.
Finally, itcan be argued that a focus on energy metabolism as a
possible explanation of obesity is unlikely to yield interesting
information because of thewide range in energy expenditure in the
population even after adjustingfor body composition. The major
dependent variable that needs to beexamined in relation to the
cause of obesity is not energy expenditurebut change in energy
balance over time and the ability to regulate bodyenergy stores.
Given that the sudden change in obesity prevalence has occurred
during a time of rapid environmental and cultural
changes,additional focus on the behavioral and environmental
effects on regulation of energy balance is warranted.
There are physiologic and genetic influences on the various
components of energy metabolism and body weight regulation,
anda major portion of individual differences in body weight can be
explained by genetic difference, it seems unlikely that the
increasedglobal prevalence of obesity has been driven by a
dramatic change inthe gene pool. It is more likely and more
reasonable that acute changesin behavior and environment have
contributed to the rapid increase inobesity, and genetic factors may
be important in the deferring individualsusceptibilities to these
changes.

57

The most striking behavioral change that has occurred is an

increased reliance on high-fat andenergy-dense fast foods, with
larger portion sizes, coupled with an ever-increasing sedentary
lifestyle. The more sedentary lifestyle is due to anincreased
reliance on technology and laborsaving devices, which hasreduced
the need for physical activity for everyday activities. Examplesof
energy-saving devices that have resulted in a decline in
physicalactivity include,
(1)To increase the use of automated transport rather thanwalking
or biking;
(2)The central heating and use of automated equipmentin the
household, such as washing machines;
(3)The reduction in physicalactivity in workplace as a result of
computers, automated equipment,and electronic mail, which all
reduce the requirement for physical activity at work;
(4)To increase the use of television and computers for
entertainment and leisure activities;
(5)The use of elevators and escalators rather thanstairs;
(6) The increased concern for crime, which has reduced the
likelihoodof outdoor playing;
(7)The poor urban planning, which does not provideadequate
biking paths or sidewalks in some communities. The
increasingprevalence, numerous health risks, and astounding
economic costs ofobesity clearly justify widespread efforts toward
prevention efforts.
Myth and Obesity
Many widely held beliefs about obesity and weight loss don't stand
up to scientific scrutiny, say doctors who want to set the public
health record straight on myths like the calorie-burning benefits of
sex or the value of eating breakfast.
In online issue of the New England Journal of Medicine, U.S.
doctors tackle seven obesity-related myths commonly found in the
media and material from government agencies as well as six

58

presumptions thought to be true despite a lack of convincing

evidence.
The myths and facts are:
Myth 1: Small, continued changes in our caloric intake or how
many we burn will accumulate to create a larger weight change
over the long term.
Fact: Little changes in caloric intake or burning do not build-up
indefinitely. Body mass changes eventually cancel out any
change in calorie burning or intake.
Myth 2: Realistic goal-setting in obesity treatment is
essential.If no goals are met, patients can become frustrated
and lose less weight.
Fact: Some data points out that people achieve more by setting
more challenging goals.
Myth 3: Slowing losing weight is better than shedding
thepounds quickly. Quick weight losses are likely to be gained
back.
Fact: People who lose weight quickly are actually more likely
to weigh less after many years.
Myth 4: You will only lose weight when you are "ready" to
doso. Health-care professionals should measure each patient's
diet readiness.
Fact: Among people who seek weight loss treatment, research
suggests that examining readiness does not predict weight loss
or helps to make it happen.
Myth 5: Childhood gym classes in their current state, play
animportant role in the prevention of childhood obesity.
Fact: Physical education classes currently do not appear to
counteract obesity.
Myth 6: Breastfeeding helps prevent future obesity for
thebreastfed baby.
Fact: Although breastfeeding has advantages for both mother
and child, data does not confirm that it protects against obesity.
59

Myth 7: One act of sex can burn up to 300 kcals per person.
Fact: In reality, it is just about one-twentieth of that on average,
and not much more than resting on the couch.

60

ASSESSMENT TOOLS AND STRATEGIES

MEASUREMENT OF OBESITY

The most basic method, and the most common, is the Body
Mass Index (BMI). Doctors can easily calculate BMI from the
heights and weights they gather at each checkup; BMI tables
and online calculators also make it easy for individuals to
determine their own BMIs.
The BMI and other so-called field methodsamong them,
waist circumference, waist-to-hip ratio, skin fold thicknesses,
and bioelectrical impedanceare useful in clinics and
community settings, as well as in large research studies.
More sophisticated methods, such as magnetic resonance
imaging or dual energy X-ray absorptiometry, are so-called
reference measurementstechniques that are typically only
used in research studies to confirm the accuracy of (or as
scientists say, to validate) body measurement techniques.
Several methods cant be used in children or pregnant women,
due to safety concerns, or are less accurate in people who are
very overweight.
Body Mass Index (BMI)
Body Mass Index (BMI) is the ratio of weight to height, calculated
as weight (kg)/height (m2), or weight (lb)/height (in2) multiplied by
703.
Advantages
Easy to measure
Inexpensive
Standardized cut-off points for overweight and obesity: Normal
weight is a BMI between 18.5 and 24.9; overweight is a BMI
between 25.0 and 29.9; obesity is a BMI of 30.0 or higher.
Strongly correlated with body fat levels, as measured by the
most accurate methods.
61

Hundreds of studies show that a high BMI predicts higher risk

of chronic disease and early death.
Limitations
Indirect and imperfect measurementdoes not distinguish
between body fat and lean body mass
Not as accurate a predictor of body fat in the elderly as it is in
younger and middle-aged adults
At the same BMI, women have, on average, more body fat than
men, and Asians have more body fat than whites
Waist Circumference
Waist circumference is the simplest and most common way to
measure abdominal obesitythe extra fat found around the
middle that is an important factor in health, even independent of
BMI. Its the circumference of the abdomen, measured at the
natural waist (in between the lowest rib and the top of the hip
bone), the umbilicus (belly button), or at the narrowest point of the
midsection.
Advantages
Easy to measure
Inexpensive
Strongly correlated with body fat in adults as measured by the
most accurate methods.
Studies show waist circumference predicts development of
disease and death.
Limitations
Measurement procedure has not been standardized.
Lack of good comparison standards (reference data) for waist
circumference in children.
May be difficult to measure and less accurate in individuals
with a BMI of 35 or higher.

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Waist-to-Hip Ratio
Like the waist circumference, the Waist-to-Hip Ratio (WHR) is
also used to measure abdominal obesity. Its calculated by
measuring the waist and the hip (at the widest diameter of the
buttocks), and then dividing the waist measurement by the hip
measurement.
Advantages
Good correlation with body fat as measured by the most
accurate methods
Inexpensive
Studies show waist-to-hip ratio predicts development of disease
and death in adults.
Limitation
More prone to measurement error because it requires two
measurements.
More difficult to measure hip than it is to measure waist.
More complex to interpret than waist circumference, since
increased waist-to-hip ratio can be caused by increased
abdominal fat or decrease in lean muscle mass around the hips.
Turning the measurements into a ratio leads to a loss of
information: Two people with very different BMIs could have
the same WHR.
May be difficult to measure and less accurate in individuals
with a BMI of 35 or higher.
Skin fold Thickness
In this method, researchers use a special caliper to measure the
thickness of a pinch of skin and the fat beneath it in specific
areas of the body (the trunk, the thighs, front and back of the upper
arm, and under the shoulder blade). Equations are used to predict
body fat percentage based on these measurements.

63

Advantages
Convenient
Safe
Inexpensive
Portable
Fast and easy (except in individuals with a BMI of 35 or higher)
Limitations
Not as accurate or reproducible as other methods.
Very hard to measure in individuals with a BMI of 35 or
higher.
Bioelectric Impedance (BIA)
BIA equipment sends a small, imperceptible, safe electric current
through the body, measuring the resistance. The current faces more
resistance passing through body fat than it does passing through
lean body mass and water. Equations are used to estimate body fat
percentage and fat-free mass.
Advantages
Convenient
Safe
Relatively inexpensive
Portable
Fast and easy
Limitation
Hard to calibrate
The ratio of body water to fat may change during illness,
dehydration or weight loss, decreasing accuracy.
Not as accurate as other methods, especially in individuals with
a BMI of 35 or higher
Underwater Weighing (Densitometry)
Individuals are weighed in air and while submerged in a tank.
Researchers use formulas to estimate body volume, body density,
64

and body fat percentage. Fat is more buoyant (less dense) than
water, so someone with high body fat will have a lower body
density than someone with low body fat. This method is typically
only used in a research setting.This tool is very accurate.
Limitations
Time consuming
Requires individuals to be submerged in water.
Generally not a good option for children, older adults, and
individuals with a BMI of 40 or higher.
Air-Displacement Plethysmography
This method uses a similar principle to underwater weighing but
can be done in the air instead of in water. Individuals sit in a small
chamber wearing a bathing suit; one commercial example is the
Bod Pod. The machine estimates body volume based on air
pressure differences between the empty chamber and the occupied
chamber.
Advantages
Relatively quick and comfortable
Accurate
Safe
Good choice for children, older adults, pregnant women,
individuals with a BMI of 40 or higher, and other individuals
who would not want to be submerged in water.
Dilution Method (Hydrometry)
Individuals drink isotope-labelled water and give body fluid
samples. Researchers analyze these samples for isotope levels,
which are then used to calculate total body water, fat-free body
mass, and in turn, body fat mass.
Advantages
Relatively low cost
Accurate
65

Safe
Can be used in individuals with a BMI of 40 or higher, as well
as in children and pregnant women
Limitations
The ratio of body water to fat-free mass may change during
illness, dehydration, or weight loss, decreasing accuracy.
Dual Energy X-ray Absorptiometry (DEXA)
X-ray beams pass through different body tissues at different rates.
So DEXA uses two low-level X-ray beams to develop estimates of
fat-free mass, fat mass, and bone mineral density. DEXA is
typically only used for this purpose in research settings.
Limitations
Equipment is expensive and cannot be moved
Cannot accurately distinguish between different types of fat (fat
under the skin, also known as subcutaneous fat vs. fat around
the internal organs, or visceral fat)
Cannot be used with pregnant women, since it requires exposure
to a small dose of radiation
Most current systems cannot accommodate individuals with a
BMI of 35 or higher
Computerized Tomography (CT) and Magnetic Resonance
Imaging (MRI)
These two imaging techniques are now considered to be the most
accurate methods for measuring tissue, organ, and whole-body fat
mass as well as lean muscle mass and bone mass. CT and MRI
scans are typically only used for this purpose in research settings.
Use of this Tool is due to its
Accuracy
Allows for measurement of specific body fat compartments,
such as abdominal fat and subcutaneous fat.

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Limitations
Equipment is extremely expensive and cannot be moved.
CT scans cannot be used with pregnant women or children, due
to the high amounts of ionizing radiation used.
Some MRI and CT scanners may not be able to accommodate
individuals with a BMI of 35 or higher.
METABOLIC RATE

Metabolism: Metabolism is the speed at which calories are

consumed (burned). A high metabolism indicates that calories are
being burned faster.
Calorie: A calorie is a measure of heat, and is a way to keep track
of the "fuel" value of food. The calories that appear on food labels
represent the potential energy, or fuel, that the food contains.
Resting Metabolic Rate(RMR):Resting Metabolic Rate is the
amount of calories you burn in a day (24 hours) if you were to rest
all day, quietly lying down. RMR is the amount of calories that
your body burns to maintain normal body functions such as
breathing, heartbeat, thinking, etc. Your RMR accounts for about
80% of all the calories that you burn.
MetaCheck measurement of metabolic rate: For every calorie
your body burns, it consumes a fixed amount of oxygen. Actually,
your body is burning (also called, oxidizing) foodthis is why our
internal temperature is 98.6 degrees Fahrenheit, rather than the
same as the air around us. Metacheck measures the oxygen you
inhale then calculates the precise number of calories you are
burning. Volume of Oxygen (V02) is a scientific, or medical,
notation for the rate at which Oxygen (02) is consumed. RMR is
calculated directly from the V02 that is measured during the test.
Total Metabolic Rate (TMR):Total Metabolic Rate is the number
of calories burned in a day including calories burned due to normal
daily activities such as walking, working, etc. This is also referred
to as Total Energy Expenditure (TEE). Taking into account the
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sorts of activities that are typically included in your day, we can

then estimate Total Energy Expenditure. Our measurement of
Resting Metabolic Rate is a direct and accurate measurement
which is our primary interest about your nutritional functioning.
Total Energy Expenditure depends on activity level, which you
control with the advice of your nutritionist.
Body Composition: Body Composition is the measurement of the
percent of our weight that is fatty tissue and what percent are
muscle and other tissue. Our total weight consists of bones,
muscle, fat, water, etc. We need it all to be healthy, including fat!
Tanita measurement of Body Composition:The Tanita machine
measures what is called electrical impedance. Measured in Ohms,
the impedance value reflects how hard a mild electrical signal has
to work to travel through the body. Lean mass (containing water
and electrolytes) conducts the current, while fat mass acts as a
resistor to the current. Standing on the machine, a very mild
electrical current is passed through the body and we measure how
much resistance occurs. You cannot feel the current at all.
With Tanita measurement, we can also measure your hydration
level. Hydration level is the amount of water you have in your
body.
Resting Metabolic Rate and Body Composition Assessments:

The Resting Metabolic Rate (RMR) is the amount of energy

(measured in calories) our body uses at rest. Knowing how many
calories your body needs in a day is essential to weight loss. Any
caloric deficit will result in weight loss but the type of weight lost
determines whether it will be a long term change or whether the
weight is likely to be regained once you return to a normal caloric
intake. With most calorie restrictive diets, the body will shed a
combination of muscle and fat. As the body loses muscle your
daily caloric requirement drops.
The RMR indicates the number of calories the body requires for
the functioning of organs. This provides a baseline that can be
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added to the number of calories burned during daily activity and

exercise. This information allows you to more accurately modify
your intake to reach your goals. Keeping your daily caloric
intake 10-15% below your daily caloric requirement helps
ensure your weight loss is fat loss.
Tracking RMR regularly gives us a window into the type of
weight you are losing.This information is then combined with
changes in your body composition. Using skin-fold calipers, the
first set of measurements act as a benchmark to compare future
results to so that we can evaluate changes. If we can maintain or
increase your RMR and lower the skin fold measurements we
know that we are maintaining or increasing muscle mass while
losing fat which is our goal.
BODY SIZE AND SHAPE

The human development isthe process of growth and change that

takes place between birth and maturity.Human growth is far from
being a simple and uniform process of becoming taller or larger.
As a child gets bigger, there are changes in shape and in tissue
composition and distribution.
In the newborn infant the head represents about a quarter of the
total length; in the adult it represents about one-seventh. In the
newborn infant the muscles constitute a much smaller percentage
of the total body mass than in the young adult. In most tissues,
growth consists both of the formation of new cells and the packing
in of more protein or other material into cells already present; early
in development cell division predominates and later cell filling.
INTRODUCTION OF HUMAN BODY

The human body is a single structure but it is made up of billions

of smaller structures of four major kinds:
Cells:
Cells have long been recognized as the simplest units of living
matter that can maintain life and reproduce themselves. Human
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body, which is made up of numerous cells, begins as a single,

newly fertilized cell.
Tissues:
Tissues are somewhat more complex units than cells. A tissue is an
organization of a great many similar cells with varying amounts
and kinds of non living, intercellular substance between them.
Organs:
Organs are more complex units than tissues. An organ is an
organization of several different kinds of tissues so arranged that
together they can perform a special function. For example, the
stomach is an organization of muscle, connective, epithelial, and
nervous tissues. Muscle and connective tissues form its wall,
epithelial and connective tissues form its lining, and nervous tissue
extends throughout both its wall and its lining.
Systems:
Systems are the most complex of the component units of the
human body. A system is an organization of varying numbers and
kinds of organs so arranged that together they can perform
complex functions for the body. Ten major systems that compose
the human body are:
Skeletal
Muscular
Nervous
Endocrine
Cardiovascular
Lymphatic
Respiratory
Digestive
Urinary
Reproductive
Human body shapeis a complex phenomenon with sophisticated
details and functions. The general shape or figure of a person is
defined mainly by the molding of skeletal structures, as well as the
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distribution of muscles and fat. Skeletal structure grows and

changes only up to the point at which a human reaches
adulthood and remains essentially the same for the rest of his or
her life.
BODY CHANGES DURING PUBERTY

During puberty, differentiation of the male and female body occurs

for the purposes of reproduction. In adult humans, muscle mass
may change due to exercise, and fat distribution may change due
to hormone fluctuations. Inherited genes play a large part in the
development of body shape.
Facial features: Due to the action of testosterone, males develop
these facial-bone features during puberty:
A more prominent brow bone
A heavier jaw
More prominent chin
Larger nose bone
Because females have around 1/10 the amount of testosterone of a
male, these features do not develop to the same extent. Hence
female faces are generally more similar to those of prepubertal children.
Skeletal structure:Skeletal structure frames the overall shape of
the body and does not alter much over a lifetime. Males are, on
average, taller, but body shape may be analysed after normalizing
with respect to height. Broad shoulders and expanded chest (in
males).Widening of the shoulders occurs as part of the male
pubertal process. Expansion of the ribcage is caused by the effects
of testosterone during puberty. Hence males generally have broad
shoulders and expanded chests, allowing them to inhale more air to
supply their muscles with oxygen.
Wide hips (in females)-Widening of the hip bones occurs as part
of the female pubertal process, and estrogens (the predominant sex
hormones in females) causes a widening of the pelvis as a part of
sexual differentiation. Hence females generally have wider hips,
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permitting childbirth. Because the female pelvis is flatter, more

rounded and proportionally larger, the head of the foetus may pass
during childbirth. The sacrum in females is shorter and wider, and
also directed more toward the rear. This sometimes affects
their walking style, resulting in hip sway, The upper limb in
females have an outward angulation (carrying angle) at elbow level
to accommodate the wider pelvis. After puberty, female hips are
generally wider than female shoulders; males exhibit the opposite
configuration. But not everyone follows this stereotypical pattern
of secondary sex characteristics.
Both male and female hormones are present in the human body,
and though only one of them is predominant in an adult, the other
hormone has effects on body's shape to some extent.Body shape is
affected by body fat distribution, which is correlated to current
levels of sex hormones. Muscles and fat distribution may change
from time to time, unlike bone structure, depending on food habits,
exercises and hormone levels.
Fat distribution: Fat distribution plays an important role in health;
some studies suggest that fat in the thighs and hips may be
beneficial to one's health.
Estrogen causes fat to be stored in the buttocks, thighs,
and hips in women. When women reach menopause and the
estrogen produced by ovaries declines, fat migrates from their
buttocks, hips and thighs to their waists; later fat is stored in
the belly. Thus females generally have relatively narrow waists and
large buttocks, and this along with wide hips make for a wider hip
section and a lower waist compared to men. Hormonal and genetic
factors may produce male-like distribution of fat in women i.e.
around the belly instead of buttocks and thighs.
Estrogen increases fat storage in the body, which results in more
fat
stored
in
the
female
body. Body
fat
percentage recommendations are higher for females, as this may
serve as an energy reserve for pregnancy. Males have
less subcutaneous fat in their faces due to the effects of
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testosterone; testosterone
also
reduces
fat
by
aiding
fast metabolism.
Males
generally
deposit
fat
around waists and abdomens (producing an "apple shape") due to
the lack of estrogen.
Muscles: Testosterone helps build and maintain muscles through
exercise. On average, males have around 10 times more
testosterone than women. Prominent muscles of the body include
the latissimus dorsi, trapezius, pectoral muscles(muscles critical for
a strong erect posture) as well as biceps and triceps in the arms
and quadriceps and hamstrings in the thighs.
Breasts:Females have enlarged breasts due to functional mammary
glands, which develop from puberty onward due to the effects of
estrogen. Mammary glands do not contain muscle tissue. The
shape of female breasts is affected by age, genetic factors, and
body weight.
Overweight and Underweight: Being overweight orunderweight
Causeschange in the human body's shape as well as posture and
walking style. This is measured using BMI or waist circumference.
Depending on the BMI, a body may be referred to as slim,
overweight, or obese. New computer based measurement, such as
the BVI, specifically take body shape and where weight on the
body is distributed as the basis in determining this.Dieting, in
conjunction with exercise, may be used to bring and keep the BMI
within an acceptable range.
The fats and carbohydrates in food constitute the majority of
energy used by the body. They are measured cumulatively in the
USA and many other places in calories and in kilojoules in some
other parts of the world.
Effect on body posture and gait: Body shape has effects on
body posture and gait, and has a major role in physical attraction.
This is because a body's shape implies an individual's hormone
levels during puberty, which implies fertility, and it also indicates
current levels of sex hormones. A pleasing shape also implies
good health and fitness of the body.
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Body Proportion: While there is significant variation in

anatomical proportions between people, there are many references
to body proportions that are intended to be canonical, either
in art, measurement,
or medicine.
In measurement,
body
proportions are often used to relate two or more measurements
based on the body. A cubit, for instance, is supposed to be
six palms. While convenient, these ratios may not reflect the
physiognomic variation of the individuals using them.Similarly,
in art, body proportions are the study of relation of human or
animal body parts to each other and to the whole. These ratios are
used in veristic depictions of the figure, and also become part of
an aesthetic canon within a culture.
It is important in figure drawing to draw the human figure in
proportion. Though there are subtle differences between
individuals, human proportions fit within a fairly standard range,
though artists have historically tried to create idealised standards,
which have varied considerably over different periods and regions.
In modern figure drawing, the basic unit of measurement is the
'head', which is the distance from the top of the head to the chin.
This unit of measurement is reasonably standard, and has long
been used by artists to establish the proportions of the human
figure. Ancient Egyptian art used a canon of proportion based on
the "fist", measured across the knuckles, with 18 fists from the
ground to the hairline on the forehead. This was already
established by the Narmer Palette from about the 31st century BC,
and remained in use until at least the conquest by Alexander the
Great some 3,000 years later.
The proportions used in figure drawing are:
An average person, is generally 7-and-a-half heads tall
(including the head).
An ideal figure, used when aiming for an impression of nobility
or grace, is drawn at 8 heads tall.

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A heroic figure, used in the heroic for the depiction of gods and
superheroes, is eight-and-a-half heads tall. Most of the
additional length comes from a bigger chest and longer legs.
ASSESSING THE BODY COMPOSITION

Introduction
Assessing the body composition in humans is usually in response
to the need to describe either deficiencies or excesses of a
component that is thought or known to be related to health risk. In
condition of obesity, the levels of body fat and bone mineral
density (BMD), respectively allow for clinical diagnoses with
implications for formulating appropriate interventions. Nutritional
assessment based on body composition in infancy and childhood
can guide optimal nutrition and nutritional management during
these early years.
The available measurement methods range from simple to
complex with all methods having limitations and some degree of
measurement error. The clinical significance of the body
compartment to be measured must be determined before a
measurement method is selected, as the more advanced techniques
are less accessible and more costly. The measurement of body
composition occurs in many areas of biology and medicine when
the outcome is a better understanding of nutrition and growth
status assessment in disease states and their treatment in
populations.
Bioelectrical
Spectroscopy

Impedance

Analysis

And

Bioimpedance

Bioelectrical impedance analysis (BIA) is a commonly used

method for estimating body composition based on a 2C body
composition model. BIA measures the impedance or resistance to a
small electrical current as it travels through the bodys water pool.
An estimate of TBW is acquired from which total body FFM is
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calculated using the assumption that 73% of the bodys FFM is

water. Single-frequency BIA (SF-BIA) is most commonly used for
assessing TBW and FFM but is limited in its ability to distinguish
the distribution of TBW into its intracellular and extracellular
compartments. Body weight is also measured in the leg-to-leg
pressure contact BIA.
Bioimpedance spectroscopy (BIS) or multifrequency BIA
allows for the differentiation of TBW into intracellular water
(ICW) and extracellular water (ECW) compartments, which is
useful to describe fluid shifts and fluid balance and to explore
variations in levels of hydration. In addition to providing
information on fat mass, multifrequency BIA (frequencies up to
300 kHz) may have an added advantage over SF-BIA (50 kHz) for
evaluating leg skeletal muscle.Multisegmental BIA is available in
both single-frequency and multi-frequency systems. The multisegmental approach assumes that the body is made up of a group
of cylinders (left and right arms, the left and right legs, and the
total body are measured).
Dual Energy X-Ray Absorptiometry
DXA systems provide whole-body and regional estimates of three
main components: bone mineral, bone-free FFM, and fat mass and
the DXA technique is accepted as a non-invasive measurement
method that can be applied in humans of all ages. The radiation
exposure from a whole-body DXA scan ranges from 0.04 to 0.86
mrem (instrument and individuals size dependent), which is
equivalent to between 1 and 10% of a chest radiograph.
The advantages of DXA include good accuracy and
reproducibility, and provides for the assessment of regional body
composition and nutritional status in disease states and growth
disorders. Disadvantages of DXA include a small amount of
radiation; the scanning bed or stretcher has an upper weight limit
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and the whole-body field-of-view cannot accommodate very large

persons.
DXA estimates of fat mass are influenced by trunk thickness
with the error increasing as the individuals trunk thickness
increases. In longitudinal studies of persons who undergo
significant changes in body composition, DXA measures can be
biased.DXA continues to be considered the gold standard
technique for the diagnosis of osteopenia and osteoporosis.
Assumptions associated with DXA include: the assumed constant
attenuation (R) of fat (R = 1.21) and of bone mineral content;
minimal effects of hydration on lean tissue estimates; lack of an
effect of variations in regional (e.g., chest, leg, and arm) thickness
on soft-tissue estimates; and that the fat content of the area being
analyzed (nonbone-containing area or pixels) is comparable with
the fat content of the unanalyzed area (bone-containing area or
pixels). The limitations associated with these assumptions when
these assumptions are not met include errors in the estimation of
fat mass, lean, and bone in both regional and whole body values. In
terms of measurement error, changes in body fatness (placement of
lard or exogenous fat) impacts the accuracy of DXA measures of
BMC and BMD. In obese and nonobese children, the measurement
error of DXA for fat mass was lower for obese than nonobese
children, but for lean mass, was higher for obese than nonobese
children.Despite these limitations, DXA is a widely used method,
owing to its ease of use, availability, and low-radiation exposure.
Quantitative Computed Tomography
Quantitative Computed Tomography (QCT) has the potential to
measure true volumetric BMD and has the advantage of
distinguishing between trabecular and cortical components but
with substantially higher-radiation exposure than DXA. Peripheral
QCT (pQCT) allows for the measurement of the compartmentspecific density and geometry-based parameters of cortical bone
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although the usefulness of pQCT remains controversial, as few

studies have used it. Recently, three-dimensional high-resolution
pQCT (HR-pQCT) measures important components of bone
quality including BMD, microarchitectural morphology and bone
mechanics.
DILUTION TECHNIQUES

Water is an important constituent in the body. Changes in the

bodys TBW will impact body composition, especially when body
composition estimates are acquired on the basis of TBW
assumptions. Deuterated (2H), tritated (3H), or oxygen-labeled
(18O) water can be used to determine TBW by dilution.
Air displacement plethysmography
The air displacement plethysmography (ADP) method for
measuring body volume and hence fat mass is an alternative to the
underwater weighing (UWW) method requiring no water
submersion and therefore is better tolerated by individuals. ADP as
determined by the BODPOD (Life Measurement Inc., Concord,
California, USA) measures the volume of air displaced by the
individual. Reliability was high for percentage body fat and body
density in adults. The advantages of the ADP methods include noninvasive, fast, no radiation exposure, and no individual sedation
required.
Three-dimensional photonic scanner
The need for accurate measurements of body shape and body
dimensions has resulted in the development and application of a
digitized optical method to generate a three-dimensional (3D)
photonic image of an object and individual. This approach
generates values for total and regional body volumes and
dimensions. Wang et al evaluated the accuracy of the threedimensional photonic scanner (3DPS) system for the measurement
of body volume, circumferences, lengths, and percentage body fat
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compared with UWW and tape measures. BMI was significantly

associated with chest and waist in men and with hips and bust in
women.
In early adulthood, the sexes differed significantly in shape;
however, these sex differences declined with increasing age.
Whereas male shape remained highly stable throughout adulthood,
upper body girths, particularly waist, increased in women, but
thigh decreased. After adjustment for other girths, waist was
significantly and inversely associated with height, particularly in
men. Waist varied widely in both sexes for a given BMI value. The
3DPS system offers a novel approach for epidemiologic research
into associations between body shape and health risks and
outcome.
MRI and magnetic resonance spectroscopy
Imaging methods are considered to be among the most accurate
approaches for the in-vivo quantification of body composition.
Specifically, MRI and computed tomography (CT) allow for the
estimation of adipose tissue, skeletal muscle, and other internal
tissues and organs. Their primary application has been in
quantifying the distribution of adipose tissue into visceral,
subcutaneous, and more recently inter-muscular depots,the
application of these depots to understanding cardiovascular disease
risk and the volumetric assessment of epicardial adipose tissue .A
further application of MRI has been to dissect the FFM
compartment for the quantification of specific high metabolic rate
organs in vivo (e.g., liver, kidneys, heart, spleen, pancreas, and
brain) with application to improving our understanding of resting
energy expenditure and as a diagnostic tool in cancer staging ,The
limitations of MRI include high costs owing to scan acquisition
and after processing of data, claustrophobic persons cannot be
scanned, and large individuals cannot fit within field-of-view.

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Quantitative Magnetic Resonance

The quantitative magnetic resonance (QMR) methodology has
recently been developed for body composition measurement
application in humans although it has been in use in small animals
for a few years. The QMR system from EchoMRI (Echo Medical
Systems, Houston, Texas, USA) uses the differences in the nuclear
magnetic resonance properties of hydrogen atoms in organic and
nonorganic properties to fractionate signals originating from fat,
lean tissue, and free water.Just one study to date has reported on
the validity of the QMR compared with a 4C model for wholebody fat and lean mass measurements in humans. The findings
were: QMR underestimated fat mass and overestimated lean mass;
the extent of difference increased with body mass such that the SD
of repeated measurements increased with increasing adiposity,
from 0.25 kg (fat) and 0.51 kg (lean) with BMI less than 25
kg/m2 to 0.43 and 0.81 kg, respectively with BMI more than 30
kg/m2. This initial study has shown shortcomings in absolute
accuracy and specificity of fat mass measures in humans.
Positron Emission Tomography
With the use of fluorodeoxyglucose positron emission tomography
(FDG-PET) combined with CT, brown adipose tissue (BAT)
depots have now been found in the supraclavicular, the neck
regions, paravertebral, mediastinal, paraaortic, and suprarenal
localizations in humans negating the commonly held belief that
BAT is lost postnatally. BAT has the potential to be of metabolic
significance for normal human physiology as well as to become
pharmaceutically activated in efforts to combat obesity.
The measurement of body composition allows for the estimation
of body tissues, organs, and their distributions in living persons
without inflicting harm. It is important to recognize that there is no
single measurement method that allows for the measurement of all
tissues and organs and no method is error free. Furthermore, bias
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can be introduced if a measurement method makes assumptions

related to body composition proportions and characteristics that are
inaccurate across different populations. The clinical significance of
the body compartment to be measured should first be determined
before a measurement method is selected, as the more advanced
techniques are less accessible and more costly.
DIETARY ASSESSMENT

Introduction
The Accurate and consistent measurement of dietary intake and
patterns of eatingbehaviour is important when evaluating the
effectiveness of public health interventionsto improve diet and
reduce obesity. Measurement of dietary intake is complex and
themost appropriate measurement method will depend on: the
objectives of thesurveillance; the type of data required; available
resources and the population ofinterest. All of these factors must be
considered carefully before selecting a dietaryassessment tool.
The measurement of dietary intake is complex and presents
significant challenges,particularly at a group and population level.
The appropriate method of measurementwill depend on the
objectives of the surveillance and the types of information
required.For example, a policy maker may be interested in dietary
intake data to measure thebehavioural response to a campaign to
encourage healthy eating, or to estimate thedifferences between the
nutrient intake of particular population subgroup. In contrast,a
commissioner may require more detailed information about the
nutritional status ofa population to determine how nutrition and
dietetics services should be resourced andtargeted.
METHODS OF ASSESSMENT

The various methods of dietary assessment are essentially asking:

What was eaten?
How much was eaten?
How often is this eaten?
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The methods vary in their ability to answer these questions

accurately. The perfect dietary assessment method does not
exist. A thorough understanding of the methods, their strengths and
their limitations, is essential in the selection of the most
appropriate dietary assessment method. Collaboration with centres
experienced in dietary assessment and/or the inclusion of a
nutritionist in the study team is recommended for any research
seeking to measure diet.
In the context of nutrition, self-report methods are commonly
used tocollect food intake data. This is because they usually use
fewer resources thanalternative methods, such as the use of clinical
indicators.
An assessment of food intake is potentially subject to many
sources of both random andsystematic error. Studies frequently
rely on the accurate reporting of habitual foodintake by a sample of
individuals within a population. The recall ability
andpsychological characteristics of individuals can influence
dietary reporting. For example, an individual may be aware that
their diet is unbalanced and so may be reluctant toprovide honest
answers to questions, or their recollection of intake may simply
beflawed. There is also evidence that participants may report
behaviour that theyperceive as socially desirable rather than
accurate.
Wherever possible, it is important to identify and quantify
sources of potential errorswhen assessing food intake, particularly
when deriving nutrient intake. Errors can beminimised through
careful design of the study and analyses of the data, and this
shouldbe taken into account when analysing data or interpreting
existing analyses.
In principle, all tools should be tested for reliability and validity.
Reliability refers to thelikelihood that an instrument or tool will
measure the same thing each time it is used either with the same
or a different respondent. Validity refers to how accurately
theinstrument reflects the actual behaviour. For example, an
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instrument that wasdeveloped to monitor population level nutrient

intake may not be valid and reliable forevaluating change in
dietary intake for a smaller group participating in a healthyeating
intervention.
Self-report tools can be tested against more reliable and
objective methods of assessment such as doubly labelled water to
measure energy intake, or nitrogen or protein intake. Biomarkers
such as these are not subject to the same sources of error and bias
as self-report instruments.
When evaluating dietary or weight management interventions, it
is essential that changes in patterns of dietary intake and dietary
behaviour over time can be measured. The use of an appropriately
developed and tested measurement tool will enhance the likelihood
of the accurate detection of any such change.
A number of tools have been developed for dietary assessment
in interventions and studies with children and/or adults. The most
appropriate tool will depend on the purpose for which it is required
and each has merits, associated problems and practical issues
which will need to be considered when selecting one method above
another.
It is important to remember that tools have been developed and
tested for specific purposes with particular population groups.
Therefore, the validity and reliability of a tool will not remain the
same when used with an alternative population group.
Physical Activity Assessment
The measurement of physical activity is dependent on the aspect of
physical activity which is central to the research question.
Decisions about the likely effect of season or days of the week may
influence the choice of method or the length of the assessment
period. A combination of methods may be required to obtain the
desired outcomes.

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The dimensions of physical activity include frequency,

intensity, duration and type. The domains in which physical
activity occur include leisure time, occupational, transport and
household / garden chores. The ideal physical activity assessment
method would measure all dimensions in all domains; no such
method currently exists.
UNDERSTAND THE BARRIERS TO CHANGE

To develop a successful strategy for change in life style, you need

to understand the types of barriers faced. Using this knowledge,
you can consider which barriers and levers may operate in your
system and which may be relevant to a particular problem.
Following careful consideration, it is possible to develop a tailored
approach to overcome the barriers, encourage changes in behaviour
and ultimately implement guidance.
Awareness and knowledge
Awareness and knowledge of what needs to change and why, are
vital first steps in enabling change to occur. Evidence shows that
healthcare professionals are often unaware of, and lack familiarity
with, the latest evidence-based guidance. In addition, they may be
aware that new guidance has been issued but dont know how their
current way of working needs to change to ensure they provide the
best care for patients in line with the guidance. Some professionals
may feel that guidance undermines their autonomy or is not
applicable to their population, and so dont consistently refer to it.
Motivation
Motivation is a fundamental part of nearly everything we do.
External factors can drive motivation and change behaviour, for
example, the provision of incentives or penalties imposed as part
of regulatory checks. But internal factors, such as individuals
self-motivation, drive and desire to improve are very important
too. Intentions and goals can impact on how much people want to
change. Their priorities and commitments may also interfere with
their ability to change.
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Acceptance and Beliefs

An individuals personal beliefs and attitudes impact significantly
on the way they behave. Perceptions of the benefits of any
proposed change versus the costs, both practical and financial, can
be important. Perceptions of the views of others may also have an
impact. Some healthcare professionals may find it difficult to
accept new guidance if it is in conflict with other guidance issued
by professional bodies or the opinion of an influential colleague.
Other professionals may not believe that recommendations reflect
the evidence or that they will achieve better patient outcomes. A
persons belief in their own ability to adopt a new behaviour also
has an impact on whether a change is implemented.
Skills
To make change in lifestyle happen, individuals need to know
not only about what needs to change, but also how best to
competently carry out the change. Healthcare professionals may
need training to ensure they have the skills to deliver best
practice. They may need the time to learn new skills and practice
them. Support from peers or mentoring might be needed.
Individual abilities, interpersonal skills and coping strategies will
also affect how easy or difficult it will be for individuals to learn
new skills.
BARRIERS BEYOND OUR CONTROL

The financial and political environment can impact on healthcare

professionals desire, motivation and ability to make changes. At
an organisational level, financial systems may not facilitate
payments for new interventions and resources may be
constrained. Incentive mechanisms and regulatory processes may
not be aligned with whats needed to implement the changes.
Evidence shows that regulation and national target setting bring
about improvements in the quality of healthcare. Mandatory
reporting has been shown to bring about improvements in patient
care and cure. There is also evidence to show that continued
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professional development is linked to improved quality of care and

better patient outcomes.
IDENTIFY THE BARRIERS TO CHANGE

Equipped with an understanding of the types of barriers faced in

healthcare, you now need to identify the barriers that your lifestyle
faces. This will involve looking at the specific barriers for different
individuals in your lifestyle in relation to a particular piece of
evidence-based guidance.
When implementing any new policy or guidance, it is essential
to identify the gap between recommended practice and current
practice (baseline assessment). Ideally, this assessment will also
help to identify the potential and actual barriers to change,
allowing you to pinpoint the practical actions needed to implement
the change along with the groups of professionals who are key in
bridging this gap.
Evidence shows that there are a number of methods that can be
used to identify where change is needed and potential barriers to
that change. Your choice of method will be guided by local
circumstances, including the numbers of professionals involved
and the time and resources available. In some situations, more than
one approach may be needed.
TALK TO KEY INDIVIDUALS

Key individuals have specific understanding of a given situation

and have the knowledge, skills and authority to enable them to
think around a topic and explore new ideas. You may want to
consider talking to a group of key individuals through one of their
regular meetings.
Talking to a key individual or a group of key individuals is an
informal way of gaining insight into a particular problem or
situation.
Talking to a key individual may be used, for example, when you
are considering introducing a new procedure on to a hospital ward.
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By discussing the potential barriers that might arise as a result of

introducing the new procedure with key individuals that will be
affected, you can get specific details of the problems you are likely
to face.
OBSERVE CLINICAL PRACTICE IN ACTION

Sometimes the best way of assessing current clinical practice in

your organisation is by observing individual behaviours and
interactions. This is especially appropriate if you are looking at
events that happen quite often, for example, hand washing. This
method has a number of advantages, for example:
it enables detailed analysis of current behaviours in context,
it eliminates reporting bias,
it can provide a useful method for monitoring progress, if
repeated on a regular basis.
There may be some disadvantages, for example:
it can be difficult to gain consent from the people you want to
observe,
peoples behaviour can alter when they know they are being
watched,
a skilled observer is needed to minimise influence on the
person being observed,
methods of data collection need careful consideration.
Use A Questionnaire
A questionnaire is a good way of exploring the knowledge, beliefs,
attitudes and behaviour of a group of geographically dispersed
healthcare professionals. Careful thought needs to be given to the
design of the questions, as the quality of the answers relies heavily
on the quality of the questions. Both electronic and paper formats
can be used to encourage responses. This method has a number of
advantages, for example:
it allows rapid collection of relatively large amounts of data
from a large number of people
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it enables statistical analysis of standardised data

it provides the opportunity to highlight the need for change
through communication of the results
it is relatively inexpensive.
There may be some disadvantages, for example:
significant time is needed to develop good questions
it is not possible to ask follow-up questions
the response rate may be poor and may be biased towards high
performers and the nature of self-reporting means it can be
inaccurate.
A questionnaire may be used, for example, when a primary care
trust (PCT) is looking for feedback from a group of practice-based
clinicians across their area.
Brainstorm
Brainstorming is a way of developing creative solutions to health
seeking problems. It can be done informally in small groups or as
part of a focus group. The session starts with an outline of the
problem and then participants are encouraged to come up with as
many ideas as possible to solve it. One of the great things about
brainstorming is that participants can bounce ideas off each other
and develop and refine them further. This method has a number of
advantages, for example:
it is fast and easy to do and generates lots of ideas.
it helps engage people in the process of change.
There may be some disadvantages, for example:
it needs a skilled facilitator and more vocal members of the
group may dominate the discussion.
It helps in organising a session among a group of healthcare
professionals can be difficult because of their clinical
commitments.

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Run A Focus Group

Focus groups are a powerful means of evaluating current practice
and testing new ideas. They comprise a facilitated discussion or
interview involving a group of 610 people. Open questions are
posed by the facilitator, who then encourages the group to discuss
their experiences and thoughts, and reflect on the views of others.
This method has a number of advantages, for example:
it enables a representative group of people to share ideas and it
allows a wide range of in-depth information to be obtained,
it encourages new ideas and perspectives,
it helps get people engaged in the change process,
it is relatively quick and easy to perform.
There may be some disadvantages, for example:
a skilled facilitator is needed to ensure everyone is able to
express their views,
it can be difficult to find a suitable time for everyone to attend
and incentives may need to be offered to encourage attendance,
its analysis can be time consuming
the careful planning and analysis are needed.
A focus group may be used, for example, as a way of exploring the
introduction of new early intervention services that will impact on
the work of a range of healthcare professionals in different care
settings.
OVERCOME THE BARRIERS TO CHANGE

There is no one method to overcome all the different barriers;

different approaches will be effective for different people and
different situations. These methods can be used on their own or
together; combining methods may have a bigger impact on change.
Educational materials
Booklets, leaflets, journal supplements, CD-ROMs, videos and
DVDs, online tools and computer programs are often used to
inform healthcare professionals about the latest developments in
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their field. At NICE we publish a quick reference guide, which

summarises our recommendations, designed especially for the
healthcare professionals upon whom it impacts. This document
alerts the reader to key changes in practice and provides a resource
that can be referred to again and again.
Educational materials raise awareness of the desired change.
The Formats and layout can affect the influence of materials in
changing behaviour.
The impetus is on healthcare professionals to read and
recognise what change is needed.
Even if the change produced is modest, this could be important
if replicated in everyday practice.
Printed materials are low cost price.
Educational materials are most effective in changing behaviour
when they are combined with other methods.
Educational meetings
The Conferences, workshops, training courses and lectures are
often used to educate healthcare professionals about the latest
developments in their field.
These meetings can be divided into two categories: large-scale
meetings, such as lectures and conferences where the audience is
largely passive and small-scale meetings, such as interactive
workshops and training courses where the participants take a more
active role in learning.
The more interactive a meeting is, the more effective it is in
changing behaviour.
Conferences and lectures raise awareness about the desired
change, but are less effective in making changes happen.
Interactive workshops are effective in changing behaviour.
Educational outreach visits (also known as academic detailing)
were originally used by the pharmaceutical industry to
influence the prescribing behaviour of doctors. Trained
individuals visit healthcare professionals in their own practice

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and offer information, support and instruction in line with

current best practice.
Outreach visits are effective in tackling certain types of change,
such as changes in prescribing, the delivery of preventative
services and management of common clinical problems in
general practice.
Visiting more than once increases its effectiveness.
The identity of the outreach visitor may have an impact on its
effectiveness.
Visits are more effective when combined with reminders
and/or interventions aimed at patients.
Visits are also more effective when tailored to individual
barriers and situations.
It is not clear if visits are effective in tackling more
complicated changes in practice, such as the use of diagnostic
tests and referral practices.
Using the influence of opinion leaders is generally an effective
way of disseminating information.
It can be difficult to identify appropriate opinion leaders; the
most influential individuals are not necessarily evident from
their job titles.
Patient-mediated Strategies
Patient-mediated strategies focus on giving information to
patients and the wider public. These strategies can help to change
the behaviour of healthcare professionals in a number of ways.
Equipped with knowledge about the latest evidence-based
practice, patients are more able to influence decisions made
during consultations about their care. Patients are also more
accepting of any changes to their care if they know that it is in
line with the evidence.
There is evidence that mass media campaigns work by
educating both professionals and patients about changes in
practice. Patients are also more likely to adhere to the treatment

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offered if they are well informed, which in turn helps to keep

professionals motivated.
The Information disseminated through the mass media is
effective in changing behaviour.
Both planned and unplanned media campaigns are effective.
Provision of educational materials to patients is effective in
changing the behaviour of healthcare professionals.
Provision of educational materials to patients helps ensure
concordance, leading to better outcomes which motivate
healthcare professionals.
ACCEPTANCE AND BELIEFS

Mapping Barriers To Methods

If we now take all of the information gathered about what needs to
change, who is affected and the likely barriers, and combine it with
our understanding of what works to make change happen in
different situations, we can map the barriers to specific methods.
Tackling Triggers
The toolkit looks at ways of tackling overweight and obesity. It
focuses on the five key themes highlighted in Healthy Weight,
Healthy Lives: A strategy for tackling excess weight:
Children: healthy growth and healthy weight focuses on the
importance of prevention of obesity from childhood. It looks at
recommended government action during the following life
stages pre-conception and antenatal care, breastfeeding and
infant nutrition, early years and schools. Importantly, it also
discusses the psychological issues that impact on overweight
and obesity.
Promoting healthier food choices details the government
recommendations for promoting a healthy, balanced diet to
prevent overweight and obesity. It provides standard population
dietary recommendations and theeatwell plate recommendations
for individuals over the age of five years.
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Building physical activity into our lives provides details of

government recommendations for active living throughout the
life course. It focuses on action to prevent overweight and
obesity by everyday participation in physical activity, the
promotion of a supportive built environment and the provision
of advice to decrease sedentary behaviour.
Creating incentives for better health focuses on action to
maintain a healthy weight in the workplace by the provision of
healthy eating choices and opportunities for physical activity. It
provides details of recommendations from the National Institute
for Health and Clinical Excellence (NICE) guidance.
Personalised support for overweight and obese individuals
focuses on recommended government action to manage
overweight and obesity through weight management services
(NHS and non-NHS based). It provides clinical guidance and
examples of appropriate services for children and adults.

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CAUSES OF OBESITY
Obesity is generally caused by eating too much and moving too
little.If you consume high amounts of energy from your diet,
particularly from fat and sugars, but do not burn off the energy
through exercise and physical activity, much of the surplus energy
is then stored by the body as fat.
CALORIES

The energy value of food is measured in units called calories. The

average physically active man needs about 2,500 calories a day to
maintain a healthy weight, and the average physically active
woman needs about 2,000 a day.This may sound high, but it can be
easy to reach this limit if you eat certain types of food. For
example, eating a large takeaway hamburger, fries and a milkshake
can total 1,500 calories and that's just one meal.
Another problem is that many people are not physically active,
so lots of the calories they consume end up being stored in the
body as fat.
POOR DIET

Obesity does not happen overnight. It develops gradually over

time, as a result of poor diet and lifestyle choices, such as:
Eating large amounts of processed or fast food This food is
high in fat and sugar.
Drinking too much alcohol Alcohol contains a lot of
calories, and people who drink heavily are often overweight.
Eating out a lot You may be tempted to also have a starter or
dessert in a restaurant and the food can be higher in fat and
sugar.
Eatinglarger portions than you need You may be
encouraged to eat too much if your friends or relatives are also
eating large portions.
Drinking too many sugary drinks Including soft drinks and
fruit juice.
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Comfort eating If you feel depressed or have low selfesteem, you may eat to make yourself feel better.
Unhealthy eating habits tend to run in families, as you learn bad
eating habits from your parents when you are young and continue
them into adulthood.
LACK OF PHYSICAL ACTIVITY

Lack of physical activity is another important factor related to

obesity. Many people have jobs that involve sitting at a desk for
most of the day. They also rely on their cars, rather than walking or
cycling. When people relax, they tend to watch TV, browse the
internet or play computer games, and rarely take regular exercise.
If you are not active enough, you do not use the energy provided
by the food you eat, and the extra energy you consume is stored by
the body as fat.
The Department of Health recommends adults do at least 150
minutes of moderate-intensity aerobic activity, such as cycling or
fast walking, every week. This doesnt need to be done in one go,
but can be broken into smaller periods. For example, you could
exercise for 30 minutes a day for five days. If you are obese and
trying to lose weight, you may need to do more exercise than this.
It may help to start off slowly and gradually increase the amount of
exercise you do each week.
GENETICS

Some people claim there is no point in trying to lose weight

because "it runs in my family" or "it's in my genes. While there
are some rare genetic conditions that can cause obesity, such
as Prader-Willi syndrome, there is no reason why most people
cannot lose weight. It may be true that certain genetic traits
inherited from your parents such as having a large appetite may
make losing weight more difficult, but it certainly doesn't make it
impossible. In many cases, obesity is more to do with
environmental factors, such as poor eating habits learned during
childhood.
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MEDICAL REASONS

In some cases, underlying medical conditions may contribute to

weight gain. These include:
an underactive thyroid gland (hypothyroidism) where
your thyroid gland does not produce enough hormones
Cushing's syndrome a rare disorder that causes the overproduction of steroid hormones.
However, if conditions such as these are properly diagnosed and
treated they should pose less of a barrier to weight loss.
Certain medicines, including some corticosteroids, medications
for epilepsy and diabetes, and some medications used to treat
mental
illness including antidepressants and
medicines
for schizophrenia can contribute to weight gain. Weight gain can
also sometimes be a side effect of stopping smoking.
BIOLOGICAL FACTORS

The regulation of energy intake (food) and output (activity,

including internal activity) is tremendously complex, intricate, and
finely tuned. In a recent issue of Science, Jeffrey Friedman, expert
on the biological causes of obesity, points out that we take in close
to 10 million calories over the course of a decade, and that for most
of us, our weight varies very little. We may take in a little more
one day, have an increase in activity on another - and yet, without
much thought, most people naturally adjust and weight stays fairly
stable. He goes on to write, "this extraordinary level of precision
exceeds by several orders of magnitude the ability of nutritionists
to count calories and suggests that conscious factors alone are
incapable of precisely regulating calorie intake".
Additionally, people of the same height and weight can vary
tremendously in the number of calories they use, even in the
resting state. In other words, we've got to find other ways of
dealing with weight besides merely counting calories. What are
some of the mechanisms that keep some people more well-padded
than others.
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Medical Causes Of Obesity Includes:

Hypothyroidism-This is a condition where the thyroid
gland, located in the neck, produces too little thyroid
hormone. Thyroid hormone regulates our metabolism. So
too little hormone slows the metabolism and often causes
weight gain. If your doctor suspects thyroid disease as a
cause of your obesity, he or she may perform blood tests to
check your hormone levels.
Cushing's syndrome- This condition results when the
adrenal glands (located on top of each kidney) produce an
excess amount of a steroid hormone called cortisol. This
leads to a build-up of fat in characteristic sites such as the
face, upper back, and abdomen.
Depression-Some people with depression overeat, which
can lead to obesity.
There are also certain inherited conditions and other diseases of the
brain that can cause excess weight gain. Certain medications,
notably steroids, some antidepressants, high blood pressure drugs,
and seizure medications can also cause increased body weight.
LIFESTYLE

It is the typical way of life of an individual, group, or culture. The

term was originally used by Austrian psychologist Alfred
Adler (1870-1937). The term refers to a combination of
determining intangible or tangible factors. Tangible factors relate
specifically to demographic variables, i.e. an individuals
demographic profile, whereas intangible factors concern the
psychological aspects of an individual such as personal values,
preferences, and outlooks.
A rural environment has different lifestyles compared to an
urban metropolis. Location is important even within an urban
scope. A particular neighborhood affects lifestyle due to varying
degrees of affluence and proximity to open spaces. For example, in
areas within a close proximity to the sea, a surf culture or lifestyle
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is often present. The concept of Lifestyle Management has

developed as a result of the growing focus on lifestyle.
Organization: A lifestyle management company directly
embraces the concept of lifestyle. Lifestyle management
Organization provide personal assistant and concierge services so
as to cater to all areas of an individual's life ranging from family to
professional matters. The majority of lifestyle management
businesses offer standard services, though some have expanded so
as to offer clients a tailor-made service accounting for their
individual needs and objectives. Catering for a city lifestyle for
example employs a range of concepts and proposals in different
areas
including
the
urban
environment, architecture, culture, design, fashion, media, gastrono
my, leisure and entertainment, and education, which together
create and provide unique and distinctive experiences.
Lifestyle and behaviours:Lifestyle and behaviour choices are
important factors in influencing weight status. Unhealthy diets and
physical inactivity are major risk factors for overweight and
obesity as well as a number of chronic health conditions including
cardiovascular disease, diabetes, some cancers and high blood
pressure.
Physical activity:Physical activity includes all forms of activity,
such as walking or cycling for everyday journeys, active play,
work-related activity, active recreation (such as working out in a
gym), dancing, swimming, gardening or playing games as well as
competitive and non-competitive sport.
Physical activity is a key determinant of energy expenditure and
a fundamental part of energy balance and weight control. Regular
physical activity can reduce the risk of obesity, as well as many
chronic conditions including coronary heart disease, stroke, type 2
diabetes, cancer, mental health problems and musculoskeletal
conditions.

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The Department of Health recommends that adults accumulate

at least 150 minutes (2.5 hours) of moderate-intensity aerobic
activity (i.e. cycling or fast walking) every week and children over
five should engage in at least 60 minutes (1 hour) of moderate to
vigorous intensity physical activity every day. Physical activity
that can be incorporated into everyday life, for example brisk
walking and cycling has been found to be as effective for weight
loss as supervised exercise programmes.
Sedentary behavior is also linked to overweight and obesity and
likely to be independently associated with all-cause mortality, type
2 diabetes, some types of cancer and metabolic dysfunction.
Sedentary behaviours in adults are impacted by age, gender, socioeconomic conditions, occupation, weight status and some
characteristics of the physical environment. These relationships are
independent of the level of overall physical activity. For example,
spending large amounts of time being sedentary may increase the
risk of some health outcomes, even among people who are active
at the recommended levels.
EMOTIONAL AND MENTAL FACTORS

Most overweight people have no more psychological problems

than people of average weight. Still, up to 10 percent of people
who are mildly obese and try to lose weight on their own or
through commercial weight loss programs have binge eating
disorder. This disorder is even more common in people who are
severely obese.
During a binge eating episode, people eat large amounts of food
and feel that they cannot control how much they are eating. Those
with the most severe binge eating problems are also likely to have
symptoms of depression and low self-esteem. These people may
have more difficulty losing weight and keeping it off than people
without binge eating problems.
Food is often used as a source of pleasure by some people.
These people have experienced previous traumas in life that limit
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their ability to find sources of pleasure not associated with food.

This leads to overeating and obesity.
PSYCHOLOGICAL SEQUELAE OF OBESITY

Society views obesity very negatively and tends to believe that

people who are obese are weak-willed and unmotivated. Obese
individuals are often aware of these negative views, and internalize
them, putting themselves at risk for disorders of mood, anxiety,
and substance abuse. They perceive interpersonal and work-related
discrimination, often suffer from low self-esteem as a result, and
feel uncomfortable with their bodies (i.e. body image
dissatisfaction). These feelings may lead to strain on their intimate
and romantic relationships. 20-70% of obese individuals
considering bariatric surgery suffer from a current and/or past
psychiatric disorder, of which Major Depressive Disorder is the
most prominent.
PSYCHOLOGICAL FACTORS

Many people eat for emotional reasons. Eating helps them deal
with stress, boredom, sadness, block out a distressing thought.
Food is pleasurable for all of us and it helps to relieve our stress.
There are nice smells, colours and tastes, and there are chemicals
in food that actually make us feel different, for eg.chocolate,
coffee. There is nothing particularly wrong with eating for
emotional reasons, unless the food is making the weight go up and
causing a weight problem. But people often refer to themselves as
being bad or their food being bad.
TELEVISION AND SEDENTARY HABITS

Excessive television watching plays a critical role in obesity in

children. Not only is it a sedentary activity, but television also
offers innumerable temptations with its advertisements for fast
foods, sugar cereals, and unhealthy snacks. Obesity rates increase
in relation to the amount of time spent watching television.
Sugar, particularly from soda, other sweetened beverages, and
fruit juice, may be the major contributor to childhood obesity.
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One study reported that drinking soda regularly increases a

child's risk for obesity by 60%. The average American
adolescent consumes 15 - 20 extra teaspoons of sugar a day just
from soda and sugary drinks. (Juice, while better than soda, is
still filled with sugar.)
Less physical exercise and greater sedentary activities play
another significant role in obesity in children. A high level of
physical activity -- not just using up energy -- is important for
weight control in young people. Unfortunately, according to one
study, the annual distance walked by children has fallen by
nearly 30% since 1972. Schools are also offering fewer
opportunities for daily physical activities than in the past.
FAST FOODS AND RESTAURANT EATING

Eating Habits
The eating habits may be contributing to weight problem. There
are a number of eating styles, which are not compatible with good
weight control. Some of these are:
Fasting and feasting style: Poor (low) calorie intake for most
of the day followed by hunger and sometimes excessive or even
unbearable hunger and then catch up eating, that never seems to
satisfy. Some people, knowing that calories increase your
weight try skipping meals. Then they start eating later in the day
and then dont seem to be able to stop eating. They are fasting
and feasting. This eating style is terrible for weight control.
Quick eaters: The speed of eating is closely tied to weight
control. People who eat their food quickly are more likely to be
obese. This makes sense when you think of fullness. It stakes
around 10 to 20 minutes to feel full, no matter what you have
eaten. If in that time you have eaten a large meal and gone back
for seconds or thirds and then had desert, you will have eaten
much more than the person who is still tucking into their first
course. Also, you are less likely to remember what or how much
you have eaten if it goes down very quickly. If food tastes really
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nice, and we want more, we are likely to eat less and therefore
less calories if we savour every mouthful and eat slowly. So
eating slowly is like a substitute for having more.
Emotional Eaters: See below (Psychological Factors), but
basically eating associated with various emotions. We are
emotional creatures, but if emotions are connected strongly to
eating this makes weight control more challenging.
Pleasure Eaters: So many yummy foods, so little time, I love
to eat, bring me some more. I love food!. It can be hard to limit
eating when it is so pleasurable.
Habitual Eaters: This is eating the same food over and over
again, because (so you think) you are addicted to it. What is
really happening here is that a well-worn habit of eating a
certain food is giving you an excess of that food, and of course
the calories that go with it.
Non-Pragmatic Eaters: Pragmatic eaters eat only those foods
that they have calculated their body need. For example, I need
to eat more protein today, because I went to the gym and did
weight training., I havent eaten my serve of fruit today. Ill
have an apple. These people are very unlikely to have a weight
problem. We should all eat like this to a certain extent. Nonpragmatic eaters never think like this and are more likely to
struggle with their weight.
STRESS AND ITS RELATIONSHIP TO WEIGHT IMBALANCE

There are several ways in which stress can contribute to weight

gain. One has to do with cortisol, a stress hormone. When were
under stress, the fight or flight response is triggered in our bodies,
leading to the release of various hormones.If you remain in this
state for a prolonged amount of time due to chronic stress, your
health becomes at risk. Aside from a host of other dangers, chronic
stress can also cause weight gain -- which is why some products
like Cortislim are marketed as diet aids.

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Chronic Stress And Cortisol Can Contribute To Weight Gain

In The Following Ways:
Metabolism: Do you feel like you're prone to putting on more
weight when you're stressed, even if you're eating the same
amount of food as you always have? Too much cortisol can
slow your metabolism, causing more weight gain than you
would normally experience. This also makes dieting more
difficult.
Cravings: OK, you're stressed. Do you reach for a nice salad or
a pint of Ben & Jerry's? I'll bet on the latter. People
experiencing chronic stress tend to crave more fatty, salty and
sugary foods. This includes sweets, processed food and other
things that arent as good for you. These foods are typically less
healthy and lead to increased weight gain.
Blood Sugar:Prolonged stress can alter your blood sugar levels,
causing mood swings, fatigue, and conditions like
hyperglycemia. Too much stress has even been linked
to metabolic syndrome, a cluster of health concerns that can
lead to greater health problems, like heart attacks and diabetes.
Fat Storage:Excessive stress even affects where we tend to
store fat. Higher levels of stress are linked to greater levels of
abdominal fat. Unfortunately, abdominal fat is not only
aesthetically undesirable,its linked with greater health
risks than fat stored in other areas of the body.
Stress And Weight Gain Are Connected In Other Ways:
Emotional Eating: Increased levels of cortisol can not only
make you crave unhealthy food, but excess nervous energy can
often cause you to eat more than you normally would. How
many times have you found yourself scouring the kitchen for a
snack, or absently munching on junk food when youre stressed,
but not really hungry? More on what causes emotional eating.
Fast Food: Experts believe that one of the big reasons were
seeing more obesity in our society these days is that people are
too stressed and busy to make healthy dinners at home, often
opting to get fast food a the nearest drive-thru instead.
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Too Busy to Exercise: With all the demands on your

schedule, exercise may be one of the last things on your to-do
list. If so, youre not alone. Now a day live a more sedentary
lifestyle than we have in past generations, yet our minds seem to
be racing from everything we have to do. Unfortunately, from
sitting in traffic, clocking hours at our desks, and plopping in
front of the TV in exhaustion at the end of the day, exercise
often goes by the wayside.
Fortunately, there are things you can do to reverse the pattern of
weight gain and actuallyreduce your stress level and waistline at
the same time.
WATER INTAKE

Despite the fact that most diets call for drinking at least eight, 8ounce glasses of water a day, few studies have been done to
determine if the practice actually speeds weight loss. After
drinking approximately 17 ounces of water, the subjects' metabolic
rates -- or the rate at which calories are burned -- increased by 30%
for both men and women. The increases occurred within 10
minutes of water consumption and reached a maximum after about
30 to 40 minutes. The study also showed that the increase in
metabolic rate differed in men and women. In men, burning more
fat fuelled the increase in metabolism, whereas in women, an
increased breakdown of carbohydrates caused the increase in
metabolism seen.
Drinking Water Is Important For Weight Loss
There are many reasons why it is important to drink water,
especially if you are dieting:
Initial weight loss is largely due to loss of water, and you need
to drink an adequate amount of water in order to avoid
dehydration.
The process of burning calories requires an adequate supply of
water in order to function efficiently; dehydration slows down
the fat-burning process.
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Burning calories creates toxins (think of the exhaust coming out

of your car), and water plays a vital role in flushing them out of
your body.
Dehydration causes a reduction in blood volume; a reduction in
blood volume causes a reduction in the supply of oxygen to
your muscles; and a reduction in the supply of oxygen to your
muscles can make you feel tired.
Water helps maintain muscle tone by assisting muscles in their
ability to contract, and it lubricates your joints. Proper hydration
can help reduce muscle and joint soreness when exercising.
A healthy (weight loss) diet includes a good amount of fiber.
But while fiber is normally helpful to your digestive system,
without adequate fluids it can cause constipation instead of
helping to eliminate it.
Drinking water with a meal may make you feel full sooner and
therefore satisfied eating less. Note, however, that drinking
water alone may not have this effect. In order to feel satiated
(not hungry), our bodies need bulk, calories and nutrients.
Changing MetabolismThroughLife

A metabolism is the process of breaking down proteins,

carbohydrates, and fats to yield the energy your body needs to
maintain itself. The rate of your metabolism depends on the
interaction between the number of calories you consume, the
number of calories you burn while eating and exercising, and the
calories you burn based on your individual genetic makeup.
Causes For Change In The Metabolic Rate
Metabolic rate changes due to many reasons. Here you'll find an
overview with causes and tips how to maintain a fast metabolic
rate.
Exercise, Stress and Lack of Sleep Can Affect Your
Metabolism:
Metabolism refers to the rate at which your body utilizes calories
to meet energy demands. The Basal Metabolic Rate (BMR) refers
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to the number of calories you burn while your body is at rest. Your
BMR decreases as you age. This means that when you get older it
is harder for your body to burn calories and harder for you to lose
weight. A daily routine of cardiovascular exercise can improve
your health and fitness and increase your BMR.
Exercise
Exercise increases the BMR is a well known weight loss fact. But
some exercises will cause the body to continue burning calories at
a higher rate after the exercise is finished. The amount depends on
how hard and how long you exercise. For example:
A 154 pound person runs 8 mph and will burn 320 calories in 20
minutes. If that same person walks 3 mph for an hour, she will
burn 235 calories.
Walking or jogging will restore the BMR within 60 minutes,
meaning that, at best, you will lose 10-30 additional calories during
your recovery period. Low-intensity exercise training does have a
plus side. Studies have shown that fat oxidation increases by 40%.
High-intensity exercise training, on the other hand, does not affect
fat oxidation, but you will continue burning calories at the
accelerated rate well into the next morning. So which form of
exercise should you choose? Experts say that low-intensity
exercise is preferable because the risk of musculoskeletal injuries
is lower and you are more likely to stay with a low intensity
exercise program.
Stress
During periods of stress, the hypothalamus instructs the adrenal
glands to release epinephrine (adrenaline), norepinephrine and
cortisol into the bloodstream to speed up heart rate, respiration,
blood pressure, and metabolism. Epinephrine breaks down
glycogen into glucose in the liver. Both hormones increase
circulating free fatty acids. The extra glucose and fatty acids are
used by the body as fuel in times of stress.

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Prolonged stress disrupts the digestive system. The stomach

produces excessive amounts of digestive acids. Irritable bowel
syndrome develops when the smooth muscular contractions that
move food along the large become spastic. When the abdomen
becomes bloated, a person experiences cramping, constipation and
diarrhea. Studies suggest that stress may make a person more
susceptible to peptic ulcers or sustain existing ulcers. Stress has
also been related to increased flare-ups of ulcerative colitis. Such
conditions serve to lower the BMR. If the stress is removed, the
body improves and the Basal Metabolism is raised.
Lack of Sleep
The lack of sleep has been shown to change hormone levels in the
body. As sleep decreases, the adrenal gland produces more of the
hormone cortisol. It regulates appetite and when its levels increase
people continue to feel hungry despite being full. Lack of sleep
also causes levels of growth hormone to decline.
This results in following consequences:
Reduction of muscle mass and strength
Increase of fat tissue
Weakening of the immune system
Insulin is a hormone produced by the pancreas to carry sugar
(glucose) from the blood to the muscles and other tissues within
the body. Insulin levels increase when the body does not get
enough sleep. Because insulin causes sugars to be stored as fats,
increased insulin makes weight control difficult. Sleep deprived
individuals often eat candy or cookies when they feel their energy
level dropping. As their blood sugar rises, energy returns, but the
unneeded calories are converted to fat.
Tired people burn fewer calories because they lack the energy to
exercise or work out intensely. They may exercise the same
duration as a rested person, but they will burn fewer calories.
Getting enough sleep reduces the effects of increased cortisol
levels.
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Age
When we get older, our metabolism decreases which makes it more
difficult for us to maintain or lose weight. But there are lots of
other factors. When we turn 30 our physical abilities will decline
throughout our life. It depends on your fitness level and your
lifestyle how fast the decrease will happen.
Decrease in reaction slower performance of tasks is about 15%.
Lung capacity will decrease approximately 40 %.
Reduction of muscles circa 40 to 50%.
Because of less activity and a slower metabolism the fat cells
will increase. When you train regularly you could slower the
metabolism decrease.
Medical Conditions Or Diseases
A disease is a particular abnormal, pathological condition that
affects part or all of an organism. It is often construed as a medical
condition associated with specific symptoms and signs. It may be
caused by factors originally from an external source, such as
infectious, or it may be caused by internal dysfunctions, such
as autoimmune diseases. In humans, "disease" is often used more
broadly
to
refer
to
any
condition
that
causes pain, dysfunction, distress, social problems, or death to the
person afflicted, or similar problems for those in contact with the
person.
In this broader sense it includes injuries, disabilities, syndromes,
infections,
isolated symptoms,
deviant behaviors,
and
atypical variations of structure and function, while in other
contexts and for other purposes these may be considered
distinguishable categories. Diseases usually affect people not only
physically, but also emotionally, as contracting and living with

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many diseases can alter one's perspective on life, and one's

personality.
Death due to disease is called death by natural causes. There are
four main types of disease: pathogenic disease, deficiency disease,
hereditary disease, and physiological disease. Diseases can also be
classified as communicable and non-communicable. The deadliest
disease in humans is ischemic heart disease (blood flow
obstruction), followed by cerebrovascular disease and lower
respiratory infections respectively.
Disease
The term disease broadly refers to any condition that impairs
normal function, and is therefore associated with dysfunction of
normal homeostasis.Commonly, the term disease is used to refer
specifically to infectious diseases, which are clinically evident
diseases that result from the presence of pathogenic microbial
agents, including viruses, bacteria, fungi, protozoa, multicellular
organisms,
and
aberrant
proteins
known
as prions.
An infection that does not and will not produce clinically evident
impairment of normal functioning, such as the presence of the
normal bacteria and yeasts in the gut, or of a passenger virus, is not
considered a disease. By contrast, an infection that is asymptomatic
during its incubation period, but expected to produce symptoms
later, is usually considered a disease. Non-infectious diseases are
all other diseases, including most forms of cancer, heart disease,
and genetic disease.

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Illness
Illness and sickness are generally used as synonyms for disease.
However, this term is occasionally used to refer specifically to the
patient's personal experience of his or her disease. In this model, it
is possible for a person to have a disease without being ill (to have
an objectively definable, but asymptomatic, medical condition),
and to be ill without being diseased (such as when a person
perceives a normal experience as a medical condition,
or medicalizes a non-disease situation in his or her life).
Illness is often not due to infection, but a collection of evolved
responses-sickness behavior by the body- that helps clear infection.
Such aspects of illness can include lethargy, depression, anorexia,
sleepiness, hyperalgesia and inability to concentrate.
Disorder
In medicine, a disorder is a functional abnormality or disturbance.
Medical
disorders
can
be
categorized
into mental
disorders, physical disorders, genetic disorders, emotional and
behavioral disorders, and functional disorders. The term disorder is
often considered more value-neutral and less stigmatizing than the
terms disease or illness, and therefore is a preferred terminology in
some circumstances.
In mental health, the term mental disorder is used as a way of
acknowledging the complex interaction of biological, social, and
psychological factors in psychiatric conditions. However, the
term disorder is also used in many other areas of medicine,
primarily to identify physical disorders that are not caused by
infectious organisms, such as metabolic disorders.

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Medical Condition
A medical condition is a broad term that includes all diseases and
disorders. While the term medical condition generally includes
mental illnesses, in some contexts the term is used specifically to
denote any illness, injury, or disease except for mental illnesses.
The Diagnostic
and
Statistical
Manual
of
Mental
Disorders (DSM), the widely used psychiatric manual that defines
all mental disorders, uses the term general medical condition to
refer to all diseases, illnesses, and injuries except for mental
disorders. This usage is also commonly seen in the psychiatric
literature. Some health insurance policies also define a medical
condition as any illness, injury, or disease except for psychiatric
illnesses.
As it is more value-neutral than terms like disease, the
term medical condition is sometimes preferred by people with
health issues that they do not consider deleterious. On the other
hand, by emphasizing the medical nature of the condition, this term
is sometimes rejected, such as by proponents of the autism rights
movement.
The term medical condition is also a synonym for medical state,
in which case it describes an individual patient's current state from
a medical standpoint. This usage appears in statements that
describe a patient as being in critical condition.
Only some diseases such as influenza are contagious and
commonly believed infectious. The micro-organisms that cause
these diseases are known as pathogens and include varieties of
bacteria, viruses, protozoa and fungi. Infectious diseases can be
transmitted, e.g. by hand-to-mouth contact with infectious material
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on surfaces, by bites of insects or other carriers of the disease, and

from contaminated water or food (often via fecal contamination),
etc. In addition, there are sexually transmitted diseases. In some
cases,microorganisms that are not readily spread from person to
person play a role, while other diseases can be prevented or
ameliorated with appropriate nutrition or other lifestyle changes.
Some diseases, such as most (but not all) forms of cancer, heart
disease, and mental disorders, are non-infectious diseases. Many
non-infectious diseases have a partly or completely genetic basis
(see genetic disorder) and may thus be transmitted from one
generation to another.
Social determinants of health are the social conditions in which
people live that determine their health. Illnesses are generally
related to social, economic, political, andenvironmental
circumstances. Social determinants of health have been recognized
by several health organizations such as the Public Health Agency
of Canada and the World Health Organization to greatly influence
collective and personal well-being. The World Health
Organization's Social Determinants Council also recognizes Social
determinants of health in poverty.
When the cause of a disease is poorly understood, societies tend
to mythologize the disease or use it as a metaphor or symbol of
whatever that culture considers evil. For example, until the
bacterial cause of tuberculosis was discovered in 1882, experts
variously ascribed the disease to heredity, a sedentary
lifestyle, depressed mood, and overindulgence in sex, rich food, or
alcoholall the social ills of the time.

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RISK FACTORS OF WEIGHT IMBALANCE

Obesity occurs when you eat and drink more calories than you
burn through exercise and normal daily activities. Your body stores
these extra calories as fat. Obesity usually results from a
combination of causes and contributing factors, including:
Genetics: Your genes may affect the amount of body fat you
store and where that fat is distributed. Genetics may also play a
role in how efficiently your body converts food into energy and
how your body burns calories during exercise. Even when
someone has a genetic predisposition, environmental factors
ultimately make you gain more weight.
Family lifestyle: Obesity tends to run in families. That's not just
because of genetics. Family members tend to have similar
eating, lifestyle and activity habits. If one or both of your
parents are obese, your risk of being obese is increased.
Inactivity: If you're not very active, you don't burn as many
calories. With a sedentary lifestyle, you can easily take in more
calories every day than you burn off through exercise and
normal daily activities.
Unhealthy diet and eating habits: A diet that's high in
calories, lacking in fruits and vegetables, full of fast food,
missing breakfast, and laden with high-calorie beverages and
oversized portions contributes to weight gain.
Quitting smoking: Quitting smoking is often associated with
weight gain. And for some, it can lead to enough weight gain
that the person becomes obese. In the long run, however,
quitting smoking is still a greater benefit to your health than
continuing to smoke.
Pregnancy: During pregnancy, a woman's weight necessarily
increases. Some women find this weight difficult to lose after
the baby is born. This weight gain may contribute to the
development of obesity in women.
Lack of sleep: Not getting enough sleep or getting too much
sleep at night can cause changes in hormones that increase your
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appetite. You may also crave foods high in calories and

carbohydrates, which can contribute to weight gain.
Certain medications: Some medications can lead to weight
gain if you don't compensate through diet or activity. These
medications include some antidepressants, anti-seizure
medications, diabetes medications, antipsychotic medications,
steroids and beta blockers.
Age:Obesity can occur at any age, even in young children. But
as you age, hormonal changes and a less active lifestyle increase
your risk of obesity. In addition, the amount of muscle in your
body tends to decrease with age. This lower muscle mass leads
to a decrease in metabolism. These changes also reduce calorie
needs and can make it harder to keep off excess weight. If you
don't control what you eat and consciously become more
physically active as you age, you'll likely gain weight.
Social and economic issues: Certain social and economic
issues may be linked to obesity. You may not have safe areas to
exercise, you may not have been taught healthy ways of
cooking or you may not have money to buy healthier foods. In
addition, the people you spend time with may influence your
weight you're more likely to become obese if you have obese
friends or relatives.
Medical problems: Obesity can rarely be traced to a medical
cause, such as Prader-Willi syndrome, Cushing's syndrome, and
other diseases and conditions. Some medical problems, such as
arthritis, can lead to decreased activity, which may result in
weight gain.
Ethnic group: The high prevalence of obesity across all the
racial/ethnic groups highlights the importance of implementing
effective intervention strategies among the general population.
Given the significant racial and ethnic disparities in obesity
prevalence, it is also crucial to ensure that racial/ethnic groups
with the greatest need benefit most from these intervention
efforts and are engaged in helping identify effective strategies in
their communities. To reduce racial and ethnic disparities in the
prevalence of obesity, an effective public health response is
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needed that includes surveillance, policies, programs, and

supportive environments achieved through the effort of
government, communities, workplaces, schools, families, and
individuals.
Even if you have one or more of these risk factors, it doesn't mean
that you're destined to become obese. You can counteract most risk
factors through diet, physical activity and exercise, and behavior
changes.

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DIETARY HABITS THAT INCREASE RISK

The night eating syndrome may consume most of their calories at
night, additional important features include no significant caloric
consumption or appetite in the morning, and the feeling that it is
essential to eat in order to get back to sleep. Based on the study,
occasional late night snacks were not a concern unless they
occurred more frequently or on a nightly basis.
According to the researchers, it is important to separate night
eating from binge eating because available treatments and
management for night eating are different than other eating
disorders, which may also coexist. Individuals with the night eating
syndrome (NES) often describe feelings such as lack of control
over their eating behaviors, resulting in feelings of guilt and shame
related to their condition.
It is also important to distinguish between sleep-related eating
disorder, (SRED) a disorder which has received a significant
amount of media attention, and the night eating syndrome. People
with SRED eat while sleepwalking or while in a twilight state
between sleep and being awake. People with SRED are not aware
of what theyre doing, and often they may wake up to discover
dishes or food in their bed, and have no memory of eating at all. A
high percentage of these patients typically use prescription
sleeping medications. By contrast, those with the night eating
syndrome are fully awake and aware of what they are consuming
with no memory deficits or lack of recall for their nightly eating
rituals.
Night eating was also common in the students taking
medications for ADHD, as well as those with anorexia
nervosa. As a result, it is possible that other disorders may
increase the risk of developing a nighttime eating syndrome.
Based upon classification criteria in the newest psychiatric
DSM-5 (Diagnostic and Statistical Manual-5) night eating disorder
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is a distinct diagnosis. While the hallmark of the syndrome is

often defined by increased appetite at night, it commonly is
characterized by so called grazing on food during the evening, as
opposed to outright bingingand also may include waking up
during the night to eat. Often the urge to eat is linked to the feeling
it that it will improve sleep or allow the person to get back to sleep.
According to the National Institutes of Mental Health, the night
eating syndrome affects an estimated 1-2 percent of the population,
equally prevalent in both men and women.
MEDICAL EFFECTS OF THE NIGHT EATING SYNDROME

Those with the night eating syndrome may also display concerning
behaviors found in those with other eating disorders, which may
predispose them not only to emotional or psychological effects, but
to serious medical problems including weight gain, the metabolic
syndrome, diabetes, and elevated blood pressure.Individuals with
the night eating syndrome often have a history of substance abuse,
and may also suffer from depression. They typically report being
more depressed at night. They also frequently have sleep disorders.
Recognition and awareness of the night eating syndrome is vital
so individuals can be referred for treatment. It is especially
important to be aware of persons waking up and eating multiple
times throughout the night, concurrent with missing food and
progressive weight gain.
SIGNS AND CLUES SUGGESTING IN THE NIGHT EATING
SYNDROME

Those with the night eating syndrome may be overweight or obese,

but can also be close to normal weight as well. They may also feel
as though they have no control over their eating behavior, eat in
secret and even when they are not hungry. They may also feel
shame and remorse over their behavior.
Some may hide food out of shame or embarrassment. Those
with the night eating syndrome typically eat rapidly, eating more
than most people would in a similar time period and may also feel
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a loss of control over their eating. Some may eat even when they
are not hungry and continue eating even when they are
uncomfortably full. Feeling embarrassed by the amount they eat,
they typically eat alone to minimize their embarrassment. They
often feel guilt, depression, disgust, distress or a combination of
these symptoms.
Those with night-eating syndrome eat a majority of their food
during the evening. They generally eat little or nothing in the
morning, and wake up during the night and typically fill up on
high-calorie snacks. Traits of patients with night-eating syndrome
may include being overweight, frequent failed attempts at dieting,
depression or anxiety, substance abuse, concern about weight and
shape, perfectionism and a negative self-image.
ETIOLOGY OF THE NIGHT EATING SYNDROME

The exact cause of the night eating syndrome is not clear, as well
as its link to addiction and depression. One theory is that the night
eating syndrome involves a disruption in the hormones that
regulate sleep, appetite, and moodspecifically, an alteration or
disruption in the hypothalamic-pituitary-adrenal axis. It is possible
that the night eating syndrome may be a form of self-medication,
since a large proportion of snacking late at night generally involves
carbohydrate-rich or comfort type foods.
There may also be a number of contributing factors to the night
eating syndrome. Some college students may develop the habit of
nighttime eating, and this may continue into adulthood. Those with
the night eating syndrome may also be high achievers who work
through lunch, and may then make up the caloric debt by eating
more at night.
The night eating syndrome can also be viewed as a response to
dieting. With restriction of calories during the day, persons
typically overcompensate at night by eating greater amounts. Night
eating may also be a response to stress bottled up during the day,

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with eating serving as a way to self- medicate, according to some

persons with the syndrome.
TREATMENTS FOR THE NIGHT EATING SYNDROME

Consistent with other eating disorders, successful treatment of the

night eating syndrome generally requires a combination of
therapies. Educating patients about their condition is an important
first step in therapy for the night eating syndrome, primarily so
they develop a greater awareness of their eating behaviors and can
begin to identify triggers that influence how they eat.
Potential treatments of the night eating syndrome may include
nutrition assessment and therapy, cognitive-behavioral therapy
(CBT), exercise physiology, dialectical behavioral therapy (DBT),
interpersonal therapy (IT) along with management of stress. Online
support groups as well as individual counseling may also help
patients reduce symptoms and gain independence and control over
the syndrome.
Identification of individuals with the night eating syndrome and
referral for further evaluation is essential in order to help identify
other important issues such as underlying depression and substance
abuse that require further attention.
BINGE EATING AND EATING DISORDERS

The Binge eating disorder is a serious eating disorder in which

person frequently consume unusually large amounts of food.
Almost everyone overeats on occasion, such as having seconds or
thirds of a holiday meal. But for some people, overeating crosses
the line to binge-eating disorder and it becomes a regular
occurrence, usually done in secret.
When a person has binge-eating disorder, this may be deeply
embarrassed about gorging and vow to stop. But feel such a
compulsion that you can't resist the urges and continue binge
eating. If you have binge-eating disorder, treatment can help.

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Symptoms
There are numerous behavioural and emotional signs and
symptoms, such as:
Eating unusually large amounts of food
Eating even when you're full or not hungry
Eating rapidly during binge episodes
Eating until you're uncomfortably full
Frequently eating alone
Feeling that your eating behaviour is out of control
Feeling depressed, disgusted, ashamed, guilty or upset about
your eating
Experiencing depression and anxiety
Feeling isolated and having difficulty talking about your
feelings
Frequently dieting, possibly without weight loss
Losing and gaining weight repeatedly, also called yo-yo dieting.
Talk to your primary care doctor or a mental health provider about
your binge-eating symptoms and feelings. If you're reluctant to
seek treatment, talk to someone you trust about what you're going
through. A friend, loved one, teacher or faith leader can help you
take the first steps to successful treatment of binge-eating disorder.
A person with binge-eating disorder can become an expert at
hiding behaviour, making it hard for others to detect the problem.
If you have a loved one you think may have symptoms of bingeeating disorder, have an open and honest discussion about your
concerns. You can offer encouragement and support and help your
loved one find a qualified doctor or mental health provider and
make an appointment.
Causes
The causes of binge-eating disorder are unknown. But family
history, biological factors, long-term dieting and psychological
issues increases risk.

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Risk factors
Factors that can increase the risk of developing binge-eating
disorder include:
Family history and biological factors. You're much more
likely to have an eating disorder if your parents or siblings have
(or had) an eating disorder. Some people with binge-eating
disorder may have inherited genes that make them more
susceptible to developing the disorder, or their brain chemicals
may have changed.
Psychological issues. Most people who have binge-eating
disorder are overweight, acutely aware of their appearance, and
feel bad about it. When you have binge-eating disorder, you
may act impulsively and feel you can't control your behaviour.
You may have a history of depression or substance abuse. And
you may have trouble coping with stress, worry, anger, sadness
and boredom.
Dieting. Many people with binge-eating disorder have a history
of dieting some have dieted to excess dating back to
childhood. Dieting may trigger an urge to binge eat, especially
if you have low self-esteem and symptoms of depression.
Your age. Although people of any age can have binge-eating
disorder, it often begins in the late teens or early 20s.
Complications
This may develop psychological and physical problems related to
binge eating. Some of these complications arise from being
overweight due to frequent bingeing. Other complications may
occur because of unhealthy yo-yo eating habits bingeing
followed by harsh dieting. In addition, food consumed during a
binge is often high in fat and low in protein and other nutrients,
which could lead to health problems.
Complications that may be caused by, or linked with, binge-eating
disorder include:
Depression
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Suicidal thoughts
Insomnia
Obesity
High blood pressure
Type 2 diabetes
High cholesterol
Gallbladder disease and other digestive problems
Heart disease
Some types of cancer
Joint pain
Muscle pain
Headache
Menstrual problems
RESTRAINED EATING

Restrained eating is the act of abstaining or avoiding certain foods,

entire food categories, specific ingredients (like sugar) or eating in
specific patterns that eliminate social flexibility. Its a sub-clinical
eating disorder, an anxious state where you never let yourself eat
what you want or you're always watching what you eat. If a
restrained eater finally gives in and eats what she is craving, she
generally gets out of control. Many chronic dieters are restrained
eaters, depriving themselves and then bingeing, over and over
again.
Restrained eating does not address the point of caloric control.
In other words, you could be a highly restrained eater with very
few food choices you deem as acceptable or healthy but still overeat those foods such that youre consuming more calories than you
need.Restrained eating also sets you up for major binge and crash
episodes when you eat even just one bite of foods that you have
arbitrarily labelled as forbidden. Retrained eating will rarely lead
to long term sustainable weight loss success because of the crash
and binge scenario is presents when you crack and finally have a
bite of forbidden food.

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Self-control is generally viewed as highly desirable. In the

eating behavior domain, however, the dominance of restraint
theory has made the proposition that individuals should attempt to
control their eating more controversial.The evidence from the
dietary restraint literature and from studies of self-regulation
processes to examine how far self-imposed control around food
can be seen as beneficial for effective weight management.
Epidemiological and field study evidence provides little support
for the proposition that restrained eating causes disinhibited eating
patterns.
Restraint is often initiated as a response to weight gain, and the
co-occurrence of disinhibited and restrained eating patterns on an
individual level might better be explained by restraint acting as a
marker for overeating tendencies. A sustained effort to monitor and
control food intake characterizes successful long-term weight
maintenance, suggesting that self-regulation in the eating domain is
essential for those with a tendency to gain weight.
Evidence from the literature on cognitive self-regulation
suggests that there may be potential for people to learn to selfregulate better, both through training and controlled exposure
techniques. Integration of the disparate theories of self-regulation
is needed to identify the best ways of promoting self-regulation in
order to support effective weight control, both in clinical and
community settings.
INFREQUENT EATING

Individuals who experience a mix of anorexia and/or bulimia

and/or binge-eating symptoms, but who don't fall neatly into one of
the medical categories, are said to have an eating disorder not
otherwise specified (ED-NOS). These individuals should also
receive the help and resources provided to individuals who have a
"neat" clinical diagnosis. For instance, individuals with ED-NOS
may exhibit all the symptoms of anorexia but:
Women may continue to experience menstruation.
Men won't typically experience abnormally low sex hormones.
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Both men and women may lose weight but still remain in the
normal weight range.
Others may have all the symptoms of bulimia, but won't binge
and/or purge as often as is required to be categorized as having
bulimia.
Many people with ED-NOS also engage in other symptoms
associated with anorexia, bulimia or binge eating, like:
Purging, or compensating for normal eating by inducing
vomiting, using laxatives or over-exercising - but don't do it
often enough to be diagnosed with one of the other clinical
eating disorders.
Chewing food repeatedly and often spitting it out rather than
swallowing it.
Binge eating regularly and compensating for it through the use
of laxatives or by vomiting, etc.
Remaining within their normal weight range despite disordered
eating.
THE RISKS OF A SEDENTARY LIFESTYLE

In addition to obesity, living a sedentary lifestyle increases your

risk of other health problems. Worldwide, it is estimated that a
sedentary lifestyle is responsible for 6% of coronary heart disease
cases, 7% of type 2 diabetes, 10% of breast cancer and 10% of
colon cancer cases. In fact, it was recently reported that inactivity
is responsible for more annual deaths than smoking.
Physical inactivity (sedentary lifestyle) is considered the failure
to meet the recommendations of the Center for Disease Control
(CDC), stating that an individual should participate in a minimum
of 150 minutes of moderate exercise, or 75 minutes of a more
vigorous regimen. Most health professionals are also in agreement
that walking 10,000 steps a day (approximately 5 miles) is the
ideal goal to set for improving health and reducing the health risks
caused by inactivity. Traditional thought suggests that having a
healthy diet and getting aerobic exercise will offset the effects of
time spent being sedentary. Even if you exercise for 30 minutes a
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day, you may not be able to counteract the effects brought on by a

lack of activity throughout the rest of your day. "Rather, the
solution seems to be less sitting and more moving overall," says
Levine. Again, we suggest aiming for 10,000 steps a day.
There is no surprise that sitting behind a desk, commuting or
relaxing on the couch for too many hours a day can be harmful to
the health, but what may find surprising is the extent of havoc it is
causing. According to the World Health Organization (WHO), 60
to 85% of the population worldwide does not engage in enough
activity, therefore leading a sedentary lifestyle.
Marc Hamilton Ph.D., a professor of biomedical sciences at the
University of Missouri in Columbia, has labelled this area of study
as "inactivity physiology". "The existing data, by numerous
studies, are starting to show that the rates of heart disease, diabetes
and obesity are doubled and sometimes tripled in people who sit a
lot," says Hamilton, suggesting that "if you can perform a behavior
while sitting or standing I would choose standing".
In 2005, James A. Levine, an obesity specialist at Mayo Clinic,
pioneered the way for research on the negative effects of a
sedentary lifestyle by publishing an article in Science magazine.
Levines conclusion was that "Any extended sitting such as
behind a desk at work or behind a wheel can be harmful". Levine
has even gone as far as labelling sitting as "the disease of our
time".
The general workplace movement is heading to a more
sedentary setting as machines continue to replace jobs in which
require more activity. The easiest way to increase activity levels is
doing so at the workplace, a place in which the average individual
spends up to eight or more hours sitting. Simply by ditching the
chair for a few hours a day you can immensely reduce the effects
caused by inactivity. "Within two weeks, people basically get
addicted to walking and working," says Levine. "You just have to
give them the chance.
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Ex Smokers and Obesity

Weight gain after quitting is a serious concern for some smokers.
About 80 per cent of smokers put on weight when they quit.
However, most ex-smokers only gain a modest amount of weight.
The average weight gain is about five kilograms in the first year
after stopping smoking and about six to seven kilograms overall.
People who quit can have very different experiences with weight
change, ranging from those who lose weight to a minority of
people who gain over ten kilograms. Research shows that in the
long term, the average body weight of ex-smokers is similar to
people who have never smoked. Smoking appears to change the
distribution of fat in women to a less healthy male apple pattern.
Women who smoke tend to put on more fat around their waist
compared to women who do not smoke. Fat in this area is
associated with risks such as stroke, heart disease, type-2 diabetes
and a general increased death rate. When women quit smoking,
any weight gain that occurs is in the normal and safer female
pattern, with a preference to the hips rather than the waist.
The best approach is to focus on strategies to keep healthy rather
than on weight control. These include making realistic goals for
healthy eating, getting regular exercise and getting enough sleep.
These strategies can also help minimise weight gain. However, it
can be helpful to be prepared to accept at least a small increase in
weight.
It can be difficult to quit cigarettes and manage weight at the
same time, because both activities require effort and commitment.
If this is the case for you, concentrate first on quitting. Weight gain
is typically about one kilo per month in the first three months, but
it does slow down the longer you stay quit, provided you have a
sensible diet.
Causes of Weight Gain When Quitting Smoking
The two main causes of weight gain when quitting smoking are
thought to be:
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Eating more food: Many smokers find their eating habits

change when they quit cigarettes. Some people experience
increased hunger as a withdrawal symptom, but research
suggests their eating patterns eventually return to normal.
The effect of nicotine on the body: nicotine is the addictive
substance in tobacco that causes smokers to continue their habit.
Although nicotine isnt thought to cause cancer, it does speed
up the bodys food processing system, the metabolism. After
many years of smoking, smokers tend to weigh slightly less
than non-smokers.
Researchers suggest that one of the reasons why smokers tend to
put on some weight after quitting is because their metabolism
slows down, and they burn fewer kilojoules than while they were
smoking. This would explain why some ex-smokers put on weight
even if they do not eat any more than usual.
Eating Instead of smoking
Some ex-smokers eat more, particularly in the first few weeks after
quitting. Some of the reasons include:
The restless, empty feeling of nicotine withdrawal can feel very
similar to hunger pangs. The smoker may be fooled into
thinking theyre hungry when they are not.
Missing the oral satisfaction of putting a cigarette into their
mouths prompts some ex-smokers to substitute food for
cigarettes. Instead of lighting up, they eat something.
Food can be comforting. If an ex-smoker is having a hard time
during the withdrawal period, they may reward themselves with
treats and snacks in an attempt to feel better.
Some smokers regularly skip meals for example, breakfast
may be a cup of coffee and a couple of cigarettes. Once you
stop smoking, you may find that you dont feel like skipping
meals anymore.
Many ex-smokers find that food tastes better, and this may lead
to more helpings.

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LONG-TERM HEALTH EFFECTS OF SHIFT WORK

Rotating Shifts
The best rotating shift pattern is still undecided. For the most
people, rotating forward through day, afternoon and night shift is
better than backwards (night, afternoon then day). The frequency
of rotation is also controversial. Some people advocate prolonged
rotation, such as two to three weeks. Others advocate short
rotations of two to three days. Both have advantages and
disadvantages.
It takes about 10 days for the body to adjust to night shift work.
However, it is common for night shift workers to revert to daytime
routines for a day or two during days off, which tends to make the
circadian rhythm unstable. The amount of hours (8-hour versus 12hour shifts) is also controversial. It can be said that 12-hour shifts
stretch the bodys tolerance as far as possible. Its very important
that no overtime should be allowed during a rotation of 12-hour
shifts. Another risk to sleep is when a worker on seven 12-hour
shifts a fortnight uses their free time for another, almost full-time
job.
A proportion of shift workers may have marked daytime
sleepiness, called Shift Work Sleep Disorder. The long-term
effects of shift work are harder to measure. But researchers have
found compelling connections between shift workers and an
increased risk of serious health conditions and diseases. Shift work
is extremely frequent in several services and industries, in order to
meet the needs for flexibility of the workforce, necessary to
optimize the productivity and the business competitiveness in
developed countries, where the proportion of shift workers is
estimated to represent >20% of the entire working population.
Shift work is associated with several health problems, possibly
due to an impairment of biological rhythms. In particular, an
increased risk of coronary heart disease (CHD) has been reported
in several studies performed in shift workers, with a direct
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association between relative risk (RR) for CHD and time of

exposure to shift work. However, this significant correlation
between shift work and CHD mortality has not been found by other
groups dealing with this issue. Therefore, further insight is needed
to elucidate the effect of shift work on cardiovascular risk.
Obesity and Shift Work
There are several possible reasons for the link between obesity and
shift work. Poor diet and lack of exercise might be part of the
problem. Hormone balance seems to be important too. The
hormone leptin plays a key role in regulating our appetite; it helps
make us feel full. Since shift work seems to lower the levels of
leptin, it could be that night workers just feel hungrier and thus eat
more than day workers.
Obesity is a well known independent cardiovascular risk
factor and, interestingly, it has been shown to be more prevalent
among shift workers; similarly, a more marked weight gain has
been reported in shift working subjects. Moreover, abdominal fat
accumulation is a cardiovascular risk factor stronger than obesity
itself, and it is noteworthy that shift workers have been shown to
have higher waist-to-hip ratio (WHR) (i.e. more central fat) than
day workers, independently of body mass index (BMI).
Among several well known cardiovascular risk factors, total
cholesterol and triglycerides have been shown to be higher in shift
workers than in day workers, independently of other lifestyle
factors. Significant elevations in the serum levels of cholesterol,
glucose, uric acid, and potassium have been reported during the
first week after a night shift, and this impairment could not be
explained by changes in dietary habits or other lifestyle
variables. Interestingly, shift workers on counter-clockwise
rotation are characterized by higher systolic blood pressure (SBP)
levels, urinary catecholamines excretion, and plasma levels of
triglyceride and glucose compared to shift workers on clockwise
rotation.

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People with Disability

Studies have shown that individuals with disabilities are more
likely than people without disabilities to report:
Poorer overall health.
Less access to adequate health care.
Smoking and physical inactivity.
People with disabilities need health care and health programs for
the same reasons anyone else does to stay well, active, and a part
of the community. Although a smaller percentage than people
without disabilities, most people with disabilities report their health
to be good, very good, or excellent. Being healthy means the same
thing for all of us getting and staying well so we can lead full,
active lives. That means having the tools and information to make
healthy choices and knowing how to prevent illness. For people
with disabilities, it also means knowing that health problems
related to a disability can be treated. These problems (also called
secondary conditions) can include pain, depression, and a greater
risk for certain illnesses.
Secondary Conditions
People with disabilities often are at greater risk for health problems
that can be prevented. As a result of having a specific type of
disability, such as a spinal cord injury, spina bifida, or multiple
sclerosis, other physical or mental health conditions can occur.
Some of these other health conditions are also called secondary
conditions and might include:
Bowel or bladder problems
Fatigue
Injury
Mental health and depression
Overweight and obesity
Pain
Pressure sores or ulcers

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Bowel and Bladder

Some disabilities, such as spinal cord injuries, can affect how well
a persons bladder and bowel works.
Fatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
Fatigue can affect the way a person thinks and feels. It can also
interfere with a persons activities of daily living.
Injury
Injuriesincluding unintentional injury, homicide, and suicideare the
leading cause of death for people 1 through 44 years of age. The
consequences of injuries can include physical, emotional, and
financial consequences that can affect the lives of individuals, their
families, and society.
Mental Health and Depression
Mental health is how we think, feel, and act as we cope with life.
People with disabilities report higher rates of stress and depression
than people without disabilities. There are different ways to treat
depression. Exercise can be effective for some people. Counselling
or medication also might be needed.
Overweight and Obesity
Children and adults with disabilities are less likely to be of healthy
weight and more likely to be obese than children and adults
without disabilities. Overweight and obesity can have serious
health consequences for all people.
Pain
Pain is commonly reported by people with many types of
disabilities. For some, pain can affect functioning and activities of
daily living. The length of time a person experiences pain can be
classified as either long term (also called chronic) or short term.

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Pressure Sores or Ulcers

Pressure ulcers, also known as bed sores, pressure sores, or
decubitus ulcers, are wounds caused by constant pressure on the
skin. They usually develop on body parts such as the elbow, heel,
hip, shoulder, back, and back of the head. People with disabilities
who are bedridden or use a wheelchair are at risk for developing
pressure sores.
Other Concerns, Conditions, and Prevention
Many related health conditions and chronic diseases can be
prevented. Chronic diseases are among the most common and
costly of all health problems, even though many chronic diseases
can be prevented. Some chronic diseases can be prevented by
living a healthy lifestyle, visiting a health care provider for
preventive care and routine screenings, and learning how to
manage health issues.
Arthritis
Arthritis or join inflammation is the most common cause of
disability among adults .People with disabilities can be at greater
risk of having arthritis.
Asthma
Asthma is a disease that affects the lungs. It is one of the most
common long-term diseases among children, but adults can have
asthma, too. Asthma is the most common chronic disease of
childhood and a leading cause of disability among children.
Cancer
Getting screened for breast, cervical and colorectal cancers as
recommended helps find these diseases at an early, often highly
treatable, stage. Research shows that women with disabilities are
less likely to be screened for breast and cervical cancer within the
recommended guidelines. Some reasons identified by women
include encountering inaccessible facilities and equipment, and
having to focus on other health issues.
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Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is four times more common
among females than males. People of both sexes and of every race
and ethnicity and age (including adolescents) can develop CFS.
Diabetes
Diabetes is a chronic disease for which care and treatment can help
people to live normal and productive lives. However, some people
might be limited in their everyday activities. People with diabetes,
in general, report rates of disability that are significantly higher
than those reported by the general population.
Flu
People with certain types of disability have a higher risk of getting
flu-related complications, such as pneumonia. Some physical
disabilities can affect how well their body fights off infection.
They should discuss their risk of illness with their health care
provider.
Heart Disease
Heart disease, also called cardiovascular disease, is the leading
cause of death. Around 630,000 people die of heart disease each
year. It is also a leading cause of disability.
Learning Disabilities
Learning disabilities are disorders that may affect a persons ability
to understand or use spoken or written language, do mathematical
calculations, coordinate movements, or direct attention. Learning
disabilities can be lifelong conditions and some people can have
several overlapping learning disabilities. Other people can have a
single, isolated learning problem that has little effect on their lives.
Limb Loss
Limb loss can occur due to trauma, infection, diabetes, vascular
disease, cancer, or other diseases. Some children are born with
limb loss or differences. Limb loss more often is the result rather
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than the cause of other health problems. However, loss of a limb

can result in decreased physical activity, skin problems associated
with using a prosthesis, and phantom pain for the residual limb.
MRSA
Methicillin-Resistant Staphylococcus Aureus, or MRSA, is a type
of bacteria that is resistant to certain antibiotics. MRSA, most often
occurs among people in hospitals and health care facilities such as
(nursing homes and dialysis centers) who have weakened immune
systems. A person can get MRSA through direct contact with an
infected person or by sharing personal items, such as towels or
razors that have touched infected skin.
Musculoskeletal Disorders
Musculoskeletal disorders include problems such as back pain,
joint injuries, tendinitis, and repetitive strain. Musculoskeletal
injuries can cause temporary or even permanent disability, leaving
some individuals unable to move around easily. Work-related
musculoskeletal disorders are the leading cause of disability for
people during their working years.
Nutrition (Healthy Eating)
Healthy eating is associated with reduced risk for many diseases,
including the three leading causes of death,heart disease, cancer,
Andstroke.
Oral Health
Good oral health is important and can affect the health and wellbeing of a persons life. Oral health is more than just having
healthy teeth; for example, lifestyle behaviors, such as tobacco use,
can affect general and oral health. Oral diseases and conditions are
associated with other health problems as well. However, safe and
effective measures exist to prevent the most common dental
diseases.

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Respiratory Virus
Respiratory syncytial virus or RSV is a virus common in childhood
and important among older adults. RSV infects the lungs and
breathing passages. Most otherwise healthy people recover from
RSV infection in 1 to 2 weeks. However, infection can be severe
among some people.
Substance Abuse
Alcohol, tobacco, illicit drugs, and prescription medications all can
be substances of abuse. People with disabilities might have
multiple risk factors that can increase their chances for substance
abuse.
Violence
Violence is a serious public health problem. People with
disabilities are 4 to 10 times more likely to become victims of
violence, abuse, or neglect than people without disabilities.
Children with disabilities are more than twice as likely to be
physically or sexually abused as children without disabilities.
Challenges Facing People with Disabilities
People with disabilities can find it more difficult to eat healthy,
control their weight, and be physically active. This might be due
to:
A lack of healthy food choices.
Difficulty with chewing or swallowing food, or its taste or
texture.
Medications that can contribute to weight gain, weight loss, and
changes in appetite.
Physical limitations that can reduce a persons ability to
exercise.
Pain and lack of energy.
A lack of accessible environments (for example, sidewalks,
parks, and exercise equipment) that can enable exercise.
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A lack of resources (for example, money, transportation, and

social support from family, friends, neighbours, and community
members).

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COMPLICATIONS OF WEIGHT IMBALANCE

GENERAL ADVERSE EFFECTS OF OBESITY

The concern issue is the association between obesity and mortality.

While some researchers believe that obesity will shorten the life
expectancy of obese populations, there are other data describing a
U-shaped association, with excess mortality in both under-weight
and severe obesity, while milder degrees of overweight do not
show increased rates. In addition, improved standards of medical
care may attenuate the effect of obesity on life expectancy. The
economic burden of providing this medical care to increasing
numbers of obese subjects cannot however be dismissed.
Not all obese patients will develop complications. Further
characterization of physical activity and fitness, fat distribution,
insulin resistance and family history of obesity-related diseases,
can identify the obese person who is at increased risk. The age of
onset of obesity also needs to be taken into account, as the life-long
risk of developing obesity-related complications is higher in earlyonset compared with late-onset obesity.
Suggestions are Firstly, for patients who suffer from obesityrelated complications listed in that have been shown to respond
favourably to weight loss, we recommend that dietary consultation
be part of the treatment plan.Secondly, since not all obese subjects
will develop associated morbidities, we list clinical characteristics
that are of assistance in identifying those asymptomatic obese
people who have a particularly high risk for developing obesityrelated complications.
The rationale of focusing the effort to achieve weight reduction
in this high-risk group, is based on data from studies such as the
large Diabetes Prevention Program, in which 3234 non-diabetic
overweight or obese patients with elevated glucose levels were
randomized to placebo, lifestyle modification program or
metformin. The lifestyle modification program was aimed at
achieving 7% weight loss and 150 min of physical activity per
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week. This program lasted for 3 years, and resulted in a 58%

reduction in diabetes incidence.
GENERAL ADVERSE EFFECTS OF BEING OVERWEIGHT

For overweight persons with a high-risk profile or the abovementioned complications, who fail to lose weight, pharmacological
adjunct therapy and bariatric surgery should be considered. This is
supported by the results of two large intervention studies with a
relatively long-term follow up. In the first, a randomized trial
comparing combined dietary intervention with orlistat (lipase
inhibitor) and dietary intervention to dietary intervention alone, the
combined therapy given for 4-year period, resulted in a 37%
reduction in the incidence of diabetes due to the effect in a
subgroup of patients with impaired glucose tolerance.
In the second large study, 1703 obese patients who underwent
bariatric surgery were followed for 10 years, and compared to
conventionally treated obese subjects. The surgery group lost
significantly more weight and maintained the weight loss
throughout the follow-up period and this weight loss was
accompanied by a significantly lower incidence of diabetes and
hypertriglyceridemia.
The issues of safety, cost-effectiveness and quality of life,
related to pharmacological and surgical therapies for obesity, are
still debated, and an individual approach has been
suggested. Before establishing definite treatment guidelines, more
large intervention studies, focusing on different age groups and
obesity-related comorbidities are needed to address the long-term
cost-effectiveness and quality of life associated with various
treatment modalities.
If person considered to be overweight, losing as little as 5
percent of your body weight may lower your risk for several
diseases, including heart disease and type 2 diabetes. If you weigh
200 pounds, this means losing 10 pounds. Slow and steady weight

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loss of 1/2 to 2 pounds per week, and not more than 3 pounds per
week, is the safest way to lose weight.
HEALTH PROBLEMS ARE LINKED TO OVERWEIGHT AND
OBESITY

Excess weight may increase the risk for many health problems,
including,
Heart Disease and Stroke
Insulin Resistance, Type 2 Diabetes, and Metabolic Syndrome
Cancer
Reproductive and Hormonal Problems
Effects on the Lungs
Effect on the Liver
Sleep Disorders
Emotional and Social Problems
Heart Disease
Heart disease is a term used to describe several problems that may
affect your heart. The most common type of problem happens
when a blood vessel that carries blood to the heart becomes hard
and narrow. This may keep the heart from getting all the blood it
needs. Other problems may affect how well the heart pumps. If you
have heart disease, you may suffer from a heart attack, heart
failure, sudden cardiac death, angina (chest pain), or abnormal
heart rhythm. Heart disease is the leading cause of death.
People who are overweight or obese often have health problems
that may increase the risk for heart disease. These health problems
include high blood pressure, high cholesterol, and high blood
sugar. In addition, excess weight may cause changes to your heart
that make it work harder to send blood to all the cells in your body.
Losing 5 to 10 percent of your weight may lower your chances
of developing heart disease. If you weigh 200 pounds, this means
losing as little as 10 pounds. Weight loss may improve blood
pressure, cholesterol levels, and blood flow.

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Stroke
A stroke happens when the flow of blood to a part of your brain
stops, causing brain cells to die. The most common type of stroke,
called ischemic stroke, occurs when a blood clot blocks an artery
that carries blood to the brain. Another type of stroke, called
hemorrhagic stroke, happens when a blood vessel in the brain
bursts. Overweight and obesity are known to increase blood
pressure. High blood pressure is the leading cause of strokes.
Excess weight also increases your chances of developing other
problems linked to strokes, including high cholesterol, high blood
sugar, and heart disease.
One of the most important things you can do to reduce your
stroke risk is to keep your blood pressure under control. Losing
weight may help you lower your blood pressure. It may also
improve your cholesterol and blood sugar, which may then lower
your risk for stroke.
Type 2 diabetes
It is a disease in which blood sugar levels are above normal. High
blood sugar is a major cause of heart disease, kidney disease,
stroke, amputation, and blindness. Type 2 diabetes is the most
common type of diabetes. Family history and genes play a large
role in type 2 diabetes. Other risk factors include a low activity
level, poor diet, and excess body weight around the waist.
About 80 percent of people with type 2 diabetes are overweight
or obese. It isn't clear why people who are overweight are more
likely to develop this disease. It may be that being overweight
causes cells to change, making them resistant to the hormone
insulin. Insulin carries sugar from blood to the cells, where it is
used for energy. When a person is insulin resistant, blood sugar
cannot be taken up by the cells, resulting in high blood sugar. In
addition, the cells that produce insulin must work extra hard to try
to keep blood sugar normal. This may cause these cells to
gradually fail.
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If you are at risk for type 2 diabetes, losing weight may help
prevent or delay the onset of diabetes. If you have type 2 diabetes,
losing weight and becoming more physically active can help you
control your blood sugar levels and prevent or delay health
problems. Losing weight and exercising more may also allow you
to reduce the amount of diabetes medicine you take.
Insulin resistance and the metabolic syndrome
Insulin resistance and the compensatory hyperinsulinemia, are
strongly associated with increased risk for type 2 diabetes, CVD
and CHD mortality in large epidemiological studies. The metabolic
syndrome, a cluster of abnormalities related to insulin resistance
was also associated with increased risk of developing type 2 DM
and CVD in large prospective studies. Population-attributable risk
estimates associated with the metabolic syndrome were 34%, 29%
and 62% in men, and 16%, 8% and 47% in women, for CVD,
CHD, and type 2 DM, respectively.
The metabolic syndrome includes known risk factors for CVD
such as abdominal obesity, hypertension, glucose intolerance, high
triglycerides and low HDL-cholesterol. In addition, some data
suggest that even after adjusting for these known risk factors, the
metabolic syndrome remains an independent risk factor for CVD.
Obese and overweight people tend to be more insulin-resistant, yet
only about half have significant insulin resistance.
Identifying obese insulin-resistant individuals in daily practice
is of great importance, since weight reduction is especially
beneficial in reducing CVD risk factors in this sub-group.
Fortunately, insulin resistance can be identified by relatively
simple measures such as high fasting serum insulin levels or by
high triglycerides and low HDL-cholesterol levels.
Obesity has been associated with increased risk of several types
of commonly occurring cancer, as noted above. In addition, obesity
is associated with both a higher rate of recurrence of breast cancer
and a worse prognosis. Interestingly, abdominal obesity and insulin
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resistance were shown to be associated with some types of cancer

such as colon and breast neoplasia, suggesting that one of the
mechanisms linking obesity and cancer is related to insulin-like
growth factors.
Cancer
Being overweight increases the risk of developing certain cancers,
including the following:
breast, after menopause
colon and rectum
endometrium (lining of the uterus)
gallbladder
kidney
Cancer occurs when cells in one part of the body, such as the
colon, grow abnormally or out of control. The cancerous cells
sometimes spread to other parts of the body, such as the liver.
Gaining weight as an adult increases the risk for several cancers,
even if the weight gain doesn't result in overweight or obesity. It
isn't known exactly how being overweight increases cancer risk.
Fat cells may release hormones that affect cell growth, leading to
cancer. Also, eating or physical activity habits that may lead to
being overweight may also contribute to cancer risk.
Avoiding weight gain may prevent a rise in cancer risk. Healthy
eating and physical activity habits may lower cancer risk. Weight
loss may also lower your risk, although studies have been
inconclusive.
Reproductive and Hormonal Problems
Overweight and obesity raise the risk of health problems for both
mother and baby that may occur during pregnancy. Pregnant
women who are overweight or obese may have an increased risk
fordeveloping gestational diabetes (high blood sugar during
pregnancy)
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having preeclampsia (high blood pressure during pregnancy that

can cause severe problems for both mother and baby if left
untreated)
needing a C-section and, as a result, taking longer to recover
after giving birth
Babies of overweight or obese mothers are at an increased risk of
being born too soon, being stillborn (dead in the womb after 20
weeks of pregnancy), and having neural tube defects (defects of the
brain and spinal cord).
Guidelines from the Institute of Medicine and the National
Research Council, issued in 2009, recommend the following
amount of weight gain during pregnancy:
Pre-pregnancy Weight

Amount to Gain

Underweight

(BMI < 18.5) 2840 lbs

Normal Weight

(BMI 18.524.9) 2535 lbs

Overweight

(BMI 2529.9) 1525 lbs

Obesity

(BMI 30+) 1120 lbs

Pregnant women who are overweight are more likely to develop

insulin resistance, high blood sugar, and high blood pressure.
Overweight also increases the risks associated with surgery and
anesthesia, and severe obesity increases surgery time and blood
loss.
Gaining too much weight during pregnancy can have long-term
effects for both mother and child. These effects include that the
mother will have overweight or obesity after the child is born.
Another risk is that the baby may gain too much weight later as a
child or as an adult.

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If you are pregnant, check the sidebar for general guidelines

about weight gain. Talk to your health care provider about how
much weight gain is right for you during pregnancy.
If you are overweight or obese and would like to become
pregnant, talk to your health care provider about losing weight
first. Reaching a normal weight before becoming pregnant may
reduce your chances of developing weight-related problems.
Pregnant women who are overweight or obese should speak with
their health care provider about limiting weight gain and being
physically active during pregnancy.
Losing excess weight after delivery may help women reduce
their health risks. For example, if a woman developed gestational
diabetes, losing weight may lower her risk of developing diabetes
later in life.
EFFECTS ON THE LUNGS

Asthma
The prevalence of asthma is increased in overweight subjects and
obese or overweight subjects account for 75% of emergency
department visits for asthma. Longitudinal studies indicate that
obesity antedates asthma, and that the relative risk of incident
asthma increases with increasing obesity.In addition, asthmatic
subjects studied after weight loss demonstrate decreased severity
of asthma symptoms. Obesity also appears to be a risk factor for
airway hyper-responsiveness.
The relationship between obesity and asthma is underlined by
the finding that obesity is a strong predictor of the persistence of
childhood asthma into adolescence. Potential mechanisms for this
relationship include obesity-related changes in lung volumes,
systemic inflammation and other adipocyte-derived factors that
might alter airway smooth muscle function and promote airway
narrowing.

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Recently, the relationship between respiratory function and

obesity has been examined in the EPIC-Norfolk cohort in Norfolk,
UK. This group included 9674 men and 11 876 women aged 45
79 years. FEV1 and FVC were linearly and inversely correlated
across the entire spectrum of the waist-hip ratio in both men and
women, and this relation persisted after adjustment for BMI.
This suggests that abdominal obesity may impair respiratory
function, and more so than generalized obesity. Furthermore,
a post-hoc analysis of a database of four previous placebocontrolled studies of monteleukast or inhaled beclomethasone,
showed a lower placebo response and also a lower response to
inhaled corticosteroid, with increasing BMI, whereas response to
monteleukast was not affected by BMI.
EFFECT ON THE LIVER

Fatty liver disease, also known as NonalcoholicSteatohepatitis

(NASH), occurs when fat builds up in the liver and causes injury.
Fatty liver disease may lead to severe liver damage, cirrhosis (scar
tissue), or even liver failure. Fatty liver disease usually produces
mild or no symptoms. It is like alcoholic liver disease, but it isn't
caused by alcohol and can occur in people who drink little or no
alcohol. The cause of fatty liver disease is still not known. The
disease most often affects people who are middle-aged, overweight
or obese, and/or diabetic. Fatty liver disease may also affect
children.
Although there is no specific treatment for fatty liver disease,
patients are generally advised to lose weight, eat a healthy diet,
increase physical activity, and avoid drinking alcohol. If you have
fatty liver disease, lowering your body weight to a healthy range
may improve liver tests and reverse the disease to some extent.
SLEEP DISORDER

Sleep Apnea
Sleep apnea is a condition in which a person has one or more
pauses in breathing during sleep. A person who has sleep apnea
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may suffer from daytime sleepiness, difficulty focusing, and even

heart failure.
Obesity is the most important risk factor for sleep apnea. A
person who is overweight may have more fat stored around his or
her neck. This may make the airway smaller. A smaller airway can
make breathing difficult or loud (because of snoring), or breathing
may stop altogether for short periods of time. In addition, fat stored
in the neck and throughout the body may produce substances that
cause inflammation. Inflammation in the neck is a risk factor for
sleep apnea.Weight loss usually improves sleep apnea. Weight loss
may help to decrease neck size and lessen inflammation.
EMOTIONAL AND SOCIAL PROBLEMS

Obesity in the past was seen as a sign of wealth and wellbeing.

This remains the case in many parts of Africa, partly as a result of
the HIV epidemic and its associated wasting. However, in affluent
countries there is a stigma associated with obesity in areas such as
education, employment and health care. A survey of more than
10 000 adolescents found that women with a BMI above the 95th
percentile for age and sex completed fewer years of school (0.3
years), were 20% less likely to be married, had lower household
incomes and higher rates of household poverty compared to
women who had not been overweight, independent of their
baseline socioeconomic status and aptitude test scores. Men who
had been overweight were less likely to be married.
In a group of 294 patients seeking consultation for bariatric
surgery, half the patients had a psychiatric disorder and 29% had
comorbidity. The highest prevalence rates were 29% for
somatization, 18% for social phobia, 155 for hypochondriasis
and14% for obsessive-compulsive disorder. In addition, eating
disorders such as binge eating disorder and night eating syndrome
have been linked with depression and obesity.

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OBESITY IN CHILDREN
The number of overweight children in India has doubled in recent
years, with a quarter of children considered overweight or obese.
Causes of obesity in children include unhealthy food choices, lack
of physical activity and family eating habits. This rise in the
number of overweight children is disturbing, because it causes
health problems and can lead to social problems. Overweight
children are more likely to be teased by their peers or to develop
low self-esteem or body image problems. Once children are
overweight, it requires a lot of effort and commitment for them to
return to a healthy weight. Overweight and obesity in children are
among the most important risks to childrens long and short-term
health. Overweight children are very likely to become overweight
adults.
RISK FACTORS FOR CHILDHOOD OBESITY

Human body stores unused energy (kilojoules) as body fat. To

maintain a healthy weight, you need to use (or burn) the energy
from the foods you eat. If you eat more than you use, your body
will store the extra energy as fat. Factors that may cause children to
become overweight and obese include:
Food choices. These include choosing high fat and sugary foods
instead of healthier options.
Lack of physical activity. Australian children are less active
than they were in the past.
Spending a lot of time on sedentary pursuits. Indian children
watch, on average, around 2 hours of television a day, as well
as spending time using computers and other electronic games. It
seems that these pastimes are replacing active ones.
Overweight parents.A familys eating patterns can have a
major influence on whether a child maintains a healthy weight.
Some overweight parents may be less concerned about their
children also being overweight than parents who have a healthy
weight.
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Genetics. Some rare gene disorders cause severe childhood

obesity. In many other people, particular genes acting together
probably make some children more susceptible to obesity. If
there is a family tendency to become overweight, parents need
to be even more aware of making healthy food choices for the
whole family.
CHILDHOOD OBESITY IS A WORLDWIDE PROBLEM

Levels of childhood obesity are increasing at alarming rates in

many countries, including the United States, the United Kingdom
and Australia. In Australia, one in five children and adolescents are
either overweight or obese. From 1985 to 1995 the number of
overweight 715 year olds almost doubled. The numbers of obese
children has more than tripled. At the current rate, it is predicted
that 65 per cent of young Indianswill be overweight or obese by
2020.
Society Has Contributed To Obesity
As overweight and obesity have become more common, there have
been some major changes in how we live. These changes have led
to people either eating more or becoming less active, all of which
has contributed to an increase in overweight and obesity. For
example:
The overall cost of food has gone down.
More food is prepared away from home.
Energy-dense foods and drinks are more readily available.
Portion sizes have increased.
Marketing of energy-dense foods and drinks has increased.
The use of cars has increased.
The number of two-income families has increased.
The time spent in paid employment has increased.
The role of physical education in the school curriculum has
reduced.

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HEALTH PROBLEMS ASSOCIATED WITH OBESITY

Most of the health problems associated with obesity will become

obvious in adulthood. Early signs of these later problems are
commonly found in children.
Potential health problems for obese children include:
Type 2 diabetes. While this condition is most commonly seen in
adults, it is now also being diagnosed in children
Eating disorders such as bulimia or binge eating
Orthopaedic disorders: Problems with foot structure
Liver problems, including fatty liver
Respiratory disorders, such as blocked airways and restrictions
in the chest wall, which cause breathlessness during exercise
Sleep apnoea: This is a condition that causes difficulty
breathing when sleeping. It also causes snoring, waking often
and poor sleep. It makes people feel tired and contributes to
poor concentration during the day
Cardiomyopathy: A problem with the heart muscle, caused
when extra effort is needed to pump blood.
OBESITY IN
ADULTHOOD

CHILDHOOD

LEADS

TO

OBESITY

IN

Overweight or obese children are more likely to remain obese as

adolescents and become overweight or obese adults. About 80 per
cent of obese adolescents will become obese adults.
SOCIAL PROBLEMS
ADOLESCENTS

FOR

OBESE

CHILDREN

AND

Obesity can have a major impact on how children feel about

themselves and how they interact with others. Obese adolescents
are more likely to have low self-esteem, which may impact on
other aspects of their lives, such as the development of friendships
and competency at school. Being obese as a child or adolescent
increases the risk of a range of diseases and disorders in adulthood,
regardless of whether the adult is obese or not. Its important to
identify and start to reverse the condition before children become
adults. Ideally, overweight and obesity should be prevented.
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Children have fewer weight-related health and medical

problems than adults. However, overweight children are at high
risk of becomingoverweight adolescents and adults, placing them
at risk of developing chronic diseases such as heart disease and
diabetes later in life. They are also more prone to develop stress,
sadness, and low self-esteem.
Children become overweight and obese for a variety of reasons.
The most common causes are genetic factors, lack of physical
activity, unhealthy eating patterns, or a combination of these
factors. Only in rare cases is being overweight caused by a medical
condition such as a hormonal problem. A physical exam and some
blood tests can rule out the possibility of a medical condition as the
cause for obesity.Although weight problems run in families, not all
children with a family history of obesity will be overweight.
Children whose parents or brothers or sisters are overweight may
be at an increased risk of becoming overweight themselves, but
this can be linked to shared family behaviours such as eating and
activity habits.
A child's total diet and activity level play an important role in
determining a child's weight. Today, many children spend a lot
time being inactive. For example, the average child spends
approximately four hours each day watching television. As
computers and video games become increasingly popular, the
number of hours of inactivity may increase.
Obese children are at risk for a number of conditions, including:
High cholesterol
High blood pressure
Early heart disease
Diabetes
Bone problems
Skin conditions such as heat rash, fungal infections, and acne
The best person to determine whether or not your child is
overweight is your child's doctor. In determining whether or not
your child is overweight, the doctor will measure your child's
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weight and height and compute his ''BMI,'' or body mass index, to
compare this value to standard values. The doctor will also
consider your child's age and growth patterns. Assessing obesity in
children can be difficult, because children can grow in
unpredictable spurts.
If you have an overweight child, it is very important that you
allow him or her to know that you will be supportive. Children's
feelings about themselves often are based on their parents' feelings
about them, and if you accept your children at any weight, they
will be more likely to feel good about themselves. It is also
important to talk to your children about their weight, allowing
them to share their concerns with you.
It is not recommended that parents set children apart because of
their weight. Instead, parents should focus on gradually changing
their family's physical activity and eating habits. By involving the
entire family, everyone is taught healthful habits and the
overweight child does not feel singled out.
WEIGHT PROBLEMS & OBESITY IN CHILDREN

The number of children who are obese or overweight is growing at

an alarming rate. Extra pounds put kids at risk of serious health
problems, including diabetes, heart disease, and asthma. Childhood
obesity also takes an emotional toll. Overweight children are
frequently teased and excluded from team activities, which can
lead to low self-esteem, negative body image, and depression.
However, with the right support, encouragement, and positive role
modeling, you can help your child reach and maintain a healthy
weight.
DIAGNOSING
CHILDREN

WEIGHT

PROBLEMS

AND

OBESITY

IN

Overweight and obese children are at a greater risk of developing

serious health problems such as:
type 2 diabetes
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high blood pressure

high cholesterol
bone and joint problems
asthma
restless or disordered sleep patterns
liver and gall bladder disease
depression and low self-esteem
Kids who are unhappy with their weight may also be more likely to
develop eating disorders and substance abuse problems.
Diagnosing and treating weight problems and obesity in children as
early as possible may reduce the risk of developing these and other
serious medical conditions as they get older. Whatever your
childrens weight, though, let them know that you love them and
that all you want to do is help them be healthy and happy.
Children grow at different rates at different times, so it is not
always easy to tell if a child is overweight. Body mass index (BMI)
uses height and weight measurements to estimate how much body
fat a child has, and can be used to screen for weight and obesity
problems from the age of 2. However, while BMI is usually a good
indicator, it is NOT a perfect measure of body fat and can be
misleading in some situations. For example, BMI can be difficult
to interpret during puberty when children are experiencing periods
of rapid growth.
If your child registers a high BMI-for-age measurement, your
health care provider may need to perform further assessments to
determine if excess fat is a problem. These assessments may
include skin fold thickness measurements, plus evaluations of diet,
physical activity, family history, and other appropriate health
screenings. The doctor may also decide to screen for some of the
medical conditions that can be associated with obesity.
Calculating BMI
See the Resources section below for a BMI calculator to determine
the body mass index for children between the ages of 2 to 19.
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A childs BMI-for-age shows how his or her BMI compares with

kids of the same age. A child between the 85th and 95th percentile
on the growth chart is considered at risk of overweight. A child at
the 95th percentile or above is considered overweight.
CAUSES OF
CHILDREN

WEIGHT

PROBLEMS

AND

OBESITY

IN

Understanding how children become obese or overweight in the

first place is an important step toward breaking the cycle. Most
cases of childhood obesity are caused by eating too much and
exercising too little. Children need enough food to support healthy
growth and development. But when they take in more calories than
they burn throughout the day, the result is weight gain. Many
factors contribute to this growing imbalance between calories in
and calories out:
Busy families are cooking less and eating out more.
Easy access to cheap, high-calorie fast food and junk food.
Food portions are bigger than they used to be, both in
restaurants and at home.
Kids spend less time actively playing outside, and more time
watching TV, playing video games, and sitting at the computer.
Many schools are eliminating or cutting back their physical
education programs.
MYTHS AND TRUTHS ABOUT WEIGHT PROBLEMS AND
OBESITY IN CHILDREN

MYTH: Childhood obesity is genetic, so theres nothing you can

do about it.
TRUTH: While a persons genes do influence weight, they are
only one small part of the equation. Although some children are
more prone to gaining weight than others, that doesnt mean
theyre destined for weight problems. Most kids can maintain a
healthy weight if they eat right and exercise.
MYTH: Children who are obese or overweight should be put on a
diet.

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TRUTH: Unless directed by your childs doctor otherwise, the

treatment for childhood obesity is not weight loss. The goal should
be to slow or stop weight gain, allowing your child to grow into his
or her ideal weight.
MYTH: Its just baby fat. Children will outgrow the weight.
TRUTH: Childhood obesity doesnt always lead to obesity in
adulthood, but it does raise the risks dramatically. The majority of
children who are overweight at any time during the preschool or
elementary school are still overweight as they enter their teens.
Most kids do not outgrow the problem.
WEIGHT PROBLEMS AND OBESITY IN CHILDREN

Tip 1: Get the whole family involved

Healthy habits start at home. The best way to fight or prevent
childhood obesity and weight problems is to get the whole family
on a healthier track. Making better food choices and becoming
more active will benefit everyone, regardless of weight. And with
the whole family involved, it will be much easier for your
overweight child to make lasting changes.
The most effective way to influence your child is by your own
healthy example. If your children see you eating your vegetables,
being active, and limiting your TV time, theres a good chance that
they will do the same. These habits will also have the happy side
effect of helping you maintain a healthy weight.
What you eat: Tell your child about the healthy food you are
eating, while you are eating it. You might say, Im eating
broccoli with garlic sauce. Want a bite?
When you cook: Cook healthily in front of your children.
Better yet, give them an age-appropriate job. Tell them about
what you are making and why its good for your body.
How you move: Exercise in some way, every day. Be
authenticdo things you enjoy. Tell your kids what youre
doing, and invite them to join you.

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Your free time: Avoid the television or too much computer

time. Kids are much less likely to turn screens on if they are off
and you are doing something they can get involved in.
Strategies for real life
Recognize that you have more control than you might think.
You can turn off the TV and the video game. You can choose to
get off the bus one stop earlier than usual and walk the rest of
the way, especially when you are with your kids. You can give
your family more vegetables for dinner.
Think about the immediate benefits. If reducing the risk of
future heart disease seems abstract, focus on the good things
that can happen right now. You wont feel so full if you have a
smaller portion or skip dessert. Going hiking with your teenager
might lead to a wonderful talk that neither of you anticipated. A
fruit salad tastes great and looks beautiful. Dancing or playing
with your kids is lots of fun and can give you a great workout.
Make small, easy changes over time. Suggesting that family
members take a run together every day will probably get you
lots of eye-rolling and no-thank-you. Its easier and more
appealing to start out with some new approaches to nutrition
and physical activity that the whole family is really willing to
try. For example, take a walk after dinner a couple of nights a
week instead of turning on the TV. And, instead of chocolate
cake with frosting, enjoy sliced strawberries over angel food
cake.
Tip 2: Encourage healthy eating habits
Begin eating right today, as a family. Remember the importance of
role modelling: there should be emphasis on what you do so that
your child can follow. It is crucial to get the whole family in on the
idea of eating healthily at home and away.
Making healthier food choices:Helping your child beat obesity
begins with helping him or her forge a healthy relationship with

155

food. You may need to make major changes to your eating

lifestyle.
Eat the rainbow. Serve and encourage consumption of a wide
variety of fruits and vegetables. This should include red (beets,
tomatoes), orange (carrots, squash), yellow (potatoes, bananas),
green (lettuce, broccoli) and so onjust like eating a rainbow.
Make breakfast a priority. Children who eat breakfast are less
likely to be overweight or obese than those who skip the first
meal of the day. Focus on healthy choices like oatmeal, fresh
fruit, whole grain cereal, and low-fat milk instead of sugary
cereals or toaster pastries.
Cut back on fat. Your child does need some fat to maintain
good health, but these fats should come from sources of
polyunsaturated and monounsaturated fatty acids, such as fish,
nuts and vegetable oils. Cut way back on fast food, junk food,
and sweets.
Schedule regular meal times. The majority of children like
routine. If your kids know they will only get food at certain
times, they will be more likely to eat what they get when they
get it.
Limit dining out. If you must eat out, avoid fast food and make
the healthy choices you are trying to make at home.
Tip 3: Be smart about snacks and sweets
Your home is where your child most likely eats the majority of his
or her meals and snacks, so it is vital that your kitchen is stocked
with healthy choices and treats.
Dont ban sweets entirely. While many kids' sugar
consumption exceeds healthy limits, having a no sweets rule is
an invitation for cravings and overindulging when given the
chance. Instead, limit the amount of cookies, candies, and baked
goods your child eats and introduce fruit-based snacks and
desserts instead.
Limit juice and soda. Soft drinks are loaded with sugar
empty calories that dont do anything healthy for your childs
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growing body. Many juices arent any better nutritionally.

Instead of soda, offer your child sparkling water with a twist of
lime or a splash of fruit juice.
Keep snacks small. Dont turn snacks into a meal. Limit them
to 100 to 150 calories.
Focus on fruit. Keep a bowl of fruit out for your children to
snack on. Offer fruit as a sweet treat. Kid-friendly favourites
include frozen juice bars, fruit smoothies, frozen bananas
dipped in chocolate and nuts, strawberries and a dollop of
whipped cream, fresh fruit added to plain yogurt, and sliced
apples and peanut butter.
Tip 4: Watch portion sizes
There are strategies you can employ to retrain you and your
familys appetites and avoid oversized servings when eating out.
Learn what a regular portion size looks like. The portion
sizes that you and your family are used to eating may be equal
to two or three true servings. Limit portions to the size of your
fist.
Read food labels. Information about serving size and calories
can be found on the backs of packaging. You may be surprised
at how small the recommended portions are or how many
calories are in the dish.
Use smaller dishes. Portions will look bigger and youll eat less
when you use small bowls or plates.
Dish up in the kitchen. To minimize the temptation of second
and third helpings, serve food on individual plates, instead of
putting the serving dishes on the table.
Divide food from large packages into smaller containers.
The larger the package, the more people tend to eat without
realizing it.
Downsize orders. When eating out, share an entre with your
child or order an appetizer instead. Order half-orders or a
medium size instead of a large.

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Tip 5: Get your kid moving

Children who sit too much and move too little are at the highest
risk for becoming overweight. Kids need an hour of exercise daily
for optimum health. This may seem like a lot, but exercise doesnt
have to happen in a gym or all at once. Instead, try to incorporate
movement into your familys regular routine.
Exercise ideas for kids
It used to be commonplace to find children running around and
playing in the streets of their neighborhoods, naturally expending
energy and getting exercise. In todays world, thats not always an
option. If youre not comfortable letting your children roam free,
you still have options for boosting their activity level.
Play active indoor games. Put the remote away and organize
some active indoor games. You can play tag (perhaps crawling
tag, so that you keep messes to a minimum), hide-and-seek, or
Simon Says (think jumping jacks and stretches).
Get outside with your child. Take a walk together, bike around
the neighborhood, explore a local park, visit a playground, or
play in the yard. If it makes sense for your neighborhood and
schedule, walk to and from activities and school.
Do chores together. Perhaps its not your childs first choice,
but doing household chores is a very effective way to get
exercise. Mopping, sweeping, taking out trash, dusting or
vacuuming burns a surprising number of calories.
Enroll children in after school sports or other activities. If
your budget allows, sign children up to play a sport or get
involved in an activity where they are physically active. The
local YMCA, YWCA, or Boys and Girls Club are safe places
for children to exercise and play.
Sign up for a 5 or 10K race with your child. Sometimes
having a goal in mind can motivate even the most reluctant
exercisers. Find a kid-friendly walk/run race in your area and
tell your child youll be training for it together. Be sure to
celebrate when you accomplish this feat.
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Tip 6: Reduce screen time

The more time your children spend watching TV, playing video
games, or using the computer, the less time theyll spend on active
pastimes. Limits on television and computer time lead directly to
your child spending more time being physically active. Remember
how important it is for you to be a positive role modelyes, you
may have to cut down on your own viewing habitsand have a
good attitude about the change.
Limit daily screen time. Studies show a link between screen
time and obesity, so set limits on your childs TV-watching,
gaming, and web surfing. Experts recommend no more than two
hours per day.
Stop eating in front of the TV. Limit your childs calorie intake
by limiting time spent eating in front of the tube. Tell your child
that, starting now, your family does all their eating at the table.
Pick a different reward or punishment. Instead of rewarding
your child with more time in front of the television or computer,
promise something different, such as an outing or an activity of
their choice.
Encourage your child to develop new hobbies
Making major lifestyle changes has the potential to add more stress
to a childs life. At times, your overweight or obese child might
feel singled out, sad, angry, embarrassed, or discouraged. In the
past, they might have dealt with stress by eating or zoning out in
front of the TV. Since this is no longer an option, help them find a
healthy alternative. Ask your child what he or she might like to
take up as a hobby. Hobbies can help kids boost their self-esteem,
relieve stress, and provide a positive outlet.
Tip 7: Get involved
You can make a huge impact on your childrens health by being
involved with the details of their lives.

159

Talk to your children. Ask them about the school day, every
day. Listen to their concerns and take action if there is
something they need.
Be in touch with teachers. Speak to your childs teachers,
especially P.E. instructors, either in person or on the phone.
Defy busy schedules. You may feel like neither you nor your
child has time for long chats about the day. This may be the
toughest lifestyle change to make, due to busy schedules, but it
can be done. If you need to, treat getting involved like another
appointment or meeting in your day.
Spend time with your children. You dont have to spend all
your time having heart-to-hearts. Playing, reading, cooking, or
any other activity, when done together, can supply your child
with the self-esteem boost he or she may need to make positive
changes.
SEEKING PROFESSIONAL HELP FOR WEIGHT PROBLEMS
AND OBESITY IN CHILDREN

There are no easy options when it comes to tackling childhood

weight problems and obesity. Weight-loss surgery and medications
are rarely recommended for children and adolescents. If you have
changed your familys eating and physical activity habits and your
child has not reached a healthy weight, or if your doctor
determines that your childs health or emotional well-being is at
risk because of his or her weight, you may want to consider a
weight-control program.
Depending on your child's BMI, age, and health, your doctor
may refer you to a registered dietician, psychologist, and/or
exercise physiologist for additional guidance on healthy eating,
physical activity, and weight control. Again, any treatment
program should address healthy eating and physical activity habits
for your entire family.

160

PART III
WEIGHT LOSS
AND
MAINTENANCE
STRATEGIES

161

WEIGHT MANAGEMENT AND ITS BENEFITS

MAINTAINING WEIGHT LOSS

Benefits Of Maintaining Weight Loss

While losing weight is difficult for many people, it is even more
challenging to keep the weight off. Most people who lose a large
amount of weight have regained it 2 to 3 years later. One theory
about regaining lost weight is that people who decrease their
caloric intake to lose weight experience a drop in their metabolic
rate, making it increasingly difficult to lose weight over a period of
months. A lower metabolic rate may also make it easier to regain
weight after a more normal diet is resumed. For these reasons,
extremely low calorie diets and rapid weight loss are discouraged.
Losing no more than 1/2 to 2 pounds per week is recommended.
Incorporating long-term lifestyle changes are required to increase
the chance of successful long-term weight loss.Weight loss to a
healthy weight for a person's height can promote health benefits
such as lower cholesterol and blood sugar levels, lower blood
pressure, less stress on bones and joints, and less work for the
heart. Thus, it is vital to maintain weight loss to obtain health
benefits over a lifetime.
Keeping extra weight off requires effort and commitment, just
as losing weight does. Weight loss goals are reached by a
combination of changes in diet, eating habits, exercise, and, in
extreme circumstances, bariatric surgery.
Weight Loss Maintenance Strategies
Support systems used effectively during weight loss can
contribute to weight maintenance. According to the National
Weight Control Registry, 55% of registry participants used
some type of program to achieve their weight loss.
Physical activity plays a vital and essential role in maintaining
weight loss. Studies show that even exercise that is not rigorous,
such as walking and using stairs, has a positive effect. Activity
162

that uses 1,500 to 2,000 calories per week is recommended for

maintaining weight loss. Adults should try to get at least 40
minutes of moderate to vigorous level physical activity at least 3
to 4 times per week.
Diet and exercise are vital strategies for losing and maintaining
weight. Ninety-four percent of the registrants in the National
Weight Control Registry increased their physical activity.
Once the desired weight has been reached, the gradual addition
of about 200 calories of healthy, low-fat food to daily intake
may be attempted for one week to see if weight loss continues.
If weight loss does continue, additional calories of healthy foods
may be added to the daily diet until the right balance of calories
to maintain the desired weight has been determined. It may take
some time and record keeping to determine how adjusting food
intake and exercise levels affect weight.
Continuing to use behavioral strategies is necessary to maintaining
weight. Be aware of eating as a response to stress and use exercise,
activity, or meditation to cope instead of eating.A temporary return
to old habits does not mean failure. Paying renewed attention to
dietary choices and reverting to exercise can help sustain behaviors
that maintain weight loss. Identifying situations such as negative
moods and interpersonal difficulties and incorporating alternative
methods of coping with such situations rather than eating can
prevent relapses to old habits
''Lifestyle changes that include healthier diets, regular physical
activity, and weight loss of 7%-10% have shown phenomenal
health benefits that can be more effective than medications,'' says
Katz, author of the best-selling book What to Eat.Lowering body
weight can reverse or prevent diabetes; lower blood pressure,
cholesterol, and triglyceride levels; and improve sleep apnea and
other sleep problems -- along with helping you feel better about
yourself.
According to Katz, 90% of all diabetes, 80% of heart disease, and
60% of cancers are preventable with healthier lifestyles and normal
163

body weights.''We have seen a consistent pattern in our weight loss

studies that when patients lose 5%-10% of their body weight, they
lower blood pressure, reduce LDL ["bad"] cholesterol, improve
glucose tolerance, and in general, lower the risk for cardiovascular
disease," says Catherine Champagne, a researcher with Louisiana
State University's Pennington Biomedical Research Center.
If an obese person loses 10% of body weight, it is said to confer
the following benefits:
In those with hypertension there is a fall of 10 mm Hg in both
systolic and diastolic pressure.
In those newly diagnosed with diabetes, an abnormal fasting
blood glucose falls in 50%.
In impaired glucose tolerance:
There is >30% fall in fasting or two hours insulin levels.
>30% rise in insulin sensitivity.
40-60% reduction in the rate of progress to overt diabetes.
Lipid profiles improve with:
10% fall in total cholesterol.
15% fall in LDC.
8% rise in HDC.
Mortality improves with:
>20% fall in all-cause mortality.
>30% fall in mortality related to diabetes.
>40% reduction in mortality related to obesity.

164

ESSENTIAL NUTRIENTS AND HEALTHY EATING

NUTRIENTS
CARBOHYDRATE

Carbohydrates are one of the three macronutrients, a group that

also includes protein and fat. This information can be used to
understand the complexities of carbohydrates and their role in the
body, and to support your discussions with parents on the value of
this important nutrient as well as healthy food sources.
Carbohydrates play a crucial role in a healthy, balanced diet.
For example, without carbohydrates, our body would lack a key
fuel source. Similar to fats, the role and value of carbohydrates is
often misunderstood, which can lead to a diet that restricts this
important nutrient rather than including healthy food choices to
provide carbohydrates in recommended amounts.
Carbohydrates are the body's primary source of energy, and
provide about 4 calories per gram. This nutrient category includes
sugars, starches, and fiber. The American Dietetic Association
(ADA) recommends that for children 211 years of age,
carbohydrates should make up 4565% of total energy intake each
day. Following these recommendations, approximately one half of
total daily energy intake comes from carbohydrate, with the other
half from protein and fat.
A principal role of carbohydrate is to supply energy in the form
of glucose. Glucose is a simple sugar and is often called blood
sugar, since it is the main carbohydrate found in the blood of
mammals. The health and functioning of every cell relies on blood
glucose.Carbohydrates are made up of units of sugar (also called
saccharides), and are classified as either simple or complex,
depending on the number of sugar units they contain.

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Simple Carbohydrates
Simple carbohydrates are those that contain only one sugar unit
(monosaccharides) or two sugar units (disaccharides). Glucose and
fructose are the two most common monosaccharides. Glucose is
the primary form of sugar stored in the human body for energy,
and fructose is the main sugar found in most fruits. The most
common disaccharide is sucrose, which is table sugar.
Complex Carbohydrates
Complex carbohydrates are composed of more than two sugar
units, and include oligosaccharides (310 units of simple sugar)
and polysaccharides (more than 10 units of simple sugar).
Complex carbohydrates can be digestible, like starches, or not
digestible, like dietary fiber, based on how the monosaccharides
are linked to make polysaccharides.
Starch and fiber (or cellulose) are both complex carbohydrates.
Starch is broken down into simple carbohydrates to be used by the
body. Because both soluble and insoluble fiber are undigested, they
do not serve as energy sources. Insoluble fiber remains intact
during digestion, and aids digestion by providing bulk in the stool.
Soluble fiber, which forms a gel when combined with a liquid,
helps regulate cholesterol levels and blood sugar. An
oligosaccharide is a saccharide polymer. Oligosaccharides reach
the colon almost completely undigested, where they may act as
food for intestinal microbiota (also known as microflora).
Prebiotics are carbohydrates such as oligosaccharides.
Prebiotics allow specific changes in the gastrointestinal microbiota,
such as supporting a healthy balance of bacteria in the digestive
tract. This balance in turn provides benefits to the individual
including
support
for
healthy
immune
system
function.Approximately 1/3 of dietary fiber occurs as
hemicellulose, and to 1/3 as cellulose. Approximately 1520%
of dietary fiber is present as pectin.
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Until recently, functions of a specific type of fiber were

determined by whether or not the fiber was classified as "soluble"
or "insoluble". Soluble fibers, such as the type found in oat bran,
have been shown to reduce blood cholesterol levels and help
normalize blood sugar levels, while insoluble fibers, such as the
type found in wheat bran, are known to promote bowel regularity.
But the effect of fiber on the GI tract may depend more on the
properties of the specific fiber especially the viscosity and
fermentability. The terms "viscous fiber" or "fermentable fiber"
therefore may better describe the effect on the GI tract than the
older terms.
Many studies have shown a beneficial effect of viscous fibers
on plasma glucose and insulin response. Viscous fibers help
normalize blood glucose levels by slowing the rate at which food
leaves the stomach and by delaying the absorption of glucose
following a meal.Fermentable fibers are fermented by the
beneficial bacteria that inhabit the large intestine, and help
maintain these healthy populations.Fibers that are not fermentable
in the large intestine help maintain bowel regularity by increasing
the bulk of the feces and decreasing the transit time of fecal matter
through the intestines.
Classification Of Carbohydrates
Carbohydrates are traditionally classified as simple (sugars, i.e.,
mono- and disaccharides) or complex (starches, i.e.,
polysaccharides) on the basis of the number of sugar molecules in
their chemical structures. It had been assumed that complex
carbohydrates cause smaller rises in blood glucose than simple
carbohydrates. Dietary guidelines for individuals with diabetes
mellitus that recommend the use of complex rather than simple
carbohydrates to control blood glucose levels reflect this
assumption.

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A growing body of data, however, contradicts this notion. In the

mid-1970s, the first series of studies were published in the English
literature showing that various starchy foods differ in their ability
to induce plasma glucose and insulin responses. These findings
initiated a new era of research on the in vivo physiologic effects of
carbohydrates. Collectively, these data demonstrate that digestion
of carbohydrates, particularly starch, is not a rate-limiting event
and is often quite rapid because of the presence of sufficient
amylolytic capacity in the intestine. As an example, postprandial
glycemic responses to potato and white bread are similar to the
response to pure glucose, indicating that complex carbohydrates
may not differ from simple sugars in their effect on plasma glucose
level.
Glycemic Index (GI)

Glycemic Index (GI) is a measurement carried out on

carbohydrate-containing foods and their impact on our blood sugar.
GI is a relatively new way of analyzing foods. Previously, most
meal plans designed to improve blood sugar analyzed the total
amount of carbohydrates (including sugars and starches) in the
foods themselves. GI goes beyond this approach, looking at the
impact of foods on our actual blood sugar. In other words, instead
of counting the total amount of carbohydrates in foods in their
unconsumed state, GI measures the actual impact of these foods on
our blood sugar. We rank our WHFoods as being very low, low,
medium, or high in their GI value. You can find a GI value for
each individual food in its food profile. Just go to any food profile
and take a look at the DRI%/DV% bar chart that is located towards
the beginning of the article. At the top right-hand side of the chart
you will find the food's GI value.
Over the past 15 years, low-GI diets have been associated with
decreased risk of cardiovascular disease, type 2 diabetes, metabolic
syndrome, stroke, depression, chronic kidney disease, formation of
gall stones, neural tube defects, formation of uterine fibroids, and
cancers of the breast, colon, prostate, and pancreas. Taking
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advantage of these potential health benefits can be as simple as

sticking with whole, natural foods that are either low or very low in
their GI value. We've ranking all of our WHFoods as being either
high GI, medium GI, low GI, or very low GI to make it easier for
you to focus on foods whose GI values fall into the low or very
low range.
Measurement of GI
Typically, a food is consumed in whatever serving size will
provide 50 grams (about 1.8 ounces) of available carbohydrates.
Available carbohydrates (or avCHOs) are carbohydrates that get
readily digested, absorbed, and metabolized by our body. These
carbohydrates have a much greater impact on our blood sugar level
than carbohydrates in general because carbohydrates in general
include substances that aren't readily digested, absorbed, and
metabolized. Insoluble fibers, for example, are carbohydrates that
do not have an immediate impact on our blood sugar level because
they cannot be readily digested.
As a very general way of estimating available carbohydrates in
a serving of food, researchers take the total amount of
carbohydrates and subtract out the total amount of fiber. Available
carbohydrates are what's left.After 50 grams of available
carbohydrates have been consumed, blood sugar levels are
measured over a period of 2 hours. The results are plotted on a
graph and summarized in what is called glucose AUC, or "area
under the curve." Glucose AUC shows the immediate impact of the
food on our blood sugar.
Measuring GI also requires a second step. In this second step,
50 grams of available carbohydrate are consumed, but this time the
food involved is one of two reference foods: either white bread or
pure sugar (glucose). Once again, blood sugar levels are measured
over a period of 2 hours, and the glucose AUC is calculated. At
this point, it is possible to compare the two results. The impact of
the first food on our blood sugar is compared to the impact of
either white bread or glucose itself. When these two results are
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compared, the impact of the white bread or glucose is arbitrarily

given a value of 100 to make the comparison easier. As an
example, let's say that researchers are trying to establish a GI for
green peas and they decide to compare the impact of green peas on
blood sugar to the impact of white bread. And in this example, let's
say that a person consumes a starchy vegetable like green peas, and
the glucose AUC (area under the curve) is 48% as large the
glucose AUC when white bread is consumed. In this case, the GI
for green peas would be established at 48% of 100, or 48.
PROTEINS

Proteins are necessary for building the structural components of the

human body, such as muscles and organs. You also need proteins
to keep your immune system healthy, synthesize neurotransmitters,
create and signal hormones, and much more. A balanced diet
supplies you will all of the protein you need. Meats, fish, seafood,
poultry, eggs, and dairy products are significant sources of protein,
but you can also get protein from a variety of grains, legumes, nuts,
and seeds.
Proteins tend to be large molecules. They're made from building
blocks called amino acids. The general structure of any amino acid
molecule includes a carboxyl group of atoms, an amine group and
a side chain. The carboxyl group contains one carbon, two oxygen,
and one hydrogen atom. The amine group contains one nitrogen
atom with two hydrogen atoms attached to it.
All 20 amino acids have different side chains, which vary in
shape including straight chains of atoms, branched chains of atoms
and rings of atoms. The side chains may include carbon, hydrogen,
sulphur, nitrogen and oxygen atoms. The configuration and
molecules found in the side chain is what differentiates one amino
acid from another. The branched-chain amino acids are isoleucine,
leucine, and valine. These amino acids are necessary for muscle
structure. Tyrosine, phenylalanine and tryptophan are called
aromatic amino acids. Each one contains a side chain with a ring170

shaped formation. These three amino acids are needed for

neurotransmitter production.
There are 20 different amino acids. Amino acids are linked
together to form peptides, which are small chains of amino acids.
The peptides are then linked together to form larger proteins.There
are thousands of different proteins that carry out a large number of
jobs in the human body. Even though so many different proteins
are at work in your body, you don't have to worry about consuming
each individual protein from the foods you eat. Your body will
make those proteins.
All you need to do is to make sure your body has a healthy
supply of all 20 of the different amino acid "building blocks."
Having enough of those amino acids is easy because your body can
make 11 of them from other compounds already in your body. That
leaves nine amino acids that you must get from your diet-- they're
called "essential amino acids."
Non Essential And Essential Amino Acids
The 11 non-essential amino acids are not called "non-essential"
because they are not important. They are important, and your body
requires them to perform several functions. These amino acids are
called "non-essential" because you don't need to get them from
your diet. Your body can build those 11 amino acids from
chemicals already present in your body. The non-essential amino
acids include:
Alanine
Arginine
Asparagine
Aspartic Acid
Cysteine
Glutamic Acid
Glutamine
Glycine
Proline
Serine
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Tyrosine
The amino acids arginine, cysteine, glycine and tyrosine are
sometimes also considered to be "conditionally essential." That
means most people manufacture them on their own, but some with
certain illness or genetic abnormalities don't and need to get them
through their diets.
The nine essential amino acids are called "essential" because
you can't manufacture them; you have to eat proteins that contain
those amino acids. They include:
Histidine
Isoleucine
Leucine
Lysine
Methionine
Phenylalanine
Threonine
Tryptophan
Valine
Do you need to worry about essential amino acids when you
plan your daily meals? Not really. Animal sources of protein such
as meat, eggs, and dairy products are "complete proteins." That
means that each protein found in an animal product contains each
of the nine essential amino acids. Vegetarians and vegans may
need to pay a little more attention to the dietary proteins. Plant
proteins are called "incomplete proteins." Each plant protein is
missing at least one of the nine essential amino acids. However,
every amino acid is found in some type of plant, so you can
combine different plant proteins to get all of the amino acids you
need.
Learn about vegan and vegetarian protein combinations.
There are many different proteins in your body, and they perform
different functions. Proteins functions include:

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Contributing to enzyme activity that promotes chemical

reactions in the body.
Signalling cells what to do and when to do it.
Transporting substances around the body.
Keeping fluids and pH balanced in the body.
Serving as building blocks for hormone production.
Helping blood clot.
Promoting antibody activity that controls immune and allergy
functions.
Serving as structural components that give our body parts their
shapes.
The digestion of protein begins in the mouth with chewing, which
makes food easier to swallow. It also helps with digestion by
chopping food up into smaller bits. Remember that it's important to
chew your food thoroughly; don't gulp your food down in huge
bites.Protein digestion continues in the stomach with the release of
digestive juices that include hydrochloric acid and pepsinogen.
Hydrochloric acid converts pepsinogen into pepsin, which begins
to break down the bonds between the amino acids. This process
takes place while the muscles surrounding the stomach squeeze
and squish the foods and stomach fluids together.
The next step occurs in the small intestine where the
hydrochloric acid is neutralized with bicarbonates released from
the pancreas. The pancreas also releases an enzyme called trypsin.
Trypsin continues to break apart the amino acids, which are then
absorbed into the blood stream. Once in the bloodstream, the
amino acids are carried to the cells in various parts of your body.
Your body uses the individual amino acids to build the proteins
needed for the various functions.
You may not think of protein as an energy source, but proteins
do contribute calories to you diet. Those calories need to be
acknowledged if you are watching your weight. Each gram of
protein you eat has four calories. The United States Department of
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Agriculture suggests that you get about 15 percent to 20 percent of

your calories from protein. For someone who needs 2000 calories
per day, that would equal 75 to 100 grams of protein.
It isn't difficult to get enough protein in your diet. One chicken
leg alone will provide you with about 30 grams of protein. One
salmon fillet has about 40 grams of protein, a cup of oatmeal has
six grams of protein, and a cup of asparagus even has two grams of
protein (find out why asparagus makes your urine smell funny).
Since most people get enough protein from their diet, protein
deficiency is rare in developed countries. In underdeveloped
countries, protein deficiency is more common. Severe protein
deficiency is called kwashiorkor. Children with kwashiorkor tend
to have very thin arms and legs and large, distended bellies. Lack
of protein can cause growth failure, loss of muscle mass, depressed
immune system function, lung problems, heart problems, and
death.
FAT

Lipids are the generic names assigned to a group of fat soluble

compounds found in the tissues of plants and animals; and are
broadly classified as: a) fats, b) phospholipids, c) sphingomyelins,
d) waxes, and e) sterols.

Fats are the fatty acid esters of glycerol and are the primary
energy depots of animals. These are used for long-term energy
requirements during periods of extensive exercise or during
periods of inadequate food and energy intake. Fish have the unique
capability of metabolizing these compounds readily and, as a
result, can exist for long periods of time under conditions of food
deprivation. A typical example is the many weeks of migration by
salmon in their return upstream to spawn; stored lipid deposits are
burned for fuel to enable body processes to continue during the
strenuous journey.

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Phospholipids are the esters of fatty acids and phosphatidic acid.

These are the main constituent lipids of cellular membranes
allowing the membrane surfaces to be hydrophobic or hydrophylic
depending on the orientation of the lipid compounds into the intra
or extracellular spaces.

Sphingomyelins are the fatty acid esters of sphingosine and are

present in brain and nerve tissue compounds.

Waxes are fatty acid esters of long-chain alcohols. These

compounds can be metabolized for energy and to impart physical
and chemical characteristics through the stored lipids of some plant
and several animal compounds.

Sterols are polycyclic, long-chain alcohols and function as

components of several hormone systems, especially in sexual
maturation and sex-related physiological functions.
Fatty acids can exist as straight chain or branch chain components;
many of the fish fats contain numerous unsaturated double bonds
in the fatty acid structures. A short bond designation for fatty acids
will be used throughout where the w number identifies the position
of the first double bond counting from the methyl end. Linolenic
acid would be written 18:3w 3. The first number identifies the
number of carbons; the second number, the number of double
bonds; and the last number, the position of the double bonds.
Metabolism:
The major dietary lipids for humans and other animals are animal
and plant triglycerides, sterols, and membrane phospholipids. The
process of lipid metabolism synthesizes and degrades the lipid
stores and produces the structural and functional lipids
characteristic of individual tissues.
Biosynthesis:
In animals, when there is an oversupply of dietary carbohydrate,
the excess carbohydrate is converted to triglycerides. This involves
the synthesis of fatty acids from acetyl-CoA and the esterification
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of fatty acids in the production of triglycerides, a process called

lipogenesis. Fatty acids are made by fatty acid synthases that
polymerize and then reduce acetyl-CoA units. The acyl chains in
the fatty acids are extended by a cycle of reactions that add the
acetyl group, reduce it to an alcohol, dehydrate it to an alkene
group and then reduce it again to an alkane group.
The enzymes of fatty acid biosynthesis are divided into two
groups, in animals and fungi all these fatty acid synthase reactions
are carried out by a single multifunctional protein, while in plant
plastids and bacteria separate enzymes perform each step in the
pathway.The fatty acids may be subsequently converted to
triglycerides that are packaged in lipoproteins and secreted from
the liver.
The synthesis of unsaturated fatty acids involves a desaturation
reaction, whereby a double bond is introduced into the fatty acyl
chain. For example, in humans, the desaturation of stearic acid by
stearoyl-CoA desaturase-1 produces oleic acid. The doubly
unsaturated fatty acid linoleic acid as well as the triply unsaturated
-linolenic acid cannot be synthesized in mammalian tissues, and
are therefore essential fatty acids and must be obtained from the
diet.
Triglyceride synthesis takes place in the endoplasmic reticulum
by metabolic pathways in which acyl groups in fatty acyl-CoAs are
transferred to the hydroxyl groups of glycerol-3-phosphate and
diacylglycerol.
Terpenes and isoprenoids, including the carotenoids, are made by
the assembly and modification of isoprene units donated from the
reactive precursorsisopentenyl pyrophosphate and dimethylallyl
pyrophosphate. These precursors can be made in different ways. In
animals and archaea, the mevalonate pathway produces these
compounds from acetyl-CoA, while in plants and bacteria the nonmevalonate pathway uses pyruvate and glyceraldehyde 3phosphate as substrates. One important reaction that uses these
activated isoprene donors is steroid biosynthesis. Here, the
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isoprene units are joined together to make squalene and then folded
up and formed into a set of rings to make lanosterol.Lanosterol can
then be converted into other steroids such as cholesterol and
ergosterol.
Degradation:
Beta oxidation is the metabolic process by which fatty acids are
broken down in the mitochondria and/or in peroxisomes to
generate acetyl-CoA. For the most part, fatty acids are oxidized by
a mechanism that is similar to, but not identical with, a reversal of
the process of fatty acid synthesis. That is, two-carbon fragments
are removed sequentially from the carboxyl end of the acid after
steps of dehydrogenation, hydration, and oxidation to form a betaketo acid, which is split by thiolysis. The acetyl-CoA is then
ultimately converted into ATP, CO2, and H2O using the citric acid
cycle and the electron transport chain.
Hence, the Krebs Cycle can start at acetyl-CoA when fat is
being broken down for energy if there is little or no glucose
available.The energy yield of the complete oxidation of the fatty
acid palmitate is 106 ATP. Unsaturated and odd-chain fatty acids
require additional enzymatic steps for degradation.
VITAMINS

They do not supply calories. They work with enzymes by

triggering specific chemical reactions that allow the digestion,
absorption, metabolism, and use of other nutrients. They act like
catalyst or co-enzymes to help a reaction take place, but are neither
changed nor incorporated into the products of the reaction.
Types Of Vitamins
1. Water soluble (C and B complex): Water soluble vitamins are
vitamins that our bodies do not store. These vitamins dissolve in
water when they are ingested, then go in to the blood stream. The
body keeps what it needs at that time, and excess amounts are
excreted in the urine. Since they cant be stored, everybody needs a
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continuous supply of water soluble vitamins in order to stay

healthy.
Water soluble vitamins are not stored to any extent in the body
so you need an adequate supply of water soluble vitamins every
day. Any excess is excreted in the urine. They are found in fruits
and vegetables. The Foods need to be cooked carefully so that
water soluble vitamins are not destroyed by heat or lost through
steam or in cooking water.
Cook fruits and vegetables quickly
Steam them, or use only small amounts of cooking water
Cover food during cooking
Use leftover liquid in soups and stews
2. Fat Soluble (A D E K): Fat soluble vitamins are those that
are normally stored in the body. When these vitamins are ingested,
they dissolve in fat. In a person with a healthy digestive system,
the body uses what it needs at that time and stores the rest for
future use. Since people with cystic fibrosis often have pancreatic
insufficiency and do not digest or store fats properly, the excess is
not stored but excreted in the stool. Due to this, people with cystic
fibrosis need a continuous supply of fat soluble vitamins just as
they do with water soluble vitamins.
a. They are absorbed and transported by fat.
b. The body stores fat-soluble vitamins in fatty tissue.
c. Any excess build-up of these vitamins can have a dangerous
toxic effect.
d. People who take nutrient supplements with very large doses of
fat soluble vitamins are especially vulnerable to the toxic effects.
Some Vitamin Deficiency Diseases
1. Pellagra lack of niacin (B group vitamin): It can produce
dermatitis, a painful skin rash, diarrhea, and mentaldisturbances.
Not commonly occurs, because commercially made bread and
flour is enriched with niacin.
2. Rickets lack of vitamin D:Without this vitamin bones
become weak and are unable to support the weight of the body.
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This causes the skeleton to become deformed. Teeth may fail to

develop. Today milk is fortified with vitamin D.
3. Thiolysis:Without this vitamin you develop swollen, bleeding
gums, and loss of teeth.
MINERALS

A mineral is a naturally occurring substance that is solid and stable

at room temperature, representable by a chemical formula, usually
abiogenic, and has an ordered atomic structure. It is different from
a rock, which can be an aggregate of minerals or non-minerals and
does not have a specific chemical composition. The exact
definition of a mineral is under debate, especially with respect to
the requirement a valid species be abiogenic, and to a lesser extent
with regard to it having an ordered atomic structure. The study of
minerals is called mineralogy.
There are over 4,900 known mineral species; over 4,660 of
these have been approved by the International Mineralogical
Association (IMA). The silicate minerals compose over 90% of the
Earth's crust. The diversity and abundance of mineral species is
controlled by the Earth's chemistry. Silicon and oxygen constitute
approximately 75% of the Earth's crust, which translates directly
into the predominance of silicate minerals. Minerals are
distinguished by various chemical and physical properties.
Differences in chemical composition and crystal structure
distinguish various species, and these properties in turn are
influenced by the mineral's geological environment of formation.
Changes in the temperature, pressure, and bulk composition of a
rock mass cause changes in its mineralogy; however, a rock can
maintain its bulk composition, but as long as temperature and
pressure change, its mineralogy can change as well.
Minerals can be described by various physical properties which
relate to their chemical structure and composition. Common
distinguishing characteristics include crystal structure and habit,
hardness, lustre, diaphaneity, colour, streak, tenacity, cleavage,
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fracture, parting, and specific gravity. More specific tests for

minerals include reaction to acid, magnetism, taste or smell, and
radioactivity.
Minerals are classified by key chemical constituents; the two
dominant systems are the Dana classification and the Strunz
classification. The silicate class of minerals is subdivided into six
subclasses by the degree of polymerization in the chemical
structure. All silicate minerals have a base unit of a [SiO4]4- silica
tetrahedrathat is, a silicon cation coordinated by four oxygen
anions, which gives the shape of a tetrahedron.
These tetrahedra can be polymerized to give the subclasses:
orthosilicates (no polymerization, thus single tetrahedra),
disilicates (two tetrahedra bonded together), cyclosilicates (rings of
tetrahedra), inosilicates (chains of tetrahedra), phyllosilicates
(sheets of tetrahedra), and tectosilicates (three-dimensional
network of tetrahedra). Other important mineral groups include the
native elements, sulfides, oxides, halides, carbonates, sulfates, and
phosphates.
WATER AND HYDRATION

Water is an essential nutrient, meaning the body cannot function

without it. Water has many functions, including helping the body
to maintain a stable temperature, carrying nutrients and waste
throughout the body, and acting as a lubricant around joints. Some
people, especially those who have difficulty feeding themselves or
those who have cognitive problems, may have trouble drinking
enough. Without enough fluid, the body can become dehydrated.
The act or process of combining or treating with water: as
a. The introduction of additional fluid into the body <hydration
sometimes helps to reduce the concentration of toxic substances in
the tissues>.
b. A chemical reaction in which water takes part with the
formation of only one product <hydration of ethylene to ethyl

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alcohol especially, a reaction in which water takes part in the form

of intact molecules.

The Food Pyramid

The food pyramid is designed to make healthy eating easier.

Healthy eating is about getting the correct amount of nutrients
protein, fat, carbohydrates, vitamins and minerals you need to
maintain good health.Foods that contain the same type of nutrients
are grouped together on each of the shelves of the Food Pyramid.
This gives you a choice of different foods from which to choose
a healthy diet. Following the Food Pyramid as a guide will help
you get the right balance of nutritious foods within your calorie
range. Studies show that we take in too many calories from foods
and drinks high in fat, sugar and salt, on the top shelf of the Food
Pyramid. They provide very little of the essential vitamins and
minerals your body needs. Limiting these is essential for healthy
eating.
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So in a nutshell, healthy eating involves:

plenty of bread, rice, potatoes, pasta and cereals going for the
wholegrain varieties whenever you can,
plenty of fruits and vegetables,
some milk, cheese and yoghurt,
some meat, poultry, eggs, beans and nuts,
a very small amount of fats and oils,
and a very small amount or no food and drinks high in fat, sugar
and salt.
RECOMMENDED DAILY INTAKE OF NUTRIENTS

The nutrients found in all foods and drinks provide nourishment

for the body. This nourishment is in the form of:
Substances which provide energy
Building blocks for bone, muscle, organs, hormones and blood
Substances needed for processes to occur in the body (like
digestion)
Substances that protect the body
Nutrients are drawn from a wide variety of foods and the more
varied your diet, the more likely you are to obtain all the nutrients
you need.
The 4 Key Nutrients
The Daily Intake Guide features Energy + 4 Key Nutrients:
Fat
Saturated Fat
Sugars
Sodium (salt)
Additional Nutrients:
Protein
Carbohydrates
Fibre
Vitamins & Minerals play many crucial roles in the body's function
and wellbeing, but do not provide energy (kilojoules).
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Energy
Energy is not a nutrient but, kilojoules (food energy) are important
for providing energy for your daily activities.Protein, fats and
carbohydrates are converted into energy in different
quantities. Vitamins and minerals are also essential nutrients for
the body, but they are not converted into energy.
Energy is required to fuel body processes (metabolism) and
physical activity. If we consume more energy than we use for
metabolism and physical activity, the excess is stored as body
fat. You need to be sure to balance the energy you consume
through foods with the energy you expend during the day. The
more active you are the more energy you need and vice versa.
The reference value for an average adult is 8,700 kJ.
Fat:Fat contributes to energy intake and helps you absorb vital
vitamins; therefore a healthy diet should always contain a certain
amount of fat. The two main forms of fat are saturated,
predominately from animal sources, and unsaturated,
predominately from vegetable sources.Because fat is a rich source
of energy, you should try and eat no more than your recommended
intake. It is also important to choose unsaturated fats as much as
possible, such as those found in oily fish, nuts and seeds, avocado,
and spreads made from sunflower, rapeseed and olive oil.The
reference value for fat for an average adult is 70 grams.
Saturated Fat:
Too much saturated fat can raise blood cholesterol, which can
increase the risk of heart disease. You should therefore consume no
more than your recommended daily intake.
The reference value for saturated fat for an average adult is 24
grams.
Sugars:
Sugars are carbohydrates that provide the body with energy, our
bodys fuel. Sugars occur naturally in fruit, vegetables and dairy
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foods and are added to foods for flavour, texture and colour. You
should aim to consume no more than your recommended intake
and limit foods that are high in added sugars and low in other
nutrients.
The reference value for sugars for an average adult is 90 grams.

Sodium (salt):
Sodium (salt) is needed for good health; however, too much can
cause adverse health effects through its function of raising blood
pressure. Our diets generally contain far more sodium than we
need, due to the level of added salt in some packaged products. It is
important for you to be aware of your sodium intake for heart
health and you should aim to consume no more than your
recommended intake.
The reference value for sodium for an average adult is 2,300
milligrams.
Protein :
Protein is important for the growth and repair of the bodys cells
and for building muscle. It can also be used to provide energy.
Animal-based foods are excellent sources of protein, such as fish,
meat, chicken, eggs, milk, cheese and yoghurt. Good sources of
vegetable-based protein include legumes soybeans, baked beans,
kidney beans, chickpeas and lentils nuts and seeds. Grain-based
foods such as bread, cereal, rice and pasta also contribute some
protein to the diet. It is best to choose protein-rich foods that are
low in saturated fat.
The reference value for protein for an average adult is 50 grams.
HEALTHY EATING

Healthy eating is not about strict dietary limitations, staying

unrealistically thin, or depriving yourself of the foods you love.
Rather, its about feeling great, having more energy, and
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stabilizing your mood. If you feel overwhelmed by all the

conflicting nutrition and diet advice out there, youre not alone. It
seems that for every expert who tells you a certain food is good for
you, youll find another saying exactly the opposite. But by using
these simple tips, you can cut through the confusion and learn how
to create a tasty, varied, and healthy diet.

Healthy Eating Tip 1:

To set yourself up for success, think about planning a healthy diet
as a number of small, manageable steps rather than one big drastic
change. If you approach the changes gradually and with
commitment, you will have a healthy diet sooner than you think.
Simplify. Instead of being overly concerned with counting
calories or measuring portion sizes, think of your diet in
terms of color, variety, and freshness. This way it should be
easier to make healthy choices. Focus on finding foods you
love and easy recipes that incorporate a few fresh ingredients.
Gradually, your diet will become healthier and more
delicious.
Start slow and make changes to your eating habits over
time. Trying to make your diet healthy overnight isnt
realistic or smart. Changing everything at once usually leads
to cheating or giving up on your new eating plan. Make small
steps, like adding a salad (full of different color vegetables)
to your diet once a day or switching from butter to olive oil
when cooking. As your small changes become habit, you can
continue to add more healthy choices to your diet.
Every change you make to improve your diet
matters. You dont have to be perfect and you dont have to
completely eliminate foods you enjoy to have a healthy diet.
The long term goal is to feel good, have more energy, and
reduce the risk of cancer and disease. Dont let your missteps
derail youevery healthy food choice you make counts.
Think of water and exercise as food groups in your diet.
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Water. Water helps flush our systems of waste products and

toxins, yet many people go through life dehydrated, causing
tiredness, low energy, and headaches. Its common to mistake
thirst for hunger, so staying well hydrated will also help you
make healthier food choices.
Exercise. Find something active that you like to do and add it to
your day, just like you would add healthy greens, blueberries, or
salmon. The benefits of lifelong exercise are abundant and
regular exercise may even motivate you to make healthy food
choices a habit.
Healthy Eating Tip 2: Moderation is the key
People often think of healthy eating as an all or nothing
proposition, but a key foundation for any healthy diet is
moderation. But what is moderation? In essence, it means eating
only as much food as your body needs. You should feel satisfied at
the end of a meal, but not stuffed. Moderation is also about
balance. Despite what certain fad diets would have you believe, we
all need a balance of carbohydrates, protein, fat, fiber, vitamins,
and minerals to sustain a healthy body.
The goal of healthy eating is to develop a diet that you can
maintain for life, not just a few weeks or months, or until you've
hit your ideal weight. For most of us, that means eating less than
we do now. More specifically, it means eating far less of the
unhealthy stuff (refined sugar, saturated fat, for example) and
replacing it with the healthy (such as fresh fruit and vegetables).
But it doesn't mean eliminating the foods you love. Eating bacon
for breakfast once a week, for example, could be considered
moderation if you follow it with a healthy lunch and dinner, but not
if you follow it with a box of donuts and a sausage pizza. If you eat
100 calories of chocolate one afternoon, balance it out by
deducting 100 calories from your evening meal. If you're still
hungry, fill up with an extra serving of fresh vegetables.
Try not to think of certain foods as off-limits. When you
ban certain foods or food groups, it is natural to want those
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foods more, and then feel like a failure if you give in to

temptation. If you are drawn towards sweet, salty, or
unhealthy foods, start by reducing portion sizes and not
eating them as often. If the rest of your diet is healthy, eating
a burger and fries once a week probably wont have too much
of a detrimental effect on your health. Eating junk food just
once a month will have even less of an impact. As you reduce
your intake of unhealthy foods, you may find yourself
craving them less or thinking of them as only occasional
indulgences.
Think smaller portions. Serving sizes have ballooned
recently, particularly in restaurants. When dining out, choose
a starter instead of an entree, split a dish with a friend, and
don't order supersized anything. At home, use smaller plates,
think about serving sizes in realistic terms, and start small. If
you don't feel satisfied at the end of a meal, try adding more
leafy green vegetables or rounding off the meal with fresh
fruit. Visual cues can help with portion sizesyour serving of
meat, fish, or chicken should be the size of a deck of cards
and half a cup of mashed potato, rice, or pasta is about the
size of a traditional light bulb.
Healthy Eating Tip 3:
Healthy eating is about more than the food on your plate. It is
also about how you think about food. Healthy eating habits can
be learned and it is important to slow down and think about food
as nourishment rather than just something to gulp down in
between meetings or on the way to pick up the kids.
Eat with others whenever possible. Eating with other
people has numerous social and emotional benefits,
particularly for children, and allows you to model healthy
eating habits. Eating in front of the TV or computer often
leads to mindless overeating.
Take time to chew your food and enjoy mealtimes. Chew
your food slowly, savouring every bite. We tend to rush
though our meals, forgetting to actually taste the flavours and
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feel the textures of our food. Reconnect with the joy of

eating.
Listen to your body. Ask yourself if you are really hungry,
or have a glass of water to see if you are thirsty instead of
hungry. During a meal, stop eating before you feel full. It
actually takes a few minutes for your brain to tell your body
that it has had enough food, so eat slowly.
Eat breakfast, and eat smaller meals throughout the
day. A healthy breakfast can jumpstart your metabolism, and
eating small, healthy meals throughout the day (rather than
the standard three large meals) keeps your energy up and
your metabolism going.
Avoid eating at night. Try to eat dinner earlier in the day
and then fast for 14-16 hours until breakfast the next
morning. Early studies suggest that this simple dietary
adjustmenteating only when youre most active and giving
your digestive system a long break each daymay help to
regulate weight. After-dinner snacks tend to be high in fat
and calories so are best avoided, anyway.
Healthy Eating Tip 4:
Fruits and vegetables are the foundation of a healthy diet. They are
low in calories and nutrient dense, which means they are packed
with vitamins, minerals, antioxidants, and fiber.Try to eat a
rainbow of fruits and vegetables every day and with every meal
the brighter the better. Colorful, deeply colored fruits and
vegetables contain higher concentrations of vitamins, minerals, and
antioxidants, and different colors provide different benefits, so eat
a variety. Aim for a minimum of five portions each day.
Some great choices include:
Greens. Branch out beyond bright and dark green lettuce.
Kale, mustard greens, broccoli, and Chinese cabbage are just
a few of the optionsall packed with calcium, magnesium,
iron, potassium, zinc, and vitamins A, C, E, and K.
Sweet vegetables. Naturally sweet vegetablessuch as corn,
carrots, beets, sweet potatoes, yams, onions, and squashadd
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healthy sweetness to your meals and reduce your cravings for

other sweets.
Fruit. Fruit is a tasty, satisfying way to fill up on fiber,
vitamins, and antioxidants. Berries are cancer-fighting, apples
provide fiber, oranges and mangos offer vitamin C, and so
on.
The Importance Of Getting Vitamins From FoodNot In
Form Of Pills
The antioxidants and other nutrients in fruits and vegetables help
protect against certain types of cancer and other diseases. And
while advertisements abound for supplements promising to deliver
the nutritional benefits of fruits and vegetables in pill or powder
form, research suggests that its just not the same.
A daily regimen of nutritional supplements is not going to have
the same impact of eating right. Thats because the benefits of
fruits and vegetables dont come from a single vitamin or an
isolated antioxidant.The health benefits of fruits and vegetables
come from numerous vitamins, minerals, and phytochemicals
working together synergistically. They cant be broken down into
the sum of their parts or replicated in pill form.
Healthy Eating Tip 5: Eat more healthy carbs and whole
grains
Choose healthy carbohydrates and fiber sources, especially whole
grains, for long lasting energy. In addition to being delicious and
satisfying, whole grains are rich in phytochemicals and
antioxidants, which help to protect against coronary heart disease,
certain cancers, and diabetes. Studies have shown people who eat
more whole grains tend to have a healthier heart.
A quick definition of healthy carbs and unhealthy carbs
Healthy carbs (sometimes known as good carbs) include whole
grains, beans, fruits, and vegetables. Healthy carbs are digested
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slowly, helping you feel full longer and keeping blood sugar and
insulin levels stable.
Unhealthy carbs (or bad carbs) are foods such as white flour,
refined sugar, and white rice that have been stripped of all bran,
fiber, and nutrients. Unhealthy carbs digest quickly and cause
spikes in blood sugar levels and energy.

Tips for eating more healthy carbs

Include a variety of whole grains in your healthy diet. It
should include whole wheat, brown rice, millet, quinoa, and
barley. Experiment with different grains to find your
favorites.
Make sure you're really getting whole grains. Be aware
that the words stone-ground, multi-grain, 100% wheat, or
bran can be deceptive. Look for the words whole grain or
100% whole wheat at the beginning of the ingredient list.
In the U.S., Canada, and some other countries, check for the
Whole Grain Stamps that distinguish between partial whole
grain and 100% whole grain.
Try mixing grains as a first step to switching to whole
grains. If whole grains like brown rice and whole wheat
pasta dont sound good at first, start by mixing what you
normally use with the whole grains. You can gradually
increase the whole grain to 100%.
Avoid: Refined foods such as breads, pastas, and breakfast cereals
that are not whole grain.
Healthy Eating Tip 6: Enjoy healthy fats & avoid unhealthy
fats
Good sources of healthy fats are needed to nourish your brain,
heart, and cells, as well as your hair, skin, and nails. Foods rich in
certain omega-3 fats called EPA and DHA are particularly
important and can reduce cardiovascular disease, improve your
mood, and help prevent dementia.
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Add to your healthy diet:

Monounsaturated fats, from plant oils like canola oil,
peanut oil, and olive oil, as well as avocados, nuts (like
almonds, hazelnuts, and pecans), and seeds (such as pumpkin,
sesame).
Polyunsaturated fats, including Omega-3 and Omega6 fatty acids, found in fatty fish such as salmon, herring,
mackerel, anchovies, sardines, and some cold water fish oil
supplements. Other sources of polyunsaturated fats are
unheated sunflower, corn, soybean, flaxseed oils, and
walnuts.
Reduce or eliminate from your diet:
Saturated fats, found primarily in animal sources including
red meat and whole milk dairy products.
Trans fats, found in vegetable shortenings, some margarines,
crackers, candies, cookies, snack foods, fried foods, baked
goods, and other processed foods made with partially
hydrogenated vegetable oils.
What is a healthy daily limit for saturated fat and trans fat?
Experts recommend you limit the amount of saturated fats you
eat to less than 7 percent of total daily calories. That means, for
example, if you need about 2,000 calories a day, no more than
140 of them should come from saturated fats. Thats about 16
grams of saturated fat a day.No more than 20 of those
calories should come from trans fat. Thats less than 2 grams
of trans fat a day.
Given the amount of naturally occurring trans fat you probably
eat every day, this leaves virtuallyno room at all for
industrially manufactured trans fat.
Healthy Eating Tip 7: Enjoy healthy fats & avoid unhealthy
fats
Protein gives us the energy to get up and goand keep going.
Protein in food is broken down into the 20 amino acids that are the
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bodys basic building blocks for growth and energy, and essential
for maintaining cells, tissues, and organs. While too much protein
can be harmful to people with kidney disease, the latest research
suggests that most of us need more high-quality protein than the
current dietary recommendations. It also suggests that we need
more protein as we age to maintain physical function.
How much protein do you need?
Protein needs are based on weight rather than calorie
intake. Adults should eat at least 0.8g of protein per kilogram
(2.2lb) of body weight per day. A higher intake may help to lower
your risk for obesity, osteoporosis, type 2 diabetes, and stroke.
-Older adults should aim for 1 to 1.5 grams of protein for each
kilogram of weight. This translates to 68 to 102g of protein per day
for a person weighing 150 lbs.
-Divide your protein intake among meals but aim for 25 to 40g of
high-quality protein per meal; less than 15g wont benefit bone or
muscle.
-Get plenty of calcium (1,000 to 1,200 mg per day).
The key to ensuring you eat high-quality protein is to try
different types, rather than relying on red meat and whole milk
dairy products which are high in saturated fat. Trying different
healthy protein sources such as fish, beans, nuts, seeds, peas, tofu,
chicken, and soy products will open up new options for healthy
mealtimes.
Good Sources of Protein *
The following is a sampling of high-protein foodssome may not be healthy to eat in
anything but moderation. Most red meat is very high in fat, as are whole-milk cheeses
and the skin on chicken or turkey. In the U.S., non-organic meat and poultry may also
contain antibiotics and hormones.
Aim for sufficient protein intake at each mealincluding breakfastin the leanest
and healthiest form.
Food

Serving
size

Protein
grams

Sat.
fat (g)

FISH

192

Calo
ries

Good Sources of Protein *

Canned
tuna

3.5
oz
(100g)

1
9

0.
2

86

Salmon

3.5
oz
(100g)

2
1

0.
8

130

Halibut

3.5
oz
(100g)

2
3

0.
4

111

Fresh
tuna

3.5
oz
(100g)

3
0

1.
6

184

POULTRY (skinless)
Turkey
breast

3.5
oz
(100g)

3
1

0.
6

147

Chicke
n breast

3.5
oz
(100g)

3
1

165

Chicke
n thigh

3.5
oz
(100g)

2
5

2.
3

179

Chicke
n leg

3.5
oz
(100g)

2
4

2.
1

174

MEAT
Pork
chops

1 chop
(145g)

39

286

Skirt
steak

3.5 oz
(100g)

27

205

Ground
beef
(70%
lean)

3.5 oz
(100g)

14

11

332

Leg of
lamb

3.5 oz
(100g)

26

6.
9

258

Cured
ham

3.5 oz
(100g)

23

178

LEGUMES
Soy
beans

1/3 cup
(100g)

17

1.
3

173

Kidney
beans

1/3 cup
(100g)

10

123

193

Good Sources of Protein *

Black
beans

1/3 cup
(100g)

0.
1

132

Baked
beans
(canne)

1/3 cup
(100g)

94

Peas

1/3 cup
(100g)

118

MILK & EGGS

Skim
milk

1/2 cup
(100g)

3.4

34

Soy
milk

1/2 cup
(100g)

3.3

0.
2

54

Eggs

2
boiled
(100g)

13

3.
3

155

Egg
white

3 eggs
(100g)

11

52

Non-fat
mozzar
ella

3.5 oz
(100g)

32

141

Non-fat
cottage
cheese

3.5 oz
(100g)

10

72

Lowfat
cheddar

3.5 oz
(100g)

24

4.
3

173

Lowfat
Swiss
cheese

3.5 oz
(100g)

28

3.
3

179

CHEESE

NUTS & SEEDS

Peanuts

1/4
cup
(28g)

164

Almon
ds

1/4
cup
(28g)

167

194

Good Sources of Protein *

Pistachi
os

1/4
cup
(28g)

159

Sunflo
wer
seeds

1/4
cup
(28g)

166

Flaxsee
d

1/4
cup
(28g)

150

OTHER PROTEIN OPTIONS

Veggie
burger

1 patty
(100g)

23

219

Tofu

3.5 oz
(100g)

0.
3

55

Highprotein
cereal

1 cup
(50g)

13

160

Greek
yogurt
(nonfat)

1/2 cup
(100g)

10

59

Whey
protein
powder

1/3 cup
(32g)

19

0.
2

120

* Nutrition values are approximate only; significant variations occur according to

brand, cut of meat, cooking method, etc.

Healthy Eating Tip 8: Add calcium for strong bones

Calcium is one of the key nutrients that your body needs in order to
stay strong and healthy. It is an essential building block for lifelong
bone health in both men and women, as well as many other
important functions.You and your bones will benefit from eating
plenty of calcium-rich foods, limiting foods that deplete your
bodys calcium stores, and getting your daily dose of magnesium
and vitamins D and Knutrients that help calcium do its job.
Recommended calcium levels are 1000 mg per day, 1200 mg if
you are over 50 years old. Try to get as much of your daily calcium
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needs from food as possible and use only low-dose calcium

supplements to make up any shortfall.
Good Sources Of Calcium Include
Dairy: Dairy products are rich in calcium in a form that is
easily digested and absorbed by the body. Sources include
milk, yogurt, and cheese.
Vegetables and greens: Many vegetables, especially leafy
green ones, are rich sources of calcium. Try turnip greens,
mustard greens, collard greens, kale, romaine lettuce, celery,
broccoli, fennel, cabbage, summer squash, green beans,
Brussels sprouts, asparagus, and cremini mushrooms.
Beans: For another rich source of calcium, try black beans,
pinto beans, kidney beans, white beans, black-eyed peas, or
baked beans.
Healthy Eating Tip 9: Limit sugar and salt
If you succeed in planning your diet around fiber-rich fruits,
vegetables, whole grains, lean protein, and good fats, you may find
yourself naturally cutting back on foods that can get in the way of
your healthy dietsugar and salt.
Sugar
Sugar causes energy ups and downs and can add to health and
weight problems. Unfortunately, reducing the amount of candy,
cakes, and desserts we eat is only part of the solution. Often you
may not even be aware of the amount of sugar youre consuming
each day. Large amounts of added sugar can be hidden in foods
such as bread, canned soups and vegetables, pasta sauce,
margarine, instant mashed potatoes, frozen dinners, fast food, soy
sauce, and ketchup. Here are some tips:
Avoid sugary drinks. One 12-oz soda has about 10
teaspoons of sugar in it, more than the daily recommended
limit! Try sparkling water with lemon or a splash of fruit
juice.

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Sweeten foods yourself. Buy unsweetened iced tea, plain

yogurt, or unflavoured oatmeal, for example, and add
sweetener (or fruit) yourself. Youre likely to add far less
sweetener than the manufacturer would have.
Eat naturally sweet food such as fruit, peppers, or natural
peanut butter to satisfy your sweet tooth. Keep these foods
handy instead of candy or cookies.
How sugar is hidden on food labels?
Check food labels carefully. Sugar is often disguised using
terms such as:
cane sugar or
maple syrup

corn sweetener or
corn syrup

honey
or
molasses

brown rice syrup

crystallized or evaporated cane

juice

fruit juice concentrates, such

as apple or pear

maltodextrin (or dextrin)

Dextrose, Fructose, Glucose,

Maltose, or Sucrose

Most of us consume too much salt in our diets. Eating too much
salt can cause high blood pressure and lead to other health
problems. Try to limit sodium intake to 1,500 to 2,300 mg per day,
the equivalent of one teaspoon of salt.
Avoid processed or pre-packaged foods. Processed foods
like canned soups or frozen dinners contain hidden sodium
that quickly surpasses the recommended limit.
Be careful when eating out. Most restaurant and fast food
meals are loaded with sodium. Some offer lower-sodium
choices or you can ask for your meal to be made without salt.
Most gravy and sauces are loaded with salt, so ask for it to be
served on the side.
Opt for fresh or frozen vegetables instead of canned
vegetables.
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Cut back on salty snacks such as potato chips, nuts, and

pretzels.
Check labels and choose low-salt or reduced-sodium
products, including breakfast cereals.
Slowly reduce the salt in your diet to give your taste buds
time to adjust.
Healthy Eating Tip 9: Limit sugar and salt
Eating foods high in dietary fiber can help you stay regular, lower
your risk for heart disease, stroke, and diabetes, and help you lose
weight. Depending on your age and gender, nutrition experts
recommend you eat at least 21 to 38 grams of fiber per day for
optimal health. Many of us aren't eating half that amount.
In general, the more natural and unprocessed the food, the
higher it is in fiber.
Good sources of fiber include whole grains, wheat cereals,
barley, oatmeal, beans, nuts, vegetables such as carrots,
celery, and tomatoes, and fruits such as apples, berries, citrus
fruits, and pearsmore good reasons to add more fruit and
vegetables to your diet.
There is no fiber in meat, dairy, or sugar. Refined or white
foods, such as white bread, white rice, and pastries, have had
all or most of their fiber removed.
An easy way to add more fiber to your diet is to start your
day with a whole grain cereal, such as Fiber-One or All-Bran,
or by adding unprocessed wheat bran to your favourite cereal.
Water is the best choice for quenching your thirst. Coffee and
tea, without added sweeteners, are healthy choices, too.
Some beverages should be limited or consumed in moderation,
including diet drinks, fruit juice and milk.
Alcohol in moderation can be healthy for some people, but not
everyone.
Avoid sugary drinks like soda, sports beverages, and energy
drinks.

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Water
There are many options for what to drink, but for most people who
have access to safe drinking water, water is the best choice: Its
calorie-free, and its as easy to find as the nearest tap.Water
provides everything the body needspure H2Oto restore fluids
lost through metabolism, breathing, sweating, and the removal of
waste. Its the perfect beverage for quenching thirst and rehydrating your system.
How much water do I need?
There is no one estimate for how much water the average
American needs each day. Instead, the Institute of Medicine has set
an adequate intake of 125 ounces (about 15 cups) for men and 91
ounces (about 11 cups) for women. (1) Note that this is not a daily
target, but a general guide. In most people, about 80% of this water
volume comes from beverages; the rest comes from food.
Water is an excellent calorie-free, sugar-free choice. For some
people who are accustomed to drinking sweet beverages, water can
initially taste bland. To increase water consumption without losing
flavour or to spice up your daily water intake, try these refreshing
water-based beverages:
Infused water
Instead of purchasing expensive flavoured waters in the grocery
store, you can easily make your own at home. Try adding any of
the following to a cold glass or pitcher of water:
Sliced citrus fruits or zest (lemon, lime, orange, grapefruit)
Crushed fresh mint
Peeled, sliced fresh ginger or sliced cucumber
Crushed berries
Sparkling water with a splash of juice: Sparkling juices may
have as many calories as sugary soda pop. Instead, make your own
sparkling juice at home with 12 ounces of sparkling water and just
an ounce or two of juice. For additional flavour, add sliced citrus
or fresh herbs like mint.
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Beverages to limit
Drinks that are loaded with sugar are the worst choice; they contain
a lot of calories and virtually no other nutrients. Consuming highsugar drinks can lead to weight gain and increased risk of type 2
diabetes, cardiovascular disease and gout.
The average can of sugar-sweetened soda or fruit punch
provides about 150 calories. If you were to drink just one can of
a sugar-sweetened soft drink every day, and not cut back on
calories elsewhere, you could gain up to 5 pounds in a year.
Cutting back on sugary drinks may help control your weight and
may lower your risk of type 2 diabetes.
Sports beverages are designed to give athletes carbs,
electrolytes, and fluid during high-intensity workouts that last
an hour or more. For other folks, theyre just another source of
sugar and calories.
Energy drinks have as much sugar as soft drinks, enough
caffeine to raise your blood pressure, and additives whose longterm health effects are unknown. For these reasons its best to
skip energy drinks.
CHOOSING HEALTHY DRINKS

1. Sugar
Limit the sugar intake.
The average can of sugar-sweetened soda or fruit punch
provides about 150 calories. If you are drinking just one can of
such soft drink every day and you are not cutting back on
calories elsewhere, you could gain up to 15 pounds in a year.
Cutting back on sugary drinks may help control your weight and
lower your risk of type 2 diabetes. See how much sugar is in
your drink.
2. Alcohol
Moderate alcohol consumption lowers the risk of heart disease
and diabetes. But there is slight increase in the risk of breast and
colon cancer.
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Its consumption is not advocated for pregnant women, person

with liver disease and people taking one or more medications
that interact with alcohol. In few cases the risk of drinking
alcohol clearly outweighs the benefits.
So dont drink alcohol at all or at least limit its consumption and
drink in moderation.
3. Sports drinks
Remember sports drinks are for athletes or people working out
in gym or having heavy physical activity as a part of their work.
Sports beverages are designed to give carbohydrates,
electrolytes and fluid during high-intensity workouts that last an
hour or more. For normal sedentary people, theyre just another
source of sugary calories. They might increase your weight.
4. Energy drinks
Energy drinks are pricey concoctions which have as much sugar
as soft drinks and enough caffeine to raise your blood pressure.
It has a long list of herbs and additives. Long term health effects
of them are unknown. So you must consider these factors before
consuming such energy drinks.
5. Calorie free drink
Go calorie-free naturally. Drink water.
Diet drinks with artificial sweeteners may condition our taste
buds to crave super sweet foods. Plain water is the best caloriefree beverage. As it is just too plain, try adding a squeeze of
lemon or a splash of 100% fruit juice. Plain coffee and tea are
also healthy calorie-free choices, but only in moderation. It
helps a lot in case you are interested in weight loss.
Quick Facts...

Dietary Guidelines for Americans suggest we eat less fat, sugar

and salt and more complex carbohydrates and fiber.
Many recipes are higher in fat, sugar and salt than needed for
good flavour or quality.
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When modifying recipes, look for ingredients that can be

eliminated, reduced or replaced with more nutritious ones.
Look for ways to include fiber-rich fruits, vegetables and whole
grains in favourite recipes.
The link between diet and health is important. Food alone cannot
make you healthy. But good eating habits, based on variety and
moderation, can help keep you healthy and even improve your
health. Good eating habits include knowing how to prepare and
select foods that fit into the Dietary Guidelines.
The Dietary Guidelines for Americans suggest that we eat less fat,
sugar and salt and more complex carbohydrates, fruits, vegetables
and fiber. One way to help meet the recommendations of the
Dietary Guidelines is to modify our recipes and methods of food
preparation. This is relatively easy because many recipes are
higher in fat, sugar and salt than is needed for good flavor and
quality. This fact sheet provides information and tips on how to
modify recipes to promote better health.
How to modify recipes?
Identify the Dietary Goal:
To cut calories, identify what ingredients contribute the most
calories. To cut fat, sugar or sodium or to increase fiber, identify
the ingredients that contain these components.Fat is the most
concentrated source of calories. Each gram of fat supplies 9
calories, compared to 4 calories for each gram of protein or
carbohydrate and 7 calories for each gram of alcohol. Reducing the
amount of fat in a recipe is the most effective way to cut calories.
Fatty acids are the basic chemical units in fat. They are
classified as saturated, monounsaturated, polyunsaturated or trans
fats. All fats found in foods are mixtures of these fatty acid types.
Saturated fats are found in the largest proportions in foods of
animal origin. Whole milk, cream, butter, lard, meat and poultry

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are important sources. Coconut oil and palm kernel oil also contain
a high proportion of saturated fats.
Important sources of monounsaturated fats include olive oil,
canola oil, peanut butter and peanut oil avocados, and many types
of nuts.
Polyunsaturated fats are found in the largest proportions in
foods of plant origin. Liquid vegetable oils (safflower, sunflower,
corn, cottonseed and soybean) and the margarines and salad
dressings made from them are important sources. Peanut oil
contains a combination of monounsaturated and polyunsaturated
fats.
Trans fats are formed when liquid vegetable oils undergo a
chemical process called hydrogenation to make the oils more solid.
This enhances the shelf life of the oil and can help improve the
taste and texture of processed foods. However, trans fats act like
saturated fats and can raise LDL cholesterol and lower HDL
cholesterol.
Cholesterol is a fat-like substance found only in foods of animal
origin. Significant sources include egg yolks, meats (particularly
organ meats), butter, cream, cheese and whole milk.
Sugar comes in many forms: white sugar, brown sugar, honey,
corn syrup, molasses and maple syrup
Sucralose is a non-caloric alternative to sugar, also known by
the brand name Splenda. It is about 500 times sweeter than table
sugar (sucrose) and is used to sweeten many food and beverage
products. Sucralose is the most heat stable non-caloric sweetener
currently available, so it is often used to replace some or all of the
sugar called for in recipes.
Sodium is found in salt (salt is 40 percent sodium); leavening
agents (baking soda and baking powder); monosodium glutamate
(MSG); condiments such as soy sauce, bouillon, pickles and olives;

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cured meats; many canned vegetables and frozen dinners; and most
cheeses, sauces, soups and salad dressings.
Fiber is found in whole grain breads and cereals, dry beans and
peas, nuts and seeds, and fruits and vegetables -- especially those
with edible skins or seeds.
Change the Ingredients to Achieve the Dietary Goal
Ingredients can be eliminated completely, reduced in amount, or
replaced with a more nutritionally acceptable ingredient.To choose
the best approach, it's helpful to have a general idea of the function
of the ingredient and what will happen if it is changed. Table 1 lists
the functions of several ingredients.
Table 1: Functions of various ingredients.
Fat

Provides flavour and richness.

Improves texture and tenderness in baked goods.
Promotes flakiness and lightness.
Promotes smoothness and creaminess.

Eggs

Provide structure, elasticity and richness.

Act as a thickener and emulsifier.
Act as leavening agents when beaten.

Sugar

Provides flavour, volume and texture.

Increases tenderness and browning in baked goods.
Acts as a preservative in jams, jellies and pickles.
Acts as food for yeast.
Provides flavour.
Acts as a preservative in cured meats and in brined
vegetables.
Controls action of yeast.

Sodium

When to Modify Recipes?

Not all recipes need modification.
Is the recipe already low in fat, cholesterol, sugar or salt?
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If so, only minor or no changes may be needed. If a recipe calls for

one egg and the dish serves eight people, the amount of cholesterol
per serving already is relatively low.
How often is the food eaten?
It is not as important to modify a recipe for a dish eaten once or
twice a year as it is for foods eaten more often. It is more important
to cut the fat in a weekly tuna fish salad sandwich than it is to cut
the fat in a birthday cake.
How much of the food is eaten?
Sometimes the best way to modify the intake of a certain food is to
eat less of it. Decreasing the quantity eaten may be more satisfying
than decreasing the quality. Many people prefer to eat less real jam
or jelly than to eat the regular amount of a low-sugar jam.
Tips For Healthy Modifications
Here are a few ways to update recipes. These suggestions apply to
most foods except when specific proportions of ingredients are
essential to prevent spoilage (such as cured meats, pickles, jams
and jellies).
Decrease total fat and calories
Reduce fat by one-fourth to one-third in baked products. For
example, if a recipe calls for 1 cup hydrogenated shortening, try
2/3 cup oil. This works best in quick breads, muffins and
cookies.
In recipes such as muffins and snack cakes, try replacing half to
all of the fat with prune puree, low fat yogurt or unsweetened
applesauce. The pectin in these "fat replacers" helps hold the
product together and gives the mouth-feel of fat. Because they
add sugar calories, you also may want to decrease the added
sugar by one-fourth.
Cut back or even eliminate added fat in casseroles and main
dishes. For example, browning meat in added fat is unnecessary
because some fat will drain from the meat as it cooks. Use a
microwave oven, non-stick pan or cooking spray.
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Saute or stir-fry vegetables with little fat or use water, wine or

broth.
To thicken sauces and gravies without lumping, eliminate fat
and mix cornstarch or flour with a small amount of cold liquid.
Stir this mixture slowly into the hot liquid to be thickened and
bring it to a boil, stirring constantly. Add herbs, spices and
flavourings.
Chill soups, gravies and stews; skim off hardened fat before
reheating to serve.
Select lean cuts of meat and trim off visible fat. Remove skin
from poultry before cooking.
Bake, broil, grill, poach or microwave meat, poultry or fish
instead of frying.
Decrease the proportion of oil in homemade salad dressings.
Try one-third oil to two-thirds vinegar. Low-fat cottage cheese
or buttermilk seasoned with herbs and spices also makes a lowfat dressing.
Use reduced-calorie sour cream or mayonnaise. To reduce fat
further, use plain low-fat or non-fat yogurt, buttermilk or
blended cottage cheese instead of regular sour cream or
mayonnaise for sauces, dips and salad dressings. If you heat a
sauce made with yogurt, add 1 tablespoon of cornstarch to 1 cup
of yogurt to prevent separation.
Use fat-free low-fat milk instead of whole milk. For extra
richness, try evaporated fat-free milk.
Choose low-fat cheeses such as feta, neufchatel and mozzarella
instead of high-fat ones such as Swiss or cheddar. Also use less
cheese.
Decrease saturated fat and cholesterol
Use two egg whites or an egg substitute product instead of one
whole egg. In some recipes, simply decrease the total number of
eggs. This is especially true if the fat and sugar also are
decreased in the recipe.
Use margarine instead of butter. Look for margarines that
contain no trans fats and list liquid vegetable oil as the first
ingredient.
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Use vegetable oils instead of solid fats. To substitute liquid oil

for solid fats, use about one-fourth less than the recipe calls for.
For example, if a recipe calls for 1/4 cup (4 tablespoons) of
solid fat, use 3 tablespoons of oil. For cakes or pie crusts, use a
recipe that specifically calls for oil, because liquid fats require
special mixing procedures.
Decrease sugar
Reduce sugar by one-quarter to one-third in baked goods and
desserts. Add extra spice or flavouring to enhance impression of
sweetness. This works best with quick breads, cookies, pie
fillings, custard, puddings and fruit crisps.
Decrease or eliminate sugar when canning or freezing fruits.
Buy unsweetened frozen fruit or fruit canned in its own juice or
water.
In cookies, bars and cakes, replace one-quarter of the sugar
called for with an equal amount of non-fat dry milk. This
reduces calories and increases calcium, protein and riboflavin in
the recipe.
Choose fruit juices, club soda or skim milk over soft drinks and
punches. Make fruit juice coolers with equal parts fruit juice
and club soda or seltzer.
Set Goal for Healthy Eating/ Set Goal for Success
Eating healthy is easier than you might think. Add these simple
healthy eating habits to your daily life over the next few weeks and
you'll see just how easy it is. By making small changes like these
over time, and taking them one at a time, not trying to rush into all
of them at once, the changes are more likely to stick.
Eat more fruits and vegetables. Aim for 4-5 servings each of
fruits and vegetables every day, if you consume a 2,000 calorie
diet. Vegetable or 100% fruit juice counts toward thisgoal.
Eat more whole-grain foods. Like fruits and vegetables,
whole-grain foods are low in saturated fat and cholesterol and
rich in fibre. Whole-grain foods include whole-wheat bread, rye
bread, brown rice and whole-grain cereal.
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Use liquid vegetable oils such as olive, canola, corn or

safflower as your main kitchen fat. Limit how much fat or oil
you use in cooking, and use liquid vegetable oils in place of
solid fats.
Eat more chicken, fish and beans than other meats. In
general, skinless poultry, fish and vegetable protein (such as
beans) are lower in saturated fat and cholesterol than other
meats (beef, pork and lamb).
Read food labels to help you choose healthy foods. Food
labels provide information to help you make better food
choices. Learn what information to look for (for example,
sodium content) and how to find it quickly and easily.
Set your goal:
1. Create specific, realistic goals to improve your diet.
2. Decide where you want to start.Focus on one small goal at a
time. This could be eating a healthy breakfast, being sure to get
6 to 10 servings of fruits and vegetables a day, or cutting back
the number of times you eat fast foods to once a week.
3. Set up a realistic timeline for meeting your goals.
The self-confidence you get from accomplishing a small goal
helps keep you on your path for achieving your big goal.
4. Write down your goals and why you want to achieve
them. Post them where you will constantly see them. This
provides you with clear direction and also the motivation to
keep at it.
5. Involve your family and friends. They can provide support
and encouragement.
6. When youre ready, set a new healthy eating goal.
As your small changes add up, you'll see that you've made
significant changes to your eating habits without too much fuss
or interruption to your life.
7. Track your progress
8. It's important to track your progress when you are trying to
change a habit. It helps you to see if you're meeting your goals
and serves as a reminder to keep trying.
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9. Record the healthy things you do.Write it down in a notebook

or food diary to help track your progress. You can also look this
over when you begin to doubt yourself or your abilities.
10.Pay attention to how you feel. Can you notice any difference
when you're eating better? Do you feel different when you eat
poorly? Have your food preferences changed?
11. Consider tests to measure success.You and your doctor may
decide that certain tests will help see if your diet and exercise plans
are working. Talk to your doctor about which tests to have and
how often to have them.
12. Reward yourself
13. When you reach your goal, reward yourself in a healthy way.
14.Reward every success, no matter how small.Tie each reward
to a specific, measurable goal, such as eating 3 servings of
vegetables every day for a week.
15. Make your rewards healthy ones. Pick a non-food reward
such as the latest tech gadget, a night at the movies, or a massage.
Or choose something that will help you maintain your healthy
eating habits, such as a new cookbook or a cooking class.
16.Big reward. When you meet challenging goals, reward your
hard work with something special.
17. Manage setbacks
18. Setbacks are a natural part of the process. The secret to
continued success is learning how to manage these setbacks as you
progress toward your goal.
19. Learn from mistakes.Use your setback as a chance to evaluate
what went wrong, modify your plan so that you're more likely to
succeed, and reapply yourself to reaching your goal.
20.Keep your favourites on the menu. Leave room for your
favourite foods in small doses. If you completely cut out what you
love to eat, you may start to feel deprived and are likely to give up
on your healthy eating goal.
21.Don't give up!Even if you splurge on your favourite foods,
dont give up your plan altogether. You can resume your diet at the
next meal.
CHOOSE AND PREPARE HEALTHY FOOD
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Quick Facts for preparation healthy food......

Dietary Guidelines for Americans suggest we eat less fat, sugar
and salt and more complex carbohydrates and fiber.
Many recipes are higher in fat, sugar and salt than needed for
good flavour or quality.
When modifying recipes, look for ingredients that can be
eliminated, reduced or replaced with more nutritious ones.
Look for ways to include fiber-rich fruits, vegetables and whole
grains in favourite recipes.
The link between diet and health is important. Food alone cannot
make you healthy. But good eating habits, based on variety and
moderation, can help keep you healthy and even improve your
health. Good eating habits include knowing how to prepare and
select foods that fit into the Dietary Guidelines.
The Dietary Guidelines for Americans suggest that we eat less
fat, sugar and salt and more complex carbohydrates, fruits,
vegetables and fiber. One way to help meet the recommendations
of the Dietary Guidelines is to modify our recipes and methods of
food preparation. This is relatively easy because many recipes are
higher in fat, sugar and salt than is needed for good flavor and
quality. This fact sheet provides information and tips on how to
modify recipes to promote better health.
DISEASES

Cardiovascular disease
There is compelling evidence that a diet rich in fruits and
vegetables can lower the risk of heart disease and stroke. The
largest and longest study to date, done as part of the Harvard-based
Nurses Health Study and Health Professionals Follow-up Study,
included almost 110,000 men and women whose health and dietary
habits were followed for 14 years.
The higher the average daily intake of fruits and vegetables, the
lower the chances of developing cardiovascular disease.
Compared with those in the lowest category of fruit and
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vegetable intake (less than 1.5 servings a day), those who

averaged 8 or more servings a day were 30 percent less likely to
have had a heart attack or stroke.
Although all fruits and vegetables likely contribute to this
benefit, green leafy vegetables such as lettuce, spinach, Swiss
chard, and mustard greens; cruciferous vegetables such as
broccoli, cauliflower, cabbage, Brussels sprouts, bok choy, and
kale; and citrus fruits such as oranges, lemons, limes, and
grapefruit (and their juices) make important contributions.
When researchers combined findings from the Harvard studies
with several other long-term studies in the U.S. and Europe, and
looked at coronary heart disease and stroke separately, they
found a similar protective effect: Individuals who ate more than
5 servings of fruits and vegetables per had roughly a 20 percent
lower risk of coronary heart disease and stroke, compared with
individuals who ate less than 3 servings per day.
Blood pressure
The Dietary Approaches to Stop Hypertension (DASH)
study examined the effect on blood pressure of a diet that was
rich in fruits, vegetables, and low-fat dairy products and that
restricted the amount of saturated and total fat. The researchers
found that people with high blood pressure who followed this
diet reduced their systolic blood pressure (the upper number of a
blood pressure reading) by about 11 mm Hg and their diastolic
blood pressure (the lower number) by almost 6 mm Hgas
much as medications can achieve.
A randomized trial known as the Optimal Macronutrient Intake
Trial for Heart Health (Omni Heart) showed that this fruit and
vegetable-rich diet lowered blood pressure even more when
some of the carbohydrate was replaced with healthy unsaturated
fat or protein.
Cancer
Numerous early studies revealed what appeared to be a strong link
between eating fruits and vegetables and protection against cancer.
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Unlike case-control studies, cohort studies, which follow large

groups of initially healthy individuals for years, generally provide
more reliable information than case-control studies because they
dont rely on information from the past. And, in general, data from
cohort studies have not consistently shown that a diet rich in fruits
and vegetables prevents cancer.For example, in the Nurses Health
Study and the Health Professionals Follow-up Study, over a 14year period, men and women with the highest intake of fruits and
vegetables (8+ servings a day) were just as likely to have
developed cancer as those who ate the fewest daily servings.
A more likely possibility is that some types of fruits and vegetables
may protect against certain cancers.
A report by the World Cancer Research Fund and the American
Institute for Cancer Research suggests that non-starchy
vegetablessuch as lettuce and other leafy greens, broccoli,
bok choy, cabbage, as well as garlic, onions, and the likeand
fruits probably protect against several types of cancers,
including those of the mouth, throat, voice box, oesophagus,
and stomach; fruit probably also protects against lung cancer.
Specific components of fruits and vegetables may also be
protective against cancer. For example:
A line of research stemming from a finding from the Health
Professionals Follow-up Study suggests that tomatoes may help
protect men against prostate cancer, especially aggressive forms
of it. One of the pigments that give tomatoes their red hue
lycopenecould be involved in this protective effect. Although
several studies other than the Health Professionals study have
also demonstrated a link between tomatoes or lycopene and
prostate cancer, others have not or have found only a weak
connection.
Taken as a whole, however, these studies suggest that increased
consumption of tomato-based products (especially cooked
tomato products) and other lycopene-containing foods may
reduce the occurrence of prostate cancer. Lycopene is one of
several carotenoids (compounds that the body can turn into
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vitamin A) found in brightly colored fruits and vegetables, and

research suggests that foods containing carotenoids may protect
against lung, mouth, and throat cancer. But more research is
needed before we know the exact relationship between fruits
and vegetables, carotenoids and cancer.
Diabetes
Some research looks specifically at whether individual fruits are
associated with risk of type 2 diabetes. While there isnt an
abundance of research into this area yet, preliminary results are
compelling.
In a study of over 66,000 women in the Nurses Health Study,
85,104 women from the Nurses Health Study II, and 36,173
men from the Health Professionals Follow-up Study who were
free of major chronic diseases, findings suggested that greater
consumption of whole fruits especially blueberries, grapes,
and apples is associated with a lower risk of type 2 diabetes.
Another important finding: Greater consumption of fruit juice is
associated with a higher risk of type 2 diabetes.
Additionally, in a study of over 70,000 female nurses aged 38-63
years who were free of cardiovascular disease, cancer, and
diabetes, research showed that consumption of green leafy
vegetables and fruit was associated with a lower risk of diabetes.
While not conclusive, research also indicated that consumption of
fruit juices may be associated with an increased risk among
women. A study of over 2,300 Finnish men showed that fruit and
vegetables, especially berries, may reduce the risk of Type 2
diabetes.
Gastrointestinal Health
Fruits and vegetables contain indigestible fibre, which absorbs
water and expands as it passes through the digestive system. This
can calm symptoms of an irritable bowel and, by triggering regular
bowel movements, can relieve or prevent constipation. The bulking
and softening action of insoluble fiber also decreases pressure
inside the intestinal tract and may help prevent diverticulosis.
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Vision
Eating fruits and vegetables can also keep your eyes healthy, and
may help prevent two common aging-related eye diseases
cataracts and macular degenerationwhich afflict millions of
Indians over age 65. Lutein and zeaxanthin, in particular, seem
protective against cataracts. Fruits and vegetables are high in
vitamins, minerals and fiber and theyre low in calories. Eating a
variety of fruits and vegetables may help you control your weight
and blood pressure.
Which fruits and vegetables are the best?
Thats easy: Theyre all good! If you eat many different types of
fruits and veggies, youre sure to get all the different types of
nutrients you need. The American Heart Association recommends
filling at least half your plate with fruits and veggies in order to
make it to the recommended 4-5 servings of each per day. The
good news is that all produce counts, which means canned, dried,
fresh and frozen varieties can help you reach your goal.
When buying canned, dried or frozen vegetables and fruit, be sure
to compare food labels and choose the products with the lowest
amount of sodium and added sugars.
How to eat more fruits and vegetables?
Eat melon, grapefruit or other fruit.
Add bananas, raisins or berries to your cereal.
Drink a small (6-ounce) glass of juice. Be sure its 100% fruit or
vegetable juice without excess sodium or sugars not fruit
drink, "cocktail" or punch.
Add chopped up vegetables to your eggs or potatoes. Try
onions, celery, green or red bell peppers, or spinach.
Take the Next Step
If youre already eating plenty of fruits and veggies every day, you
may be ready for the next step: include more color. All fruits and
vegetables contain vitamins, minerals and other nutrients that may
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help prevent heart disease, cancer and other illnesses. Some of

these nutrients are fiber, potassium, folate, and vitamin A and
C. The best way to get all the various nutrients is to eat fruits and
vegetables of many different colors.
The five main color groups and examples in each group are
listed below. Eat from as many color groups as you can each day.
Color

Fruits and Vegetables

Red / Pink

beets,
cherries,
cranberries,
pink
grapefruit,
pomegranates,
radicchio,
radishes, raspberries, red apples, red
grapes, red peppers, red potatoes, rhubarb,
strawberries, tomatoes, tomato sauce,
tomato
juice,
watermelon

Orange / Yellow

acorn or butternut squash, apricots,

cantaloupe, carrot, corn, grapefruit,
lemons, mangoes, nectarines, oranges,
orange juice, orange peppers, papaya,
peaches, pineapple, pumpkin, summer
squash, sweet potatoes, tangerines, yams,
yellow apples, yellow peppers, yellow
squash

Green

artichokes, asparagus, avocados, bok

choy, broccoli, Brussels sprouts, celery,
collard greens, cucumber, green beans,
green cabbage, green grapes, green
onions, green peppers, kale, kiwi, leeks,
limes, mustard greens, okra, pears, peas,
romaine lettuce, snow peas, spinach, sugar
snap peas, watercress, zucchini

White

bananas, cauliflower, garlic, Jerusalem

artichoke, mushrooms, onion, potatoes,
parsnips, shallots
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Blue / Purple

blackberries, blueberries, currants, dates,

eggplant, purple grapes, purple grape
juice, plums, prunes, purple figs, raisins

CHOOSE WHOLE GRAINS

Tips To Help You Eat Whole Grains

At Meals:
1. To eat more whole grains, substitute a whole-grain product for a
refined product such as eating whole-wheat bread instead of
white bread or brown rice instead of white rice. Its important to
substitute the whole-grain product for the refined one, rather than
adding the whole-grain product.
2. For a change, try brown rice or whole-wheat pasta. Try brown
rice stuffing in baked green peppers or tomatoes and whole-wheat
macaroni in macaroni and cheese.
3. Use whole grains in mixed
dishes, such as barley in vegetable
soup or stews and bulgur wheat in
casserole or stir-fries.
4. Create a whole grain pilaf with a
mixture of barley, wild rice, brown
rice, broth and spices. For a special
touch, stir in toasted nuts or
chopped dried fruit.
5. Experiment by substituting whole wheat or oat flour for up to
half of the flour in pancake, waffle, muffin or other flour-based
recipes. They may need a bit more leavening.
6. Use whole-grain bread or cracker crumbs in meatloaf.
7. Try rolled oats or a crushed, unsweetened whole grain cereal as
breading for baked chicken, fish, veal cutlets, or eggplant
parmesan.
8. Try an unsweetened, whole grain ready-to-eat cereal as croutons
in salad or in place of crackers with soup.

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9. Freeze leftover cooked brown rice, bulgur, or barley. Heat and

serve it later as a quick side dish.
As Snacks:
Snack on ready-to-eat, whole grain cereals such as toasted
oat cereal.
Add whole-grain flour or oatmeal
when making cookies or other
baked treats.
Try 100% whole-grain snack
crackers.
Popcorn, a whole grain, can be a
healthy snack if made with little or
no added salt and butter.
What to Look for on the Food Label?
Choose foods that name one of the following whole-grain
ingredients first on the labels ingredient list:
Whole Grain Ingredients

brown rice
buckwheat
bulgur
millet
oatmeal
quinoa
rolled oats
whole-grain barley
whole-grain corn
whole-grain sorghum
whole-grain triticale
whole oats
whole rye
whole wheat
wild rice

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Foods labelled with the words "multi-grain," "stone-ground,"

"100% wheat," "cracked wheat," "seven-grain," or "bran" are
usually not whole-grain products.
Color is not an indication of a whole grain. Bread can be brown
because of molasses or other added ingredients. Read the
ingredient list to see if it is a whole grain.
Use the Nutrition Facts label and choose whole grain products
with a higher % Daily Value (% DV) for fiber. Many, but not
all, whole grain products are good or excellent sources of fiber.
Read the food labels ingredient list. Look for terms that
indicate added sugars (such as sucrose, high-fructose corn
syrup, honey, malt syrup, maple syrup, molasses, or raw sugar)
that add extra calories. Choose foods with fewer added sugars.
Most sodium in the food supply comes from packaged foods.
Similar packaged foods can vary widely in sodium content,
including breads. Use the Nutrition Facts label to choose foods
with a lower % DV for sodium. Foods with less than 140 mg
sodium per serving can be labelled as low sodium foods. Claims
such as low in sodium or very low in sodium on the front of
the food label can help you identify foods that contain less salt
(or sodium).
Whole Grain Tips for Children
1. Set a good example for children
by eating whole grains with meals
or as snacks.
2. Let children select and help
prepare a whole grain side dish.
3. Teach older children to read the
ingredient list on cereals or snack food packages and choose those
with whole grains at the top of the list.
Know Your Portions: Moderation is the key
Portion control is a key player when it comes to a balanced
diet, but it can be hard to stop when your cravings are telling
you to reach for seconds or thirds. When you first begin to
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realize that you're full, use these tricks to tell your mind that
the meal is over.
Pick peppermint: A piece of hard candy, a mint, a mug of tea,
or even mouthwashafter eating, go for anything peppermintflavoured to flood your senses and keep your instincts in check.
As a natural appetite suppressant, peppermint will help you
control your cravings and avoid post meal munchies.
Get up and move: The best way to let your body know that it's
time to stop eating? Switch locations. It's hard to keep eating if
you're no longer near the food! Move from the kitchen to the
living room, and busy yourself with other tasks. Even better,
consider going on a walk once mealtime is over.
Have a small taste of something sweet: Sometimes, just a
spoonful of something sweet can curb the urge to keep eating
while also signifying the end of a meal. Instead of reaching for a
giant slice of cake, choose a healthy, water-based food that will
help you feel full. Try a handful of berries, a serving of
watermelon, or a spoonful of pomegranate seeds the tart
seeds pack a major antioxidant punch, plus they're high in
vitamin A, vitamin C, and fiber.
Make post meal plans: If you have something to do after a
meal, you'll find it easy to steer clear of unnecessary seconds
and quit eating once you're satisfied. It doesn't need to be a
major to-do, either simply planning to call a friend or pack
tomorrow's gym bag will help you stay focused and stop
snacking.

KEY COMPONENTS OF A LIFESTYLE CHANGE

PROGRAM
LIFESTYLE CHANGES AND PSYCHOSOCIAL TREATMENTS

Even modest weight loss can reduce the risk factors for heart
disease and diabetes. The simplest approach to weight loss is
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reducing calories and exercising at least 150-170 minutes a week.

Behavioural and mental changes in eating habits, physical activity,
and attitudes about food and weight are also essential to weight
management. Studies show that people who lost at least 10% of
their body weight and kept the weight off for more than 1 year
share several characteristics, including:
Take a session of exercising for at least 1 hour each day.
Always eating a low-fat, low-calorie diet.
Eating breakfast each day.
Weighing themselves regularly and often.
Eating the same diet on weekends as they do on weekdays.
SOME TIPS FOR LOSING WEIGHT

Start with realistic goals. Diet failure is extremely common, and

the odds of significant weight loss are low, particularly in people
with the highest weights. People who are able to restrict calories,
engage in an exercise program, and get help in making behavioral
changes can expect to lose 5-10% of their current body weight.
That is generally all that is needed to achieve meaningful health
changes. Certainly, the distorted image of a super-thin female
shape should not be anyone's goal.
Maintain a regular exercise program, assuming you have no
health problems that will stop you. Choose a program that you
enjoy. Check with your doctor about any health considerations.
Do not use hunger pangs as cues to eat. A stomach that has been
stretched by large meals will continue to signal hunger for large
amounts of food until its size reduces over time with smaller
meals.
Be honest about how much you eat and start by recording all
calories in writing. Many people significantly underestimate
their consumption of high-calorie foods and overestimate intake
of low-calorie foods. People who do not carefully note
everything they eat tend to take in too many calories when they
believe they are dieting.
Observe weekend eating. People tend to eat more on the
weekends. If it is difficult to monitor all meals during the week,
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it be may be useful to at least track eating habits during the

weekends.
Once the pounds are lost, do your best to keep the healthier
weight. Make daily, even hourly, conscious decisions about
eating and exercising activities. Such thinking, in many cases,
can become automatic and not painful.
Don't give up, even after repeated weight loss failures. Most
studies indicate that yo-yo dieting or weight cycling have no
bad psychological or physical effects. Repeated dieting also
does not harm the body's ability to burn calories efficiently.
Weight loss, in any case, should not be the only or even the
primary goal for people concerned about their health. The
success of weight loss efforts should be evaluated according to
improvements in disease risk factors or symptoms, and by the
adoption of healthy lifestyle habits, not just by the number of
pounds lost.

CHANGING SEDENTARY HABITS AND EXERCISE

CHANGING SEDENTARY HABITS

Making even small changes in physical activity can expend energy.

For example, simply getting up to turn the TV on and off instead of
using the remote, and standing (instead of sitting) while talking on
the phone may help a person lose up to five pounds a year. Other
suggestions include cooking one's own food (instead of eating
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take-out or fast food), walking to as many places as possible, using

stairs instead of escalators or elevators, and gardening.
Even fidgeting may be helpful in keeping pounds off, and, in
one study, chewing gum increased energy expenditure.No one
should rely on such mild activities, however, for serious weight
loss. Only high levels of physical activity -- not just using up
energy -- help prevent obesity.Interventions to help children and
adolescents lose weight and maintain weight loss have yet to show
consistent benefit
Approach To Exercise
Exercise, which replaces fat with muscle, is the critical companion
for any weight control program. In a one-year study, women who
regularly averaged 3.5 days (176 minutes) of exercise each week
lost significantly more weight than women who did not exercise
regularly. Women who exercised more than 195 minutes a week
lost nearly 7% of their abdominal fat.
It should be noted that increasing activity level in daily work
and home life helps a great deal. For example, walking down the
hall to speak with a co-worker, rather than spending the same time
sending an e-mail, may result in a loss of 5 kg over a 10-year
period.People who exercise are more apt to stay on a diet plan.
Exercise improves psychological well-being and replaces
sedentary habits that usually lead to snacking. Exercise may even
act as a mild appetite suppressant. Moreover, exercise improves
overall health even with modest weight loss.
Be aware, however, that the pounds won't melt off magically.
Losing significant weight requires both intensive exercise and
calorie restriction. In addition, if a person exercises but doesn't
diet, any actual pounds lost may be minimal, because denser and
heavier muscle mass replaces fat. Nonetheless, regardless of
weight loss, a fit body will look more toned and be healthier. In
addition, exercise benefits the heart even with modest weight loss.

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The following are some suggestions and observations on

exercise and weight loss:
The more strenuous the exercise, the better the chances for
short-term and long-term success. With intense exercise, the
metabolism continues to burn calories before returning to its
resting level. This state of elevated metabolism can last for as
little as a few minutes after light exercise to as long as several
hours after prolonged or heavy exercise.
Of the standard aerobic machines, the treadmill burns the most
calories. It may be particularly effective when used in short
multiple bouts during the day. In fact, frequent exercise sessions
as short as 10 minutes in duration (about four times a day) may
be the most successful exercise program for obese people.
Resistance or strength training is excellent for replacing fat with
muscles. It should be performed two or three times a week.
As people slim down, their initial level of physical activity
becomes easier and they burn fewer calories for the same
amount of work. The rate of weight loss slows down, sometimes
discouragingly so, after an initial dramatic head start using diet
and exercise combinations. People should be aware of this
phenomenon and keep adding to their daily exercise program.
As people age, they also need to exercise more to keep off the
same amount of weight.
Changes in fat and muscle distribution may differ between men
and women as they exercise. Men tend to lose abdominal fat
(which lowers their risk for heart disease faster than reducing
general body fat). Exercise, however, does not appear to have
the same effect on weight distribution in women. In one
interesting study, women in aerobic and strength training
programs lost fat in their arms and trunk, but did not gain
muscle tissue in these regions.
Spot Exercising
Anyone seeking to lose weight must expect that the results may not
be as cosmetically satisfying as one would wish. Spot exercising
(training particular areas of the body) is ineffective in reducing fat
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in specific locations because exercise draws on fat stores

throughout the body. Gimmicky devices such as bust developers,
vacuum pants, and exercise belts do absolutely nothing to reduce
fat or add bulk in specific locations. Electrical pads wrapped
around the waist, arms, or thighs were reported to cause burns and
fires.
CALORIC RESTRICTION

Caloric
Restriction (CR)or calorie
restrictionis
a dietary
regimen that is based on low calorie intake. "Low" can be defined
relative to the subject's previous intake before intentionally
restricting calories, or relative to an average person of similar body
type. Caloric restriction without malnutrition has been shown to
work in a variety of species, among them yeast, fish, rodents and
dogs to decelerate the biological aging process, resulting in longer
maintenance of youthful health and an increase in
both median and maximum lifespan.
The long-term effects of moderate CR with adequate intake of
nutrients on humans are unknown.Two main lifespan studies have
been performed involving nonhuman primates (rhesus monkeys).
One, begun in 1987 by the National Institute on Aging, published
interim results in August 2012 indicating that CR confers health
benefits in these animals, but did not demonstrate increased
median lifespan. A second study by the University of Wisconsin
beginning in 1989 issued preliminary lifespan results in 2009, and
final results in 2014.It found that CR primates were only 36.4% as
likely to die from age-related causes when compared with control
animals, and had only 56.2% the rate of death from any cause.
Calorie restriction or caloric restriction, usually abbreviated to
CR, is a strategy proven to extend healthy, average, and maximum
life span in many short lived species, including mice and rats, and
at least healthy and average life span in primates. In research
papers it is more usually called Dietary restriction, abbreviated to
DR, and rodent studies conducted over the past 20 years have

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reliably demonstrated up to a 40% increase in maximum life span

through life-long DR.
These benefits to health and longevity have been shown in
animal studies to roughly scale with the degree of calorie restriction
imposed, but there is good reason to believe that any gain in
primate (and especially human) life span through CR is much more
modest than that observed in mice. The calorie restriction response
exists in near all species tested to date, and probably evolved very
early in the history of life on Earth as a way to increase the chances
of surviving seasonal famines or other periodic shortages. Such
shortages are the same length whether you are a mouse living a few
years or a man living for decades, but for the mouse a season is a
much greater fraction of a life span, and thus only the mouse
evolved dramatic extension of life in response to famine.
While human calorie restriction doesn't have the same impact on
life span, it does provide numerous benefits, such as a greatly
lowered risk for most degenerative conditions of aging, and
improved measures of health. In recent years, human studies of
long-term and short-term calorie restriction havecomprehensively
demonstrated these benefits. Many researchers believe that the
evidence to date shows the practice of CR will in fact extend the
healthy human life span, but there simply isn't enough data yet to
pin down the effects on life expectancy. It is plausible that they are
at least as good as those resulting from exercise. If so, it
could mean a difference of 5-10 years of life.
CALORIE RESTRICTION RESEARCH

The beneficial effects of CR in laboratory animals have been

known for more than 80 years, but only in the past decade has an
appreciable level of funding and attention been given to this field.
Human studies such as CALERIE have been underway for years
and many research groups are digging into the operating details of
cells and metabolism to firstly explain how the CR response works
to extend life, and secondly to try to produce treatments that can
mimic this effect. So far a great deal has been learned, but little
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headway
has
been
made
towards calorie
restriction
mimetic therapies. The genes and processes that control
metabolism are notoriously complex, and scientists do not yet have
a complete understanding of even this one narrow slice of the
bigger picture.
Loss of visceral fat tissue should be mentioned in the context of
CR, as we all know that if you eat fewer calories, you will tend to
slim down. A mountain of research indicates that carrying excess
body fat is harmful to your long term health in many different
ways. Even modest levels of excess weight increases the risk of
later suffering common age-related conditions such as diabetes,
cancer, and Alzheimer's, with one of the contributing factors
being the relationship between fat cells and chronic inflammation.
It is no exaggeration to say that if you are overweight, you will
have a shorter, less healthy life. This is repeated by the scientific
community in study after study. Given all of this, it is plausible that
some portion of the health benefits of CR stem from the
accompanying loss of fat tissue, although biochemical research
indicates that there is clearly more than just that going on under the
hood.
CR is also creating a variety of positive changes in the
controlling mechanisms of metabolism. For example, it appears
that CR provides a boost to the processes of autophagy. Autophagy
is the way in which cells remove damaged components in order to
recycle the materials into new replacement parts. Several lines of
research indicate specific types of damaged cellular components
left to cause problems over time contribute to age-related decline
and damage inflicted upon the rest of your body's machinery. A
greater level of autophagy may help reduce this contribution to the
aging process, and thereby extend life.
Practicing Calorie Restriction
A restricted diet of this sort aims to reduce the intake of calories to
a level 20-40% lower than is typical, while still providing all the
necessary nutrients and vitamins. With this in mind, CR is
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sometimes called "calorie restriction with optimal nutrition" or

CRON, and its practitioners have accumulated many years of
experience in how best to achieve this end. Good books and a
supportive community exist to help newcomers adopt the best
practices for CR in humans. Mild CR can be as easy as adopting a
much healthier diet, taking a few supplements and not eating
snacks.
If you were eating an unhealthy diet, you will probably notice
the benefits of healthy eating within a few weeks. Your palate will
become more sensitive to subtle tastes, you'll need less sleep, feel
more alert, and mood swings will be diminished. Much of this
stems from cutting the intake of processed sugars.
Pay Attention to Calories
Counting calories is a good thing, and something that you have to
pay attention to. Your body will let you eat far more than is good
for you, so your brain is going to have to take over managing the
process. Almost everything you buy from the grocery or
supermarket has the calorie content listed on the packet.For foods
like apples, rice, loose vegetables, and so forth, you will need a
book of calorie values. Recent editions tend to contain (fairly
horrifying) values for fast foods as well as the more usual suspects.
You might try the well regarded "Food Values of Portions
Commonly Used":
Remember the Supplements
You should always take a good multivitamin supplement when
practicing calorie restriction. In theory it's perfectly possible to
obtain all the vitamins and micronutrients you need from your
food. In practice, for most people living busy, working lives, this
just isn't going to happen. Remember to take your supplements.
The Water Trick
Many people find it easy to mistake low-level thirst for low-level
hunger. A very helpful tactic for those practicing calorie restriction
is to drink a glass of water when first feeling hungry. If you are still
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hungry twenty minutes later, then maybe it's time to think about
eating. Half the time, you were just thirsty, however.
There is a large and very helpful calorie restriction community
out there. You might start to become involved by joining the CR
Society mailing lists and feel free to speak out. These folks have
plenty of advice and helpful hints for newcomers. Everyone was
new to calorie restriction at some point in the past, and there are no
stupid questions.
It's Just a Diet, So Relax
Too many people approach diets in an all-or-nothing way. They
slip up or eat poorly one day, become stressed, and abandon the
diet entirely in frustration. The key to health through diet is a
relaxed attitude. If you slip up, let it go. Keep at it, do better next
time, and work on the average. Remember that a diet is simply a
tool to make you healthier, and thus enable you to keep up with
what you enjoy in life.
THE FUTURE OF YOUR LONGEVITY

If you've read this far, you are probably interested in living a

longer, healthier life. Calorie restriction is still the only widely
available tool in the longevity toolkit today, which, when you stop
to think about it, is a rather sorry state of affairs. This will not
always be the case, however, as medical science and biotechnology
are advancing ever onward. It is worth remembering that as time
progresses your remaining healthy life span is determined ever less
by how well you maintain your health, and ever more by the rate of
progress in regenerative medicine, work aimed at repairing the
accumulated cellular damage that is the root cause of all age-related
disease and infirmity.
You should look into calorie restriction today, but also consider
the long-term view: supporting medical research into extending and
restoring health is just as important, and it will become ever more

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important as time goes on that you made some effort to help the
development of better longevity medicine.

FAT AND SUGAR SUBSTITUTES

Commonly used sweeteners are table sugar, honey, fructose, carob,

dextrose and corn syrup and may be called natural sweeteners.
However, it does not mean they are healthier for you. A few do
have the benefit of tasting sweeter than regular sugar, so less is
used to sweeten a food product, but they still contain calories and
carbohydrates that can affect your blood sugar levels if you have
diabetes.
Sugar Alcohols
Some of the most common nutritive sweeteners are sugar
alcohols. The most common are sorbitol, mannitol, erythritol and
xylitol. They are used in many sugar free candies and desserts.
They have one-half the carbs than table sugar. Sugar alcohols
still turn into sugar and can raise blood sugar levels, if you have
diabetes. Eating too much of these can cause gas, cramps, bloating
and/or diarrhoea.Other nutritive sweeteners are honey, fructose
(fruit sugar), carob, dextrose and corn syrup. They are also called
natural sweeteners. You might think they are healthier. A few are
sweeter than table sugar. Less is used in a food product. They still
have calories and carbs.
Non-Nutritive Sweeteners
Non-nutritive sweeteners are also called artificial sweeteners. The
most common are aspartame, saccharin, stevia, neotame and
acesulfame-K. These products have little or no calories or carbs.
They do not affect blood sugar levels. Replacing regular sugar with
these products in foods actually does lower the calorie and carb
levels in foods.
Aspartame can only be used in recipes that are baked for 20
minutes or less. This sweetener breaks down under long periods of
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heat. Neotame is similar to aspartame. It is used in small amounts

because it is so sweet. Saccharin and acesulfame-K are more stable.
They can be used in recipes that have a longer baking time. Since
these sweeteners are sweeter than table sugar, you do not need as
much. Sucralose is found in many foods. It is very sweet (600 times
sweeter than sugar) and is easy to use in baking. The newest nonnutritive sweetener is Trivia. It is made from the stevia plant. This
plant has been sold as an herbal supplement for many years in
health food stores.
Fat Substitutes
Olestra(Procter and Gamble brand name: Olean(R))
We all need a certain amount of fat in our diets. Too much is not
good either, but none is potentially dangerous. Fat is needed for
proper growth and development, for the proper absorption of fatsoluble vitamins like A, D, E and K, and is the only source of
certain essential fatty acids.
Olestra is a fat-based fat substitute -- a synthetic mixture of
sugar and vegetable oil that passes through the body without adding
fat or calories. The FDA and a great number of critics do not
believe there has been sufficient testing on its safety in long-term
use. It passes through the body undigested, so what does it do as it
runs its course? Critics are concerned that it will steal from the
body essential nutrients such as vitamins A, D, E and K, betacarotene (and others) by up to 30%. "These vitamins attach
themselves to fat, so when they stick to olestra by mistake they get
flushed out of the body undigested."
Olestra can also deplete the body of carotenoids -- a group of
substances (such as lutein and zeaxanthin) that keep your immune
system healthy and help to prevent things like heart disease, cancer,
and vision problem. One of Olestra's immediate effects, because of
the way it is passed through the system, is that it can cause gas,
cramping and diarrhoea.

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Artificial Sweetener
Saccharin
Around for more than 100 years it is the oldest artificial sweetener,
in 1977 the FDA required that all food containing Saccharin
contain a warning label: "Use of this product may be hazardous to
your health. This product contains saccharin, which has been
determined to cause cancer in laboratory animals."
In a study conducted by the National Cancer Institute during
1978 and 1979, it was concluded that heavy users of Saccharin,
and products containing it such as diet soda, could be at an
increased risk of developing bladder cancer. "Heavy use" was
defined as "two or more 8-ounce servings of a diet drink per day,"
or "six or more servings of (packets of) sugar substitute per day."
Saccharin, used long-term, does not promote good health, but if
you must use an artificial sweetener (for example, if you are a
diabetic), please choose Saccharin products over popular
Aspartame-containing ones.
Aspartame
Aspartame is the most popular artificial sweetener used. It is also
known to potentially cause cancer and be responsible for a wide
variety of behavioural changes in humans. It can cause seizures
and even death. It is considered one of the most dangerous
additives in food today. Of the allergic reactions to food that are
reported to the FDA, it accounts for the reason in 75% of the cases.
Aspartame, is made up of three parts. Aspartic Acid (40%) -considered an "excitotoxin" that "excite or stimulate the neural
cells to death"; Phenylalanine (50%) -- which can build up in the
brain; and Methanol (10%) -- wood alcohol which is a deadly
poison. (reference: Aspartame; L-aspartyl-L-phenylalanine methyl
ester.)
Side effects can include everything from minor to severe. The
more use of Aspartame and the longer the person consumes it
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increase the risks. Here are some of the side effects, and diseases
that can be caused by, triggered or made worse by the use of
Aspartame: Headaches/migraines, dizziness, nausea, weight gain,
muscle spasms, depression, fatigue, insomnia, heart palpitations,
vision and hearing problems, anxiety attacks, vertigo, memory loss
and joint pain, Emotional Disorders, Multiple Sclerosis, Lupus,
Chronic Fatigue Syndrome, Brain Tumours, Brain Cancer,
Diabetes, Parkinson's Disease, Alzheimer's Disease, Epilepsy,
Birth Defects, Mental Retardation and Diabetes.
Aspartame can often be found in: diet sodas, ice-teas, coffee
drinks, breath mints, cereals, sugar-free gums, jello, frozen yogurt,
wine coolers, multivitamins and children's vitamins, milks drinks,
laxatives and many more products. It can also be in products that
are NOT promoted as "sugar-free".
Sucralose (Splenda)
Sucralose is an artificial sweetener made from sugar -- it is a
chlorinated sucrose derivative. Though considered "safer" than
aspartame or saccharin by many, it is thought that there have not
been enough long-term studies done on this product, and many
believe it may be just as some of its competitors.Research in
animals has shown the following side effects: chest pains,
irritability, confusion, fatigue, shrunken thymus gland, enlarged
liver and kidneys, reduced growth rate, decreased red blood cell
count, hyperplasia of pelvis, miscarriage, decreased fetal body
weights, changes in mood, and diarrhoea.
LIQUID MEAL REPLACEMENTS

Liquid meal replacements, generally smoothies or milkshakes,

contain enough calories and nutrients to be substituted for a meal.
This means that they provide as many carbohydrates, proteins and
fats to nourish your body as would eating a balanced meal. Liquid
meal replacements are a good way to maintain a healthy body
weight and consume nutrients quickly and on the go.

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Pour a liquid base, such as water, low-fat or skim milk or

freshly squeezed juice, into a blender. This will help dilute and
blend all the ingredients in your liquid meal replacement.Blend in
healthy carbohydrates, such as berries, apples, oranges, bananas or
other fruits. You can also add vegetables, such cucumbers, kale
and spinach, depending on the type of smoothie or milkshake you
are making.
Add a protein source, such as low-fat yogurt, to your drink.
Other protein sources include crushed almonds, soy milk or tofu.
Another good source is whey protein powder, a highly digestible
protein found in milk. Use protein powder only as directed on the
product label. Blend all ingredients until smooth.
Blend in a healthy fat source, such as avocado pieces or ground
flaxseeds. Avocados are cholesterol-free, low in saturated fats and
contain "good" mono- and polyunsaturated fats, which can help
reduce blood cholesterol levels and decrease your risk of heart
disease and stroke. Flaxseed contains healthy omega-3 fatty acids
that help reduce inflammation in your body.
Liquid Diet Plan
The liquid diet plan is exactly what it sounds like -- a diet that
consists almost entirely of fluids. It is not meant to be a "lifestyle
change," or something you take up for the rest of your life, like
healthful eating habits. Rather, it should only be done for a few
days at a time as your body cannot sustain itself over the long term
on a few different liquids alone.
There are two basic types of liquid diets: the clear liquid diet
and the full liquid diet. While similar, the clear liquid diet is more
restricted than the full liquid diet, which takes a few liberties with
its inclusion of items like oatmeal, cream of wheat and even
butter.The liquid diet plan may actually be recommended by your
doctor -- however, probably not for weight loss. More often,
physicians will put someone on a liquid diet before or after
surgery.
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In addition, you might be put on such a diet if you need internal

tests or x-rays that require an empty stomach and intestines. A
liquid diet should last for just a couple days, possibly up to a week
at most. However, obese people undergoing bariatric surgery may
be put on the liquid diet for a longer time period in order to help
their gastrointestinal tract adjust to the surgery.Put down that
1,500-calorie chocolate peanut butter milkshake though -- not just
any liquid is allowed on the liquid diet. Read on to discover what
you can drink.
Liquid Diet Drinks
Depending on the type of liquid diet you follow, you are typically
allowed different drinks. If your doctor puts you on a liquid diet,
however, drink only what he or she recommends.
Generally, on a clear liquid diet, you need to stick to transparent
fluids. Sample foods include:
Clear soup broths
Clear fruit juices
Clear carbonated beverages
Coffee
Tea
Popsicles
Gelatin
On the full liquid diet, you can have clear liquids but also thicker
foods with a bit more substance. Sample foods include:
Milk
Ice cream
Pudding
Cream soups
Oatmeal
Cream of wheat
Honey
Pureed vegetables

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Many people also follow a modified liquid diet in which they use
meal-replacement shakes or protein powders for one to two meals
per day and consume one regular, solid-food meal. This can help
stimulate weight loss by consuming fewer calories while allowing
the third solid meal to replenish nutrients that are often lacking
from diet drinks. Meal-replacement shakes are sold pre-made in
cans or in a powder you add to water or milk; people often choose
these for the convenience of an easy-travelling meal.If you are put
on a liquid diet plan by your doctor, follow all advice he or she
gives you. And, if you're planning to start a liquid diet on your
own, it's a good idea to discuss it with your doctor first so that he
or she can be notify you of any potential health risks.

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SUPPORT GROUPS AND BEHAVIORAL

MODIFICATIONS
SUPPORT GROUPS AND BEHAVIOR MODIFICATION

Behaviour plays a significant role in weight management.

Modifying behaviours that contributed to developing obesity is one
way to treat the disease of obesity either alone or in conjunction
with other treatments. A few behaviour modifiers include:
Self-monitoring
Increasing physical activity
Becoming educated about the body and how to nourish it
appropriately
Engaging in a support group
Setting realistic goals
Self-Monitoring
Though scientists have now proven that losing weight is more
complex than simply taking in fewer calories than you burn off,
keeping track of how many calories you consume and how active
you are continue to be beneficial to successful weight-loss and
weight maintenance. Because self-monitoring is critical for success
with lifestyle changes, it is important to look at the various selfmonitoring techniques.
Self-monitoring refers to the observing and recording of eating,
drinking and physical activity patterns, followed by feedback on
the behaviours. The goal of self-monitoring is to increase selfawareness of target behaviours and outcomes, thus it can serve as
an early warning system if problems are arising and can help track
success.
Some commonly used self-monitoring techniques include:
Food diaries
Regular self-weighing
Exercise logs
High-tech tools such as pedometers, accelerometers and
metabolic devices.
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All of these techniques can be utilized simultaneously to track

patterns in daily activity. You can then use these patterns to
determine which behaviours tend to result in weight gain versus
weight-loss. To optimize your weight-loss, focus on making the
healthy patterns part of your long-term lifestyle change.
With technology advancements, self-monitoring techniques are
changing and improving to help defeat some of the major barriers
to adherence. The bottom line is that no matter how you do it, selfmonitoring should be an important part of your weight-loss, weight
maintenance or healthy lifestyle change.
Physical Activity:
Studies have proven that individuals affected by obesity who
maintain an optimal level of fitness have lower risk of heart attacks
than individuals affected by obesity who are not very fit. Regular
physical activity is necessary for good health. It is primarily
important for someone who is trying to lose weight or maintain a
healthy weight. Exercise can not only help to control weight, but it
also contributes to healthy bones and emotional health. Be sure to
check with your doctor that you are healthy enough to exercise
before embarking on an exercise routine.
To maintain your weight, the Centres for Disease Control (CDC)
recommends 150 minutes of moderate aerobic activity, 75 minutes
of vigorous activity or an equivalent mix of the two each week.
This recommendation can vary, however, depending on your
fitness level and abilities so consult with a healthcare professional
for your individual needs.
Aerobic activity of 240 to 300 minutes per week may add
additional benefits to reduced calorie intake.
Moderate and Vigorous Physical Activities:
Physical activity does not have to be strenuous to be beneficial.
Someone who has been sedentary but wants to get started with an
exercise program should begin by incorporating a few minutes of
activity into each day.
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Moderate: Moderate activity is physical activity ranging from 64

to 76 percent of maximum heart rate. Moderate intensity activity
causes a slightly increased rate of breathing and it feels light to
somewhat hard.
Examples of moderate intensity activities:
Brisk walking (a 15 minute mile)
Yard/house work
Leisure bike ride
Playing with family
Light swimming
Vigorous: Vigorous intensity is physical activity greater than 76
percent of maximum heart rate. Vigorous intensity activities result
in increased rates of breathing and sweating and feel from
somewhat hard to very hard. It is quite difficult to hold a
conversation when performing this type of activity
Examples of vigorous intensity activities:
Competitive sports such as soccer or basketball
Jogging
Hiking
Cycling
Aerobics
Developing Physical Activity Goals:
Once you have decided why you want to exercise and make a
commitment, then you can set a SMART goal and use the FITT
principle to make a plan.
Your goals should be SMART
S Specific: Choose one specific behaviour modifier per
goal to work on.
M Measurable: Can you measure this against a baseline?
A Attainable or Action-based behaviours: Is the goal
attainable? Use action words when writing goals such as
I will and I do, rather than try, should, would,
could.
R Realistic: Do you have honest and realistic expectations
of yourself with your time, body, likes/dislikes?
238 reasonable and manageable
T Timely: Is the time allotted
for you right now? And, when will it conclude?

Then use the FITT principle to develop your physical activity

plan:
F Frequency: How often?
I Intensity: What percentage of your target heart rate do
you exercise? How hard do you plan on working?
T Type: What mode of exercise are you using (walk,
swim, aerobics, bike, dance, weights, yoga, Pilates,
etc.)?
T Time: How long can you exercise per day?

(This does not have to be all in one session. Time can be divided
throughout the day.)
Now, let us look at how to put these two principles together and
start our plan. Here are some examples of poor and well-written
goals:
Poor Goals:
I want to increase my cardiovascular exercise.
I need to lose weight.
These goals are too general and do not clearly define the plan.
SMART Goals:
I will increase my exercise by walking Monday, Wednesday
and Friday two times a day for 15 minutes each time. I will
walk at a pace that is somewhat difficult.
I will record my food intake and exercise every day. My goal is
to stay under 2,000 calories and to exercise 150 minutes this
week.
These SMART goals are specific and allow you to easily
determine if you are following your plan or not.
Remember these few things about exercise:
Make it simple.
Make it realistic.
Make it happen.
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Most importantly, make it fun!

The most important commitment YOU make is to YOUR health
and wellness.
EDUCATION AND YOUR BODY

Although we often take it for granted, the body is a complex

system. Recognizing this and making an effort to learn more are
essential to your weight-loss and health. There are a wide variety
of ways you can learn about your body, ways to properly nourish it
and more, such as:
Talk to Your Primary Care Provider (PCP) Discussing your
weight with your PCP is an excellent place to start. It is important
to be prepared for this visit. Here are some quick tips to help you
prep for your visit:
Write down food consumed in a food diary (even snacks).
List any exercise activities you participate in daily, weekly.
List any family history of conditions (type 2 diabetes, heart
disease, etc.).
Bring a list of any medications and dietary supplements you
currently take.
Speak to a Dietician Dieticians are an excellent resource for an
individual wanting to lose weight and improve health. Quite often,
we think we know whats healthy for our bodies, but we are
commonly mistaken. Dieticians can provide you with the
following:
Meal plans
Information on foods and how they impact your weight and
health
Help developing nutritional goals
Support Groups
The journey of weight-loss can often be a difficult one and a lonely
one. We all know that one person who can eat anything and not
gain a pound. Realistically, this is not true for the majority of
Peoples. Most individuals battling obesity or severe obesity find
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themselves needing support. Support groups are an excellent

resource to share your story and learn from others. Here are some
quick tips to help you find and engage in support groups:
Ask your PCP for support group references. There are a wide
variety of support groups available (women-only, men-only,
faith-based, etc.)
Dont be afraid to speak up and share your story. Theres a good
chance someone is thinking the same thing you are.
Not ready to meet face-to-face? There are numerous online
support groups available. Ask your PCP or dietitian for some of
their favorites.
Setting Realistic Goals:
When developing your goals for weight-loss, exercise, eating
healthy and more, it is important to keep them realistic. Quite
often, individuals become frustrated when they do not see
immediate weight-loss results. It is important to not let yourself
become frustrated with your weight-loss plan. Changing your diet,
incorporating exercise and more can all be significant life changes
and they need to be taken seriously. Here are a few tips for
developing realistic goals:
Average weight-loss is one to two pounds per week.
Start slow with exercise and find an activity you enjoy.
Ask your spouse, family member or friend to exercise with you.
Make meal times a family affair. Have your children help with
cooking and let them choose healthy foods as well.
Recognize your progress. Continue a proactive mindset and
remember that each day is another day forward.
COMMERCIAL AND NON-PROFIT SUPPORT PROGRAMS
FOR WEIGHT LOSS

Each year, millions of people enrol in weight-loss programs. These

include well-known commercial programs such Weight Watchers
and Jenny Craig (both of which have online versions) and
organized self-help programs such as Overeaters Anonymous.
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Fewer people may be familiar with medically supervised programs,

which include hospital-based programs or individual care from a
physician. In addition, many free online diet and exercise programs
are now available.
The commercial programs charge a fee for meetings. They offer
advice on diet and exercise regimens as well as online tools for
tracking your weight and food consumption. In some cases, they
sell prepared foods and diet aids. The self-help programs tend to
focus mainly on providing emotional support and encouragement
in sticking with a weight-loss plan.
Clinical programs, which are provided through a doctor's office
or hospital clinic, offer comprehensive diet, exercise, and
behaviour-modification programs, supplemented as needed with
prescription treatments such as very low-calorie diets, weight-loss
medications, and, increasingly, surgery.
None of the programs can guarantee that you will lose a
particular amount of weight. With the exception of the clinical
programs, these approaches are adjuncts to, not substitutes for,
professional guidance for those who need it. Indeed, the self-help
and commercial plans encourage participants to consult with health
care professionals about weight-loss strategies. Following are
descriptions of the different programs and what you can expect
from them.
Commercial Programs
Like self-help programs, the commercial programs hold regular
meetings to provide encouragement and support. But a significant
difference between the two types of programs is money. The
commercial programs charge fees to participate in meetings and
also sell diet plans, as well as prepared foods and diet aids to go
along with those plans. Costs for these programs vary, depending
on how long you commit to the program, whether you attend
meetings in person or online, and whether you purchase the foods

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or diet aids. Check with the specific organization for more

information.
Weight Watchers
The most popular of the commercial programs, Weight Watchers,
has more than 25 million participants worldwide. As a member,
you receive a daily allotment of points (based on your weight, age,
gender, and other factors) to spend on food, along with point
values for a wide range of foods.In late 2010, Weight Watchers
introduced Points Plus, a revamped system that puts more
emphasis on the nutritional value of each food to assign point
values. On the old plan, a 100-calorie bag of cookies was two
points, the same as a 100-calorie apple. Under the new plan, fruits
and non-starchy vegetables are now zero points. And foods high in
protein and fibre have lower point values than foods high in fat and
refined carbohydrates. The idea is to encourage people to eat more
healthful, nutrient-dense foods and fewer "empty" calories from
treats.
There's no need to buy Weight Watchersbrand foods. The
program also encourages members to get regular exercise. Two
published trials showed that people who went to Weight Watchers
meetings regularly lost about 5% of their weight over three to six
months. Meetings are led by people who have successfully lost
weight and kept it off through the Weight Watchers program.
Jenny Craig
The other leading commercial weight-loss program, Jenny Craig,
has more than 725 centres around the world. To get started, you
visit a local Jenny Craig centre and have your weight analysed by a
staff member. These staff members are not dieticians or other
health professionals, but they're trained in the Jenny Craig
program, which, according to the company, was developed by
dieticians. Based on your weight, the staff member recommends a
dieting, exercise, and behaviour-modification program to help you
lose about 1 pound a week.
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In general, members are advised to eat three meals and three

snacks each day, as well as to drink eight 8-ounce glasses of water
each day and to increase their physical activity as much as they
can. Jenny Craig also sells a wide array of packaged foods, diet
aids, vitamin and mineral supplements, and even devices such as
pedometers. Members have the option of preparing their own
meals, but the prepared foods have been shown to help them stick
with the diet.
Online Options For Dieters
In addition to the Weight Watchers and Jenny Craig online
programs, there are numerous other Web-based diet and exercise
programs, some of which are free. Similar programs are also
available for use on a smartphone (see "Smartphone applications to
spur weight loss"). Most offer tools that allow you to easily track
your eating and exercise habits, count calories, and chart your
weight loss. Some have programs specifically targeted to men or
women, and many offer plans that follow specific types of diets,
such as low-carb, Mediterranean, or vegetarian. Most also feature
online chats or discussion groups, and some provide e-mail advice
from experts, including psychologists and dieticians.
These are some of the better-known options:
Calorie Counter (caloriecount.about.com)
Calorie King (www.calorieking.com)
Diet Watch (www.dietwatch.com)
eDiets (www.ediets.com)
FitDay (www.fitday.com)
NutriSystem (www.nutrisystem.com)
SparkPeople (www.sparkpeople.com)
Vtrim (www.uvm.edu/vtrim)
WebMD (www.webmd.com/diet)
A study published in Obesity involving more than 2,800
members of the Kaiser Permanente health plan revealed that
people who followed a tailored expert system lost more weight
than those assigned to an information-only plan. Both options
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were offered online only, but while the information-only group

received just factual information about weight management and
diet strategies, the tailored system focused on a healthy diet and
provided tips targeted to the participant's particular issues. For
example, those who believed overweight people lacked
willpower were given messages attempting to change that
perception, and those unable to exercise weren't given exercise
advice.
According to a review of Web-based interventions for weight
loss published in 2010 in Obesity Reviews, the frequency of a
user's log-ins, self-monitoring occasions, chat room attendances,
and bulletin board posts was correlated with losing weight or
keeping it off in many studies. But there's a dearth of information
on the long-term impact of Web-based interventions, the authors
noted. It's certainly worth checking out a few of the online
programs. Even without proof of clear benefits from a specific one,
the very act of paying more attention to your eating and exercise
habits seems to help.
Non-Profit Programmes
These non-profit programs have local chapters around the world.
They make no promises that they will help you lose any weight.
However, they aim to improve your odds of doing so by holding
regular (usually weekly) meetings where members share success
stories and frustrations and offer one another encouragement and
personal tips. Meetings are run by volunteer group leaders. Each
self-help program has a different focus.
Overeaters Anonymous
This is a 12-step program modelled after Alcoholics Anonymous
for people who suffer from compulsive overeating. The main
purpose of the meetings is to help people stop overeating by
exploring their underlying emotional issues. Overeaters
Anonymous has chapters around the world. It is free, although
members are asked to contribute what they can. A special feature
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of the program is a buddy system in which you have another

member to call if you feel the urge to overeat. Whether this
approach is appropriate or effective for overeaters remains
controversial.
Take Off Pounds Sensibly (TOPS)
This program takes a practical approach, giving members
incentives to follow whatever diet plan has been recommended by
their health care practitioners. One program that TOPS
recommends is the "exchange" diet established by the American
Dietetic Association and the American Diabetes Association, but
TOPS asks members to check with their doctors first. Weekly
private weigh-ins are followed by meetings, during which
members discuss their successes and difficulties in reaching their
weight-loss goals. Some chapters arrange for doctors, nutritionists,
and other weight-loss experts to speak at meetings. TOPS holds
retreats and rallies to give members extra incentives to stay with
their weight-loss plans. It also features online support. Members
receive a monthly magazine that contains low-calorie recipes as
well as inspirational stories by members who have met their
weight-loss goals.
Clinical Programs
These programs are run by health care professionals, either in
private practice or at hospital-based centers. Many of these
programs are staffed by multidisciplinary teams that may include
doctors, dieticians, exercise therapists, and psychologists or social
workers, who provide a wide range of services, such as nutrition
education, medical care, behavioral therapy, and guidance on
exercise.
The mainstay of clinical programs used to be a very low-calorie
diet of 800 or fewer calories a day, which is at least 400 calories
per day less than conventional diets. Very low-calorie diets feature
commercially prepared liquid formulas, such as Optifast, that
replace all of the food in a patient's diet and induce a rapid loss of
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about 20% of his or her initial weight over 12 to 16 weeks, as

much as 5 pounds a week. This type of diet is considered
appropriate only for patients with a BMI greater than 30 who need
to lose weight quickly for health reasons. Other clinical programs
offered in the United States include Health Management Resources
and Optifast.
As part of the program, people on very low-calorie diets should
have regular medical checkups to identify any adverse health
effects. Patients should also have counseling to help them adjust to
the diet, as well as guidance on how to reintroduce regular food
once the diet is over. Many programs also offer support groups to
help people maintain their weight loss by adhering to a low-calorie
diet and getting regular physical exercise. In the U.S., very lowcalorie diet programs usually cost $1,000 to $2,000 for three
months.
The clinical programs are inclined to recommend a more
moderate low-calorie diet in conjunction with a program of
exercise and behavior modification. For one thing, very lowcalorie diets have been associated with complications in some
people, including chemical abnormalities and irregular heartbeats.
And in the long run, such diets are no more effective than
conventional low-calorie diets in which people consume about
1,200 calories daily. For patients with obesity, and for those who
are overweight but at high risk for obesity-related complications,
clinical programs now often combine behavior-based treatment
with weight-loss medications or surgery.
COGNITIVE BEHAVIORAL APPROACHES AND PSYCHOSOCIAL ASPECTS

Cognitive behaviour therapy (CBT) is a type of psychotherapeutic

treatment that helps patients understand the thoughts and feelings
that influence behaviours. CBT is commonly used to treat a wide
range of disorders including phobias, addiction, depression and
anxiety.Cognitive behaviour therapy is generally short-term and
focused on helping clients deal with a very specific problem.
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During the course of treatment, people learn how to identify and

change destructive or disturbing thought patterns that have a
negative influence on behaviour.
Cognitive Behaviour Therapy Basics
The underlying concept behind CBT is that our thoughts and
feelings play a fundamental role in our behaviour. For example, a
person who spends a lot of time thinking about plane crashes,
runway accidents, and other air disasters may find themselves
avoiding air travel. The goal of cognitive behaviour therapy is to
teach patients that while they cannot control every aspect of the
world around them, they can take control of how they interpret and
deal with things in their environment.
Cognitive behaviour therapy has become increasingly popular in
recent years with both mental health consumers and treatment
professionals. Because CBT is usually a short-term treatment
option, it is often more affordable than some other types of
therapy. CBT is also empirically supported and has been shown to
effectively help patients overcome a wide variety of maladaptive
behaviours.
Types Of Cognitive Behaviour Therapy
According to the British Association of Behavioural and Cognitive
Psychotherapies, "Cognitive and behavioural psychotherapies are a
range of therapies based on concepts and principles derived from
psychological models of human emotion and behaviour. They
include a wide range of treatment approaches for emotional
disorders,
along
a
continuum
from
structured
individual psychotherapy to self help material."
There are a number of different approaches to CBT that are
regularly used by mental health professionals. These types include:
Rational Emotive Therapy
Cognitive Therapy
Multimodal Therapy
The Components Of Cognitive Behaviour Therapy
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People often experience thoughts or feelings that reinforce or

compound faulty beliefs. Such beliefs can result in problematic
behaviours that can affect numerous life areas, including family,
romantic relationships, work, and academics. For example, a
person suffering from low self-esteem might experience negative
thoughts about his or her own abilities or appearance. As a result of
these negative thinking patterns, the individual might start avoiding
social situations or pass up opportunities for advancement at work
or at school.
In order to combat these destructive thoughts and behaviours, a
cognitive-behavioural therapist begins by helping the client to
identify the problematic beliefs. This stage, known as functional
analysis, is important for learning how thoughts, feelings, and
situations can contribute to maladaptive behaviours. The process
can be difficult, especially for patients who struggle with
introspection, but it can ultimately lead to self-discovery and
insights that are an essential part of the treatment process.
The second part of cognitive behaviour therapy focuses on the
actual behaviours that are contributing to the problem. The client
begins to learn and practice new skills that can then be put into use
in real-world situations. For example, a person suffering from drug
addiction might start practicing new coping skills and rehearsing
ways to avoid or deal with social situations that could potentially
trigger a relapse.
In most cases, CBT is a gradual process that helps a person take
incremental steps towards abehaviour change. Someone suffering
from social anxiety might start by simply imagining himself in an
anxiety-provoking social situation. Next, the client might start
practicing conversations with friends, family, and acquaintances.
By progressively working toward a larger goal, the process seems
less daunting and the goals easier to achieve.

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Uses Of Cognitive Behaviour Therapy

Cognitive behaviour therapy has been used to treat people
suffering from a wide range of disorders, including anxiety,
phobias, depression, and addiction. CBT is one of the most
researched types of therapy, in part because treatment is focused on
highly specific goals and results can be measured relatively easily.
Cognitive behaviour therapy is often best-suited for clients who
are comfortable with introspection. In order for CBT to be
effective, the individual must be ready and willing to spend time
and effort analysing his or her thoughts and feelings. Such selfanalysis can be difficult, but it is a great way to learn more about
how internal states impact outward behaviour.
Cognitive behaviour therapy is also well-suited for people
looking for a short-term treatment option that does not necessarily
involve pharmacological medication. One of the greatest benefits
of cognitive-behaviour therapy is that it helps clients develop
coping skills that can be useful both now and in the future.
Psychological Aspect
Psychologists are experts in helping people make behavioural and
lifestyle changes that assist with weight management. They may
work with individuals and families independently in their private
practice or as part of a health care team, often in a setting where
mental health and medical services are integrated. Sometimes a
psychologist will work on weight control with a patient who has
been referred by a physician, dietician or other health care
professional.
People who seek help from psychologists range in age from
children to adults. They include those who simply struggle with
managing their weight as well as individuals whose weight
problems are related to chronic illnesses like diabetes and heart
disease or other conditions like depression, anxiety or eating
disorders.
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What Happens During Visits With A Psychologist?

An initial visit with a psychologist usually involves a discussion
about your history and concerns. This may include your weight
management goals and past efforts to lose weight, medical history,
stress levels, current life situation and your sources of social
support like family and friends.
In order to help you, psychologists also want to learn about your
habits and attitudes about food, eating, weight loss and body image
that may not support your health goals. Common unhealthy beliefs
that patients express include: having to clean off their plate;
needing dessert after meals; and feeling like a failure when weight
loss stalls. Some typical behaviours include: eating whatever they
want after exercise; using food to cope with feelings of boredom or
stress; and continuing to eat when they are no longer hungry.
These types of behaviours and beliefs often sabotage weight
loss efforts. Psychologists talk to patients about their challenges to
making healthy choices and identify the triggers that prompt the
patient to make unhealthy choices. A psychologist may also
evaluate a patient for anxiety, depression and eating disorders such
as binge eating. These conditions can sometimes contribute to
weight issues.
Developing A Treatment Plan
By the end of a first visit, psychologists usually have a
comprehensive picture of a patient. They discuss what patients are
already doing well and should continue; and they identify areas of
need and difficulty related to weight management. After the initial
visit, the psychologist and patient schedule follow up appointments
and start to create a treatment plan.
Treatment plans differ from one individual to another but tend
to be brief. The plan often involves teaching self-monitoring
behaviours, changing old beliefs, building new coping skills and
making changes to home and work environments to support health
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goals. Psychologists help individuals address obstacles to weight

loss, identify positive ways to change unhealthy habits and develop
new skills and ways of thinking.
Many psychologists concentrate on one health behaviour at a
time. For example, if evenings are a challenging time to maintain
good eating habits, the psychologist may ask the patient to keep a
log of food eaten in the evenings and make notes about their
environment, how they felt and what they were thinking. These
factors provide important information about what is driving eating
behaviours and helps the psychologist and patient figure out a way
to address the behaviours.
Progressing And Improving
After even a few sessions, most patients begin to notice changes.
For example, patients may start to challenge old beliefs about food
and practice new ones that support their health goals.Together with
the psychologist, a patient can determine how long treatment
should last. People with extreme anxiety and depression, eating
disorders or chronic physical health conditions, may require longer
and/or more frequent treatment.The ultimate goal is to help people
develop skills so they can lead healthy lives.
STRESS-REDUCTION TECHNIQUES

Stress is necessary for life. You need stress for creativity, learning,
and your very survival. Stress is only harmful when it becomes
overwhelming and interrupts the healthy state of equilibrium that
your nervous system needs to remain in balance. Unfortunately,
overwhelming stress has become an increasingly common
characteristic of contemporary life. When stressors throw your
nervous system out of balance, relaxation techniques can bring it
back into a balanced state by producing the relaxation response, a
state of deep calmness that is the polar opposite of the stress
response.
When stress overwhelms your nervous system your body is
flooded with chemicals that prepare you for "fight or flight." While
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the stress response can be lifesaving in emergency situations where

you need to act quickly, it wears your body down when constantly
activated by the stresses of everyday life. The relaxation response
puts the brakes on this heightened state of readiness and brings
your body and mind back into a state of equilibrium.
Producing The Relaxation Response
A variety of different relaxation techniques can help you bring
your nervous system back into balance by producing the relaxation
response. The relaxation response is not lying on the couch or
sleeping but a mentally active process that leaves the body relaxed,
calm, and focused.
Learning the basics of these relaxation techniques isnt difficult,
but it does take practice. Most stress experts recommend setting
aside at least 10 to 20 minutes a day for your relaxation practice. If
youd like to get even more stress relief, aim for 30 minutes to an
hour. If that sounds like a daunting commitment, remember that
many of these techniques can be incorporated into your existing
daily schedule practiced at your desk over lunch or on the bus
during your morning commute.
The Relaxation Technique
There is no single relaxation technique that is best for everyone.
When choosing a relaxation technique, consider your specific
needs, preferences, fitness level, and the way you tend to react to
stress. The right relaxation technique is the one that resonates with
you, fits your lifestyle, and is able to focus your mind and interrupt
your everyday thoughts in order to elicit the relaxation response. In
many cases, you may find that alternating or combining different
techniques will keep you motivated and provide you with the best
results.
Do You Need Alone Time Or Social Stimulation?
If you crave solitude, solo relaxation techniques such as meditation
or progressive muscle relaxation will give you the space to quiet
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your mind and recharge your batteries. If you crave social

interaction, a class setting will give you the stimulation and support
youre looking for. Practicing with others may also help you stay
motivated.
Relaxation Technique 1: Breathing meditation for stress relief
With its focus on full, cleansing breaths, deep breathing is a
simple, yet powerful, relaxation technique. Its easy to learn, can
be practiced almost anywhere, and provides a quick way to get
your stress levels in check. Deep breathing is the cornerstone of
many other relaxation practices, too, and can be combined with
other relaxing elements such as aromatherapy and music. All you
really need is a few minutes and a place to stretch out.
Practicing deep breathing meditation:
The key to deep breathing is to breathe deeply from the abdomen,
getting as much fresh air as possible in your lungs. When you take
deep breaths from the abdomen, rather than shallow breaths from
your upper chest, you inhale more oxygen. The more oxygen you
get, the less tense, short of breath, and anxious you feel.
Sit comfortably with your back straight. Put one hand on your
chest and the other on your stomach.
Breathe in through your nose. The hand on your stomach
should rise. The hand on your chest should move very little.
Exhale through your mouth, pushing out as much air as you
can while contracting your abdominal muscles. The hand on
your stomach should move in as you exhale, but your other
hand should move very little.
Continue to breathe in through your nose and out through
your mouth. Try to inhale enough so that your lower
abdomen rises and falls. Count slowly as you exhale.
If you find it difficult breathing from your abdomen while sitting
up, try lying on the floor. Put a small book on your stomach, and
try to breathe so that the book rises as you inhale and falls as you
exhale.
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Relaxation Technique 2: Progressive muscle relaxation for

stress relief
Progressive muscle relaxation involves a two-step process in which
you systematically tense and relax different muscle groups in the
body.With regular practice, progressive muscle relaxation gives
you an intimate familiarity with what tensionas well as complete
relaxationfeels like in different parts of the body. This awareness
helps you spot and counteract the first signs of the muscular
tension that accompanies stress. And as your body relaxes, so will
your mind. You can combine deep breathing with progressive
muscle relaxation for an additional level of stress relief.
Practicing progressive muscle relaxation
Before practicing Progressive Muscle Relaxation, consult with
your doctor if you have a history of muscle spasms, back problems,
or other serious injuries that may be aggravated by tensing
muscles.
Most progressive muscle relaxation practitioners start at the feet
and work their way up to the face. For a sequence of muscle
groups to follow, see the box below.
Loosen your clothing, take off your shoes, and get
comfortable.
Take a few minutes to relax, breathing in and out in slow,
deep breaths.
When youre relaxed and ready to start, shift your attention to
your right foot. Take a moment to focus on the way it feels.
Slowly tense the muscles in your right foot, squeezing as
tightly as you can. Hold for a count of 10.
Relax your right foot. Focus on the tension flowing away and
the way your foot feels as it becomes limp and loose.
Stay in this relaxed state for a moment, breathing deeply and
slowly.
When youre ready, shift your attention to your left foot.
Follow the same sequence of muscle tension and release.

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Move slowly up through your body, contracting and relaxing

the muscle groups as you go.
It may take some practice at first, but try not to tense muscles
other than those intended.
Progressive Muscle Relaxation Sequence
The most popular sequence runs as follows:
1. Right
6. Left thigh
11. Right arm and
foot*
7. Hips
and
hand
2. Left foot
buttocks
12. Left arm and hand
3. Right calf
8. Stomach
13. Neck
and
4. Left calf
9. Chest
shoulders
5. Right thigh 10. Back
14. Face
* If you are left-handed you may want to begin with your left foot

instead.
Relaxation Technique 3: Body scan meditation for stress relief

A body scan is similar to progressive muscle relaxation except,

instead of tensing and relaxing muscles, you simply focus on the
sensations in each part of your body.
Practicing body scan meditation:
Lie on your back, legs uncrossed, arms relaxed at your sides,
eyes open or closed. Focus on your breathing , allowing your
stomach to rise as you inhale and fall as you exhale. Breathe
deeply for about two minutes, until you start to feel
comfortable and relaxed.
Turn your focus to the toes of your right foot. Notice any
sensations you feel while continuing to also focus on your
breathing. Imagine each deep breath flowing to your toes.
Remain focused on this area for one to two minutes.
Move your focus to the sole of your right foot. Tune in to any
sensations you feel in that part of your body and imagine
each breath flowing from the sole of your foot. After one or
two minutes, move your focus to your right ankle and repeat.
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Move to your calf, knee, thigh, hip, and then repeat the
sequence for your left leg. From there, move up the torso,
through the lower back and abdomen, the upper back and
chest, and the shoulders. Pay close attention to any area of the
body that causes you pain or discomfort.
Move your focus to the fingers on your right hand and then
move up to the wrist, forearm, elbow, upper arm, and
shoulder. Repeat for your left arm. Then move through the
neck and throat, and finally all the regions of your face, the
back of the head, and the top of the head. Pay close attention
to your jaw, chin, lips, tongue, nose, cheeks, eyes, forehead,
temples and scalp. When you reach the very top of your head,
let your breath reach out beyond your body and imagine
yourself hovering above yourself.
After completing the body scan, relax for a while in silence
and stillness, noting how your body feels. Then open your
eyes slowly. Take a moment to stretch, if necessary.
For a guided body scan meditation, see the Resources section
below.
Relaxation Technique 4: Mindfulness for stress relief
Mindfulness is the ability to remain aware of how youre feeling
right now, your moment-to-moment experienceboth internal
and external. Thinking about the pastblaming and judging
yourselfor worrying about the future can often lead to a degree
of stress that is overwhelming. But by staying calm and focused in
the present moment, you can bring your nervous system back into
balance. Mindfulness can be applied to activities such as walking,
exercising, eating, or meditation.
Meditations that cultivate mindfulness have long been used to
reduce overwhelming stress. Some of these meditations bring you
into the present by focusing your attention on a single repetitive
action, such as your breathing, a few repeated words, or flickering
light from a candle. Other forms of mindfulness meditation

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encourage you to follow and then release internal thoughts or

sensations.
Practicing mindfulness meditation:
Key points in mindfulness mediation are:
A quiet environment. Choose a secluded place in your
home, office, garden, place of worship, or in the great
outdoors where you can relax without distractions or
interruptions.
A comfortable position. Get comfortable, but avoid lying
down as this may lead to you falling asleep. Sit up with your
spine straight, either in a chair or on the floor. You can also
try a cross-legged or lotus position.
A point of focus. This point can be internal a feeling or
imaginary scene or something external - a flame or
meaningful word or phrase that you repeat it throughout your
session. You may meditate with eyes open or closed. Also
choose to focus on an object in your surroundings to enhance
your concentration, or alternately, you can close your eyes.
An observant, noncritical attitude. Dont worry about
distracting thoughts that go through your mind or about how
well youre doing. If thoughts intrude during your relaxation
session, dont fight them. Instead, gently turn your attention
back to your point of focus.
Relaxation Technique 5: Visualization meditation for stress
relief
Visualization, or guided imagery, is a variation on traditional
meditation that requires you to employ not only your visual sense,
but also your sense of taste, touch, smell, and sound. When used as
a relaxation technique, visualization involves imagining a scene in
which you feel at peace, free to let go of all tension and anxiety.
Choose whatever setting is most calming to you, whether its a
tropical beach, a favorite childhood spot, or a quiet wooded glen.
You can do this visualization exercise on your own in silence,
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while listening to soothing music, or with a therapist (or an audio

recording of a therapist) guiding you through the imagery. To help
you employ your sense of hearing you can use a sound machine or
download sounds that match your chosen settingthe sound of
ocean waves if youve chosen a beach, for example.
Practicing visualization:
Find a quiet, relaxed place. Beginners sometimes fall asleep during
a visualization meditation, so you might try sitting up or standing.
Close your eyes and let your worries drift away. Imagine your
restful place. Picture it as vividly as you caneverything you can
see, hear, smell, and feel. Visualization works best if you
incorporate as many sensory details as possible, using at least three
of your senses. When visualizing, choose imagery that appeals to
you; dont select images because someone else suggests them, or
because you think they should be appealing. Let your own images
come up and work for you.
If you are thinking about a dock on a quiet lake, for example:
Walk slowly around the dock and notice the colors and
textures around you.
Spend some time exploring each of your senses.
See the sun setting over the water.
Hear the birds singing.
Smell the pine trees.
Feel the cool water on your bare feet.
Taste the fresh, clean air.
Enjoy the feeling of deep relaxation that envelopes you as you
slowly explore your restful place. When you are ready, gently open
your eyes and come back to the present.Don't worry if you
sometimes zone out or lose track of where you are during a guided
imagery session. This is normal. You may also experience feelings
of stiffness or heaviness in your limbs, minor, involuntary musclemovements, or even cough or yawn. Again, these are normal
responses.

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Relaxation Technique 6: Yoga and tai chi for stress relief

Yoga involves a series of both moving and stationary poses,
combined with deep breathing. As well as reducing anxiety and
stress, yoga can also improve flexibility, strength, balance, and
stamina. Practiced regularly, it can also strengthen the relaxation
response in your daily life. Since injuries can happen when yoga is
practiced incorrectly, its best to learn by attending group classes,
hiring a private teacher, or at least following video instructions.
TYPES OF YOGA FOR RELAXATION FROM STRESS

Although almost all yoga classes end in a relaxation pose, classes

that emphasize slow, steady movement, deep breathing, and gentle
stretching are best for stress relief.
Satyananda is a traditional form of yoga. It features gentle
poses, deep relaxation, and meditation, making it suitable for
beginners as well as anyone primarily looking for stress
reduction.
Hatha yoga is also reasonably gentle way to relieve stress and
is suitable for beginners. Alternately, look for labels
like gentle, for stress relief, or for beginners when selecting a
yoga class.
Power yoga, with its intense poses and focus on fitness, is
better suited to those looking for stimulation as well as
relaxation.
If youre unsure whether a specific yoga class is appropriate for
stress relief, call the studio or ask the teacher.
Tai chi:
If youve ever seen a group of people in the park slowly moving in
synch, youve probably witnessed tai chi. Tai chi is a self-paced,
non-competitive series of slow, flowing body movements. These
movements emphasize concentration, relaxation, and the conscious
circulation of vital energy throughout the body. Though tai chi has
its roots in martial arts, today it is primarily practiced as a way of
calming the mind, conditioning the body, and reducing stress. As
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in meditation, tai chi practitioners focus on their breathing and

keeping their attention in the present moment.
Tai chi is a safe, low-impact option for people of all ages and
levels of fitness, including older adults and those recovering from
injuries. Like yoga, once youve learned the basics of tai chi or qi
gong, you can practice alone or with others, tailoring your sessions
as you see fit.
KEEPING MOTIVATED
INTRODUCTION

Lasting weight loss is a slow process and it's all too easy to give up
before you reach your goal. With the right psychological tools your
chances of diet success can be greatly improved.The consulted
experts for diet motivation tips that will keep you, and your diet,
on the winning track to losing.
Diet Motivation Tip 1: Set Realistic Goals for Diet Success
The first step to maintaining your mojo should take place before
you cut a single calorie. In fact, one of the strongest predictors of
long-term diet success lies in setting the right goal at the start. "If
you set unattainable goals, such as losing 30 pounds in just a few
months, you're setting yourself up to fail," says Ann Kulze, MD,
author of Dr. Ann's 10-Step Diet: A Simple Plan for Permanent
Weight Loss and Lifelong Vitality. Instead, you'll be more likely to
stick with a diet if you "focus on your health and create sensible
eating strategies," says Kulze. Setting smaller, attainable
benchmarks, like losing 5 pounds or a single dress size, will give
you the confidence to continue.
Diet Motivation Tip 2: Go slow
Diet success entails making real lifestyle changes, and that doesn't
happen overnight. "You have a better chance at keeping the weight
off if you lose it slowly. People who are starving get irritable and
have a higher failure rate," Kulzetells. "If you cut back 200 calories
a day, you won't even realize it and the weight will come off and
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stay off." If you keep in mind that optimal weight loss is 1 to 2

pounds a week, you'll be less frustrated.
Diet Motivation Tip 3: Expect setbacks
Everyone is bound to give in to temptation from time to time. The
danger isn't a single splurge but letting it become an excuse for an
all-out binge. Call it the "I've already blown it so I might as well
eat the entire bag of Oreos" syndrome.
MOTIVATION AND ITS EFFECTS ON EATING

1. Have A Weigh-In
Weigh yourself every day or every other day at about the same
time. Most people weigh less in the mornings before they eat, so
that may be the best time of day to do it. The reason I
recommend weighing yourself daily is that you see trends, such as
weight gain, sooner rather than later," says Marjorie Nolan, MS,
RD, a nutritionist with a private practice in New York and a
spokeswoman for the Academy of Nutrition and Dietetics. "And if
you have gained weight, you can nip it before 2 or 3 pounds turns
into 5 or 6 and become that much harder to lose.
2. Put Money Down
Hire a personal trainer or nutritionist to help you reach your fitness
and nutrition goals. Or pay for extra fitness classes at the gym.
You need to truly invest in your success, Nolan says. When you
pay for something, youre more willing to commit to it, she
explains. Consider it your holiday present to yourself.
3. Start Fresh
Its a new year not only for the calendar but also for your
refrigerator and pantry. Purge the junk food from your cupboards
and start with a clean slate as you move to healthier eating habits.
Dont keep three dozen Christmas cookies in your freezer if you
dont have to, Nolan says. Discard the unhealthy choices you
made and restock with healthier versions.
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4. Plan Ahead
Plan time to exercise and to cook and eat healthy meals. If you
schedule time for exercise just as you do for doctors
appointments, youll find its easier to stick with it. The same goes
for eating healthy. Plan a healthy menu and write a shopping list to
take to the store. Its easier to stick to your nutrition goals when
you have a list while shopping. Youll also be better equipped to
make healthy meals and snacks at home when the foods you need
are handy.
5. Set Realistic Goals
Youre more likely to stay motivated when you have a realistic
plan rather than vague wishes or overly optimistic ideals. First be
specific. Instead of saying, Im going to lose weight, set a goal to
lose 3 to 5 pounds in one month. Then, be realistic. For example,
instead of giving up sweets entirely, say Im going to only eat
dessert three times a week instead of seven. If your nutrition plan
includes realistic goals, youll be more likely to achieve them, says
Nolan.
6. Reward Your Success
Your goal could be to lose 2 pounds or to not eat seconds at any
meal for a week. Whatever it is, when you reach it, reward yourself
with something small just be sure its not a food-related treat. Go
to the movies with a friend. Get your nails done. Buy that new
sweater. Go for a walk in the woods with your dog. These types of
rewards help provide the incentive you need to continue working
toward bigger goals.
7. Write It Down
Putting your actions down on paper helps you focus what youre
doing to help (or hurt) your goals. If you keep a food journal, you
can look back at what youve eaten, which could be more or less
than you realize. Joining an online support group where you can
share your food journal with others can help, says Nolan. When
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you know other people are seeing it, youll be more motivated to
stick to your healthy eating habits, she adds.
8. Try New Recipes and New Gadgets
Look for healthy recipes online and in newspapers and magazines.
Try the ones that appeal to you most. Breaking up your routine
with new recipes keeps your healthy eating plan interesting. And if
youre not bored, its easier to stick to your goals. Buying new
cooking items is another way to stay excited about healthy
cooking, says Nolan. Whenever I get a new kitchen appliance
pots, pans, food processor, or even a knife I want to play with it,
which can help me expand what Im eating in a healthy way.

9. Be Forgiving
What if you cant resist and you eat that piece of pecan pie from
Christmas or dig into a bag of chips? Dont be too hard on
yourself. You cant change what youve eaten, but you can make
better choices at your very next meal, Nolan says. If you wait until
tomorrow or Monday to get back to eating healthy, it will be that
much harder.Adopting a nutrition plan at the start of the year and
sticking to it as the months pass can be much easier than you think,
especially if you employ these tricks to help you along the way.
STEPS IN MOTIVATION

The following is a guide for therapists to help individuals find the

motivation to begin recovery:
Acceptance by both the therapist and patient that there is
ambivalence in recovering.
Actively seek to engage the patient; accept that psychological
feeding is likely necessary and that utilizing traditional
treatment approaches is not helpful.
Create a relational space. Help the patient notice that he/she is
not the only one in the room.
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Disturb the resistance while respecting the need for the

symptoms. Respect the power of the eating disorder and its
adaptive purposes. Questions such as, How is the eating
disorder working or not working for you? are best.
Do not prescribe too many behavioral changes during the early
phase of treatment unless medical risk is heightened or you need
to determine if a patient can do the work in an outpatient
setting.
Dependency of the therapeutic relationship (attachment theory)
is a good thing and is a vehicle for recovery and maintaining
motivation.
Be co-investigators. Inform the patient about what you are
doing and thinking in order to reduce the patients fear of loss of
control or manipulation.
Provide psycho-education about theory and treatment where
appropriate. Teach the patient about the adaptive and
metaphoric use of the eating disorder as a substitute for
relationships.
TIME MANAGEMENT AND STRESS

Time management is a way to find the time for all the things you
want and need to do. It helps you decide which things are urgent
and which can wait. Learning how to manage your time, activities,
and commitments can be hard. But doing so can make your life
easier, less stressful, and more meaningful.
When you manage your time, you decide which tasks and
activities are most important to you. Knowing what's important
helps you decide how best to spend your time.
There are three parts to time management: prioritize tasks and
activities, control procrastination, and manage commitments.
Stress is our bodys normal, automatic response to change in our
lives. The change may be negative, positive, or imagined. When
we feel unable to cope with a new demand, we begin to feel stress.
Stress is highly individual ~ what may be very relaxing to one
person may be stressful to another.
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Not all stress is bad. We need a certain amount of stress in our

lives because it stimulates and energizes us. At low levels, it
motivates us to face challenges and achieve, and it adds excitement
to our lives. Without stress, we may feel bored or depressed.
There are two main types of stress: eustress, the good type of
stress, and distress, which is considered bad stress. Distress
occurs when our stress level becomes too high and unmanageable.
As with body temperature, we cant function well if stress is too
low or too high. Each person needs to find an optimal level of
stress that is motivating but not overwhelming. Then stress will
work for you instead of against you.
HOW CHANGE CAN CREATE STRESS?

The stress reaction originally helped prehistoric humans survive

dangerous situations by preparing them for fight or flight. It
consists of 3 phases:
1. Alarm- the body is aroused by a stressor and releases hormones
to cope with the threat.
2. Resistance- the body repairs any damage done during the alarm
stage and returns to normal.
3. Exhaustion- may occur if the stressor continues or several
stressors are present; the body is chronically aroused, cannot
repair itself and adapt, and the person becomes impaired. The
stress reaction should typically be short-term and infrequent.
While physical threats are now less common, the fight or flight
response can still be activated by any change or threat, real or
imagined. If we think a situation is harmful to us, the body will
overreact as if it were a life or death matter.
CAUSES OF STRESS INCLUDE

1. External Stressors- things outside the person, often things we

cant change (e.g., noise, new residence, bad weather, schedule
changes)

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2. Relational Stressors- things we can sometimes change (e.g.,

conflicts with roommates, friends, family, dating partners, or
co-workers; losing a relationship; problems with professors)
3. Internal Stressors- including things we say or do to ourselves,
often things we can change (e.g., perfectionism, negative
thoughts or feelings about ourselves, selecting a major or
career).
SIGNS OF STRESS/DISTRESS

Physical Symptoms
Headaches
Digestive problems
Muscle tension or soreness
Skin outbreaks
Rapid breathing, shortness of breath
Change in appetite and/or eating
Sleep disturbance
Fatigue, exhaustion
Restlessness
Underactivity, overactivity
Increased illness
Decreased sex drive
Emotional Symptoms
Depression
Anxiety, worry
Feeling overwhelmed
Irritability
Mood swings
Cry easily
Feeling pressured
Emotional outbursts
Being overly sensitive/emotional
Anger, resentment, hostility
Impatience
Loss of sense of humor
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Low self-esteem
Mental Symptoms
Poor concentration
Lack of interest
Negative attitude
Procrastination
Being disorganized
Forgetfulness
Indecision
Poor judgment
Confusion
Calculation errors, increased mistakes
Reduced creativity
Social/Behavioral Symptoms
Withdrawal from others
Avoiding social situations
Decreased productivity
Lack of intimacy
Loneliness
Accident proneness
Alcohol, tobacco, and/or drug use
Buying things you dont need
Spiritual Symptoms
Apathy, indifference
Emptiness
Loss of lifes meaning
Unforgiving
Loss of direction or purpose
TO MANAGE THESTRESS

Recognizing stress is the first step toward reducing it. Stress can
build up gradually, and you may not be aware of it until it has
reached a critical level. If you are experiencing stress symptoms,
you have gone beyond your optimal stress level. This is a signal
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that you need to reduce the stress in your life and/or improve your
ability to manage it. Remember, the goal is not to eliminate all
stress. Your aim is to manage it, keep it at a healthy level, and
prevent distress.
Key steps in stress management include:
1. Identify your current stressors (external, relational, internal).
2. Identify your current coping reactions (helpful, not helpful).
3. Change stressful situations and/or your reactions.
4. Increase your positive, healthy coping reactions.
HEALTHY WAYS TO COPE WITH STRESS

For Your Body

Eat healthily and regularly.
Get your normal amount of sleep (relax 1-2 hours before
sleep).
Practice deep, diaphragmatic breathing and Regular exercise
and other physical activity (keeps energy high, loosens muscles,
improves sleep).
Listen to your bodys stress signals.
For Your Mind
Have realistic expectations of yourself.
Recognize that you are always in control of how you cope with
problems and stress.
Reframe your problems as challenges that are opportunities
for personal growth.
Pace yourself and reduce time pressures.
Practice positive self-talk (I may not get an A in chemistry, but
Im doing above average work and as well as I can right now.).
Realize that making mistakes is part of the risk-taking needed
for growth.
Anticipate and plan for change.
Improve time management (control your time and energy,
create a realistic and balanced schedule, focus on priorities,
break large demands into small parts and do one task at a time).
Take periodic vacations or mini-breaks from your work.
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For Your Emotions

Affirm yourself, your abilities, and your accomplishments daily.
Know your limits and let go of things beyond your control.
Let yourself cry (can relieve stress and anxiety).
Reward and pamper yourself.
Practice relaxation techniques.
Expect some frustrations, failures, and sorrows.
Listen to your thoughts and feelings and what they are telling
you.
Enjoy yourself and the humour in life.
For Your Relationships, Social Life, and Leisure
Build a support system of people that help you feel good.
Be assertive, support your own needs and interests.
Spend time with friends regularly ~ talking, hanging out,
sharing feelings and concerns.
Take time for fun, doing activities that are enjoyable and good
for you.
Create a comfortable environment that includes pleasant space
and people.
Allow other people to help you with tasks.
For Your Spirit
Pray, meditate
Take private quiet time ~ for a walk, a hot bath, listening to
calming music.
46 Ideas For Stress Relief
1.
2.
3.
4.
5.
6.
7.

Go dancing
Take a hot bath
Call up a friend
Exercise
Read a book
Go bowling
Watch a movie
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8. Take a nap
9. Go to the zoo
10. Go to a sporting event
11. Meditate
12. Learn a magic trick
13. Go shopping
14. Get a massage
15. Play cards
16. Go out to eat
17. Go to church
18. Go down a slide
19. Work in a garden
20. Go fishing
21. Play in intramurals
22. E-mail a friend
23. Clean your room
24. Write a poem
25. Chat online
26. SMILE
27. Listen to your favourite CD
28. Get a facial
29. Take some pictures
30. Wash your car with friends
31. Plan a surprise birthday party
32. Go for a walk
33. Attend a concert
34. Bake cookies
35. Paint your nails
36. Reorganize your room
37. Plan a day trip
38. Volunteer at a food shelf
39. Decorate your room
40. Have a snowball fight
41. Make a gift for a family member
42. Go swimming
43. Go through your closet

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or friend

44. Get involved in a club

45. Drink some hot cocoa/tea/cider
46. Find a new hobby

See Your Doctor and Get Moving

To improve heart health, experts at the American Heart
Association recommend a heart-healthy exercise routine that
consists of 30 to 60 minutes of moderate physical activity most
days of the week. But before starting any exercise regimen, it's
important to consult with your doctor, especially if you are:
Middle-aged or older
Currently inactive
Overweight
At risk for heart disease
Have any other medical conditions.
5 WAYS TO STAY ACTIVE

Once you are cleared for exercise, here are five good suggestions
on how to begin.
1. Warm up and cool down. Start by warming up with some
simple stretches that will help improve flexibility in your joints
and keep your muscles limber. Stretch your legs, back, and
torso, and go for a 5-minute walk. When you finish with your
main physical activity, do similar light stretching exercises to
cool down.
2. Get your heart rate up. Cardiovascular exercise is great for
your heart and lungs, so try to engage in an aerobic activity, like
walking, jogging, cycling, swimming, or golf (which should
include walking from hole to hole and carrying your own clubs)
for 30 to 60 minutes most days of the week.
3. Build strength. Strength-training, such as lifting weights, doing
Pilates or yoga exercises, or other activities, such as pushups,
squats, biceps curls (with dumbbells), or even carrying
groceries, taking the stairs, or lifting your laundry can all

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contribute to your overall strength, balance, coordination, and

muscle tone.
4. Sneak in exercise. Make use of idle time by doing sit-ups,
squats, lunges, or biceps curls while watching TV. Walk or do
leg lifts or another physical activity while you're on the phone.
Run around and play with your children, grandchildren, or your
pet for extra exercise. Park farther away from the entrance to
add more walking to your days, and try wearing a pedometer to
track your daily steps.
5. Stay motivated. Joining a gym, taking dance or spinning
classes, starting an online fitness program, or enlisting an
exercise buddy are all excellent ways to inspire and maintain
motivation and keep you accountable to your new active
lifestyle.
"Exercise is the real fountain of youth," says Ostfeld. "If you enjoy
walking, walk. If you like tennis, play tennis. If water polo is for
you, do water polo. Any physical activity you enjoy is great. And
any exercise is always better than no exercise at all."
Steps For Staying Active
Step 1
Set a realistic goal for getting in shape. Write your goal down and
keep track of your progress to stay motivated. A realistic goal
might be to lose 1 pound per week by eating healthier foods while
also exercising for 20 to 30 minutes a day. As you get accustomed
to eating better and engaging in daily exercise, you can create more
challenging goals based on your improved fitness level.
Step 2
Go for a 30-minute walk everyday. Start your active lifestyle with
gradual exercise instead of hitting the gym hard and wearing
yourself out or causing injury. Take a walk around your
neighborhood for 30 minutes three times a week, adding another
day of walking each week until you are walking five to six days a
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week. Bringyour portable music player to groove to some tunes as

you walk. Make sure you warm up and stretch beforeyour walk to
get your body ready for intense movement.
Step 3
Swap your walk for a light to moderate jog at least twice a week.
Once you consistently walk several days a week for one month,
challenge yourself by jogging a few days a week for 20 to 30
minutes. Alternate a 10-minute walk with a five-minute jog until
you can jog the full length of your workout. Warm up, stretch and
cool down for each workout to prevent injury and keep your
muscles flexible.
Step 4
Add strength training exercises once or twice a week for 20 to 30
minutes per workout. Diversify your workouts with light weight
training to strengthen and tone your muscles while also burning
calories. Use dumbbells to work your arm muscles and to hold
while doing squats or lunges. Muscle helps to burn fat and keep
your body in shape.
Step 5
Watch less television each day and replace that time with physical
activity. The less time you spend in front of the television, the
more time you have to dedicate to healthy fitness activities. You
can work on your garden, wash your car or get involved in
recreational sports instead of watching television to maximize your
level of activity each day. Limit television time to when you are
winding down at night, for no more than two or three hours a night.
Step 6
Replace unhealthy foods in your diet with fresh fruits and whole
grains. As you increase your activity level, you will also need
energy from food. Choose fresh produce and whole grains, which
are low in calories and nutrient-rich to give you energy throughout
the day. Limit your saturated fat intake from fatty meats and fried
food as well to optimize your fitness efforts.
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DIET AND NUTRITION PROGRAM

Diet:
Your diet is made up of what you eat. There are many different
types of diets.
A healthy diet May include fruits, vegetables, whole grains, and fat-free or
low-fat milk and milk products
May include lean meats, poultry, fish, beans, eggs and nuts
Goes easy on saturated fats, trans fat, cholesterol, salt (sodium),
and added sugars.
There are many different types of diets. Some, like a vegetarian
diet, don't include meats. Others, like the Mediterranean diet,
describe a traditional way of eating of a specific region. And there
are diets for people with certain health problems, such as diabetes.
Many people follow specific diets to lose weight. Some of these
diets are fad or crash diets that severely restrict calories or the
types of food you are allowed to eat. These diets rarely lead to
permanent weight loss and often don't provide all of the nutrients
your body needs. To lose weight, you need to use more calories
than you eat. Portion control is the key. When trying to lose
weight, you can still eat your favourite foods as long as you pay
attention to the total number of calories that you eat.
10 DIETS:

Hummus and Veggies

The Middle Eastern chickpea spread is an easy, protein-rich snack
that fights hunger and balances blood sugar levels -- and a little
goes a long way. Baked pita chips aren't the worst thing you can
eat, but substituting some veggies can make a bigger impact than
you think. "Hummus boosts energy because it contains iron, and
red bell pepper slices are high in vitamin C, which helps to utilize
and absorb the iron from the hummus," says holistic nutritionist
Peggy Kotsopoulos, author of Must Have Been Something I Ate.
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Follow her easy recipe for plain hummus by throwing 1 can of

chickpeas in a blender with a dash of ground cumin, sea salt, extra
virgin olive oil, and splash of lemon juice. Keep a few batches in
the freezer so all you have to do is thaw.
Salsa
When not paired with greasy fried tortilla chips and margaritas,
salsa is surprisingly low in calories. Kotsopoulos suggests buying
yours from the refrigerated section of the grocery store where it's
the freshest. Make an easy low-cal substitute for nacho layer dip by
putting hummus on the bottom of a dish, layering with salsa, and
then topping with olives or lettuce. Instead of chips, try Mary's
Gone Crackers, which are made of brown rice, flax, and sesame
seeds ($5.49, grocery stores nationwide).
1. Almonds
These delicious and versatile nuts contain filling protein andfiber,
not to mention vitamin E, a powerful antioxidant. They're also a
good source of magnesium, a mineral your body must have in
order to produce energy, build and maintain muscle tissue, and
regulate blood sugar. "A stable blood-sugar level helps prevent
cravings that can lead to overeating and weight gain," says David
Katz, MD, a professor at the Yale University School of Medicine.
2. Beans
Inexpensive, filling, and versatile, beans are a great source
of protein. Beans are also high in fiber and slow to digest. That
means you feel full longer, which may stop you from eating more.
3. Soup
Start a meal with a cup of soup, and you may end up eating less. It
doesnt matter if the soup is chunky or pureed, as long as it's brothbased. You want to keep the soup to 100 to 150 calories a serving.
So skip the dollops of cream and butter.
4. Dark Chocolate
Want to enjoy chocolate between meals? Pick a square or two of
dark over the milky version. In one study, chocolate lovers who
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were given dark chocolate ate 15% less pizza a few hours later
than those who had eaten milk chocolate.
5. Pureed Vegetables
You can add more veggies to your diet, enjoy your "cheat" foods,
and cut back on the calories youre eating, all at the same time.
When Penn State researchers added pureed cauliflower and
zucchini to mac and cheese, people seemed to like the dish just as
much. But they ate 200 to 350 fewer calories. Those healthy
vegetables added low-cal bulk to the tasty dish.
6. Eggs and Sausage
A protein-rich breakfast may help you resist snack attacks
throughout the day. In a study of a group of obese young women,
those who started the day with 35 grams of protein -- thats
probably way more than youre eating -- felt fuller right away. The
women ate a 350-calorie breakfast that included eggs and a beef
sausage patty. The effect of the high-protein breakfast seemed to
last into the evening, when the women munched less on fatty,
sugary goods than the women who had cereal for breakfast.
7. Nuts
For a great snack on the run, take a small handful of almonds,
peanuts, walnuts, or pecans. Research shows that when people
munch on nuts, they automatically eat less at later meals.
8. Apples
Skip the apple juice and the applesauce and opt instead for a
crunchy apple. Whole fruit blunts appetite in a way that fruit juices
and sauces dont. One reason is that raw fruit has microfiber. Plus,
chewing sends signals to your brain that youve eaten something
substantial
9. Yogurt
Whether you prefer Greek or traditional, yogurt can be good for
your waistline. A Harvard study followed more than 120,000
people for a decade or longer. Yogurt, of all the foods that were
tracked, was most closely linked to weight loss.That doesn't prove
that yogurt caused weight loss, but it stood out among other foods.
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10. Grapefruit
Yes, grapefruit really can help you shed pounds, especially if you
are at risk fordiabetes. Researchers at Scripps Clinic in San Diego
found that when obese people ate half a grapefruit before each
meal, they dropped an average of 3 pounds over 12 weeks.
Drinking grapefruit juice had the same results. But grapefruit juice
doesn't have any proven "fat-burning" properties.
DIET FOR WEIGHT LOSS

Early Morning
Start your day with lemon juice and honey in lukewarm water; this
helps your body to get rid of harmful acids produced by the body.
Breakfast
Choose any one or two from the following options
Egg white omelet (2) + 2 slices of brown bread,
Milk (Skimmed Milk) +Cornflakes/ Oats /Wheat bran
Fruit salad / Sprouts.
Vegetable Poha / Upma
Skimmed milk cottage cheese + Brown Bread
Pre Lunch
Take black coffee before the afternoon meal this helps in boosting
metabolism.
Lunch
Boiled / Roasted Chicken/ Soyabean (200 grams) +Brown
Rice (1/2 plate) / Chapatti (1)
Boiled Dal +salad + Brown Rice (1/2 plate) / Chapatti (1/2)
Take Probiotic curd (100grams) as it helps indigestion.
Vegetable Daliya
Evening
Take some citrus fruits to satisfy the hunger pangs in the
evening
Green tea with two Marie Lite biscuits
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Boiled Channa
Dinner
Choose any one or two from the following options
Boiled Soybean Nutrela/ soup + salad,
Boiled Egg White (3) + Vegetable clear soup
Chicken or Tuna salad.
Boiled Dal
Vegetable Daliya
Pre Bed time
150 -200 ml of skimmed milk.
Besides the above diet keep in mind the following points:
Avoid heavy dinner; maintain at least 3 to 4 hours of gap
between meal and sleep.
Replace cold drinks with coconut water, vegetable soup or
butter milk.
Drink at least 2 to 3 liters of water everyday.
Fibre is excellent for weight loss , so consume more of raw
vegetables and fruits.
All carbs are not bad; avoid simple carbs like sugar, sweet and
processed food.
Never skip meals.
Avoid Bakery products.
Replace Chicken Tikka with Chicken Salami.
Avoid taking water along with the meal.
Follow the above mentioned points for 6 days in a week and once
in a week please your taste buds with one meal of your choice but
don't forget only one. Try to take out some time for physical
exercises at least thrice a week.

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DETOX DIETS
Detox
Also known as detoxification, diets are popular. Detox diets are
touted as a way to remove toxins from the body. Specific detox
diets vary but typically a period of fasting is followed by a strict
diet of raw vegetables, fruit and fruit juices, and water. In addition,
some detox diets advocate using herbs and other supplements
along with colon cleansing (enemas) to empty the intestines.
Some people report feeling more focused and energetic during and
after detox diets. However, there's little evidence that detox diets
actually remove toxins from the body. Indeed, the kidneys and
liver effectively filter and eliminate most ingested toxins. The
benefits from a detox diet may actually come from avoiding highly
processed foods that have solid fats and added sugar.
Detox diets that severely limit protein or that require fasting, for
example, can result in fatigue. Long-term fasting can result in
vitamin and mineral deficiencies. Colon cleansing, which is often
recommended as part of a detox plan, can cause cramping,
bloating, nausea and vomiting.
The goal of the detox diet is to help get the body back to a
healthful, fresh state. The elimination of the toxins is believed to
purify the body and help it function better.
Low Carbohydrate Diet
A low-carb diet limits carbohydrates such as grains, starchy
vegetables and fruit and emphasizes dietary protein and fat.
Many types of low-carb diets exist, each with varying restrictions
on the types and amounts of carbohydrates you can eat.
A low-carb diet is generally used to lose weight. Some low-carb
diets say that they have health benefits beyond weight loss, such as
reducing risk factors associated with heart disease, certain cancers,
diabetes and metabolic syndrome.
You might choose to follow a low-carb diet because you:
Want to change your overall eating habits.
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Enjoy the types and amounts of foods featured in low-carb

diets.
Want a diet that restricts certain carbs to help you lose weight.
Check with your doctor or health care provider before starting any
weight-loss diet, especially if you have any health conditions,
including diabetes.
DIET DETAILS

A low-carb diet restricts the amount of carbohydrates you can eat.

Carbohydrates are a type of macronutrient found in many foods
and beverages. Most carbohydrates occur naturally in plant-based
foods, such as grains. Food manufacturers also add carbohydrates
to processed foods in the form of starch or added sugar.
Common food sources of naturally occurring carbohydrates
include:
Fruits
Vegetables
Milk
Nuts
Grains
Seeds
Legumes
Your body uses carbohydrates as its main fuel source. Sugars and
starches are broken down into simple sugars during digestion.
They're then absorbed into your bloodstream, where they're known
as blood sugar (glucose). From there, the glucose enters your
body's cells with the help of insulin. Some of this glucose is used
by your body for energy, fueling all of your activities, whether it's
going for a jog or simply breathing. Extra glucose is stored in your
liver, muscles and other cells for later use or is converted to fat.
The theory behind the low-carb diet is that insulin prevents fat
breakdown in the body by allowing sugar to be used for energy.
Proponents of the low-carb diet believe that decreasing carbs
results in lower insulin levels, which causes the body to burn
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stored fat for energy and ultimately helps you shed excess weight
and reduce risk factors for a variety of health conditions.
MENU FOR A LOW-CARB DIET

In general, a low-carb diet focuses on proteins, including meat,

poultry, fish and eggs, and some non-starchy vegetables. A lowcarb diet generally excludes or limits most grains, beans, fruits,
breads, sweets, pastas and starchy vegetables, and sometimes nuts
and seeds. Some low-carb diet plans allow certain fruits,
vegetables and whole grains. A daily limit of 50 to 150 grams of
carbohydrates is typical with a low-carb diet. Some low-carb diets
greatly restrict carbs during the initial phase of the diet and then
gradually increase the number of allowed carbs.
In contrast, the 2010 Dietary Guidelines for Americans
recommends that carbohydrates make up 45 to 65 percent of your
total daily calorie intake. So, if you consume 2,000 calories a day,
you would need to eat between 900 and 1,300 calories a day from
carbohydrates, or between 225 and 325 grams of carbohydrates a
day.
Weight Loss
Most people can lose weight on almost any diet plan that restricts
calories and what you can eat at least in the short term. Over the
long term, though, studies show that it's common to regain the lost
weight, regardless of the diet plan you follow. Some studies also
have shown that people who continued to follow certain low-carb
diet plans for two years lost an average of nearly 9 pounds (4.1
kilograms) overall, which is similar to the amount of weight lost on
higher carbohydrate diets. And it may not be just cutting carbs that
leads to weight loss. Some studies show that you may shed some
weight because you eat less on low-carb diets because the extra
protein and fat keep you feeling full longer.

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Other Health Benefits

Some low-carb diets, including the Atkins Diet, say that their
eating plans can prevent or improve serious health conditions, such
as metabolic syndrome, diabetes, high blood pressure and
cardiovascular disease. In fact, almost any diet that helps you shed
excess weight can reduce or even reverse risks factors for
cardiovascular disease and diabetes. Most weight-loss diets not
just low-carb diets may improve blood cholesterol or blood
sugar levels, at least temporarily. Low-carb diets may improve
HDL cholesterol and triglyceride values slightly more than do
moderate-carb diets. And it may not only be how many carbs you
eat but also the kinds of carbs you eat that are important to your
health. Whole grains, legumes, vegetables, fruits and low-fat dairy
products, for instance, are generally healthier than are carbs from
sweets and processed and refined grains, such as potato chips,
white bread and white rice.
Risks
If you suddenly and drastically cut carbs, you may experience a
variety of temporary health effects, including:
Headache
Dizziness
Weakness
Fatigue
Constipation
In addition, some diets restrict carbohydrate intake so much that
they can result in nutritional deficiencies or insufficient fiber. This
can cause such health problems as constipation, diarrhea and
nausea. Eating carbs that are high fiber, whole grain and nutrient
dense can improve the health profile of some low-carb diet
programs. And some low-carb diets, such as Atkins, now
recommend taking small amounts of extra salt, along with vitamins
or supplements, to help prevent diet side effects.
It's also possible that severely restricting carbohydrates to less
than 20 grams a day can result in ketosis. Ketosis occurs when you
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don't have enough sugar (glucose) for energy, so your body breaks
down stored fat, causing ketones to build up in your body. Side
effects from ketosis can include nausea, headache, mental fatigue
and bad breath.It's not clear what kind of possible long-term health
risks a low-carb diet may pose because most research studies have
lasted less than a year. Some health experts believe that if you eat
large amounts of fat and protein from animal sources your risk of
heart disease or certain cancers may increase
LOW FAT DIET

A low-fat diet is one that restricts fat and often saturated

fat and cholesterol as well. Low-fat diets are intended to reduce
diseases such as heart disease and obesity. Reducing fat in the diet
can make it easier to cut calories. Fat provides nine calories per
gram while carbohydrates and protein each provide four calories
per gram, so choosing low-fat foods makes it possible to eat a
larger volume of food for the same number of calories.
The Institute of Medicine recommends limiting fat intake to 35%
of total calories to help prevent obesity and to help control
saturated fat intake.
Reducing total fat intake leads to reductions in caloric intake,
resulting in weight loss or less weight gain. The overall benefit is
small but beneficial. With respect to weight loss low-fat diets do
not appear to differ from other diets that also reduce overall
calories.
Low-fat diets have been promoted for the prevention of heart
disease. Lowering fat intake from 35-40% of total calories to 1520% of total calories has been shown to decrease total and LDL
cholesterol by 10 to 20%; however, most of this decrease is due to
a reduction in saturate fat intake. Saturated fat has been shown to
raise total and LDL cholesterol in a large number of studies and
has also been correlated with a higher risk of heart
disease. Furthermore, a high-fat diet can contain "unacceptably
high" amounts of saturated fat, even if saturated fats from animal
products and tropical oils are avoided. This is because all fats
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contain some saturated fatty acids. For example, if a person chose

fats with only 20% saturated fatty acids, setting fat intake at 35%
of total calories would mean that 7% of calories would come from
saturated fat. For this reason, the Institute of Medicine
recommends consuming no more than 35% of calories from fat.
While low-fat diets lower total and LDL cholesterol, a sudden
increase in carbohydrate has been "consistently" shown to raise
triglycerides. Increasing the carbohydrate content of the diet
gradually has been shown to prevent hypertriglyceridemia.
HIGH FAT DIET

High-fat diets are associated with increased risk of several serious

medical conditions including obesity, cancer, and heart disease.
Consequently, current public health recommendations emphasize
the importance of reducing total fat intake to no more than 30% of
total calories, or 60 grams of fat per day in an 1800 calorie diet.
Tips for reducing fat intake include lowering intake of whole fat
dairy products, red meats, and high-fat condiments. While most
people can improve their health by reducing the total amount of fat
in their diet, the consumption of fat by children under the age of
two should not be restricted. In addition, adults reducing their total
fat intake should still be careful to include adequate amount of
specific, essential fats, particularly theomega 3 fatty acids.
During the past 20 years, the amount and type of dietary fat that
should be present in a healthy diet has been the source of
tremendous controversy. Although fat is often portrayed as a
dietary villain by the popular media, fat participates in five
essential physiological functions.
1. Fat serves as a source of energy for the body by supplying 9
calories per gram (compared to 4 calories per gram from
carbohydrates and protein).
2. Stored fat helps maintain body temperature and protects vital
organs from injury.
3. Dietary fat aids in the absorption and transport of the fat-soluble
vitamins (A, D, E and K) and other fat-soluble nutrients.
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4. Fat improves the taste and mouth feel of food and provides a
sense of satiety that helps us moderate how much food we eat at
one time.
5. Dietary fat provides two essential fatty acids (the omega 3 fat,
alpha-linolenic acid, and the omega 6 fat, linoleic acid) both of
which are necessary for a wide variety of important
physiological processes.
Eating too much of the wrong kinds of fat, however, can increase
our chances of becoming obese, or developing heart disease or
cancer. As a result, various health and nutrition organizations,
including the US Surgeon General, US Department of Health and
Human Services, and the US Department of Agriculture favour a
"low-fat" diet and have issued dietary recommendations that
include reducing intake of total and saturated fat.
In general, these guidelines suggest that for persons older than
two years, total fat intake should not exceed more than 30% of
total caloric intake and that saturated fat should account for no
more than 10% of daily caloric intake. For total fat, this guideline
means no more than 60 grams of fat per day on an 1800 calorie
diet, and within that total fat, no more than 20 grams of saturated
fat.
With the growing recognition of the dangers of eating too much
fat, and the plethora of "low-fat" and "fat-free" foods on the
supermarket shelves, you would think that everyone in the United
States is eating a low-fat diet. Unfortunately, recent statistics
suggest that the opposite is true. According to the USDA's
Continuing Survey of Food Intakes by Individuals, actual fat
consumption has increased slightly over the past few decades, from
approximately 81 grams per day in the late 1970s to about 83
grams per day in the early 1990s. In addition, results from the
Third Report on Nutrition Monitoring in the United States indicate
that a majority of the United States population fails to meet current
recommendations for dietary fat consumption. In fact, only 21%

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and 25% of males and females 20 years old and older consume less
than or equal to 30% of calories from fat.
Children and adolescents are doing even worse than their
parents at meeting current recommendations. Only about 18% of
boys and girls aged 6 to 11 consume less than or equal to 30% of
calories from fat, and only 14% and 18% of boys and girls,
respectively, aged 12 to 19 meet current dietary recommendations
for fat intake. The reason? Consumption of the major sources of
dietary fat in the American diet, which include red meat, poultry,
and dairy products (cheese, half and half, and ice cream) has not
decreased, and consumption of high-fat snack foods, especially
among children, is on the rise. All of this, despite the widespread
availability of "low-fat" and "fat-free" food choices.
In general, any diet, regardless of the foods eaten, can be
considered "low-fat" if it includes no more than 30% of total
calories as fat, which is 60 grams of fat per day in an 1800 calorie
diet. Consequently, there is no prescribed "low-fat" diet that
mandates the exact foods that must be eaten.
Some people choose to cut back on the amount of red meat they
eat, while others avoid high-fat desserts, snack foods, condiments,
or nuts. It is important to remember, however, that not every lowfat diet is necessarily a "healthy" diet. In fact, many people
following a low-fat diet substitute foods that contain fat with "fatfree" processed foods that contain large amounts of sugar, salt,
additives, and preservatives. So, what exactly can you do to
develop a healthy, low-fat diet? Here are some tips for reducing
your fat intake and promoting good health:
First and foremost, avoid all foods containing partially
hydrogenated oils, which are also called trans-fats. A growing
body of research indicates that these fats are harmful to your
health.
Saut vegetables and meat in vegetable broth instead of butter
or vegetable oil.

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Read food labels carefully, paying close attention to the serving

size and number of servings per package. Some labels are
intentionally misleading, in that the serving size listed is much
smaller than the amount of the food that is usually consumed,
which means you might end up eating more fat than you think.
(For more information on what those labels really mean, see
"Label Terminology" immediately below.)
Decrease your consumption of meat. Substitute a bean dish or a
"meat" made from soy for red meat dish as your main course as
often as possible.
When you do eat meat, choose leaner cuts of beef and trim any
visible fat before cooking. To keep poultry moist, do not
remove the skin before cooking, but take the skin off before
eating. Or better yet, remove the skin, and braise or saut your
chicken in vegetable broth.
Limit your consumption of whole-fat dairy products or
substitute low or non-fat alternatives for them.
Increase the amount of fruits, vegetables and whole grain foods
you eat. You'll have less room and less desire for high-fat
snacks.
Decrease your use of high-fat condiments, such as butter and
mayonnaise.
LABEL TERMINOLOGY

When you're trying to lower your total fat intake, knowing the true
meaning of those fat-related phrases on packaged foods will come
in handy. Here's the low-down on label terminology:
Fat Free: contains less than 0.5 grams of fat per serving
Saturated Fat Free: contains less than 0.5 grams per serving
and the levelof trans fatty acids does not exceed 1% of total fat
Low Fat: contains 3 grams or less per serving or per 50 grams
of food (if the serving size is less than 30 grams or 2
tablespoons)
Low Saturated Fat: contains 1 gram or less per serving and not
more than 15% of calories from saturated fatty acids
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Reduced or Less Fat: contains at least 25% less per serving

than reference food
Reduced or Less Saturated Fat: contains at least 25% less fat
per serving than its full-fat counterpart. For example, milk that
is labeled as "reduced fat" must contain at least 25% less fat
than whole milk.
FAT COMPOSITION

A final bit of information you may find helpful when trying to eat
low-fat is a little insight into fat chemistry. You'll find many of the
terms below on the ingredient lists of packaged foods. Knowing
more about the different types of fat can help you improve the
quality of the fats you consume, as well as help you lower your
total fat intake.
Fats are composed of chains of carbon atoms, to which
hydrogen and oxygen atoms are attached. Dietary fats are divided
into different categories depending on the arrangement of
hydrogen atoms in the carbon chain and the shape of the fat
molecule. The four main categories of dietary fats are saturated
fats, monounsaturated fats, polyunsaturated fats, and hydrogenated
fats. Although foods almost always contain a mixture of different
types of fats, foods that contain fat are typically classified by the
type of fat that is most prevalent in the food.
FOODS EMPHASIZED

A healthy low-fat diet emphasizes the consumption of whole

grains, beans, fruits, and vegetables, as well as small amounts of
healthy sources of fat including raw nuts, raw seeds, vegetable oils
(particularly monounsaturated oils like olive oil, and oils rich in
omega 3 fats such as flaxseed oil and soybean oil), and cold water
fish including salmon, herring, and mackerel.
FOODS AVOIDED

Low-fat diets often exclude or limit red meats, whole fat dairy
products (butter, milk, yogurt, heavy cream and ice cream),
mayonnaise, margarine, and salad dressings. Extremely low-fat
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diets, such as the Dean Ornish diet and the Pritikin diet, eliminate
nearly all animal products and added vegetable oils.
NUTRIENT EXCESSES/DEFICIENCIES

Low-fat diets often contain a large amount of simple carbohydrates

and refined sweeteners, especially when "low-fat" and "fat-free"
processed foods are eaten. According to the USDA's 1995
Continuing Survey of Food Intakes by Individuals, the intake of
sugar and other refined sweeteners increased from about 55 kg
(120 lb) per person per year in 1970 to 68 kg (150 lb) per person
per year in 1995. In addition, extremely low-fat diets may contain
insufficient quantities of the omega 3 and omega 6 essential fatty
acids.
Who Benefits?
Fat is the most calorie-dense macronutrient (fat contains 9 calories
per gram compared to 4 calories per gram for protein and
carbohydrate), so foods containing fat are usually high in calories.
If you are trying to lose weight by counting calories, reducing your
consumption of high-fat foods can be beneficial. Also, if you have
heart disease or cancer, or have a family history of either disease,
your health may be improved by eating a diet that is low in total
and saturated fat.
Who is Harmed?
Following a low-fat diet (or a diet that contains fewer than 30% of
calories as fat) is unlikely to cause any harm to healthy adults
eating a varied and well-balanced diet, assuming they consume an
adequate amount of essential fatty acids, especially the omega 3
fats. However, children require extra fat to maintain normal growth
and development. As a result, the consumption of dietary fat by
infants and children less than two years old should not be
restricted.

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TEACHING PORTION CONTROL

Portion Control
Portion control is an important concept when you're trying to lose
weight and keep it off. But you don't need to memorize a food list
or carry around measuring cups to get a better handle on serving
sizes. Instead, use common visual cues to remind yourself of
appropriate serving sizes. For example, a medium pepper is about
the size of a baseball and equals one vegetable serving. While not
all foods perfectly match visual cues, this method can help you
better judge serving sizes and practice portion control, which may
help with weight loss.
If you think the servings seem small, don't panic. Remember
that you can eat multiple servings every day from each food group.
A 2.5-ounce piece of cooked skinless chicken is about the same
size as two-thirds of a deck of cards and equals one protein/dairy
serving, or about 110 calories. The same is true for a 2-ounce patty
of cooked lean hamburger, which equals one serving and has about
110 calories.
Other Protein/Dairy Servings
Protein/dairy: 1 serving (110 calories)
Baked beans, canned: 1/2 cup
Egg: 1 whole
Fish (haddock), grilled or broiled: 3 ounces
Pork sausage, smoked: 2 small links
Tofu, firm or silken soft: 2 slices (1-inch width)
Two teaspoons of regular mayonnaise are about the same size as
two dice and equal one fat serving, or about 45 calories.
Other Fat Servings
Fat: 1 serving (45 calories)
Almonds: 7 almonds
Avocado: 1/6 section of fruit
Butter, regular
: 1 teaspoon
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Peanut butter, chunky or smooth:1 1/2 teaspoons

Trans-free margarine: 2 teaspoons
Salad dressing, ranch, regular: 2 teaspoons
Vegetable oil (olive, canola, safflower): 1 teaspoon
Half a cup of whole-grain cooked pasta is about the same size as a
hockey puck and equals one carbohydrate serving, or about 70
calories. If pasta isn't your thing, picture brown rice instead. You
can have 1/3 cup of cooked brown rice for 70 calories.
Other Carbohydrate Servings
Carbohydrate: 1 serving (70 calories)
Bagel, whole-grain: 1/2 bagel (3-inch width)
Bun or roll, whole-grain: 1 small
Cereal, cold, flake-type: 3/4 cup
Crackers, whole-wheat: 8
Muffin, any flavour- small
One small apple is about the same size as a tennis ball and equals
one fruit serving, or about 60 calories. The same is true for a
medium orange, which is also the size of a tennis ball and about 60
calories.
Other Fruit Servings
Fruit: 1 serving size (60 calories)
Applesauce, sweetened: 1/3 cup
Banana: 1 small
Cherries: 15 whole
Strawberries, whole: 1 1/2 cups
100 percent fruit juice, unsweetened: 1/2 cup
Half a cup of cooked carrots is about the same as half a baseball
and equals one vegetable serving, or about 25 calories. You can eat
even more raw leafy vegetables. Two cups of spinach think of
two baseballs are about 25 calories.
Other Vegetable Servings
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Vegetable: 1 serving (25 calories)

Asparagus, cooked: 1/2 cup (6 spears)
Cauliflower: 1 cup florets (about 8)
Green beans, canned or frozen: 2/3 cup
Tomato sauce, canned
: 1/3 cup
Zucchini, cooked or fresh: 3/4 cup
One and a half to 2 ounces of low-fat hard cheddar cheese are
about the same size as three to four dice and equal one
protein/dairy serving, or about 110 calories.
MYTHS AND FACTS ABOUT FATS

Myth: All fats are equaland equally bad for you.

Fact: Trans fats and saturated fats are bad for you because they
raise your cholesterol and increase your risk for heart disease. But
monounsaturated fats and polyunsaturated fats are good for you,
lowering cholesterol and reducing your risk of heart disease.
Myth: Lowering the amount of fat you eat is what matters the
most.
Fact: The mix of fats that you eat, rather than the total amount in
your diet, is what matters most when it comes to your cholesterol
and health. The key is to eat more good fats and less bad fats.
Myth: Fat-free means healthy.
Fact: A fat-free label doesnt mean you can eat all you want
without consequences to your waistline. Many fat-free foods are
high in sugar, refined carbohydrates, and calories.
Myth: Eating a low-fat diet is the key to weight loss.
Fact: The obesity rates for Americans have doubled in the last 20
years, coinciding with the low-fat revolution. Cutting calories is
the key to weight loss, and since fats are filling, they can help curb
overeating.
Myth: All body fat is the same.
Fact: Where you carry your fat matters. The health risks are
greater if you tend to carry your weight around your abdomen, as
opposed to your hips and thighs. A lot of belly fat is stored deep
below the skin surrounding the abdominal organs and liver, and is
closely linked to insulin resistance and diabetes.
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THE CONTROVERSY SURROUNDING SATURATED FAT

For decades, doctors, nutritionists and health authorities have told

us that a diet high in saturated fats raises blood cholesterol levels
and increases the risk of heart disease and stroke. However, recent
studies have made headlines by casting doubt on those claims,
concluding that people who eat lots of saturated fat do not
experience more cardiovascular disease than those who eat less.
What these studies highlighted is that when cutting down on
saturated fats in your diet, its important to replace them with the
right foods. For example, swapping animal fats for vegetable
oilssuch as replacing butter with olive oilcan help to lower
cholesterol and reduce your risk for disease. However, swapping
animal fats for refined carbohydrates, such as replacing your
breakfast bacon with a bagel or pastry, wont have the same
benefits. Thats because eating refined carbohydrates or sugary
foods can also have a negative effect on cholesterol levels and your
risk for heart disease.
In short, nothing has changed. Reducing your intake of
saturated fats can still improve your cardiovascular healthas long
as you take care to replace it with good fat rather than refined
carbs. In other words, dont go no fat, go good fat.If you are
concerned about your weight or heart health, rather than avoiding
fat in your diet, try replacing trans fats and saturated fats with good
fats. This might mean replacing fried chicken with fresh fish,
swapping some of the meat you eat with beans and legumes, or
using olive oil rather than butter.
Try to eliminate trans fats from your diet. Check food labels
for trans fats. Avoiding commercially-baked goods goes a long
way. Also limit fast food.
Limit your intake of saturated fats. You can do this by cutting
back on red meat and full-fat dairy foods. Try replacing red
meat with beans, nuts, poultry, and fish whenever possible, and
switching from whole milk and other full-fat dairy foods to
lower fat versions.
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Eat omega-3 fats every day. Good sources include fish,

walnuts, ground flax seeds, flaxseed oil, canola oil, and soybean
oil.
How much fat is too much depends on your lifestyle, your weight,
your age, and most importantly the state of your health. The USDA
recommends that the average individual:
Keep total fat intake to 20-35% of calories.
Limit saturated fats to less than 10% of your calories (200
calories for a 2000 calorie diet).
Limit trans fats to 1% of calories (2 grams per day for a 2000
calorie diet).
When focusing on healthy fats, a good place to start is eliminating
your consumption of trans fats. A trans fat is a normal fat molecule
that has been twisted and deformed during a process
calledhydrogenation. During this process, liquid vegetable oil is
heated and combined with hydrogen gas. Partially hydrogenating
vegetable oils makes them more stable and less likely to spoil,
which is very good for food manufacturersand very bad for you.
No amount of trans fats is healthy. Trans fats contribute to major
health problems, from heart disease to cancer.
Sources Of Trans Fats
Many people think of margarine when they picture trans fats, and
its true that some margarines are loaded with them. However, the
primary source of trans fats in the Western diet comes from
commercially prepared baked goods and snack foods:
Baked goods cookies, crackers, cakes, muffins, pie crusts,
pizza dough, and some breads like hamburger buns
Fried foods doughnuts, French fries, fried chicken, chicken
nuggets, and hard taco shells
Snack foods potato, corn, and tortilla chips; candy; packaged
or microwave popcorn
Solid fats stick margarine and semi-solid vegetable shortening
Pre-mixed products cake mix, pancake mix, and chocolate
drink mix.
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When shopping, read the labels and watch out for partially
hydrogenated oil in the ingredients. Even if the food claims to
be trans fat-free, this ingredient makes it suspect.
With margarine, choose the soft-tub versions, and make sure the
product has zero grams of trans fat and no partially
hydrogenated oils.
When eating out, put fried foods, biscuits, and other baked
goods on your skip list. Avoid these products unless you
know that the restaurant has eliminated trans fat.
Avoid fast food. Most states have no labeling regulations for
fast food, and it can even be advertised as cholesterol-free when
cooked in vegetable oil.
When eating out, ask your server or counter person what type of
oil your food will be cooked in. If its partially hydrogenated
oil, run the other way or ask if your food can be prepared using
olive oil, which most restaurants have in stock.
Saturated fats are mainly found in animal products such as red
meat and whole milk dairy products. Poultry and fish also contain
saturated fat, but less than red meat.
Simple ways to reduce saturated fat:
Eat less red meat (beef, pork, or lamb) and more fish and
chicken
Go for lean cuts of meat, and stick to white meat, which has less
saturated fat.
Bake, broil, or grill instead of frying.
Remove the skin from chicken and trim as much fat off of meat
as possible before cooking.
Avoid breaded meats and vegetables and deep-fried foods.
Choose low-fat milk and lower-fat cheeses like mozzarella
whenever possible; enjoy full-fat dairy in moderation.
Use liquid vegetable oils such as olive oil or canola oil instead
of lard, shortening, or butter.
Avoid cream and cheese sauces, or have them served on the
side.

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The best sources of healthy monounsaturated and polyunsaturated

fats are vegetable oils, nuts, seeds, and fish.
Cook with olive oil. Use olive oil for stovetop cooking, rather
than butter, stick margarine, or lard. For baking, try canola or
vegetable oil.
Eat more avocados. Try them in sandwiches or salads or make
guacamole. Along with being loaded with heart and brainhealthy fats, they make for a filling and satisfying meal.
Reach for the nuts. You can also add nuts to vegetable dishes
or use them instead of breadcrumbs on chicken or fish.
Snack on olives. Olives are high in healthy monounsaturated
fats. But unlike most other high-fat foods, they make for a lowcalorie snack when eaten on their own. Try them plain or make
a tapenade for dipping.
Dress your own salad. Commercial salad dressings are often
high in saturated fat or made with damaged trans fat oils. Create
your own healthy dressings with high-quality, cold-pressed
olive oil, flaxseed oil, or sesame oil.
TIPS TO REDUCE FAT

Use reduced-fat or non-fat salad dressings.

Use non-fat or lower fat spreads, such as jelly or jam, fruit
spread, apple butter, nonfat or reduced-calorie mayonnaise, nonfat margarine, or mustard.
Use high-fat foods only sometimes; choose more low-fat and
non-fat foods.
To top baked potatoes, use plain non-fat or low-fat yogurt, nonfat or reduced-fat sour cream, non-fat or low-fat cottage cheese,
non-fat margarine, non-fat hard cheese, salsa or vinegar.
Use a little lemon juice, dried herbs, thinly sliced green onions,
or a little salsa as a non-fat topping for vegetables or salads.
Use small amounts of high-fat toppings. For example, use only
1 tsp butter or mayonnaise; 1 tbsp sour cream; 1 tbsp regular
salad dressing.

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Switch to 1 percent or skim milk and other non-fat or lower fat

dairy products (low-fat or non-fat yogurt, non-fat or reduced-fat
sour cream).
Cut back on cheese by using small (1 oz) amounts on
sandwiches and in cooking or use lower fat and fat-free cheeses
(part-skim mozzarella, 1 percent cottage cheese, or non-fat hard
cheese).
Try small amounts of these low-fat treats: fig bars, vanilla
wafers, ginger snaps, angel food cake, jelly beans,, gum drops,
hard candy, puddings made with low-fat (1 percent) skim milk,
non-fat frozen yogurt with a fruit topping, or fruit popsicles. Try
pretzels or popcorn without butter or oil for an unsweetened
treat.
Save French fries and other fried foods for special occasions;
have a small serving; share with a friend.
Save high-fat desserts (ice cream, pastries) for special
occasions; have small amounts; share a serving with a friend.
Choose small portions of lean meat, fish, and poultry; use lowfat cooking methods (baking, poaching, and broiling); trim off
all fat from meat and remove skin from poultry.
Choose lower fat luncheon meats, such as sliced turkey or
chicken breast, lean ham, lean sliced beef.
Once a week or more, try a low-fat meatless meal or main dish
that features beans (tacos or burritos stuffed with pinto beans;
chilli with kidney beans; black beans over rice.
Try kidney beans or black-eyed peas. It's a fast and easy way to
use beans and peas without cooking them from scratch.
Use beans as a dip for vegetables or filling for sandwiches.
Serve soup made from beans or peas - minestrone, split- pea,
black bean, or lentil (once a week or more).
Try black-eyed peas or black beans as a vegetable side dish with
meat or fish.
Add beans to salads. Many salad bars feature kidney beans,
three-bean salad, or chick peas (garbanzo beans).

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GENERAL WAIGHT LOSS TIPS

Sensible lifestyle changes, the kind you can stick to for the long
haul, work best when it comes to weight loss. As you might
suspect, among peoples who have successfully lost weight, the
most effective strategies used include:
Eating less
Controlling portion sizes
Eating more natural foods
Avoiding sugar, sweets and soda
Exercise
While many people are successful at losing weight initially, the
hard part comes in maintaining that weight loss a feat that is
achieved by only about 20 percent of overweight or obese
individuals. Experts agree that successful long-term weight loss,
which means you lose weight and keep it off for at least one year,
involves dietary modification, physical activity and behavioral
interventions, including the following proven strategies:
Eat breakfast every day
Watch less than 10 hours of television a week
Exercise about one hour per day, and increase your physical
activity in general
Modify your food intake in some way to lose weight
Establish a social support network
Limit or avoid disinhibited and binge eating
Avoid eating in response to negative emotions and stress
Be accountable for your decisions
Foster a sense of autonomy, internal motivation, and selfefficacy toward weight loss maintenance
Avoid periods of excessive hunger
In addition, certain supplements can work with your dietary,
exercise and behavioral modifications to support successful and
healthy long-term weight loss. This includes:
Calcium: Its important to get enough calcium in your diet, as
low levels will prompt your body to release parathyroid
hormone and calcitriol, substances that help your body release
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and absorb calcium. These substances also stimulate the

production of fat, however, and research suggests calcium
supplementationmay help prevent weight gain, particularly in
women who report inadequate calcium intakes.
L-carnitine: L-carnitine is an amino acid derivative found in
almost all of your body's cells. Its essential for breaking down
fats into energy, and promotes healthy fat metabolism. Lcarnitine is found in avocado and fermented soy foods like
tempeh, as well as in animal products. However, animal
products contain only small amounts of L-carnitine, making it
difficult to get enough from diet alone.
Green tea extract: Derived from green tea leaves, green tea
extract increases the rate at which your body burns calories and
enhances fat oxidation.
Whey protein: Useful for supporting muscle and weight
management, whey protein may be a useful dietary addition for
reaching your desired weight and muscle mass. In one recent
study, those who consumed supplemental whey protein lost
weight and body fat, while those drinking soy shakes did not,
and those who drank carbohydrate shakes actually gained
weight.
Probiotics: The makeup of your gut bacteria has a profound
impact on your overall health, and emerging research suggests it
may even impact your weight. In one study, people with obese
tendencies who drank a probiotic-rich fermented milk beverage
for 12 weeks had a 4.6 percent reduction in abdominal fat and a
3.3 percent reduction in subcutaneous fat. Overall, their body
weight dropped by 1.4 percent and their waist size was reduced
by 1.8 percent.
You can get probiotics in your diet naturally by consuming
fermented foods like kefir and sauerkraut.
By combining the proven strategies above dietary modification like
limiting sugary beverages and sweets and eating breakfast,
exercising regularly, modifying your behaviors, and taking
advantage of supportive nutritional and supplemental options you
can achieve a healthy weight, the healthy way. Rather than simply
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being a quick fix, this will be your ticket to safe, natural and
long-term weight loss.
HEALTHY EATING TIPS

Water, water, water. It kick-starts your metabolism. Stop

drinking soda.
Make one change at a time. Dont cut everything out at once.
For example, cut out fried foods. When youre used to that, cut
out soda, etc.
Lay off the rubbish food.Lay off the rubbish food, apart from
one day a week where you can eat what you like itll help you
stick to it and you wont have the temptation to eat rubbish all
the time.
Eat according to the Glycemic Index, sticking with low and
medium index foods.
Be mindful of what you are eating. Keep a food journal or diary.
Seeing it in writing always gives it weight and helps reveal
patterns or triggers.
Stop the evening eating. You dont want to eat and then go to
sleep. All those calories just sit there unused while you sleep.
Eat mostly raw fruits, veggies and nuts.
Brush your teeth early in the evening rather than just before bed.
It keeps you from snacking if youre not really hungry.
Cut wheat-flour based products out of your diet. Wheat is
surprisingly easy to replace when you start thinking about it
rice, oats (still some gluten there, but a lot less), more
vegetables.
Portion control used with a 20 minute wait time wait 20
minutes after eating the sensible portions, and then see if you
still feel hungry. Nine times out of ten, you wont. If you do, get
a little more.
Cut out sugar.
No fast food. Period.
Commit to one diet and stick to it for life. Start by making a list
of low-calorie foods that you love, that you find satisfying; and
when youre hungry make sure you eat lots of those foods.
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If youre a parent, dont absorb invisible calories by eating

your kids food.
Snack between meals starving yourself for 6 or 7 hours at a time
between lunch and dinner means you will overeat at dinner.
Eat slow and you will only eat as much as you need to be full.
Whenever you eat, think about how much food you would
waste by overeating. Your body doesnt need all the food thats
on your plate, why waste it? You could eat the leftovers for
lunch the next day and save yourself some money, or you could
split it with your loved one and have company while you eat.
You could give it to the homeless guy down the block who
REALLY needs it. Any reason you find not to waste that food is
a good one.
Lentils.
Everything in moderation. If you really want French fries and a
hamburger, or ice cream, or a cookie its OK to indulge a little
occasionally. Key word is occasionally. Better to indulge a
little, than to binge later.
Learn to cook, from scratch. That way, you control what you are
eating.
Dont buy into the idea of diet foods. Its better to eat the
original food that has been less processed and only eat less.
Observe your hunger patterns. Choose a bedtime thats early
enough to keep you from after-dinner snacking. Stick to that
bed-time. If you must snack before bed, have a something small
and healthful. Maybe a tiny portion of whole grain cereal with
milk.
Eat lots of fiber. Its surprisingly filling compared to that
cupcake.
Eat as soon after you get up as possible. This gets your
metabolism working at a higher rate sooner in the day.
Cut out alcohol or reduce your intake to one or two glasses a
week.
If you are hungry between meals, try eating a small portion of
food that is high in protein. It can be more effective to eat one

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piece of cheese or some yoghurt or nuts than to eat bread or

crackers or other snack foods.
Go to bed early and get up early. If you stay up late, you will
overeat, guaranteed. It doesnt matter if you are a night person;
change into a morning person. When you go to bed early, you
dont think about food all night.
Instead of counting calories, concentrate on reducing your fat
intake. Fat that you eat converts more readily into body fat than
does protein or carbohydrate.
Try to enjoy your food, eat it slowly and consciously.
Only diet on weekdays. Dont binge on weekends, but save two
days a week to eat the yummy things. Also, because many
people really cant break that chocolate addiction, calculate one
treat every day into your calories.
Positive change is easier than negative change. Instead of
thinking of foods that are bad and that you feel like you need
to cut out, think about all the new recipes and foods you will get
to try if you start experimenting with more vegetables, more
beans, more spices, etc.
Dont count calories after you each them, count before.
Create a routine for what you eat for a month, do not think of
food as something to be enjoyed, think of it as fuel.
Take one of the three meals a day, and make it healthier
(veggies, fruits, whole grains, etc.). Combine this with drinking
ONLY water when at work, and its quite the effective method
to lose a few pounds.
Eat a varied diet. Only, half your usual portions.
Eat nothing that you have not bought yourself, cooked yourself,
and cleaned up after. This way laziness works in your favour. If
you dont feel like going to the store, or if you have stuff but
dont feel like cooking it or cleaning up afterwards, you are less
likely to eat.
If youre a stress eater, try sunflower or pumpkin seeds. Lots of
chewing, not many calories. Just dont spit the seeds on the
floor.

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Reduce the intake of three white things white flour (all purpose
flour), salt and sugar. Get rid of white flour completely if
possible.
EXERCISE TIPS

Go backpacking. Carrying a heavy pack and walking around a

lot will help you shed a lot of pounds.
Exercise 3 times per week.
Exercise: any kind any time. Sure there are better times and
better exercises for fat burning, but they all beat sitting on the
couch.
Cardiovascular training in the morning before you eat breakfast.
This forces your body to utilize stored body fat for energy rather
than carbohydrates, since you are in a carb-depleted state after
having not eaten for 8-10 hours.
Regular aerobic exercise helps, for a period of at least 40
minutes.
If you cant run, start slow by walking for 9 minutes and jog for
1 minute. Do that a couple of times and then slowly exchange
the minutes walking for minutes running.
Buy a pedometer and try to get 10,000 steps per day in. Thats
about 5 miles +/- depending on your stride length.
Walk everywhere (carrying a baby while you walk also helps a
lot).
Swim, swim, swim.
Find fun exercise. Join a softball team, commute to work on a
bike, whatever. Your strategy should be time-sensitive only
make choices you can see yourself committing to for years, be it
gym, dieting, whatever temporary wont work.
If you are resistant to exercising, consider volunteer labor. Walk
dogs at the animal shelter. (Find a shelter at Petfiinder.com. Do
beach or riverside clean-ups with a local environmental group.
Volunteer on building and repair projects.)
Replace your least favourite TV show with mild calisthenics for
30 or so minutes.

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Get an active dog! They will force you to get outside every day,
and they make the best exercise companions.
Make friends (if you havent already) with very physically
active people. If you have very active friends, you will be
exercising without even noticing it because you will be having
fun with friends.
Do squats while brushing the back sides of your teeth and calf
rises while brushing the fronts. Then you get in at least some
exercise and also brush long enough.)
Take the stairs. Walk or bike ride that short distance instead of
driving.
Use those multi-coloured stars on the calendar for each day
youve achieved your goal exercise, diet, whatever it is. Gives
you something, small as it may be, to look forward to.
Start walking outside to get fresh air, which translates into
better mood. If rains, use treadmill. But walk fast, no sissy stuff.
HOW TO USE FOOD DIARIES?

Benefits Of Keeping A Food Diary For Weight Loss

Taking the time to record your food and drink intake may seem
like a lot of hard work, but it is one of the most effective tools to
assist with weight loss. Here are some of the benefits of keeping a
food diary.
You can use it to help you determine the volume and
composition of your current eating habits.
Food diaries force you to think consciously about what you are
eating, and keeps you focused on your weight loss program.
A food diary will help you visualize what you eat. When your
food intake is written down, areas where your diet goes wrong
may become more obvious.
It helps keep you honest too. It does not work if you 'forget'
some items or pretend that certain calories don't count.
The food diary can serve as a reminder about nutrition goals
such as drinking enough water, or having the right number of

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serves of fruit, veggies, dairy, protein, cereals/grains and good

fats each day.
If you are keeping a long term food diary, you can look back
over the records and see periods where things went right or
wrong. You may start to see some patterns emerge regarding
why you are eating when you do, increasing awareness and
assisting behavior change.
A health professional or dietitian can use an accurately recorded
food diary to determine underlying nutritional problems, give
professional dietary advice and recommendations.
Keeping a food diary is an effective way to keep track of the
number of calories that you eat everyday. And whether you are
trying to lose weight or simply maintain a healthier diet, a food
diary can help you out.In addition to keeping your own written
diary, you can also use Fitday's online journal to track your
calories. By doing this, you won't have to look up the number of
calories in your meals and you can have the convenience of
quickly tallying up your calorie count for each day.
Regardless, there are a number of reasons that you should start
keeping a food diary today. Here are 5 of them:
1. Your food diary will show you what you eat
This is one of the most underrated aspects of keeping a food diary.
You probably think that you know exactly what you eat everyday.
You probably even think you could guess the number of calories
that you take in through your meals. But the truth is that most
people eat more than three times everyday and most of their extra
calories probably come from eating between meals. Especially if
you are trying to lose weight, keeping track of these calories is
what's most important.
2. Your food diary can help you lose weight
By seeing exactly what you eat everyday, you can begin to cut
certain types of food out of your diet. You might be surprised to
see that some foods that you thought were healthy actually have
the highest amount of calories according to your food journal. By
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taking this into account, you can cut these calories by finding
healthy alternatives for your diet.
3. Your food diary can help you plan out meals
At first, you should use your food diary to keep track of the meals
that you eat. But over time, you can actually use your food diary to
plan out basic meals and snacks in order to create a more balanced
diet.
4. Your food diary will show you what you need to eat
Whether you're not getting enough vegetables into your diet or
you're skipping lunch a little too often, your food diary serves as a
record of everything that you do and do not eat. Knowing that you
are deficient in certain food groups can be helpful and can help you
plan out your diet a little better than ever before.
5. Your Food Diary Will Keep You on Track
You may not realize it right away, but over time, your food diary
will actually make you want to eat healthier. Every time you write
down a food that has a lot of calories in it, you'll want to avoid
doing it in the future. Your food diary can actually help you to look
at food in a whole new way. It's one of the best reasons you should
want to start a food diary today. Your food diary will not help you
enjoy new foods, but it will give you a reason to try to cut back on
your calories.
GENERAL MOTORS: WEIGHT LOSS DIET PROGRAM

This diet and health program was developed for employees and
dependents of General Motors, Inc. and is intended for their
exclusive use. This program was developed in conjunction with a
grant from U.S. Department of Agriculture and the Food and Drug
Administration. It was field tested at the Johns Hopkins Research
Centre and was approved for distribution by the Board of
Directors, General Motors Corp. at a general meeting on August
15, 1985. General Motors Corp. wholly endorses this program and
is making it available to all employees and families. This program
will be available at all General Motors Food Service Facilities. It is
management's intention to facilitate a wellness and fitness program
for everyone.
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This program is designed for a target weight loss of 10-17 lbs

per week. It will also improve your attitudes and emotions because
of its cleansing systematic effects.The effectiveness of this seven
day plan is that the food eaten burn more calories than they give to
the body in caloric value.This plan can be used as often as you like
without any fear of complications. It is designed to flush your
system of impurities and give you a feeling of well being. After
seven days you will begin to feel lighter because you will be
lighter by at least 10 lbs. You will have an abundance of energy
and an improved disposition.
During the first seven days you must abstain from all alcohol.
You must drink 10 glasses of water each day.
Day One- All fruits except bananas. Your first day will consist of
all the fruits you want. It is strongly suggested that you consume
lots of melons the first day. Especially watermelon and a loupe. If
you limit your fruit consumption to melons, your chances of losing
three lbs. on first day are very good.
Day Two- All vegetables. You are encouraged to eat until you are
stuffed with all the raw or cooked vegetables of your choice. There
is no limit on the amount or type. For your complex carbohydrate,
you will start day two with a large baked potato for breakfast. You
may top the potato with one pat of butter.
Day Three- A mixture of fruits and vegetables of your choice.
Any amount, any quantity. No bananas yet. No potatoes today.
Day Four- Bananas and milk. Today you will eat as many as eight
bananas and drink three glasses of milk. This will be combined
with the special soup which may be eaten in limited quantities.
Day Five- Today is feast day. You will eat beef and tomatoes. Eat
two 10 oz. portions of lean beef. Hamburger is OK. Combine this
with six whole tomatoes. On day five you must increase your water
intake by one quart. This is to cleanse your system of the uric acid
you will be producing.
Day Six- Beef and vegetables. Today you may eat an unlimited
amount of beef and vegetables. Eat to your hearts content.

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Day Seven- Today your food intake will consist of brown rice,
fruit juices and all the vegetables you care to consume.
Tomorrow morning you will be 10-17 lbs. lighter than one week
ago. If you desire further weight loss, repeat the program again.
You may repeat this program as often as you like, however, it is
suggested that you are allowed two glasses of white wine in
addition to the instructions on the program. You may substitute
champagne for white wine.
Under no circumstances are you to drink any other alcoholic
beverages with the exception of beer which is allowed. Any liquor
(bourbon,vodka, rum) is forbidden. Cream drinks are especially
forbidden. You may have an occasional cordial such as creme de
menthe or schnapps, but you must always limit yourself to two
drinks. If you wine, drink only wine that day. If you have beer,
drink only beer that day, etc. Alcohol adds empty calories to your
diet. However, after the first week it will help your digestion and
settle your stomach.
G.M.'S Wonder Soup
The following soup is intended as a supplement to your diet. It can
be eaten any time of the day in virtually unlimited quantities. You
are encouraged to consume large quantities of this soup.28 oz,
Water, 6 Large Onions, 2 Green Peppers, Whole Tomatoes (fresh
or canned), 1 Head Cabbage, 1 Bunch Celery, 4 Envelopes Lipton
Onion Soup Mix, Herbs and Flavouring as desired.
Additional Comments
Vegetables as may be taken in the form of a salad if desired. No
dressing except malt, white or wine vinegar, squeezed lemon,
garlic, herbs. No more than one tea spoon of oil.
You have been given a recipe for the WONDER SOUP which
can be eaten in unlimited quantities. This soup is a supplement
while you are on the program and it should be a pleasure to eat.
Not everyone likes cabbage, green peppers, calory etc. This recipe
is not inflexible. You may substitute vegetables according to your
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taste. You may add any vegetables you like: asparagus, peas, corn,
turnips, green beans, cauliflower, etc. Try to stay away from beans
(lima, pinto, kidney, etc.), however, because they tend to be high in
calories even though they are very good for you.
Beverages You May Consume While On The Program
1. Water (flavoured with lemon/lime if desired).
2. Club Soda is OK.
3. Black Coffee. No cream or cream substitute. No sugar or
sweetness.
4. Black Tea = Herb or Leaf.
5. Absolutely nothing else except the fruit juices which are part of
day seven. No fruit juices before day seven.
How and Why It Works?
Day One you are preparing your system for the upcoming
programme. Your only source of nutrition is fresh or canned fruits.
Fruits are nature's perfect food. They provide everything you could
possibly want to sustain life except total balance and variety.
Day Two starts with a fix of complex carbo-hydrates coupled with
an oil dose. This is taken in the morning for energy and balance.
The rest of day two consists of vegetables which are virtually
calorie free and provide essential nutrients and fibre.
Day Three eliminates the potato because you get your
carbohydrates from the fruits. You system is now prepared to start
burning excess pounds. You will still have cravings which should
start to diminish by day four.
Day Four, bananas, milk and soup sound the strangest and least
desirable. You're in for a surprise. You probably will not eat all the
bananas allowed. But they are there for the potassium you have
lost and the sodium you may have missed the past three days. You
will notice a definite loss of desire for sweets. You will be
surprised how easy this day will go.
Day Five, Beef and tomatoes. The beef is for iron and proteins, the
tomatoes are for digestion and fibre. Lots and lots of water purifies
your system. You should notice colourless urine today. Your
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allowance calls for the equivalent of five "quarter ponders". Do not

feel you have to eat all this beef. You must eat the six tomatoes.
Day Six is similar to day five, Iron and proteins from beef,
Vitamins and fibre from vegetables. By now your system is in a
total weight loss inclination. There should be a noticeable
difference in the way you look today, compared to day one.
Day Seven finished off the program like a good cigar used to
finish off Victorian meals, except much healthier. You have your
system under control and it should thank you for the flushing and
cleaning you just gave it.
BALANCING CALORIES AND EXERCISE

Calorie balance is simply the number of calories you consume

versus the number of calories you burn through your activities of
daily living and exercise. Calories count! If you eat more calories
than you burn, you will gain weight. If you eat fewer calories than
you burn, you will lose weight.
Calorie Balance Equations:
Weight
Calories Consumed = Calories Burned
Maintenance
Weight Loss
Calories Consumed < Calories Burned
Weight Gain

Calories Consumed > Calories Burned

One pound = 3,500 calories. To lose 1 pound of weight, you need

to create a deficit of 3,500 calories. How do you know how many
calories you need and are consuming?
You can also calculate your calorie needs by manually calculating.
Women: 655 + (4.3 x weight in pounds) + (4.7 x height in inches)
(4.7 x age in years)
Men: 66 + (6.3 x weight in pounds) + (12.9 x height in inches)
(6.8 x age in years)
The most accurate means of determining caloric needs are
through measuring your metabolism. Many medical or fitness
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centers have medical devices that measure Resting Metabolic Rate.

You may choose to search for a location in your area to get your
metabolism measured and individualize your caloric needs.
To fully understand the calorie balance equation, you need to
know how many calories your body needs and burns on a daily
basis. Once you know how many calories you need per day to
reach your goal, how do you know how many calories you burn
per day? Each day will be different depending on if you sit at a
desk, do physical activity at your job and if you incorporate
exercise (and there should always be exercise). There are several
products that can be worn daily which will determine how many
calories you burn. Search the Internet for exercise calorie
counter or activity calorie counter.
It is crucial to learn how many calories are in the foods and
beverages you consume. It is easy to underestimate how much you
are eating and overestimate how much you are exercising. In fact,
logging your food intake is a key habit to success and is an
absolute must in your program.
ENERGY BALANCE

Energy is another word for "calories." Your energy balance is the

balance of calories consumed through eating and drinking
compared to calories burned through physical activity. What you
eat and drink is ENERGY IN. What you burn through physical
activity is ENERGY OUT.You burn a certain number of calories
just by breathing air and digesting food. You also burn a certain
number of calories (ENERGY OUT) through your daily routine.
For example, children burn calories just being studentswalking
to their lockers, carrying books, etc.and adults burn calories
walking to the bus stop, going shopping, etc.
A chart of estimated calorie requirements for children and
adults is given below; this chart can help you maintain a healthy
calorie balance.An important part of maintaining energy balance is
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the amount of ENERGY OUT (physical activity) that you do.

People who are more physically active burn more calories than
those who are not as physically active.
The same amount of ENERGY IN (calories consumed) and
ENERGY OUT (calories burned) over time = weight stays the
same
More IN than OUT over time = weight gain
More OUT than IN over time = weight loss
Your ENERGY IN and OUT don't have to balance every day. It's
having a balanceover time that will help you stay at a healthy
weight for the long term. Children need to balance their energy,
too, but theyre also growing and that should be considered as
well. Energy balance in children happens when the amount of
ENERGY IN and ENERGY OUT supports natural growth without
promoting excess weight gain.Thats why you should take a look at
the Estimated Calorie Requirement chart, to get a sense of how
many calories (ENERGY IN) you and your family need on a daily
basis.
Estimated Calorie Requirements
This calorie requirement chart presents estimated amounts of
calories needed to maintain energy balance (and a healthy body
weight) for various gender and age groups at three different levels
of physical activity. The estimates are rounded to the nearest 200
calories and were determined using an equation from the Institute
of Medicine (IOM).

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Estimated Calorie Requirements (in kilocalories) for Each Gender

and Age Group at Three Levels of Physical Activity.
Activity Level
Gender

Age
(years)

Sedentary

Moderately
Active

Active

Child

2-3

1,000

1,000 - 1,400

1,000 - 1,400

Female

4-8

1,200

1,400 - 1,600

1,400 - 1,800

Female

9-13

1,600

1,600 - 2,000

1,800 - 2,000

Female

14-18

1,800

2,000

2,400

Female

19-30

2,000

2,000 - 2,200

2,400

Female

31-50

1,800

2,000

2,200

Female

51+

1,600

1,800

2,000 - 2,200

Male

4-8

1,400

1,400 - 1,600

1,600 - 2,000

Male

9-13

1,800

1,800 - 2,200

2,000 - 2,600

Male

14-18

2,200

2,400 - 2,800

2,800 - 3,200

Male

19-30

2,400

2,600 - 2,800

3,000

Male

31-50

2,200

2,400 - 2,600

2,800 - 3,000

Male

51+

2,000

2,200 - 2,400

2,400 - 2,800

Source: HHS/USDA Dietary Guidelines for Americans: 2005

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These levels are based on Estimated Energy Requirements

(EER) from the IOM Dietary Reference Intakes macronutrients
report, 2002, calculated by gender, age, and activity level for
reference-sized individuals. "Reference size," as determined by
IOM, is based on median height and weight for ages up to age
18 years of age and median height and weight for that height to
give a BMI of 21.5 for adult females and 22.5 for adult males.
Sedentary means a lifestyle that includes only the light physical
activity associated with typical day-to-day life.
Moderately active means a lifestyle that includes physical
activity equivalent to walking about 1.5 to 3 miles per day at 3
to 4 miles per hour, in addition to the light physical activity
associated with typical day-to-day life.
Active means a lifestyle that includes physical activity
equivalent to walking more than 3 miles per day at 3 to 4 miles
per hour, in addition to the light physical activity associated
with typical day-to-day life.
The calorie ranges shown are to accommodate needs of
different ages within the group. For children and adolescents,
more calories are needed at older ages. For adults, fewer
calories are needed at older ages.
Energy Balance In Real Life
Think of it as balancing your "lifestyle budget." For example, if
you know you and your family will be going to a party and may eat
more high-calorie foods than normal, then you may wish to eat
fewer calories for a few days before so that it balances out. Or, you
can increase your physical activity level for the few days before or
after the party, so that you can burn off the extra energy.The same
applies to your kids. If theyll be going to a birthday party and
eating cake and ice creamor other foods high in fat and added
sugarhelp them balance their calories the day before and/or after
by providing ways for them to be more physically active.
Here's another way of looking at energy balance in real
life.Eating just 150 calories more a day than you burn can lead to
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an extra 5 pounds over 6 months. Thats a gain of 10 pounds a

year. If you don't want this weight gain to happen, or you want to
lose the extra weight, you can either reduce your ENERGY IN or
increase your ENERGY OUT. Doing both is the best way to
achieve and maintain a healthy body weight.
Here are some ways to cut 150 calories (ENERGY IN):
Drink water instead of a 12-ounce regular soda.
Order a small serving of French fries instead of a medium , or
order a salad with dressing on the side instead.
Eat an egg-white omelet (with three eggs), instead of whole
eggs.
Use tuna canned in water (6-ounce can), instead of oil.
Here are some ways to burn 150 calories (ENERGY OUT), in just
30 minutes (for a 150 pound person):
Shoot hoops
Walk two miles
Do yard work (gardening, raking leaves, etc.)
Go for a bike ride
Dance with your family or friends
EXERCISE PLAN

Entering a weekly Exercise Plan will increase your Target Daily

Food Cals by the average expected daily calories burned by
exercise. An Exercise Plan exists to fine-tune your Target Daily
Food Cals. You can enter an Exercise Plan in Plan tab on the web
if you have Maximum membership. If you have a mobile app at
any membership level, you can enter it under Avg. Daily Exercise
Cals in My Plan section.
Having an Exercise Plan is not essential to using MyNetDiary.
Many members do not enter an Exercise Plan since they do not
want their Target Daily Food Cals to adjust upwards. They still log
their daily exercises but the calories burned from exercise is not
"eaten up." This works fine for many people - it essentially creates
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a larger calories deficit than planned, and helps nudge people into
meeting their weight loss goals a little more quickly.
If you are active and use MyNetDiary to gain weight, or to
ensure you are consuming enough calories to avoid weight loss,
then consider entering an Exercise Plan so that your Target Daily
Food Cals is adjusted upwards to cover typical exercise.
Your Daily Analysis statement (see below) will still give you the
daily net calories based upon your actual food intake and exercise
each day.
Activity Level
If you account for typical exercise by using a higher baseline
activity level, then do not enter an exercise plan with those same
activities, and do not log those same activities in your daily
exercise log since doing so will double-count those calories. Most
adults should use the sedentary activity level since it accounts for
activities of daily living (including incidental walking up to about a
mile or 2000 steps) and that is what most people do every single
day of their lives. You can account for calories burned from
exercise in your daily exercise log.
Daily Analysis

Daily Analysis is an incredibly useful summary found in Details

tab on web, or in Analysis row in mobile apps. This calories
statement displays your daily net calories and summarizes how that
compares to the net calories needed that day to continue to meet
your stated Target Weight by your Target Date, based upon your
current weight.
If you constantly see a recommendation to exercise a lot more
than you can reasonably perform by the end of the day, then
troubleshoot to see if a goal needs to be adjusted. The most
common problem is trying to lose too much weight too fast - you
are unable to create a large enough calories deficit to meet your
stated goals. In that case, simply move the Target Date further out
or decrease the Target Weekly Rate of weight loss.
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Remaining Calories
Remaining Calories is a great, quick check on how many calories
you have left compared Target Daily Food Cals. On the web, the
calories summary bar is displayed in the top right hand corner of
screen when you are in Food, Exercise, or Details tabs. This bar
shows how your actual food and exercise calories compare to your
goals. This bar uses the Target Daily Food Cals - whether it is an
overridden goal that you have customized or MyNetDiary's
calculation. If Remaining Calories is a positive number (e.g. 300
calories), then you can still eat 300 more calories that day to meet
your Target Daily Food Cals goal. If the Remaining Calories is a
negative number (e.g. -150 calories), then you have eaten 150
calories too many compared to your food and exercise goals. You
can choose to burn an extra 150 calories from exercise that day to
stay exactly on track. In mobile apps, Remaining Calories is
termed Food Left in the Meals row. As well, Day Nutrition
Summary at the bottom of the Meals screen in mobile apps
displays your current intake as well as how much you have left to
consume that day.
Setting Your Own Calories Goal
Sometimes members want to use their own calories goal rather
than use MyNetDiary's calculated goal. If you have had your
energy expenditure measured or have been given a specific goal by
your doctor or healthcare provider, then you can use that goal. If
you have a Maximum membership, then make sure AutoPilot
checkbox is not selected in the Plan tab on the web. Enter your
customized calories goal in Target Daily Food Cals in Plan tab on
the web or in Customize row at the very bottom of My Plan screen
in your mobile app.
Be sure to update your current weight using the weight field in
Details tab on the web or in Weight row in mobile apps to avoid
resetting your customized calories goal. If the system notes a
discrepancy in calories between your overwritten value and what
the system thinks you should do to meet your goals, there will be
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text in red just below Target Daily Food Cals (web) and you can
choose to follow the recommendation or not. That is, you can
always view MyNetDiary's recommended calories goal in the red
text below theTarget Daily Food Cals field (web) or in the
"Recommended" column next to your customized goals in My Plan
in mobile apps.
As mentioned earlier, Daily Analysis statement (in Details tab
on web or Analysis row in mobile apps) will still analyze your
current food intake compared to the system's calculated
maintenance calories to arrive at the day's net calories, just as it
would if you had chosen not to customize your caloric goal. And
this is a good thing. You can view this analysis as a "reality
check," which does not use your customized Target Daily Food
Cals on purpose.
If your actual consumption relative to calories burned misses
target here and there, then you might not realize how to "catch up"
to achieve your Target Weight by your Target Date. The benefit
of Daily Analysis is that it accounts for net caloric balance over
time and performs the caloric adjustments for you so that you stay
on track for losing weight by your stated Target Date. If you keep
missing your plan and do not mentally keep track of the overs and
unders while also accounting for your current body weight,
achieving your Target Weight becomes even harder.
Tips on Goal Setting
Choose SEDENTARY activity level since that is most likely to
be closest to your true level of baseline activity every single
day. Sedentary level includes typical activities of daily living
such as cooking, shopping, sitting, standing, and walking short
distances throughout the day (up to about a mile or 2000 steps).
Account for calories burned by simply logging exercise daily. If
you select an activity level higher than sedentary, do not enter
an Exercise Plan or log exercises unless they are in addition to
the activities already included in the activity level chosen. Be

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sure to review the activity level descriptions carefully before

using an activity level higher than sedentary.
Target Daily Food Cals should meet rather than dip below your
estimated BMR calories. If your target calories are a lot less
than your BMR calories, then consider pushing out your Target
Date or decreasing your Target Weekly Rate of weight loss to
bump up target calories. Or you can add an Exercise Plan so
that the system can account for expected calories burned from
exercise (which will increase target calories by average daily
expected exercise calories burned).
Achieving a high calories deficit (e.g.1000 calories daily deficit
to achieve a 2 lb weight loss per week) is difficult for most
people to sustain every day for the long term, especially without
exercise. Two red flags that indicate your weight loss goal
might be too aggressive are: 1) you are constantly hungry and
irritable, and 2) Your Daily Analysis statement consistently
recommends that you burn a lot more calories from exercise to
meet your calories deficit goal.
Don't starve yourself to meet an unrealistic weight loss goal. Be
smart set reasonable, attainable goals that allow you to eat
healthfully, exercise regularly, and do not cause undue hunger.
BOOSTING YOUR METABOLISM

The most effective way to "boost" your metabolism is

through exercise, especially if you are dieting. Cardio training and
weight lifting exercise provides a protective effect against a drop in
metabolism. This is because people tend to lose a considerable
portion of muscle in calorie-reduction programs that don't include
strength training, whereas one of the main benefits from exercise in
weight loss programs is the preservation of muscle.
METABOLIC ACCELERATORS WORKOUTS

1. Maximize the weights workout: Researches show around 7

percent increase in resting metabolic rate after several weeks of
resistance training. The squat effect does not end here. Recent
studies have revealed similar elevations in resting metabolic rate (5
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to 9 percent) for three days following a single session of resistance

training, explains Wayne L. Wescott, Ph.D., in Sports Medicine
Reports.
To make the most out of your metabolism, heavy lifting is
needed. When you lift a dumbbell and do 8 to 10 reps struggling at
the last two reps you activate more fast-twitch fiber, which are the
ones that have the highest strength and power capabilities and way
less endurance. Studies show exercises that rely on these fibers,
such as sprint, plyometric moves, heavy lifting, etc., create higher
metabolic load compared to the slow-twitch fiberthe ones that
work the most in aerobic-endurance exercises.
Your plan: Resistance training increases epinephrine, dopamine,
and other catecholomines, which increases fat breakdown. To
maximize the sympathetic response and post energy expenditure
(the calories that your body burns after the workout ends) experts
recommend using high volume (eight multi-joint exercises, such as
push-press, pull-ups, dips, deadlift, and weighted squats ; 4 to 6
sets, and up to 10 reps each) and short rest intervals (30 to 90
seconds).
2. Mix cardio and weights: Working both your cardiovascular
system and muscles in the same session will make you burn more
calories during the 30-minute period after your workout. This is
due to increased oxygen uptake, and the more oxygen you
consume the more calories you burn and thus the more active your
metabolism. However, you have to properly mix the two.
In a study, published in The Journal of Strength and
Conditioning Research, subjects performed six resistance
exercises, 3 sets of 10 repetitions, with a 60 second interval rest.
They then cycled for 20 minutes (two minutes low intensity, one
minute high intensity) before, after, and in the middle of the
resistance training. The results showed that doing the cardio in
the middle provided the most metabolic impact postexercisemeaning your metabolism will stay on fire after the
exercise session has ended.
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Your plan: Choose six multi-joint exercises (squat, bench press,

leg press, lat-pull down, abdominals, and back extensions), which
you will perform 3 sets of 10 reps with a 60 second rest period.
After doing three of the exercises for the numbers of sets and reps
described, perform 20 minutes of interval-cardio as explained
above, and finish up with the remaining three resistance exercises.
3. Interval training to get more in less time: A study published
in the International Journal of Sports Nutrition and Exercise
Metabolism compared sprint-interval training (2 minutes long) to
continuous endurance training (30 minutes total) to measure
oxygen consumption during the exercise and then again after 24
hours. The results showed that sprint-interval training elicited 24hour oxygen consumption similar to continuous endurance
exercise. In other words, you got more benefits during a shorter
period of time.
Your plan: Select your favourite aerobic exercise and do intervals
of 30 seconds at high intensity, followed by 1 minute at low
intensity for recovery. Do a 5 minute warm-up and a 5 minute cool
down for a total of 20 minutes. The key here is for the high
intensity intervals to be tough where you can barely sustain the
pace for the time suggested.
4. Stretch it out: You may not always have the time to stretch, but
will it make a difference before your workout in terms of your total
caloric expenditure. When subjects did different dynamic
stretching exercises before running, they increased their caloric
burnt significantly compared with those that did nothing
beforehand. In addition, their average oxygen consumption and
flexibility increased.
Your plan: Before working out, perform five different dynamic
stretching exercises, such as toe heel walks, hand walks, different
angle lunges, and walking groaners (2 sets, 4 reps). Keep in mind
the exercises should be dynamic, which means not holding the
stretching position for set time. Static stretching should be reserved
at the end of the workout.

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Physical activity is also good for your mental health. Experts

believe that exercise releases chemicals in your brain that make
you feel good. Regular exercise can also boost your self-esteem
and help you concentrate, sleep, look and feel better.

"When I left the gym that morning I felt as if someone had given
me a million pounds it was the sense of achievement."
Being active doesnt have to mean going to the gym, taking up
jogging or wearing lycra. There are lots of ways to be active - and
they dont need to cost much money.As well as releasing natural
chemicals that improve your mood and make you feel happier,
having an active lifestyle can do more to help your mental health.
Taking part in physical activities offers many opportunities. Its
a great way to meet people. And it can be a chance to give yourself
a well-deserved break from the hustle and bustle of daily life to
find some quiet time.Leading an active life can help raise your
self-worth and improve your confidence. It can help you feel
valued and value yourself.Exercise and physical activity can
provide something worthwhile in your life. Something that you
really enjoy, that gives you a goal to aim for and a sense of
purpose.
Here are a few of the benefits:
less tension, stress and mental fatigue
a natural energy boost
improved sleep
a sense of achievement
focus in life and motivation
less anger or frustration
a healthy appetite
better social life
having fun.
You should aim to do 30 minutes of moderate exercise five times a
week. It may sound like a lot, but it isnt as daunting as it first
appears.
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Moderate exercise means being energetic enough so you:

breathe a little heavier than normal, but arent out of breath
feel warmer, but dont end up hot and sweaty.
You dont have to leap in at the full amount.
Build up slowly at a pace that suits you
You dont have to do a solid half hour either. Find three tenminute slots each day if that suits you or two quarter hours.
Getting Started
Once you have decided that you want to be more physically active,
there are a few points its worth thinking about. Apart from
improving your physical and mental well-being, what else do you
want to get out of being active?
Do you want to:
Make your daily life more energetic?
Be indoors or out?
Meet people?
Do a group or individual activity?
Try a new sport?
An active lifestyle doesnt necessarily mean doing a sporty
exercise, or limiting yourself to just one activity. A walk, doing
housework and gardening are all physical activities.
Make time
What time do you have available for exercise?
You may need to re-jig commitments to make room for extra
activities.
Alternatively, choose something that fits into your busy
schedule.
Be Practical
Consider any issues that could affect you.
Will you need support from friends and family?
Will your active lifestyle have an impact on others in your life?

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Find out how much it will cost and, if necessary, what you can
do to make it affordable.
Right For You
What kind of activity would suit you best?
Is there a specific part of your body you want to exercise?
Do you need to be more physically active at home?
Do you want a change of scene?
Do you like a structured activity that someone else has
organised?
Making It Part Of Daily Life
Adopting a more active lifestyle can be as simple as doing daily
tasks more energetically, or making small changes to your routine.
Here are a few suggestions.
At home
Walk the children or grandchildren to school, then jog home.
Push the mower with extra vigour.
Get an exercise DVD and use it!
Speed up the housework vac harder and faster till youre
warm.
Put on some music for a ten minute dance.
Apply some real elbow grease when cleaning the car.
When you do get a break, go for a swim.
At work
Time your daily walks to and from the train station. Can you
walk faster?
Use the stairs for journeys less than four floors.
Dont pick up the phone, walk to see a colleague.
Use your lunch hour take a brisk walk, do an exercise class or
go for a swim
Walk or cycle a slightly longer route home the change of
scenery will do you good too.
Stop at the gym on your way home.

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Out and about

Leave the car at home for short journeys.
Get off the bus a stop earlier, or get on a stop later.
Park at the far end of the supermarket car park, or walk to the
shops.
Join in with your childrens/grandchildrens games be part of
the football team.
Jog and walk the dog jog ten paces, then walk ten.
Join an exercise class at your community centre and meet
your neighbours.
OVERCOMING BARRIERS

It can be a bit scary making changes to your life. Most people get
anxious about trying something new. Practical and emotional
support from friends, family and experts really does help.
Fear of failure
Start with a beginners class then move on to the advanced group.
Set realistic targets start your new running schedule with a 1km
walk or jog, then increase gradually.
Responsibilities
Having children or being a carer can make time scarce. Who can
help give you a break? What services can you use, like a
community crche?
Money
Is cost a worry? Many councils offer discounted rates at gyms and
leisure centres. Alternatively, choose an activity that is cheaper.
Social anxiety
Joining a new group can be daunting, so ask a friend to go along
with you. If you are uncomfortable using communal changing
rooms, or with the clothing you need to wear, leisure centre staff
may have a solution. Otherwise try a single-sex gym or exercise
class.

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Feeling lost
If you cant find your way round the leisure centre, ask the experts.
Staffis there to help.
Transport
People at your activity class may share lifts, or try walking or
cycling. If you are eligible, use your council dial-and-ride service.
However you travel, always think how you will stay safe.
Overwhelmed
If life is getting on top of you, talk with your GP about how you
feel before you get active. GPs can prescribe an exercise scheme
where you are given free or discounted access to a range of leisure
facilities for a period of time.It could be anything from the gym to
belly dancing, depending what is available and suitable for you. A
referral officer provides you with support, motivation and advice
and there are interviews at key points to monitor how you are
getting on.
Staying on track
After the initial motivation, maintaining an active lifestyle can
have its challenges. Sometimes staying active is hard, both
physically and mentally but there are plenty of rewards.
Stress
This is a normal part of life. Keeping active can help you deal with
it. Remember, the natural chemicals that exercise produces can
help put a smile on your face.
Feeling low
When you feel down it can be hard to motivate yourself. Ask your
friends for some support. Or try a different activity if that helps.
Seasons
When the clocks change for winter that evening cycle might not be
so appealing or safe. Create a winter exercise plan. Try an indoor
activity where its warm and dry.
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Energy
Not all of us leap out of bed full of beans and ready for exercise.
Work with your energy highs and lows. Accept that some days its
best to take a break.
Injury or illness
Always ease back into your exercise routine take advice from
your GP if you need to. If an injury is going to be an on-going
problem, switch to a more suitable activity.
Rewards
There are many positive spins offs from being active. Enjoy the
ups give yourself a quiet pat the back or celebrate with others.
Loving life
Nothing can beat that natural high. Take a moment to recognise
how you feel more positive about yourself and life.
Sharing
Taking part in an activity with others chance to share what you are
thinking and feeling. Achieving a result together can bring real
feeling of satisfaction.
Time out
Maybe a half hour brisk walk gives you space to think about
things. Clear your head well as build your fitness!
Healthy life
Being active can make you start thinking about your general
health.
In the long run
Long term, staying active needs sustained motivation. Youll find
your own way of doing this with time and experience. Dont see
small setbacks as failures, just something to learn from.
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Record
Keeping an exercise record can be helpful. As well as noting what
you do, record how you feel. It can be a good way to remember the
ups. Work out how youll avoid repeating the downs.
Goals
Setting goals to measure progress might motivate you.
Use a cycle computer look to improve your average speed.
Push in an extra stomach crunch at circuit training.
Use a pedometer to measure how far you walk each day.
Swim an extra length.
How do you feel when you reach your goal? And what will your
new goal be?
If you didnt reach your goal, work out why. Was it unrealistic?
Were there influences outside your control, like bad weather? Or
do you need to try just a little bit harder?
Remember, you wont see improvement every day. Making the
regular commitment to doing physical activity is an achievement in
itself.

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Exercises Technique and Program Design

SPECIFIC ASPECT OF EXERCISE WHEN OBESE

Besides the obvious challenges of being overweight or obese in our

world, when it comes to exercise, plus-sized people have even
more obstacles getting in their way. My clients have shared some
of their experiences with exercise, such as:
Intimidation at the gym. Gyms can be scary even for the most
experienced exerciser. Walking into a room full of sweaty
exercisers, all of whom seem to know what they're doing, is
hard for many of us. My obese clients have mentioned how
much more humiliating it is when you're very overweight.
Confusion about cardio. Cardio exercise can be a challenge at
a gym. Some of the problems these clients have faced include:
Some machines are difficult to use or can cause knee or
back problems.
Swimming is a recommended exercise for obese people,
and while this is wonderful if you have a pool in your
backyard, what if you don't? Walking around in a bathing
suit causes instant panic for plenty of people, but even more
so if you're overweight or obese.
Recumbent bikes are another good option for obese people.
The problem is, many aren't built with big enough seats,
and climbing onto them can be a real challenge.
Walking. This is a simple exercise that can be done
anywhere, right? For people with joint or knee problems,
walking isn't always comfortable, and some of my clients
have even experienced name-calling and other rude
behavior when they've gone out for a walk.
Strength-training issues. These are just a few of the problems
my clients have encountered when they've tried strength training
at the gym:
Weight benches are too narrow and/or too tall for larger
bodies. Many seats on strength machines are too small for
larger behinds.
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Getting up and down from the floor is a workout all on its

own, and many supine exercises cause problems breathing.
Many clients carry weight around their bellies, which
makes some exercises impossible.
Traditional leg exercises, such as squats and lunges, are
difficult for people with knee problems. Balance is
sometimes an issue as well.
If I were queen of the world, I would wave my magic wand and
eliminate this obesity problem altogether. Until my magic wand
gets here, I've put together some ideas for people who need to be
more creative when it comes to exercise.
PRIVATE PERSONAL TRAINING

Personal training is an excellent option for anyone, but especially

for someone who's obese and looking to lose weight and get
healthy. However, because of the gym intimidation factor, there
are plenty of obese people who miss out on the opportunity to
work one-on-one with an expert. One option, if you want to avoid
the masses, is to work privately with a personal trainer. You can
opt for hiring a trainer to come to your home or work with a trainer
at a personal training studio. Some of the advantages of working
out at a studio include:
The ability to negotiate sessions and pricing. Many chain
gyms have a set price and set packages for personal training. If
you go through a studio, you may have more room to negotiate
pricing and even the length and frequency of your sessions.
Privacy. Most studios are small and often exist only to provide
personal training (though some may also offer group fitness
classes as well). At some, you can even request that they
schedule you at a time when no other trainers or clients are
there.
Experienced and educated trainers. Nothing against trainers
at health clubs, but having worked at one, you're more likely to
find more experienced trainers at a studio.

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One note -- not all personal training studios are alike, so do your
research. Visit different places before you make a decision, and
check the trainer's credentials and experience.Right now, there's
not a lot of equipment out there specifically for obese and/or
overweight people. While I believe that will change as the demand
grows, there are some options for people who prefer to exercise at
home. Below are some great products I often use with many of my
overweight and obese clients:
Recumbent Bikes And Cross-Trainers
Recumbent bikes are great for people who need support while they
exercise. One product on the market is the Recumbent Cross
Trainer, which offers an alternative to endless pedalling. This
machine is more like a stepper than a bike and it allows you to
work your upper body and lower body at the same time without
stressing your joints. It accommodates a variety of body types and
sizes, but it's also a bit pricey, so that's something to consider if
you're on a budget.You can also look into regular recumbent bikes
by checking out some reviews of the most popular brands. There
are companies that make larger bikesfor overweight or obese
people.
Exercise Ball
Many people think they may be too big for an exercise ball, but if
you're overweight, you can still safely use an exercise ball for
exercise. Just double check the specifications of the ball you buy to
check the weight limits and make sure it's an anti-burst ball
(compare). An exercise ball can help you work on balance, stability
and abdominal strength. Some of the basic exercises you can try
include sitting on the ball (try watching TV for a while and you'll
feel your body working a little harder than usual), marching, or
balancing by lifting one foot off the floor, holding, and then lifting
the other foot. Try this Beginner Ball Workout for more ideas.

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Portable Pedlar (Compare Prices)

I use a pedal exerciser much like this with one of my clients, and
she gets a great cardio workout without having to try to manoeuvre
herself onto the recumbent bike. They do have some fancier
models out there, but this one works just as well and you can adjust
the tension to make it easier or harder to pedal. With my client, I
simply have her pedal for as long as she can, rest, and then repeat 5
or more times. We keep track of her revolutions each week to track
her improvement. (For the record, she started out with about 150
revolutions and she's now at well over 500.) You can pedal with
your hands if you're not able to use your feet, which is another way
to get your heart rate up and work on your cardio endurance.
Pedometer
If walking is your exercise of choice, a pedometer can be very
motivating. One of my clients spends much of her daylight hours
sitting in front of a computer at work. Though she did great in her
personal training sessions, it was hard to get her to be more active
in her daily life. We finally got her a pedometer and a journal and
gave her a goal of getting in at least 50 steps every hour. She set an
alarm to go off every hour, slapped on her pedometer and took a
walk around the building. It was hit-or-miss at first, but now she
walks well over 100 steps an hour and she's more productive now
that she gives herself a break. She's lost 50 pounds with diet and
exercise, and having that pedometer was just one part of her
success.
You can also do this Seated Full Body Workout, a complete
total body workout using resistance bands, dumbbells and a
medicine ball that can be done from a seated position.If you're
obese or overweight, you sometimes have to be creative when it
comes to exercise. There are many people talking about exercise
and urging you to do it, but they aren't telling you exactly what to
do if you can't do traditional exercises. The key is to find
something that is comfortable for you, something you enjoy and
something you'll continue to do over time. Remember to get
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checked out by your doctor before you begin exercising, especially

if you have any health conditions or are on any type of medication.
TIPS TO GET STARTED WITH EXERCISE

Start Small: Exercise is not an all or none endeavour. It is a

continuum. Keep in mind that a little is better than none and you
can do something today, so dont worry about what you will do
next month. This perspective is hard for anyone who expects a
lot from themselves and sets long-term fitness goals. Dont
expect results overnight. But do expect to take small steps every
day.
Start Where You Are: Your exercise program doesn't need to
be elaborate. It doesnt require you to join a gym or sweat for an
hour every day. Look at your current routine and you may
discover you already walk 15 minutes at a time taking the dog
around the block or walking to the store for milk. Thats
exercise. You can use that as a jumpstart and add another 5
minutes or walk at a faster pace -- start from where you are.
Go Low Tech:Technology is a wonderful thing, but much of it
reduces us to very lazy people. If you want to fit activity into
your daily life, just go low-tech and you will probably burn
another few hundred calories a day. Walk or ride your bike for
errands, take the stairs, mow your lawn with a push mower, give
up your television remote and actually get up to change the
channel, walk down the hall to your co-workers office rather
than calling.
Surround
Yourself
with
Good
Role
Models:
If all your friends are couch potatoes, odds are you will have a
hard time becoming active while hanging out with them. If you
surround yourself with people who are healthy and active, odds
are it will be easy for you to stay active as well. Peer pressure is
a wonderful thing if you use it in positive ways!
Set Weekly Goals:Check in with yourself each week by setting
attainable, yet realistic goals. Try to set a plan to go faster,
farther or longer with your routine. You can even set nutrition
goals such as getting 5 servings of fruit and vegetables each
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day. Your goal can be as simple as taking a daily 15 minute

walk or as intense as completing your first marathon. Only you
know what is realistic for you.
Try Something New:If you always try to start a walking
program, and always drop out after a few weeks take heart. It
may not be the exercise you cant stick with but the type of
exercise. You may need to try a variety of activities before you
find one that you really like and want to do long-term. Sign up
for a yoga class or snowboarding lesson. Try running or biking
instead of walking, go with others or go alone, try exercising at
different times of the day. Keep your options open and find
exercise you enjoy so you never view exercise as a chore. It
should be fun and fulfilling!
Write it Down:Keep an exercise log book. Simply writing
down what you did, how long and how you felt can be great
motivation. Not only can you view your progress and look back
at your accomplishments, but you can plan ahead and decide
where you want to be in a week, a month or more.
Psychology of Exercise:Some people enjoy being distracted
while exercising while others prefer to pay attention to how
their body feels while exercising. Try both tactics and see what
works best for you. If you're new to exercise, being distracted
by music, television, reading material, conversation or a
personal trainer may help you stick with it. After you've been
exercising a while it may be helpful to pay attention to your
body sensations. Athletes often focus on their breathing,
cadence or body movement to stay focused.
Make Exercise Part of Your Daily Routine:Rather than trying
to go to the gym, or squeeze in more time for exercise look for
ways you can add exercise to what you already do. Walk the
dog, bike to the store or to work, do crunches or push-ups
during commercials, pedal your exercise bike during your
favorite TV show, meet friends for walking dates rather than
dinner & drinks. If you are creative, you will realize you dont
need to change your routine much to fit exercise into your life.

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Find a Buddy:Even if this person doesnt exercise with you, let

someone know of your plans and goals to help support your
efforts. Making yourself accountable to another is a great way
to keep you honest about your success and challenges with
starting a new exercise program.
Make Exercise a Priority:If your exercise plans and goals are
at the bottom of your priority list, you will never reach them.
Period. You have to believe that this is important enough to
make it happen. Take a serious look at your words, desires and
behaviour. Do you always talk about wanting to get active, but
never actually do anything about it? If so, you are only fooling
yourself and continuing the cycle of helplessness. Get honest
with yourself about what you really want and how much you are
willing to work to make it happen. Youll be surprised how easy
it falls into place once you put your energy into action rather
than excuses.
TYPES OF EXERCISES

Exercise and physical activity fall into four basic categories

endurance, strength, balance, and flexibility. Most people tend to
focus on one activity or type of exercise and think they're doing
enough. Each type is different, though. Doing them all will give
you more benefits. Mixing it up also helps to reduce boredom and
cut your risk of injury.
Though weve described each type separately, some activities
fit into more than one category. For example, many endurance
activities also build strength. Strength exercises also help improve
balance.
Aerobic Exercise
Aerobic means "with oxygen", and refers to the use of oxygen in
the body's metabolic or energy-generating process. Many types of
exercise are aerobic, and by definition are performed at moderate
levels of intensity for extended periods of time. This intensity can
vary from 50-80% of maximum heart rate.
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There are various types of aerobic exercise. In general, aerobic

exercise is one performed at a low to moderate level of intensity
over a long period of time. For example, running a long distance at
a moderate pace is an aerobic exercise, but sprinting is not. Playing
tennis, with near-continuous motion, is generally considered
aerobic activity, while doubles tennis, with their brief bursts of
activity punctuated by more frequent breaks, may not be
predominantly aerobic.
Endurance, or aerobic, activities increase your breathing and
heart rate. They keep your heart, lungs, and circulatory system
healthy and improve your overall fitness. As a result, they delay or
prevent many diseases that are common in older adults such as
diabetes and heart disease. Building your endurance makes it easier
to carry out many of your everyday activities.
Brisk walking or jogging
Yard work (mowing, raking, digging)
Dancing
Swimming
Biking
Climbing stairs or hills
Playing tennis
Playing basketball
Strength Exercises
Strength exercisesmake your muscles stronger. Even small
increases in strength can make a big difference in your ability to
stay independent and carry out everyday activities, such as
climbing stairs and carrying groceries. These exercises also are
called "strength training" or "resistance training."
Lifting weights
Using a resistance band

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Balance Exercises
Balance exercises help prevent falls, a common problem in older
adults. Many lower-body strength exercises also will improve your
balance.
Standing on one foot
Heel-to-toe walk
Tai Chi
Flexibility exercises
Flexibility exercises stretch your muscles and can help your body
stay limber. Being flexible gives you more freedom of movement
for other exercises as well as for your everyday activities.
Shoulder and upper arm stretch
Calf stretch
Yoga
PRINCIPLES OF EXERCISES (AEROBIC, STRENGTH AND
FLEXIBILITY)

The FITT principle as a set of rules that must be adhered to in

order to benefit from any form of fitness training program.
The ACSM defines the four components of fitness, the FIT
Principles, as follows:
1.Cardiorespiratory: The ability of the heart to pump blood and
transport nutrients such as oxygen to and from the working muscle
fibers and the rest of the body
2.Muscular: Muscular strength and endurance
3.Flexibility: The ability of the joint to move through the full
range of motion
4.Body Composition: Body fat percent and lean mass percent
Cardiorespiratory training is aerobic exercise, which "burns"
carbohydrates with oxygen, so it also "burns" stored body fat to
produce energy.
Muscle training is anaerobic exercise, which "burns"
carbohydrates without oxygen to produce energy. It yields lactic
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acid as a byproduct, which causes that "burning sensation" and

fatigue in the muscles.
Muscular strength is power which equals force times velocity,
usually 1 repetition maximum.
Muscular endurance is the ability to repeat many repetitions,
usually 12 to 30.
These rules relate to the Frequency, Intensity, Type and Time
(FITT) of exercise. These four principles of fitness training are
applicable to individuals exercising at low to moderate training
levels and may be used to establish guidelines for both
cardiorespiratory and resistance training.The FITT principle is
used to guide the development of unique and bespoke fitness plans
that cater for an individual's specific needs.
FREQUENCY

Following any form of fitness training, the body goes through a

process of rebuild and repair to replenish its energy reserves
consumed by the exercise.The frequency of exercise is a fine
balance between providing just enough stress for the body to adapt
to and allowing enough time for healing and adaptation to occur...
1.
CardioRespiratory
Training:The
guidelines
for
cardiorespiratory training (also called aerobic conditioning) is a
minimum of three sessions per week and ideally five or six
sessions per week.Experts suggest that little or no benefit is
attained over and above this amount. Of course athletes often fall
outside the suggested guidelines but even elite performers must
give themselves time to rest.
2. Resistance Training:The frequency of resistance training is
dependent upon the particular individual and format of the
program. For example, a program that works every body part every
session should be completed 3-4 days a week with a day's rest
between sessions.
On the other hand, aprogram that focuses on just one or two
body parts per session, in theory you could be completed as
frequently as six days per week. Many bodybuilders follow such a
routine.Remember though, each time you complete a strenuous
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strength training session (regardless of the body part) you are

taxing your body as a whole - including all the physiological
systems and major organs.
INTENSITY

The second rule in the FITT principle relates to intensity. It defines

the amount of effort that should be invested in a training program
or any one session.
Like the first FITT principle - frequency - there must be a
balance between finding enough intensity to overload the body (so
it can adapt) but not so much that it causes overtraining.
Heart rate can be used to measure the intensity of
cardiorespiratory training. Workload is used to define the intensity
of resistance training.
1. Cardio Respiratory Training:Heart rate is the primary
measure of intensity in aerobic endurance training. Ideally before
you start an aerobic training program a target heart rate zone
should first be determined. The target heart rate zone is a function
of both your fitness level and age. Here's a quick method for
determining your target heart rate.
Heart Rate & Maximum Heart Rate
Heart rate is measured as beats per minute (bpm). Heart rate can be
monitored and measured by taking your pulse at the wrist, arm or
neck. An approximation of maximum heart rate (MHR) can also be
calculated as follows: MHR = 220 - age.
Target Heart Rate
For beginners a target heart rate zone of 50-70 percent of their
maximum of heart rate is a good place to start. So if, for example,
you are 40 years old that gives you a predicted maximum heart rate
of 180 (220 - 40). Multiply 180 by 50% and 70% and your reach a
target zone of 90bpm - 126bpm.
For fitter, more advanced individuals, a target heart rate zone of
70-85 percent of their maximum of heart rate may be more
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appropriate. Staying with the example above, that 40 year old now
has a heart rate zone of 126bpm - 153bpm.
There are limitations with heart rate and the heart rate reserve
method, while no means flawless, may be a more accurate way to
determine exercise intensity.
2. Resistance Training:For resistance training, workload is the
primary measure of intensity. Workload can have three
components:
1. The amount of weight lifted during an exercise.
2. The number of repetitions completed for a particular exercise.
3. The length of time to complete all exercises in a set or total
training session.
So, you can increase workload by lifting heavier weights. Or you
could increase the number of repetitions with the same weight.
Finally, you could lift the same weight for the same number of
repetitions but decrease the rest time between sets.However, only
increase the intensity using one of the above parameters. Do not
increase weight and decrease rest time in the same session for
example.
Type
The third component in the FITT principle dictates what type or
kind of exercise you should choose to achieve the appropriate
training response.
Cardio Respiratory Training
Using the FITT principle, the best type of exercise to tax or
improve the cardiovascular system should be continuous in nature
and make use of large muscle groups. Examples include running,
walking, swimming, dancing, cycling, aerobics classes, circuit
training, cycling etc.
Resistance Training
This is fairly obvious too. The best form of exercise to stress the
neuromuscular system is resistance training. But resistance training
does not necessarily mean lifting weights. Resistance bands could
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be used as an alternative or perhaps a circuit training session that

only incorporates bodyweight exercises.
TIME

The final component in the FITT principle of training is time - or

how long you should be exercising for. Is longer better?
Cardio Respiratory Training
Individuals with lower fitness levels should aim to maintain their
heart rate within the target heart rate zone for a minimum of 20-30
minutes. This can increase to as much as 45-60 minutes as fitness
levels increase.
Beyond the 45-60 minute mark there are diminished returns. For
all that extra effort, the associated benefits are minimal.This also
applies to many athletes. Beyond a certain point they run the risk
of overtraining and injury. There are exceptions however typically the ultra-long distance endurance athletes.
In terms of the duration of the program as a whole, research
suggests a minimum of 6 weeks is required to see noticeable
improvement and as much as a year or more before a peak in
fitness is reached.
Resistance Training
The common consensus for the duration of resistance training
session is no longer than 45-60 minutes. Again, intensity has a say
and particularly gruelling strength sessions may last as little as 20 30 minutes.
Perhaps the most important principle of training (that ironically
doesn't have it's own letter in the FITT principle) is rest. Exercising
too frequently and too intensely hinders the body's ability to
recover and adapt. As a rule of thumb, the harder you train, the
more recovery you should allow for. Unfortunately many athletes
don't have that luxury!

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SPORTS TRAINING PRINCIPLES

The FITT principle is designed more for the general population

than athletes.
Sport-specific training should be governed by a more in-depth set
of principles. These include:
Specificity
Overload
Adaptation
Progression
Reversibility
Variation
OPTIMUM TARGET HEART RATE FOR FAT BURNING

When you want to lose weight, cutting fat and calories are only
part of the story. Starting and following a consistent exercise
program will burn away calories. In addition, regular exercise
improves your health and physical fitness. Your fat-burning target
heart rate zone is a guide you can use to make sure you are
working out in a safe and effective manner.
Identification
A target heart rate zone defines a range of heart rates or heartbeats
per minute appropriate for achieving particular Physical fitness
goals. According to the Walking Site, a heart rate of 60 to 70
percent of your maximum heart rate is best suited for fat burning.
If you exercise with less intensity, you will still burn fat and
calories, but not as
much.
Calculation
To figure your fat-burning target heart rate zone, you first need to
estimate your maximum heart rate, or MHR.
If you're male, subtract your age from 220 to estimate your MHR.
If you're female, subtract your age from 226.
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For example, a 40-year-old man's MHR would be 180 beats per

minute. Since the fat-burning target heart rate
zone is 60 to 70 percent of MHR, he would aim for a heart rate of
108 to 126 beats per minute.

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HERBAL AND NATURAL WEIGHT REGULATORS

There are a lot of food and drinks that we can take to suppress
unhealthy cravings, giving us an upper hand in maintaining our
ideal weight and ultimately, our health, just made a decision to eat
healthy.Your favourite junk food presents itself as you walk along
and see that donut place. The impact is deep. You keep thinking
about it.
All of a sudden, its the most important food in the world.
Nothing else matters, nothing just cant seem to take its place. You
have to have that sweet stuff of refined flour, refined sugar, and the
trans fat that composes about half of it. You know you just ate so
you cant really be physiologically hungry. You know this is
something else. And youre right. Its one of the most vicious
enemies of dieters, weight watchers, and a lot of people dealing
with metabolic disorders. Its called cravings.
Here are some of them:
Eggs (boiled).They are ready form of available proteins,
comparable to meat with less the calories. They are relatively
easy to digest and give you that sense of fullness for a relatively
longer period of time. It satisfies our cravings for anything
meat.
Avocado. Rich in good fat and low on saturated fats, it also has
fibers that add to the sense of feeling full. It provides vitamins
and minerals so the body doesnt feel malnourished. Lack of
nutrition is one of the strongest reasons why the body generates
cravings.
Almonds. Another source of protein, healthy fats, and vitamins
and minerals, which makes them ideal for regulating cravings
while keeping the body nourished. Their ability to help manage
weight is supported by clinical data.
Ginger. Ginger has been used traditionally as a digestive aid.
By improving digestion, it makes food absorption better and
helps make you feel full longer. And it has a lot of medicinal
benefits, too!
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Cayenne (and members of the chili family). Cayenne raises

metabolism enough to burn calories, making more energy
available for the body. This in turn lessens the need of the body
to eat more and appetite is suppressed. Cayenne is a mainstay in
natural weight management protocols.
Lettuce. It is one of those negative-calorie foods. The calorie
they provide is less than the calorie used up by the body to
digest them. You actually lose calories by eating them. They are
also rich in fibers that delay absorption and make you feel full
longer.
Coffee. There is now an overwhelming number of studies that
prove the healthy benefits of coffee. They aid in weight
management by regulating appetite, increasing metabolism, and
improving the function of the heart, liver, and kidneys.
Water. There is no credible list of natural appetite suppressants
that does not involve water. Not only does it give you a sense of
fullness, it also facilitates the digestion and absorption of food
and the assimilation of their nutrients to the body. This
facilitates the bodys sense of being nourished and lessens the
cravings.
Many people turn to the best herbs for weight loss as a natural way
to help them reduce fat.For those who want natural help to lose
weight it is only natural to seek herbal remedies that may help with
dieting. In addition to eating plenty of foods from our
complete list of healthy foods adding certain herbs to your daily
diet can amplify your fat loss. The reason being is that most people
trust nature over man-made supplement that are often made of
chemicals and compounds that we have never heard of and are
crazy difficult to pronounce.Not exactly the kind of stuff some
people are comfortable putting into their body to be filtered
through their liver no mater how effective they may be.
For those of you who would rather put your trust in mothernature than some unknown chemist and quake-duck scientist, we
will explore some of the best herbs to help burn fat.Still, keep in
mind that not all these herbs have been tested by the FDA. Some
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have been tested by various medical studies. Some may have been
used by other countries traditional medicine such as China. So do
some further reading on any of these that peak your interest and
come to your own conclusion about their effectiveness and safety
factor.
The FDA is not the end-all be-all of nutritional
information. They seem to be more concerned with testing various
pharmaceuticals rather than natural health solutions. Meds are
where the big profits are and consequently thats where the most
government activity is.What the FDA will come through with is in
pulling an unsafe herbal supplement off the market. So although
they may not have approved a certain herb as effective for a
certain use, they do their best to keep the public safe from harmful
herbs. Personally, I wish they would do a little more testing to see
what kind of positive effects different plants have as well.
Keep in mind that taking any supplement or herb without the
accompanied lifestyle change (proper nutrition, rest and recovery,
and fitness program) can help to an extent but it will not be
nearly as effective as making a total behavior alteration which
leads to a body transformation. For every action there is an equal
reaction so you have to put in the work to get the results.
THE BEST HERBAL AIDS FOR WEIGHT LOSS
Bitter Orange: People use this supplement as an alternative to
the banned ephedra. It works in a similar manner, basically by
acting as a stimulant. And being a strong stimulant it carries
many of the same risks as ephedra. It has not been researched
very thoroughly at this time.
Guarana: Guarana stimulates your nervous system, helps with
stress, and can aide people with depression. Due to its known
properties of helping your emotional state it can also help
prevent you from making emotional eating decisions which is a
huge plug. Additionally it is a diuretic which will not really
help you lose fat per se but it can be a useful benefit of this
herbal supplement if you have problems with water retention.
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Dandelion: Dandelions dont just grow in your otherwise

pristine green yard, they also have a great effect on your
body. They act as a minor diuretic and help lower
cholesterol. Add to that the fact that they contain quite a few
vitamins and minerals and help your body get rid of fatty acids
and you really have no excuse not to add some dandelion greens
to some soup or salad. You can even make tea with them or
buy them in droplet form.
Guar Gum: When eating guar gum you are much less likely to
over eat because this gum has a ton of fiber which keeps you
feeling full and less likely to overeat. This derivative of the
Indian Cluster Bean is also known to help with diabetes and
decrease LDL (your bad Cholesterol.)
Hoodia: An herb from the African Kalahari Desert that is
claimed to aid fat loss by acting as an appetite
suppressant. Apparently the local tribesman would use it
suppress their hunger and thirst for long hunts.
Ginseng: Siberian Ginseng (EleutherococcusSenticosus) in
particular is a great substitute for pick me up quality of
coffee. Throw some in your tea and enjoy the increase of
stamina and decreased fatigue. You will notice more energy
when you go to work out as well as more regular blood sugar
levels which both indirectly help you lose fat.
Flaxseed: Can be used as a bulking agent when you soak
them in water before eating them. The water makes the
mucilage coating of whole flaxseeds expand and neither the
seed nor thier coating are well-absorbed by your
stomach. Again like some of the other fat loss herbs listed here,
this can elp you lose fat because of the full feeling it produces
with very few calories.
Ginger: Ginger is not just an something to take when you get a
cold. It is also useful for reducing acidity in your stomach by
making it more alkaline. The high fiber content of Ginger will
also help clean your digestive system and produce a more filling
feeling.

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Cinnamon (CinnamomumVerum): By helping to regulate

your blood sugar levels and your cholesterol cinnamon
indirectly helps you fight some of the fat by keeping more from
accumulating on your body. Basically it is helping your body
digest whatever fat you consume by helping your liver process
it more efficiently. Try using it in your coffee or tea instead of
sugar. You can also take it in a capsule format. Since it helps
regulate blood sugar it will be most useful for herbal weight loss
if you take it prior to eating your meal.
Green Tea Extract or Green Tea: Green Teas helps you to to
lose weight by boosting your metabolism and decreasing your
appetite. It does this through a class of antioxidants called
catechins. Aside from helping with fat loss, green tea also has
the added benefit of killing free radicals. What other
supplement decreases your chance of getting cancer while
burning fat at the same time? Pretty cool supplement. I would
recommend getting the decaffeinated Green Tea Extract
capsules so that you can get the proper dosage to be useful
toward fat loss without the jittery side effects. Green tea extract
comes in both liquid and capsule form. Find out more about
green teas many benefits beyond dieting purposes here.
Glucomannan: Glocomannan helps you lose weight by
slowing glucose (sugar) absorption by your intestines. This is a
relatively new supplement and it does not yet have much
research about it.
Laminaria: Laminarai is a natural thyroid regulator. If you
gained some weight due to an hypoactive (under-active)
Thyroid then Laminaria may help you lose some fat indirectly
by helping your Thyroid function more efficiently again.
Ephedra: Remember this one? It was banned from sale in the
US a few years back because of its supposed dangerous side
effects? Well these were likely due to people taking the wrong
dosages and the FDA flipping out as they often due before the
proper investigations into these relateddeaths were preformed
and long term studies conducted. According to the FDA
ephedra was responsible for people having very adverse side
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effects including stroke, psychosis, heart attacks, and death.

Because of this the FDA decided the risks outweighed the
benefits and prohibited ephedra in the US. However if you live
elsewhere in the world you may still be able to get your hands
on this herb.
Psyllium
Cayenne Pepper
Black Pepper
Mustard
Turmeric
Cardamom
Cumin
Guggul
Senna: Some people use Senna to help with weight loss but it is
really a laxative. The FDA has actually approved it as a
laxative. I suppose you could count that as a very short term
weight loss supplement, but dont count on using it in the long
term for this purpose because it can throw your bowels out of
whack.
GymnemaSylvestre: This comes from a plant that grows in
Africa and India. It does its magic by tricking your taste
buds. Apparently it works by binding to the receptors on the
taste buds so that you cannot taste sweets very well (This effect
is not permanent.) This has been demonstrated in people to
reduce the amount of sweets they consume which can in-turn
help with weight loss. Try consuming 300 milligrams 2 3
times a day spaced out before meals.
Water: Okay, I know, I know Thats not really an herb but I
wanted to add it here because its one of the simplest things you
can do to help you shed fat. Simply drink more water so your
body can work like it should! Many of these herbs may also
increase your need for water since some of them increase your
metabolism and have diarrheic effects so be sure to fuel your
finely tuned machine with the fuel that it craves H2O!

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Some more natural and herbal supplements like

Psyllium,Cayenne Pepper,Black Pepper, Mustard, Turmeric,
Cardamom, Cumin, Guggulalso are used.
Other Natural Supplements For Weight Loss
Chitosan: Chitosan is a strange supplement. Why is it
strange? It comes from the outer layers of shrimp, crabs, and
lobsters exoskeletons! It has been shown in some studies to
limit the absorption of fats and cholesterol and therefore aide in
weight loss. Some medical authorities on the other hand have
claimed that it is probably ineffective.
Chromium Picolinate: There have been some claims that
supplementing with Chromium can help with weight loss since
chromium plays an important role in the effectiveness of
insulin. Insulin is the hormone that regulates blood sugar and is
involved
with
fat
storage
and
digestion
of
carbohydrates. Logically it would make sense that this would
help with fat reduction however a recent study has show this not
to be the case and other smaller studies have even found that it
has the potential of leading to kidney or liver failure.
Conjugated Linoleic Acid (CLA): This is a popular fatty acid
used by some to help stave off hunger and indirectly help with
weight loss. Some studies have found that it helps reduce BFM
(Body Fat Mass) and increase LBM (Lean Body Mass) when
supplemented at 0.7 4.5 grams daily. However, some research
has also suggested that when used long-term it may lead to
increased insulin resistance especially in people who already
have obesity. This causes concern that it can lead to an
increased risk of Type II diabetes for already obese users when
used continually.
Fish Oil: Alright, alright, I know you are probably wondering
how fish oil which contains omega 3 fatty acids can help you
lose fat? Well somehow having more of these hear healthy fatty
acids in your system make your body burn more fat for fuel
rather than only storing it. It may also help by helping to reduce
cravings for more dietary fat. The recommended dose to help
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with fat loss is 1000 2000 milligrams per day. And if you are
Vegan or are concerned about metal content in fish oil then
there are alternative omega 3 capsules derived from other
sources such as algae or krill and several others.
L-Glutamine: Has been shown to help reduce cravings which
can aid in fat loss. In order to achieve this effect it should be
taken throughout the day in-between meals? Why? Because as
you get hungry your brain begins to crave this amino acid for
fuel. When you blood sugar drops in-between meals and even
more so if you are dieting, your brain sends signals to your body
to do something about its lack of nutrients. The result? You
start craving chocolate bars, potato chips, or whatever other
junk food you see first when the cravings hit. Take 500
milligrams three times a day in-between meals. You can get LGlutamine in either powder format to add to a drink or in a
capsule.

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NUTRITIONAL SUPPLEMENTS AND FAD

DIETS

FAD DIETS AND DIETARY SUPPLEMENTS FOR

WEIGHT LOSS

The idea of "fast and easy" weight loss appeals to everyone. For
those of us who have a long history of trying to lose weight or
whose lives and health are being affected by our weight, the
promise of 'fast and easy' weight loss is almost irresistible. We are
constantly looking at magazines showing celebrities boasting they
are using the latest "fad" diet and can understandably think that if
we try this, we too can look like them! If only it were that simple!
There are countless Fad Diets and Diet Supplements that claim
rapid and prolonged weight loss. However we really need to look
at the evidence behind these claims. When looking at the evidence,
we need to find out if they are medically and nutritionally safe?
Always ask a doctor or qualified dietitian for their opinion if you
have concerns.
A
recent
medical
journal
reviewed
several diet
supplements that are currently used for weight loss. The results
are worrying. It was found that some of the ingredients used in
these supplements could be harmful eg. ephedra or ephedrine can
double or treble the risk of developing psychiatric symptoms,
stomach problems and heart palpitations. In general the evidence
for these weight loss diet supplements is not very strong hence
their use is not recommended.
The American Heart Association "declared war" on crash diets
as they - "can undermine people's health, are monotonous so can't
be followed for long, cause physical discomfort, and lead to
disappointment when people regain the weight soon after." If we
think about it, all diets 'work'. Any diet, no matter how bizarre, that
provides a set of rules, which makes people consume less calories
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than they need, will result in weight loss. But are they healthy, can
the dietary changes be maintained &do they help people keep the
weight off? Fad diets do not teach a person how to make healthy
food choices necessary for long-term weight loss. Nearly all
dietitians agree that eating foods from all food groups is essential
for good health and efficient weight loss. Many fad diets are
unhealthy because they may not provide all the nutrients the body
needs.
Caution!
Diets that contain less than 800 kcals per day (or <12kcals/kg of
Ideal Body Weight [IBW] per day)- these are called Very Low
Calorie Diets or VLCDs and need to be done under medical
supervision as they can result in heart rhythm abnormalities,
which can be fatal. Common side effects include: fatigue,
weakness, dizziness, constipation, hair loss, dry skin, brittle
nails, nausea, diarrhoea, changes in periods, oedema, and cold
intolerance. For more information, see factsheet on VLCD's.
Diets that are short-term yet claim to offer significant weight
loss- the truth is, the faster we lose weight, the more likely it is
to be water-weight and thus the quicker it's regained.
Weight loss diets that recommend certain foods for their
'special' fat-burning or metabolic qualities- eg. cider vinegar, or
so-called 'negative calorie foods'- unfortunately, there are no
foods that possess these miraculous weight loss properties.
Be suspicious of words like "breakthrough," "miracle," and
"secret ingredient."
Examples of Fad Diets
Type
Examples
Low carbohydrate diets Atkins,
Scarsdale

Low GI diets

The GI diet

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Evidence
Zone, Some weight loss by
limiting food intake.
Worries regarding lack
of some nutrients i.e.
fibre and calcium
Relatively
balanced
diet. Ideally get a

Food Combining

Blood Type Diet

Detox diets

Single food diets

dietitian to advise you

or recommend a good
book
Fit for Life
No evidence other than
it works by limiting
food intake
Eat right 4 your type No controlled trials to
support this
The Master Cleanse Very strict usually limit
to fruit and vegetables
danger if followed long
term
due
as
nutritionally inadequate
Cabbage soup diet, Based on one food only,
Grapefruit diet
weight loss is due to
limiting other foods.
Danger- if followed
long term as they are
nutritionally inadequate

FAD DIETS

Every year a variety of nutritionally imbalanced, unhealthy diets

are circulated among those looking to lose weight. The diets all
promise quick weight loss. Many of these diets, including the
infamous cabbage soup diet, can actually undermine your health,
causing physical discomfort and frustration when you gain all the
weight you lost back. In INDIA, over sixty-four percent of the
population is estimated to be overweight; with thirty percent
estimated as obese. Obesity increases the risk for developing many
chronic disease states, including heart disease, hypertension,
stroke, diabetes, and elevated cholesterol and triglyceride levels.
How to Recognize a Fad Diet?
The American Heart Association (AHA) has declared war on fad
diets. AHA suggests using the following criteria to recognize a fad
diet.
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Magic or miracle foods that burn fat. Foods dont burn fat. If we
eat more than we need (too many calories), the extra food
energy is stored as fat.
Bizarre quantities of only one food or type of food. All foods
can be a part of a healthy diet. But eating large quantities of one
food could lead to intestinal gas, bloating, flatulence and bad
breath, as well as nutritional imbalances that could have a
serious impact on your health. Emphasizing only one food or
food type is also boring.
Rigid menus. Some fad diets allow a very limited selection of
foods which must be eaten exactly as written and at a specific
time and day. These limited diets dont allow for the taste
preferences of a diverse Indian population.
Specific food combinations. There is no scientific evidence that
eating foods in certain sequences or combinations has any
scientific or medical benefit.
Rapid weight loss of more than two pounds a week can be
dangerous over a long period of time.
No health warning for individuals with chronic diseases such as
diabetes or high blood pressure to seek medical advice before
going on the diet. Some fad diets can have a serious impact on
your health even if you lose weight.
No increased physical activity. To lose and maintain weight
loss, physical activity needs to be an integral part of the diet
plan.Popular Fad Diets Low- and no-carbohydrate
dietsrecommend a high intake of fat or protein but a very low or
no intake of carbohydrate. Examples include:
The South Beach Diet
The Complete Scarsdale Medical Diet
The Grapefruit Diet, also called the Magic Mayo Diet or Mayo
Clinic Diet
The 3-Day Diet
The Dr. Atkins Diet Revolution
Dr. Sears Enter the Zone Diet.

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These diets are popular because a rapid weight loss occurs right
away. Unfortunately, fat is not what is lost; water is. When the diet
is discontinued, the body corrects the water imbalance causing
weight gain. Normally, carbohydrates are used as the bodys main
source of energy. Excess carbohydrates are converted to fat and
stored as fat tissue. On a low- or no-carbohydrate diet, instead of
using carbohydrates as the energy source, fats from foods and fats
stored in the body are used for energy. But, the body needs
carbohydrates to completely oxidize the fat.
The short supply of carbohydrate causes the fat to breakdown
incompletely, forming ketone bodies. To rid the body of these
toxic ketones, large amounts of water is excreted. Extra water is
then needed to avoid dehydration. When the body produces more
ketones than the kidneys can get rid of, ketones accumulate in the
blood.
Popular Fad Diets
Low- and no-carbohydrate dietsa high intake of fat or protein but a
very low or no intake of carbohydrate. Examples include:
The South Beach Diet
The Complete Scarsdale Medical Diet
The Grapefruit Diet, also called the Magic Mayo Diet or Mayo
Clinic Diet
The 3-Day Diet
The Dr. Atkins Diet Revolution
Dr. Sears Enter the Zone Diet
These diets are popular because a rapid weight loss occurs right
away.
Unfortunately, fat is not what is lost; water is. When the diet is
discontinued, the body corrects the water imbalance causing
weight gain. Normally, carbohydrates are used as the bodys main
source of energy. Excess carbohydrates are converted to fat and
stored as fat tissue. On a low- or no-carbohydrate diet, instead of
using carbohydrates as the energy source, fats from foods and fats
stored in the body are used for energy. But, the body needs
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carbohydrates to completely oxidize the fat. The short supply of

carbohydrate causes the fat to breakdown incompletely, forming
ketone bodies. To rid the body of these toxic ketones, large
amounts of water is excreted. Extra water is then needed to avoid
dehydration.
DIET AIDS

Diet aids are readily available and examples include:

Dexatrim
Caffeine Pills
Ephedrine
Redux
Phen/Fen
There is no scientific data to support claims that weight loss from
diet aids is permanent. Some appetite suppressants contain caffeine
and phenylpropanolamine (PPA). According to AMA, risks
associated with PPA include temporary dramatic elevations of
blood pressure, dizziness, nervousness, nausea, and insomnia. The
Food and Drug Administration (FDA) has requested that PPA be
removed from the market.

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MEDICATIONS
OVER-THE-COUNTER WEIGHT LOSS PRODUCTS
AND HERBAL REMEDIES

Most over-the-counter medicine for weight-loss consists of

appetite suppressants. They work by "tricking" the body into
thinking that it is not hungry. This can be effective; however, longterm use can lead to addiction and may cause health problems. In
addition, weight loss only occurs while you are taking the
medicine, unless other behavioral changes such as improved diet
and increased exercise are made.
Below are some commonly used over-the-counter weight loss
drugs and appetite suppressants. Be sure to talk to your doctor
before taking any of these over-the-counter drugs, as some could
be a waste of money, or worse, dangerous.
Weight-Loss Product Options
There are many over-the-counter diet products, including many
herbal remedies. Most of these products do not work. Some can
even be dangerous. Before using an over-the-counter or herbal diet
remedy, talk with your doctor.Nearly all over-the-counter
supplements with claims of weight-loss properties contain some
combination of these ingredients:
Aloe vera
Aspartate
Chromium
Coenzyme Q10
DHEA derivatives
EPA-rich fish oil
Green tea
Hydroxycitrate
L-carnitine
Pantethine
Pyruvate
Sesamin
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There is no proof that these products help with weight loss.

Safety Of Over-The-Counter Products
Some ingredients in over-the-counter diet products may not be
safe. The Food and Drug Administration (FDA) warns people not
to use some of them. Do not use products that contain these
ingredients:
Ephedrine is the main active ingredient of herbal ephedra, also
known as ma huang. The FDA does not allow the sale of
medicines that contain ephedrine or ephedra. Ephedra can cause
serious side effects, including strokes and heart attacks.
Brazilian diet pills are also known as EmagreceSim and Herb
thin dietary supplements. The FDA has warned consumers not
to buy these products. They contain stimulant drugs and drugs
used to treat depression. These can cause severe mood swings.
Conjugated linoleic acid (CLA) is found in many diet products
(such as Bio sculpt Liquid, Body Success, and GNC Optibolic
Body Answers Dietary Formula). Possible side effects include
risk of diabetes and gallstones.
Tiratricol is also known as triiodothyroacetic acid or TRIAC.
These products contain a thyroid hormone, and they may
increase the risk for thyroid disorders, heart attacks, and strokes.
Fiber supplements that contain guar gum have caused
blockages in the intestines and oesophagus, the tube that carries
food from your mouth to your stomach and intestines.
Chitosan is a dietary fiber from shellfish. Some products that
contain chitosan are Natrol, Chroma Slim, and Enforma. People
who are allergic to shellfish should not take these supplements.
Warnings on Some Ingredients in Over-the-Counter
Diet Products
Types of weight-loss drugs
The modes of action of the following registered drugs are as
follows:

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Phentermine is a sympathomimetic amine.Phentermine is a

stimulant that acts on the central nervous system and suppresses
appetite.
Orlistat is a gastrointestinal lipase inhibitor. It binds with
lipase in the stomach or small intestine, and thereby prevents
dietary fat from being broken down and digested, Consider
treatment with orlistat for weight loss only in people who have
not reached their target weight loss or have reached a plateau
with dietary, activity, and behavioural changes.
Remember that gastrointestinal side effects, including faecal
incontinence, are likely if a person eats high-fat meals when
taking orlistat.
Tell the person to take orlistat in conjunction with a low-fat
diet.
Ensure the persons drug therapy continues beyond three
months only if the person has lost at least 5% of their initial
body weight since starting drug therapy (although note the rate
of weight loss may be slower in people with diabetes).
Consider orlistat for long-term use for weight maintenance
once the initial weight is lost.
Sibutramine: Remember that sibutramine is contraindicated in
people aged under 18 or over 65 and in people with
inadequately controlled hypertension. Caution is required in
people with some psychiatric illness. Check for other
contraindications.
Sibutramine is a serotonin and noradrenaline reuptake
inhibitor. By inhibiting reuptake more serotonin and
noradrenalin are available to act on receptors, thereby
increasing satiety and increasing energy expenditure.
Consider treatment with sibutramine for weight loss only in
people who have not reached their target weight loss or have
reached a plateau with dietary, activity, and behavioural
changes.
Continue drug therapy beyond three months only if the person
has lost at least 5% of their initial body weight since starting
drug therapy.
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Monitor the persons blood pressure to observe for any

hypertensive effect of the medication. Do not prescribe
sibutramine unless there are adequate arrangements for
monitoring adverse effects (specifically pulse and blood
pressure). MedSafe data sheets suggest fortnightly monitoring
for the first three months. MedSafe data sheets support
treatment for 12 months, but trials suggest considering longerterm use, especially for maintaining weight loss.

362

BARIATRIC SURGERY AND RESTRICTIVE

BANDING PROCEDURES

BARIATRIC SURGERY

Bariatric surgery is appropriate only if all other measures have

been tried and failed. Bariatric surgery is substantially more
effective than non-surgical interventions in achieving weight loss
among obese people, but still requires lifestyle changes.
Weight loss may reach 4050 kg one-year after the surgery
with a BMI reduction of 1018 kg/m2 and a percentage excess
body weight loss of 5080%. There is also evidence of substantial
improvements in major co-morbidities such as blood pressure, lipid
levels, diabetes, and other conditions such as obstructive sleep
apnoea, gastro- oesophageal reflux, stress incontinence, and
peripheral venous stasis.
Recommendation Bariatric surgery should be considered for
people with a BMI of 40 kg/m2 or more or a BMI of 3540 kg/m2
if they have another significant disease (eg, type 2 diabetes, sleep
apnoea, high blood pressure, or arthritis requiring joint
replacement), if all appropriate non-surgical measures have been
tried but failed.
Strength of recommendation: Strong Good practice points
Remind people considering bariatric surgery that it is not an
alternative to a lifestyle change, so they still need to modify
their dietary intake and increase their physical activity.
Remind people that after bariatric surgery, they will require lifelong nutritional monitoring.
Remind people a person who has had bariatric surgery may
need to have excess skin folds surgically removed.
Remind people they will need to consider what bariatric
procedure is required based on the surgeons expertise, hospital

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facilities, and the persons and their family/whnau

characteristics and lifestyle.
Provide information about bariatric surgery in peoples
preferred language, if possible.
TYPES OF BARIATRIC SURGERY

The three bariatric procedures available in India are:

adjustable gastric banding
sleeve gastrectomy
Roux-en-Y gastric bypass
Adjustable gastric banding: It places an adjustable band around
the persons upper stomach to create a pouch with 1530 ml
capacity. Saline in the band can be increased or decreased through
a port under the skin of the abdomen. The added volume of the
band suppresses the persons appetite, but intermittent refilling is
required to maintain that feeling. Adjustable gastric banding can
be reversed.
Sleeve gastrectomy:A sleeve gastrectomy removes the outer
three-quarters of the persons stomach and turns the stomach into a
long gastric tube or sleeve. A sleeve gastrectomy cannot be
reversed.
Roux-en-Y gastric bypass:A Roux-en-Y gastric bypass involves
changes to the persons stomach and small bowel. The operation
creates a small pouch in the stomach with a narrow outlet.
Although the pouchs capacity can vary, it is usually about 30 ml.
A bypass of the small bowel is also created to reduce the
absorption of food.
All three operations are usually performed by laparoscopy. The
operations remove a persons excess appetite or urge to eat and
limit the volume they are able to eat. Perioperative death is very
low after bariatric surgery but rates vary by procedure.
Wound infections are one of the most common complications.
Complications such as bowel leakage, bleeding, stenosis, ulcers,
and other infections may occur. With gastric bypasses, nutritional
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deficiencies may occur in the long term, in particular deficiencies

of vitamin B12, folate, and iron. People who have had this surgery
must have long-term monitoring.
RISKS OF WEIGHT LOSS SURGERY

The rapid weight loss associated with weight loss surgery can
cause a number of side effects and has a number of risks.
These are outlined below.
COMPLICATIONS IMMEDIATELY AFTER SURGERY

Complications that can occur during or immediately after surgery

include:
Infection this affects around 1 in 20 people.
Blood clots in the legs (deep vein thrombosis) or lungs
(pulmonary embolism) this affects around 1 in 100 people.
Internal bleeding this affects around 1 in 100 people.
Excess skin
While weight loss surgery can successfully remove the fat in the
body, it cannot cause skin to revert to its pre-obesity tightness and
firmness.Therefore, if you were obese, especially for many years,
you may be left with excess folds and rolls of skin, particularly
around the breasts, tummy, hips and limbs.These folds and rolls
normally become most apparent 12-18 months after surgery. They
can look ugly and are difficult to keep clean, so you may be
vulnerable to developing rashes and infections.
Cosmetic surgery can be used to remove the excess skin.
However, as this treatment is for cosmetic and not clinical reasons,
it is not available on the NHS.The price for a course of skinremoval treatment can range from 1,500 to 6,000 depending on
the amount of skin that needs to be removed.
Gallstones
Around 1 in 12 people will develop gallstones after weight loss
surgery, typically 10 months after surgery.
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Gallstones are small stones, usually made of cholesterol, that

form in the gallbladder.In most cases, gallstones do not cause any
symptoms. However, if they become trapped in a duct (an opening
or channel), they can irritate and inflame the gallbladder and cause
symptoms, such as:
a sudden intense pain in your abdomen (tummy)
nausea and vomiting
jaundice (yellowing of the skin and the whites of the eyes)
Psychosocial Effects Of Surgery
While most people who undergo weight loss surgery report an
improvement in their quality of life, several psychosocial effects
may be related to rapid weight loss.Some people have reported
relationship problems with their partner as their partner begins to
feel nervous, anxious or possibly jealous about their weight loss.
Additionally, social occasions that revolve around food, such as
family meals, can become awkward, as it is common to feel selfconscious about your reduced capacity to eat.
It is also common for a person to experience a worsening of
mood when their weight stabilises, typically two years after
surgery. This is often because many people realise that problems
that existed before surgery, such as money worries or difficulties at
work, are still there after surgery. You can also find more
information and tips for dealing with psychosocial effects of
surgery such as stress, anxiety or depression in the Moodzone.
Stomalstenosis
A common complication in people with a gastric bypass is that the
hole (stoma) that connects their stomach pouch to their small
intestine becomes blocked by a piece of food. This is known as
stomal stenosis and is thought to occur in one-fifth of people with a
gastric bypass.
The most common symptom of stomal stenosis is persistent
vomiting.Stomal stenosis can be treated by directing a small
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flexible tube, known as an endoscope, to the site of the stoma. A

balloon attached to the endoscope is inflated to unblock the stoma.
The best way to prevent stomal stenosis is to always cut food into
small chunks, chew the chunks thoroughly and avoid drinking
during meals. Read more information aboutrecommendations for
weight loss surgery.
Gastric Band Slippage
Gastric band slippage is a complication that affects around 1 in 50
people with a gastric band.As the name suggests, the band slips out
of position. This means that the stomach pouch becomes bigger
than it should be. This can cause symptoms such as:
heartburn
nausea
vomiting
Further surgery will be required to repair the band.
Food Intolerance
Around 1 in 35 people with a gastric band develop a food
intolerance, often many years after their surgery.A food intolerance
is when your body is unable to tolerate certain foods, such as red
meat or green salad, resulting in a number of unpleasant symptoms
such as:
nausea
vomiting
Gastro-Oesophageal Reflux Disease (GORD)
The reason why a food intolerance can develop after surgery is
unclear.In most cases, avoiding foods that trigger a reaction should
help improve symptoms, but if you have persistent symptoms
associated with a number of different foods, it may be necessary to
remove the band and replace it with a gastric bypass.
Death
No surgery is entirely safe and all surgical procedures carry a risk
of death. However, the outlook for weight loss surgery has greatly
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improved with modern techniques.A 2014 Indian review of over

157,000 patients found the overall risk of death, within 30 days of
having any kind of weight loss surgery, is around 1 in 1000. The
risk of death after having a gastric bypass was slightly higher.
Complications of weight loss surgery which could lead to death
include:
a pulmonary embolism that causes serious breathing difficulties
and then death
internal bleeding
infection
heart attack
stroke
A number of risk factors have been identified that increase the risk
of death during or shortly after weight loss surgery. These are:
being over 45 years old
high blood pressure
having a BMI of 50 or above
being male, as obese men tend to weigh more than obese
women having a known risk factor for a pulmonary embolism.
Known risk factors for a pulmonary embolism include:
having a previous history of blood clots
pulmonary hypertension, when the blood pressure inside your
lungs is particularly high
obesityhypoventilation syndrome, when you have persistent
breathing difficulties related to the obesity.
The risk factors above can have a significant impact on your
individual risk of death. However, untreated obesity, especially
morbid obesity, carries a significant risk of premature death itself.
MEDICAL NUTRITION THERAPY

Dietary Guidelines for Post-Bariatric Surgery

After surgery, it is important to follow special dietary guidelines to
ensure proper healing, to obtain adequate nutrition, and to avoid
complications. Because your stomach is reduced in size, the
amount of food that you eat at one time is very small at first.
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However, keep in mind that people have varied tolerances to

different foods following this type of procedure.
TIMETABLE AND DIET PROGRESSION FOR DIFFERENT
TYPES OF SURGERIES

Vertical Banded Gastroplasty (VBG)

The day after surgery:
Drink water, up to 2 fluid ounces (floz)/hour.
Add clear liquids, up to 4 floz/hour, as tolerated.
Initiate clear liquid protein supplements.
Three days after surgery:
Add full liquids, 4-6 floz/hour.
Drink at least 8 cups (C)/day to help ensure adequate hydration.
One week after surgery:
Add pureed foods, using a blender or food processor to
puree.
Eat small meals and focus on high-protein foods.
Continue to monitor fluid intake.
Three weeks after surgery:
Add soft foods, 2-4 oz of soft-cooked foods every 3-4 hours.
Continue to focus on high-protein foods, such as:
Fish
Seafood
Low-fat cheese
Cottage cheese
Yogurt
Eggs/egg substitute
Five weeks after surgery:
Continue with soft foods, focusing on those high in protein.
Add poultry and pasta, as tolerated.
Two to three months after surgery:
Add poultry, low-fat beef, and pork, as tolerated.
Add soft fruits and cooked vegetables.
Four months after surgery:
Add the following, as tolerated:
Salads
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Crunchy fruits and vegetables

Dried beans
Peanut butter
Cereal
Toast
Crackers
Potatoes
Begin maintenance plan after achieving goal weight, based on a
1200- to 1600-calorie diet, using the diabetic exchange lists as
guidelines.
Laparoscopic adjustable gastric band (LAGB)
The day after surgery:
Drink clear liquids
Three days after surgery:
Add full liquids, as tolerated.
Drink decaffeinated, noncarbonated clear liquids for hydration.
One month after surgery:
Add pureed foods, using a blender or food processor to puree.
Eat small meals and focus on high-protein foods.
Continue to monitor fluid intake.
Two months after surgery:
Add soft foods, 2-4 oz of soft-cooked foods every 3-4 hours.
Continue to focus on high-protein foods, such as:
Fish
Seafood
Low-fat cheese
Cottage cheese
Yogurt
Eggs/egg substitute
Add soft fruits and cooked vegetables, as tolerated
Add lean chopped/ground beef, turkey, or chicken, as tolerated
Limit meats high in saturated fat
Continue to monitor fluid intake
Three months after surgery:
Add solid protein foods
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Add crunchy vegetables and fruits, as tolerated

Avoid stringy foods, such as celery, rhubarb, and asparagus,
unless well cooked
Continue to monitor fluid intake
Six months after surgery:
Add whole-grain complex carbohydrates
Continue to monitor fluid intake
Begin maintenance plan after achieving goal weight, based on a
1200- to 1600-calorie diet, using the diabetic exchange lists as
guidelines.
Biliopancreatic Diversion With Duodenal Switch (BPD/DS)
The day after surgery:
Drink clear liquids
Add low-lactose full liquids once clear liquids are tolerated
Three days after surgery:
Add pureed foods, using a blender or food processor to puree
Continue to monitor fluid intake and protein supplementation
One month after surgery:
Add soft foods with focus on high-protein foods, such as:
Low-fat soft cheeses
Eggs/egg substitute
Fresh seafood
Add soft fruits and cooked vegetables, as tolerated
Reintroduce milk gradually
Two months after surgery:
Add poultry, as tolerated
Continue to monitor fluid intake
Three months after surgery:
Add lean red meat and pork
Add the following foods, as tolerated:
Salads
Crunchy fruits and vegetables
Beans
Nuts

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Begin maintenance plan after achieving goal weight, based on a

1200- to 1600-calorie diet, using the diabetic exchange lists as
guidelines.
Roux-en-Y gastric bypass surgery (RNY)
The day after surgery:
Drink clear liquids
Three days after surgery:
Add high-protein pureed foods and supplements
Two weeks after surgery:
Add soft foods with focus on high-protein foods, such as:
Fish
Seafood
Cottage cheese
Eggs/egg substitute
Soft cheese
Yogurt
Continue with high-protein supplements, as needed
One month after surgery:
Add poultry and lean meat, as tolerated
Three months after surgery:
Add soft fruits and cooked vegetables, as tolerated
Four months after surgery:
Add the following foods, as tolerated:
Salads
Crunchy fruits and vegetables
Beans
Six months after surgery:
Add seeds and nuts, as tolerated
Begin maintenance plan after achieving goal weight, based on a
1200- to 1600-calorie diet, using the diabetic exchange lists as
guidelines.
General Guidelines
These suggestions may help:
Know that clear liquids include:
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Chicken or beef broth

Sugar-free gelatin
Artificially sweetened, noncarbonated beverages
Understand that full liquids include:
Strained cream soups
Protein shakes
Milk
Yogurt
Sugar-free pudding
Take small bites of food, chew thoroughly, and eat slowly,
allowing at least 30 minutes to finish each meal.
Consider using child-sized silverware or chopsticks (for solid
foods), which will force you to eat more slowly.
Do not drink while eating, and avoid drinking liquids during
meals, and at least 30 minutes before and after each meal.
Sip on fluids (low-calorie, sugar-free, noncarbonated, and
caffeine-free beverages) throughout the day to prevent
dehydrationat least 48-64 floz total.
Stop eating when you begin to feel fullovereating can lead to
vomiting.
Add new foods one at a time to determine how well you tolerate
them.
Wait about 1 week after having a food that you did not tolerate
before trying it again.
Avoid concentrated sweets and sugar, which are found in:
Cakes
Pies
Cookies
Candy
Jelly
Syrup
Regular soda and other sweetened beverages, etc.
Avoid high-fat foods, such as:
Fried foods
Regular snack chips
Gravies
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Cream sauces
Cream soups
High-fat meats
Butter
Margarine
Oil
Regular cheese, sour cream, and cream cheese, etc.
Remove all visible fat from meat, when you are able to eat
meat.
Drink protein supplements daily for up to 6 months after
surgery, or as prescribed by your surgeon or registered dietitian.
Supplements should provide at least 60-80 grams (g)
protein/day.
Avoid carbonated beverages for at least the first 6 months
following surgery to prevent abdominal discomfort or
distention:
Limit these beverages to one or two each week, if you do
choose to drink them.
Choose sugar-free varieties.
Allow the beverage to sit open for at least 1 hour to decrease
the carbonation.
Avoid the following foods, which are high in fiber residue, until
indicated in the progression of your meal plan, because these
foods may obstruct the opening of your stomach:
Coconut
Orange pulp
Skins of some fruits and vegetables (eg, apples, pears, and
cucumber)
Take the vitamin and mineral supplements as prescribed by
your surgeon or registered dietitian every day for the rest of
your life.
Have your blood levels checked annually.
Limit alcohol intake:
Know that your tolerance to alcoholic beverages has
significantly declined.

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Avoid mixed drinks that are high in sugar, such as daiquiris,

pia coladas, and those mixed with regular fruit juices.
Avoid extreme hot or cold food temperatures, which may
produce chest pain when ingested.
Participate in a lifestyle modification program to learn how to
make healthy food decisions, adopt positive eating behaviors
that support a healthy lifestyle, and incorporate exercise into
your daily routine.
COMMON NUTRITIONAL PROBLEMS AND PREVENTION
TIPS

Nausea and Vomiting

Causes:
Overeating
Eating too quickly
Prevention tips:
Eat slowly
Chew your food very well
Stop eating as soon as you feel full
Chronic Malnutrition Problems
Cause:
Nutrients are absorbed differently following surgery
Prevention tips:
Eat a healthy diet
Always take your vitamin and mineral supplements
Lactose Intolerance
Symptoms after drinking milk:
Gas
Bloating
Cramping
Diarrhoea
Prevention tips:
Drink smaller amounts of milk at a time
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Use lactose-free or lactose-reduced milk

Try soy milk
Temporary Hair Loss
Causes:
Rapid weight loss
Lack of protein in the diet
Prevention tip:
Eat the amount of protein recommended by your registered
dietitian.
Dehydration
Symptoms:
Dark and strong smelling urine
Dry mouth
Headache
Fatigue
Prevention tip:
Take frequent sips of liquid throughout the day
Dumping Syndrome
Cause:
Food emptying too quickly from the stomach
Symptoms:
Diarrhea
Nausea
Cold sweats
Light-headedness
Prevention tips:
Avoid:
Consuming sugary foods or beverages
Drinking fluids too soon after a meal
Eating high-fat foods

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Constipation
Cause:
Food and fiber intake are reduced following surgery.
Prevention tips:
Eat applesauce, oatmeal, or prunes daily
Drink plenty of water
Exercise regularly
Take a fiber supplement
PROTEIN SHAKES

Basic Vanilla or Chocolate Shake (28 g protein)

One scoop vanilla whey protein powder
1 C fat-free milk
1 tablespoon (Tbsp) cocoa powder (for chocolate shake)
Banana-Peanut Butter Shake:
(12 g protein)
1 C fat-free milk
1 Tbsp peanut butter
One fourth to one half banana
Creamy Orange Shake
(28 g protein)
One scoop vanilla whey protein powder
One scoop sugar-free orange powder drink mix
1 C fat-free milk
Protein Shake Tips
Try these ideas when making protein shakes:
Vanilla, almond, and coconut extracts improve flavour.
Bananas, strawberries, and/or peanut butter provide the most
flavour.
Unflavored cocoa powder offers a deeper chocolate flavor
without added fat.

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Milk cubes (made by freezing milk in ice-cube trays) are great

for blending with your shake, making it icy cold and adding
protein without diluting the shake.
Yogurt adds extra creaminess and protein to your shake.
If you are lactose intolerant, use lactose-free milk or soy milk.

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PART IV
LEANNESS
AND
EATING DISORDER

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WEIGHT IMBALANCE: EXCESSIVE LEANNESS

Being underweight is just as much a problem as being overweight.
However, there is loads of matter written about obesity, yet
leanness is grossly neglected. In most cases, a lean person has less
bodily resistance and thus it can be an invitation to diseases
DEFINITION OF LEANNESS

Karshya is the condition of being excessively lean. These people

are also termed as underweight. Their weight is below standard
values, and sometimes even height. Their bodies are characterized
by the following:(i) Poor weight
(ii) Less muscle mass, known as shushka in Sanskrit
(iii) Sunken skin, leading to a skin and bones body, which is
known as atikrushain Sanskrit
(iv) Poor development of chest, limbs and buttocks
In medical terms, excessive leanness is also known as emaciation.
CAUSES OF LEANNESS

Leanness of karshya can be caused due to a wide variety of

reasons. Some of these reasons are as follows:(i) Feeding habits during younger days People who are not fed
well as infants or during their early adolescence generally grow up
to be quite underweight. This may happen due to ignorance on the
part of the mother, or if the mother herself is undernourished. Due
to nutritional deficiencies in the mother, there may be a deficiency
of the necessary fat cells that are required for producing breast
milk. As a result, the child has a high probability of growing up
lean.
(ii) Poor eating habits A very high proportion of people all over
the world have very poor eating habits. This includes eating
unhygienic or unbalanced food, eating at wrong times, eating less
in proportion to the work done, etc.
(iii) Diseases Two dietary diseases bulimia and anorexia
nervosa are directly responsible for people losing weight and
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becoming lean. Anorexia nervosa is the condition in which a

person does not feel hungry. Due to this, there is no increase in the
body weight of the person. Patients of debilitating diseases such as
cancer tend to lose their weight. Even patients of AIDS and
hepatitis become lean.
(iv) Hyperthyroidism Hyperthyroidism or excess secretion of
the hormone thyroxin is one of the prime medical causes
of karshya. People who suffer from hyperthyroidism are unable to
gain weight, and so they remain quite below their standard weight
values.
(v) Psychological factors Stress, anxieties, heavy workload, etc.
can reduce a persons desire for eating nutritional food. Due to this,
the person will lose weight and become lean.
SYMPTOMS OF LEANNESS

Leanness is a relative term. For an obese person, a medium sized

person could be lean, while for a lean person, a medium sized
person could be obese. There are no clinical or medical parameters
by which leanness can be measured. However, excessive leanness
can be adjudged by the following factors:(i) The body is extremely thin. The ribs and the clavicle (collar
bone) show out through the chest.
(ii) There is no mass of flesh over the chest, abdomen and
buttocks.
(iii) Pinching the skin brings a very thin skinny mass into the
fingers.
(iv) The body weight is much less than the normal values.
(v) The person is prone to fall sick often and takes longer time to
recover than average weighed persons.
(vi) The person has poor stamina and bodily resistance.
(vii) There is often some or the other physical ailment in the body,
such as regular coughing, sneezing, runny nose, or something else.
Eyes and skin are very sensitive.

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COMPLICATIONS DUE TO LEANNESS

Emaciation is an invitation to diseases. Since the person is lean,

there is no proper development of the body of the person. He or
she will likely have a low count of leukocytes (white blood
corpuscles), which are the blood corpuscles that fight against
attacking microorganisms. As a result, there is a chance that the
person can suffer from major diseases soon.
On a simpler note, excessive leanness is detrimental to the
wellbeing of a person because of the following reasons:(i) The person will get tired easily as he or she has low stamina.
(ii) The person will not be well-suited to do any sort of heavy or
excitable activity.
(iii) The person will have a good chance of suffering from heart
ailments.
TRANSMISSION OF LEANNESS

Since karshya is not a disease but a bodily condition, there is no

question of transmission through any contagious or infectious
factors. However, it is known that karshya runs in families. Hence,
there is a chance that the condition may be genetic. As such people
with leanness among their close family members should take
stricter precautions to avoid becoming emaciated.
DIET DURING LEANNESS

The diet that a lean person consumes must be targeted at increasing

the body bulk. Some foods are more fattening than others. There
are some other foods which can increase the tissue and muscle
mass, and thus increase the body bulk. A proper dietary regimen is
a very strong treatment method for people with karshya.
The following constituents must be integral parts of all lean
peoples diet:Lean people must not shy away from eating food. They should
preferably have a double course meal. The carbohydrates such as
rice or wheat products must be consumed in the first course with
simple vegetables or pulses.
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Later a second course must follow with richer foods, which

could be vegetarian or non-vegetarian depending on the dietary
preferences of the person. A salad must always be included in the
meals. Salads add body bulk and also provide several nutrients.
Starchier vegetables must be given preference as they increase the
bulk of the body. Potatoes, yams, carrots are very good in adding
weight. Rice must be preferred to wheat, as rice is starchier.
The person must avoid drinking fluids before meals as it will
make the stomach feel full. Similarly, it is not advisable to have
soups before meals. Some people feel that wine increases the
appetite. This is a personal preference, but must be done in
moderation. Some light snacks could be had before retiring to bed.
Dietary fats such as milk, curds, raw sugar, jaggery, black gram,
ghee and meats must be incorporated more in the diet. Fats have
several benefits in lean persons.
The following are the five major functions dietary fats perform
in the body:1. Fats are a source of energy to the lean person. A single gram
offats can provide up to 9 kcal of energy.
2. Fats form a layer under the skin, which helps in
thermoregulation of the body.
3. Fats form a layer around the vital organs, which help in
protecting the body from shocks and injuries.
4. Fats help in the circulation of important fatty acids within the
body. They also regulate several aspects of fat metabolism.
5. Fats increase the palatability and satiety value of the food. This
makes the food more appealing to the frugal eater.
Thus, the diet that an emaciated person must follow is the exact
opposite of that which is suitable for an obese person.
The manner of taking the diet is also very important. A thin person
must eat little quantities at regular intervals during the day instead
of having just a few heavy meals per day. The dietary regimen
given below is ideal for a person who is looking out to gain some
weight:383

(i) Early morning Diet of a food rich in vitamin C such as

oranges or grapes.
(ii) Morning Have a breakfast that is rich in carbohydrates to
add to the bulk of the body. Brown bread is preferable. Some
protein-rich food like an egg is suitable, or even bread and butter
will do.
(iii) Mid morning A nutritious and filling food, salad or soup
will be ideal.
(iv) Lunch Can be moderately heavy. Supplement the rice or
wheat products with at least two different kinds of vegetables. One
flesh food can be included if allowable. A fruit salad would be the
best dessert.
(v) Mid afternoon A cooling food must be taken to counter the
effects of the climate. A milkshake or cold coffee is advisable.
(vi) Evening A beverage with some light snack can be taken.
(vii) Dinner Must be rich in nutrition but easy to digest. It can
have more variety than the lunch. Avoid spicy and oily foods in the
night as they can interfere with sleep.
(vii) Bedtime An apple or a plantain would help to digest the
food eaten during the day.
Leanness is a condition in which the weight of the body according
to the Body Mass Index counts less than the average weight in the
frame. Where no one likes you being fat, similarly being extra slim
is neither appreciated by anyone nor is it a normal sign for human
body. Leanness is sometimes genetic. Chances stand positive that
if a person is extra slim his coming generation is likely to be as
slim as he is. Leanness has no clear symptoms, you can say it is
perhaps an invisible disease but totally ruins ones personality.
Where fatness is a disease, leanness is also a kind of painful
disorder. One reason of it can be defected digestive system because
many ingredients do not get absorbed in the body. Many people are
always found eating something but still they do not get fat.
Perhaps, leanness becomes a part of their body and the liver is
unable to digest even the most energetic diet. But many people out

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there who are extra slim can put on lots of weight by artificial but
safe treatment. The general causes of leanness are given below:
Improper diet
Excess driving
Excessive studies
Anxiety, fear, tension, and depression
Inappropriate sleeping time
One method to artificially put on your desired weight is to use
powered fruit supplements with milk and water. The fruit
supplements are rich in proteins and creatine that first disorders
your livers than helps you in gaining weight. This method is
mostly adopted by the weight lifters and body builders. Fruit
supplements can get you of the underweight category into the
satisfactory weight category.
Another artificial method of putting on weight is to take a
variety of fast food daily. Basically fast food is fried in the oil that
burns its proteins, carbohydrates and calories but enhances the fats
in it. Fast food can help you put on lots of weight but cannot help
you energize yourself or enhance your stamina. If you think you
can develop stamina and can gain energy using fast food; you are
mistaken.
Now after a couple of artificial treatments for leanness let us tell
you some natural ways of getting rid of leanness. Some of the
general natural treatments are given below:
Reduce the time of exercise and play.
Take a comfortable sleep of at least 10 hours.
Avoid spat feelings and expressions.
Have short meals after every 2 hours.
Avoid vinegar, tea, coffee and citrus fruits.

385

NUTRATION IN EATING DISORDER

Eating disorders are characterized by gross disturbances in eating
behavior and include anorexia nervosa, bulimia nervosa, eating
disorders not otherwise specified(NOS), and binge eating disorder.
Anorexia nervosa is characterized by refusal to maintain body
weight over a minimum level considered normal for age and
height, along with distorted body image, fear of fat and weight
gain, and amenorrhea (absence of menstruation). Bulimia nervosa
is characterized by binge eating followed by purging. These
behaviors should occur at least twice a week for three months.
Binge eating disorder typically occurs in patients who binge but
do not purge. One must have bulimic episodes at least two days a
week for six months but must not fit the criteria for bulimia
nervosa. Eating disorders not otherwise specified (EDNOS)
includes a wide array of eating disturbances that do not fall into the
anorexia, bulimia, or binge eating diagnosis. Anorexia athletics
features an intense fear of becoming fat even though one is at least
5 percent below the expected normal weight range.
Eating Disorders
Anorexia Nervosa
Bulimia Nervosa
A related syndrome is known as Binge Eating Disorder
(BED)
Eating disorders also occur in male and female athletes
Factors involved in the development of eating disorders
include:
Distortions in thinking
Excessive self-criticism
Excessive dieting
Failing to eat an adequate amount of food to maintain a
reasonable body weight
Engaging in excessive vigorous exercise
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Anorexia Nervosa
Failing to eat an adequate amount of food to maintain a
reasonable body weight.
Engaging in excessive vigorous exercise.
Amenorrhea
Brittle nails
Carotene pigmentation (yellowish appearance of the palms and
soles of the feet).
Bulimia Nervosa
Eating large amounts of food in a short period of time.
Sometimes excessive exercise as a form of purging.
Body weight is often normal.
Nervous/ agitated behaviour immediately after eating.
Loss or gain of extreme amounts of weight.
There are two subtypes of bulimia nervosa: purging and nonpurging type:
In the purging type, the person regularly engages in self-induced
vomiting or misuses laxatives/diuretics.
In the non-purging type, the person uses other strategies such as
excessive exercise or fasting.
An eating disorder is when a person experiences severe
disturbances in eating behavior, such as extreme reduction of
food intake or overeating, or feelings of intense distress or
concern about body weight or shape.
A person with an eating disorder may have started out just
eating smaller or larger amounts of food than usual, but at some
point, the urge to eat less or more spirals out of control.
People with eating disorders are usually SECRETIVE about
their eating, purging or lack of eating.
Anorexia Nervosa has four diagnostic criteria:
1. Refusal to maintain weight within a normal range for height and
age (less than 85 percent of expected body weight).
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2. Intense fear of weight gain despite being underweight.

3. Severe body image disturbance in which body image is the
predominant measure of self-worth with denial of the severity of
the illness.
4. In girls who have gone through puberty and have their period,
absence of the menstrual cycle for greater than three cycles.
There are two subtypes of anorexia nervosa: restricting and
binge eating/purging.
People with the restricting subtype restrict their food intake to
lose weight.
People with the binge/purge subtype engage in binge eating or
purging behavior (eg vomiting, laxatives).
Either subtype may also use compulsive exercise to reduce their
weight.
So, someone with anorexia may induce vomiting and still be
considered anorexic (NOT bulimic) if he/she is 15 percent below
ideal body weight.
Bulimia Nervosa diagnostic criteria:
1. Recurrent episodes of binge eating accompanied by a feeling of
a lack of control.
2. Repeated behaviors to make up for eating normal or increased
amounts of food to prevent weight gain (vomiting, laxatives,
fasting, excessive exercising).
3. The binge eating and inappropriate compensatory behaviors
occur at least twice a week for three months.
4. Dissatisfaction with body shape and weight.
There are two subtypes of bulimia nervosa: purging and
nonpurging type:
In the purging type, the person regularly engages in self-induced
vomiting or misuses laxatives/diuretics.
In the nonpurging type, the person uses other strategies such as
excessive exercise or fasting.

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CAUSES OF EATING DISORDERS

It is unclear why eating disorders occur, but is likely related to the

interaction of numerous factors (psychological, biological, family,
environmental etc). An individual may experience decreased selfesteem or self-control because of pre-disposing factors and use
dieting or weight loss to gain a sense of control.
Over one-half of teenage girls and nearly one-third of teenage
boys use unhealthy weight control behaviors such as skipping
meals, fasting, smoking cigarettes, vomiting, and taking
laxatives.
42% of 1st-3rd grade girls want to be thinner and 81% of 10
year olds are afraid of being fat.
46% of 9-11 year-olds are sometimes or very often on diets.
Several factors have been associated with the development of
eating disorders:
Dieting history
Childhood preoccupation with a thin body and social pressure
Sports in which leanness is emphasized or in which scoring is
subjective (ballet, running, gymnastics)
Some studies suggest a role for genetics
Psychiatric problems are common in patients with eating
disorders, including depression, anxiety disorders, obsessivecompulsive disorder, and substance abuse
Family stress
Neurotransmitter imbalance
Predisposing factors that make a person more vulnerable to
developing an eating disorder:
Female sex
Family history of eating disorders
Perfectionist personality (type A)
Low self-esteem
Feelings of inadequacy or lack of control in life
Depression, anxiety, anger, or loneliness
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Troubled personal relationships

Difficulty expressing emotions and feelings
History of being teased or ridiculed based on size or weight
History of physical or sexual abuse
Cultural pressures that glorify thinness and place value on
obtaining the perfect body.
COMPLICATIONS OF EATING DISORDERS

Many medical complications can occur from starvation or

persistent purging:
Osteopenia (bone thinning), fractures
Slowed growth
Heart problems (slow heart rate, low blood pressure, heart beat
irregularities)
Abdominal problems (nausea, bloating, constipation)
Dry skin, brittle hair and nails
Growth of fine hair all over body
Abnormal salts in the body
Dental erosion and enlarged salivary glands
Inflammation and possible rupture of the esophagus from
frequent vomiting
Infertility with amenorrhea (no period) (anorexia)
Liver and kidney problems
Low body temperature
Seizures
Early death.
DIAGNOSING EATING DISORDERS

As teachers, you may be able to play a key role in the diagnosis of

an eating disorder.
The following are possible warning signs of anorexia and bulimia:
Unnatural concern about body weight (even if the person is not
overweight.)
Dramatic weight loss (anorexia).
Obsession with calories, fat grams and food.

390

Use of any medicines to keep from gaining weight (diet pills,

laxatives, water pills).
Consistent excuses to avoid mealtimes or situations involving
food.
Excessive, rigid exercise regimen--despite weather, fatigue,
illness, or injury, the need to burn off calories.
Withdrawal from usual friends and activities.
Evidence of binge eating (disappearance of large amounts of
food, empty wrappers and containers).
Evidence of purging behaviors, including frequent trips to the
bathroom after meals, signs and/or smells of vomiting, presence
of wrappers or packages of laxatives or diuretics.
Unusual swelling of the cheeks or jaw area.
Calluses on the back of the hands and knuckles from selfinduced vomiting.
Discoloration or staining of the teeth.
TREATMENT OF EATING DISORDERS

An interdisciplinary team should treat eating disorders, including a

physician, dietician, and mental health professional.
Physicians must rule out other causes for the symptoms, and
monitor immediate and long-term medical complications.
Dieticians educate patients about healthy eating behaviors and
help anorexic patients regain weight through a controlled
regimen.
Mental health professionals provide counseling to the patient
and the patients family. They try to help the patient recognize
thoughts and feelings leading to disordered eating and to
develop more adaptive thoughts and coping strategies.
Refeeding syndrome: This is a potentially fatal condition
resulting from rapid changes in fluids and electrolytes when
malnourished patients are refed. Hence, patients must be
monitored very closely during the refeeding process. Patients who
are severely malnourished or experiencing significant medical
391

complications may need to be admitted to the hospital for

treatment.
Eating disorders are very difficult to treat.
Only 50 percent of patients with anorexia nervosa will have a
good outcome.
30 percent of patients with bulimia nervosa continue to engage
in binging and purging behaviors after 10 years of follow-up.
Young women with anorexia nervosa are 10 times more likely
to die than age-matched controls, either from complications of
their eating disorder, or from suicide.

392

PART V
DIET PLANNING

393

PLANNING DIET TO WEIGHT MANAGE

MOCK COUNSELLING SESSION

Nutrition Counselling Visit (~1-1.5hrs. depending on previous

nutrition knowledge)
Individualized meal planning/food choices
Basal Metabolic Rate (BMR) calculation for calorie needs
Nutrition/Weight Loss Basic Info
Weight Loss Strategies
Science behind nutrition & weight loss
Basic exercise info/plan
Special Attention paid to specific issues (ie/food allergies,
gluten-free, low-sodium, vegetarian/vegan, etc.)
E-mail correspondence for Q&A included for FREE after initial
visit.
Follow-up Visit (30-45 minutes)
Recommended for accountability and trouble shooting after
starting meal plan and behaviour changes discussed during
initial visit. (Can alternate between in-person and skype followups for convenience as well!)
Trouble shooting/Q&A
Food journal review
Strategies for specific life challenges (i.e. / travel, eating out,
special events, holidays, etc.)
Tweaking meal plan/calorie range/exercise plan
Pantry raid (optional)
E-mail correspondence for Q&A included for FREE between
and after follow-up visits.
Session packages also available at discounted price upon
request.
Exercise for Weight Loss Personal Training Session
Exercise intro at your gym or home with light strength training
and exercise ideas.
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Information on proper form, time period, reps, sets, weight, etc.

At home exercise demonstration using light dumbbells or no
equipment.
Office workout ideas.
Special attention paid to injuries or medical conditions limiting
exercise abilities.
Small Group/Office Intervention Seminar (~1 hour)
Small group setting - ideal for an office or gym group
Basic nutrition information and weight loss strategies
How to navigate the grocery store
Reading nutrition labels
Journalling/Calorie Counting
Common food/weight loss myths debunked
Useful resources/handouts provided
Q&A
EATING OUT

It's easier than you think to make good choices at a fast-food

restaurant, the mall, or even the school cafeteria. Most cafeterias
and fast-food places offer healthy choices that are also tasty, like
grilled chicken or salads. Be mindful of portion sizes and high fat
add-ons, like dressings, sauces or cheese.
Here are some pointers to remember that can help you make wise
choices when eating out:
Go for balance. Choose meals that contain a balance of lean
proteins (like fish, chicken, or beans if you're a vegetarian),
fruits and vegetables (fries and potato chips don't qualify as
veggies!), and whole grains (like whole-wheat bread and brown
rice). That's why a turkey sandwich on whole wheat with lettuce
and tomato is a better choice than a cheeseburger on a white
bun.
Watch portion sizes. The portion sizes of American foods have
increased over the past few decades so that we are now eating
way more than we need. The average size of a hamburger in the
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1950s was just 1.5 ounces, compared with today's hamburgers,

which weigh in at 8 ounces or more.
Drink water or low-fat milk. Regular sodas, juices, and energy
drinks usually contain "empty" calories that you don't need
not to mention other stuff, like caffeine.
Tips For Eating At A Restaurant
Most restaurant portions are way larger than the average serving of
food at home. Ask for half portions, share an entre with a friend,
or take half of your dish home.
Here are some other restaurant survival tips:
Ask for sauces and salad dressings on the side and use them
sparingly.
Use salsa and mustard instead of mayonnaise or oil.
Ask for olive or canola oil instead of butter, margarine, or
shortening.
Use non fat or low-fat milk instead of whole milk or cream.
Order baked, broiled, or grilled (not fried) lean meats including
turkey, chicken, seafood, or sirloin steak.
Salads and vegetables make healthier side dishes than French
fries. Use a small amount of sour cream instead of butter if you
order a baked potato.
Choose fresh fruit instead of sugary, high-fat desserts.
Tips For Eating At The Mall Or Fast-Food Place
With a little planning, it's easy to eat healthy foods at the mall.
Here are some choices:
a single slice of veggie pizza
grilled, not fried, sandwiches (for example, a grilled chicken
breast sandwich)
deli sandwiches on whole-grain bread
a small hamburger
a bean burrito
a baked potato
a side salad
frozen yogurt
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Choose the smaller sizes, especially when it comes to drinks and

snacks. If you have a craving for something unhealthy, try sharing
the food you crave with a friend. Here's another tip for eating while
shopping: Don't put off eating until you're so hungry you could
inhale everything in sight. Set a time to eat, then stop what you're
doing to take a break, sit down, and saver the food you are eating.
Tips For Eating In The School Cafe
The suggestions for eating in a restaurant and at the mall apply to
cafeteria food as well. Add vegetables and fruit whenever possible,
and opt for leaner, lighter items. Choose sandwiches on wholegrain bread or a plain hamburger over fried foods or pizza. Go easy
on the high-fat, low-nutrition items, such as mayonnaise and heavy
salad dressings.
You might want to consider packing your own lunch occasionally.
Here are some lunch items that pack a healthy punch:
Sandwiches with lean meats or fish, like turkey, chicken, tuna
(made with low-fat mayo), lean ham, or lean roast beef. For
variety, try other sources of protein, like peanut butter, hummus,
or meatless chili. If you don't like your bread dry, choose
mustard or a small amount of lite mayo.
Low-fat or non fat milk, yogurt, or cheese
Any fruit that's in season
Raw baby carrots, green and red pepper strips, tomatoes, or
cucumbers
Whole-grain breads, pita, bagels, or crackers.
EATING IN A CHANGING WORLD

Dietary supplements and herbal products come under the same

legislative regulations in the United States, whereas functional
foods are more strictly regulated. Probably even less is taught
about these groups of products than about nutrition in
undergraduate medical schools. Herbal products do not appear in
textbooks of nutrition, but nutritionists in the United States have
recently been taking a serious interest in them.
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Considerable numbers of people are taking these products, but

they may not tell their DIETARY ADVISER about herbal
products, believing that the DIETARY ADVISER would not
approve. The patient may not know exactly what herbs to use or
avoid, and the DIETARY ADVISER does not have easily
accessible information. This situation is different for vitamins and
functional foods. The patient expects an opinion from the doctor
about these and is disappointed if the doctor seems uninformed.
Also, foods go in and out of fashion, although not always because
of scientific evidence. This adds to the doctors bewilderment
about nutrition.
Todays patients in general practice tend to be more egalitarian,
informed, and demanding than patients of 2 generations ago. They
have in their heads a lot of information about medicine and disease
from the television, newspapers, and magazines. They may come
with a question about a new cure for cancer discussed on a
television show that the busy doctor did not see. Patients can have
more information about foods and nutrition (not always scientific)
than their DIETARY ADVISER.
In recommending a dietary change, it helps for the DIETARY
ADVISER to know how the patient thinks about foods in a
multicultural society. The partnership model of communication for
medical management seems to be suitable for cooperating on
dietary change.
Computers first use in medical practices was for the accounts,
insurance payments, reminders, and so on in the receptionists
office. But now computers are in many a DIETARY ADVISERs
consulting room. Some doctors look at the patient and the
computer alternately. Some share the computer screen with the
patient. Some concentrate on the patient and use the computer only
at the end of the patients visit. The computer is changing the oneon-one interaction of doctor and patient. It may dilute the doctors
authority, but it has the potential to supplement the doctors
evidence base.
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Evidence-Based Medicine
The purest evidence-based medicine, with meta-analyses from
randomized controlled trials (RCTs) of drugs to treat diseases, is
mandatory for the pharmaceutical industry. DIETARY
ADVISERS are exposed to its methods and language in their
journals, at drug representative visits, and at industry-sponsored
dinners. Practicing with the best available evidence can also lessen
the risk of litigation. Evidence-based nutrition looks very different.
For example, it is hard to imagine large RCTs of the protective
effects of broccoli against cancer.
Diets are very complex. If one component is increased or
decreased, there are compensatory changes in the rest. The most
likely RCTs relevant to diet are with pure food components that are
handled like pharmaceuticals, and the result of some of these trials
may clash with observational epidemiology.
Medical information in most types of media is in the sender-toreceiver mode. The consumer plays a passive role, can hear
incompletely, and can misunderstand, forget, or ignore. Now, with
the Internet, computer-literate consumers can search many
websites for information (correct or incorrect) about their disease,
their diet, or the disease of someone they care about.
Consumers can then visit their family doctor loaded up with
well-understood reliable information, confusing and conflicting
information, or unscientific alternative material. Most doctors have
only limited time to spend on the Internet and do not always know
how reliable a websites information is.
The Obesity Epidemic
In all the countries where people can afford to have their own
family doctors, there is a new epidemic of nutritional excess that is
more difficult to treat than malnutrition or micronutrient
deficiency. A large proportion of the patients in most practices are
overweight, and many are obese. Obesity management is, at least
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partly, by dietary change, but the results are discouraging. No one

likes a string of failures, so DIETARY ADVISERs may give up
telling people to lose weight. If doctors cannot handle the biggest
nutrition problem in affluent communities, this reduces their
feeling of self-efficacy with nutrition.
HEALTHY SHOPPING STRATRIGES

By incorporating your family's likes and dislikes, sticking to a

budget and using your store as a map, you will be on your way to a
successful supermarket sweep. This guide outlines weekly
shopping strategies for when you want to eat healthy. One great
way to put a healthy spin on your cart is to concentrate on the
foods around the perimeter of the store. With refrigeration,
ventilation and water access, this is where the fresher foods are
kept.
The foods in the centre aisles are generally more processed,
with some exceptions like dry and canned single-ingredient items
such as beans, grains or baking supplies. Try thinking about your
grocery cart like the food on your plate. Our nations new "plate"
calls for 50 percent fruits and vegetables! The rest is divided
between proteins and whole grains. Seems like a great way to start
filling your cart.
First stop: Head for the produce section. This week, youre
bulking up on fruits and vegetables, which take up a lot of space.
Pick six to eight vegetables and another four fruits to bring home
with you this week. Use up produce that will spoil quickly, such as
leafy greens and thin-skinned berries toward the beginning of the
week and rely on your pantry staples and frozen goods toward the
end. Root vegetables, like potatoes and carrots, and heartier fruits
like apples will hold just fine as the week goes on as well.
Greens: Buy a variety! There is nothing worse than a boring, limp
salad try arugula, escarole or radicchio for a fresh spin. Buy
chard and kale to wilt as a side dish or make them the star of your
dinner plate by topping with a poached egg.
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Potatoes: Potatoes get a bad rap because of their carbs, but really,
one russet potato contains about 150 calories and lots of potassium.
They are an inexpensive and filling vehicle for the addition of
more vegetables, like sauted spinach, and a sprinkling of
Parmesan cheese. Sweet potatoes also have a lot going for them.
Assorted snack veggies: Carrots, celery, cucumber, jicama and
bell peppers are all great choices to have on hand. Not only can
they be incorporated into meals, but you can also bag them up for a
bite on the run.
Berries: During the summer, stock up on berries when they are
cheap and plentiful. Usually a breakfast item, berries can also be
tossed into salads and eaten for dessert.
Apples: Apples are the perfect snack on the run try them with a
little peanut or almond butter. Also, try coring and roasting apples
with some cinnamon and brown sugar for a simple, healthful
dessert.
Next, take a walk down the protein aisle. Because this week were
incorporating more fruits and vegetables, your protein list wont be
long. Buy three to four proteins that can be used for both dinner
and lunch, with leftovers rolled into new meals.
Ground meat: Try picking up a package of lean ground chicken or
turkey. Make a healthy burger or lightened-up whole-wheat pasta
dish. Ground lean proteins offer endless options. Often on sale, buy
in bulk and freeze any meat you dont use up. Store up to three
months. (Its always good to have leftover proteins in your freezer
as a backup plan).
Pork: With the hysteria around bacon, pork belly and pig product
in general, its easy to forget that there are cuts of pork that are
lean and healthful. Try picking up a package of boneless pork
chops or pork tenderloin. Low in fat, pork can be a great
alternative
to
the
overused
chicken
breast.

401

Seafood: Fish and shellfish are low in calories and fat, and should
be turned to time and time again for healthful eating. Pick up a bag
of mussels or clams and steam with white wine and herbs. Your
cart should be filling up at this point, but you have a few more
aisles to check out. Next, the frozen food sections.
Frozen fruits and vegetables: Picked at their peak of freshness,
frozen produce is a wonderful solution. Bulk up when items are on
sale and keep in your freezer for months. Then pull them out for
soups, smoothies and stir-fries.
Frozen shrimp: Normally we would say that frozen seafood is a
big no-no, but frozen shrimp is actually a great solution when
youve run out of proteins for the week. Defrost the shrimp in your
refrigerator the night before you want to use them (worst case,
defrost in the microwave) and toss into stir-fries, pasta sauces or a
whole-grain salad.
Sorbet: Do your best to stroll past the ice cream this week, and
look for fruit sorbets that will satisfy that craving with fewer
calories and less sugar. Fruit bars are also a great substitute for ice
cream bars.
Keep walking and pick up a few necessities in the dairy section.
Eggs: Full of protein, eggs are a go-to for any meal. A great
solution once youve used your proteins for the week, eggs can be
poached and placed over a warm salad, or scrambled and served
alongside some roasted vegetables. Hard-boil them and keep them
for mid afternoon snacks as well.
Parmesan and feta cheeses: A little dairy never hurt anyone,
especially when using a small amount packs such big flavour.
Simple, salty toppings for dishes any time of day.
Non fat Greek yogurt: A great way to start the day is with a bit of
honey, scoop of berries and non fat Greek yogurt. This thick,
creamy alternative to regular yogurt is a power player in light
eating. Also, use instead of mayo in dips or creamy salad
dressings.

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Whole grains: Grains like bulgur, faro, quinoa and barley are a
fantastic substitute for rice and pasta. Higher in fibre, these grains
can be combined with leftover cooked vegetables or proteins for a
warm salad lunch or tossed with herbs and reduced-fat feta for a
zippy side dish. These whole grains will be integral in a healthy
week of eating kids wont miss pasta at all.
Grocery shopping is truly an art form, one that takes practice
to get just right. Ultimately, you need to choose items you like to
eat, so youre not tempted to pick up takeout or microwave a
frozen pizza. Think about how your family eats, their likes and
dislikes and walk the market with those needs in mind. With a plan
and the aisles of your supermarket as your guide, youre off to a
great week of healthy eating.
HEALTHY COOKING TIPS

Eating healthy food doesnt mean giving up the favourite foods.

The favourite recipes can be adapted easily to provide a healthier
alternative. For example, non-stick cookware can be used to reduce
the need for cooking oil. Vegetables can also be microwaved or
steamed instead of boiling to keep valuable nutrition.
There are many ways to make meals healthier. Limit fats, sugars
and salt and include plenty of vegetables, fruit, grains, lean meats
and low-fat dairy in your cooking. Foods with added fats, sugars or
salt are less healthy than food in which these are found naturally.
Keep Fats To A Minimum
Choose lean meats and reduced-fat dairy products and limit
processed foods to minimise hidden fats. Nuts, seeds, fish, soy,
olives and avocado are all healthier options because they include
the essential long-chain fatty acids and these fats are accompanied
by other good nutrients. If you add fats when cooking, keep them
to a minimum and use monounsaturated oils such as olive and
canola oil.

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Shopping For Healthy Food

Low-fat cooking begins when you are shopping:
Choose the reduced or low-fat version of a food if possible for
example milk, cheese, yoghurt, salad dressings and gravies.
Choose lean meat cuts and skinless chicken breasts.
Limit fast foods, chips, crisps, processed meats, pastries and
pies, which all contain large amounts of fat.
Low Fat Cooking
Suggestions include:
If you need to use oil, try cooking sprays or apply a small
amount of oil with a pastry brush.
Cook in liquids (such as stock, wine, lemon juice, fruit juice,
vinegar or water) instead of oil.
Use low-fat yoghurt, low-fat milk, evaporated skim milk or
cornstarch instead of cream in sauces or soups.
When browning vegetables, put them in a hot pan then spray
with oil, rather than adding the oil first to the pan. This reduces
the amount of oil that vegetables absorb during cooking.
An alternative to browning vegetables by pan-frying is to cook
them first in the microwave, then crisp them under the grill for a
minute or two.
Use pesto, salsas, chutneys and vinegars in place of sour
creams, butter and creamy sauces.
Retaining The Nutrients
Water-soluble vitamins are delicate and easily destroyed during
preparation and cooking. To minimise nutrient losses:
Scrub vegetables rather than peel them, as many nutrients are
found close to the skin.
Microwave or steam vegetables instead of boiling them.
If you like to boil vegetables, use a small amount of water and
do not overboil them.

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Include more stir-fry recipes in your diet. Stir-fried vegetables

are cooked quickly to retain their crunch (and associated
nutrients).
Cutting Down Salt
Salt is a common flavour enhancer, but research suggests that a
high salt diet could contribute to a range of health problems
including high blood pressure. Suggestions to reduce salt include:
Dont automatically add salt to your food taste it first.
Add a splash of olive oil, vinegar or lemon juice close to the end
of cooking time or to cooked vegetables it can enhance
flavours in the same way as salt.
Choose fresh or frozen vegetables, since canned and pickled
vegetables tend to be packaged with salt.
Limit your consumption of salty processed meats such as
salami, ham, corned beef, bacon, smoked salmon, frankfurters
and chicken loaf.
Choose reduced salt bread and breakfast cereals. Breads and
cereals are a major source of salt in the diet.
Iodised salt is best. A major dietary source of iodine is plant
foods. Yet there is emerging evidence that Australian soil may
be low in iodine and so plants grown in it are also low in iodine.
If you eat fish at least once a week, the need for iodised salt is
reduced.
Avoid salt-laden processed foods, such as flavoured instant
pasta or noodles, canned or dehydrated soup mixes, chips and
salted nuts.
Margarine and butter contain a lot of salt but no added salt
varieties are available.
Most cheeses are very high in salt so limit your intake or choose
lower salt varieties.
Reduce your use of soy sauce, tomato sauce and processed
sauces and condiments (for example mayonnaise and salad
dressings) because they contain high levels of salt.

405

Herbs
Culinary herbs are leafy plants that add flavour and colour to all
types of meals. They are also rich in health-protective phytooestrogens. In many cases, herbs can replace the flavour of salt and
oil.
Remember
Herbs are delicately flavoured, so add them to your cooking in
the last few minutes.
Dried herbs are more strongly flavoured than fresh. As a general
rule, one teaspoon of dried herbs equals four teaspoons of fresh.
Apart from boosting meat dishes, herbs can be added to soups,
breads, mustards, salad dressings, vinegars, desserts and drinks.
Herbs such as coriander, ginger, garlic, chilli and lemongrass
are especially complimentary in vegetable-based stir-fry
recipes.
Sandwich suggestions
To make a sandwich even healthier:
Switch to reduced salt wholemeal or wholegrain bread.
Limit high-fat spreads such as butter or margarine. You wont
miss butter if your sandwich has a few tasty ingredients already.
Use plenty of vegetable or salad fillings.
Limit your use of spreads high in saturated fat like butter and
cream cheese. Replace them with a thin spread of peanut butter
or other nut spreads, hummus, low-fat cheese spreads or
avocado.
Choose reduced fat ingredients when you can, such as low-fat
cheese or mayonnaise.
Try to reduce your use of processed meats. Instead use fish such
as salmon, tuna or sardines.
Enjoy toasted sandwiches with baked beans.
General Suggestions For Healthy Cooking
Healthy cooking methods include:
Steam, bake, grill, braise, boil or microwave your foods.
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Modify or eliminate recipes that include butter or ask you to

deep fry or saut in animal fat.
Avoid added oils and butter; use non-stick cookware instead.
Dont add salt to food as it is cooking.
Remove chicken skin and trim the fat from meat.
Eat more fresh vegetables and legumes.
Eat more fish, which is high in protein, low in fats and loaded
with essential omega-3 fatty acids.
Other tips
Suggestions include:
Spend a little time on presentation. You are more likely to enjoy
a meal if its visually appealing as well as tasty.
Make every meal an occasion. Set the table. Eat with your
family. Give yourself the opportunity to enjoy your food
without distractions like television.
Long-term deprivation, such as crash dieting, doesn't work.
Allow yourself the occasional guilt-free treat.
You are less likely to overeat if you eat slowly and savour every
mouthful.
DIETARY SUPPLEMENTS AND FAD DIETS

Lots of today's popular diets take advantage of our desire to drop

weight quickly. Unfortunately, though, "quick-fix" diets don't
work.
Here are 5 clues that a diet may be more about empty promises
than real results:
1. The diet is based on drastically cutting back
calories.Starvation type diets that require the body to fast often
promise quick results. But our bodies simply aren't designed to
drop pounds quickly. In fact, doctors say it's nearly impossible
for a healthy, normally active person to lose more than 2 to 3
pounds per week of actual fat, even on a starvation diet.
Here's the trick that very low-calorie diets rely on: the body's
natural reaction to near-starvation is to dump water. So most, if
not all, of the weight lost on quick-weight-loss diets is not fat
407

it's just water. And the body sucks this lost water back up like a
sponge once a person starts eating normally again.
2. The diet is based on taking special pills, powders, or herbs.
These are usually just gimmicks and the only thing they slim
down is your wallet. Some diet pills contain laxatives or
diuretics that force a person's body to eliminate more water. Just
like restricted-calorie diets, the weight lost with these
supplements is mostly water, not fat.
Other supplements claim that their ingredients speed up
metabolism; suppress appetite; or block the absorption of fat,
sugars, or carbohydrates. For most diet supplements, there's no
reliable scientific research to back up their claims. And doctors
consider diet supplements risky for teens because not much is
known about how the ingredients affect the growing body.
3. The diet tells you to eat only specific foods or foods in
certain combinations. There's no reliable scientific proof that
combining certain foods works. And limiting the foods you eat
means you might not get all the nutrition you need.
4. The diet makes you completely cut out fat, sugar, or
carbs.Depriving our bodies of needed food groups is a bad idea
(especially when they're still growing). It's better to eat smaller
portions in well-rounded meals (meals that contain lean protein,
whole grains, fruits, veggies, and low-fat dairy). When your
body gets the right balance of nutrition, it's less likely to send
you willpower-busting cravings! Eating smaller portions also
helps you set good eating habits that will help you keep the
weight off.
5. The diet requires you to skip meals or replace meals
withspecial drinks or food bars. As with diets that ban certain
food groups, skipping or substituting meals can mean you don't
get the nutrition needed to support healthy development. Plus,
you miss out on the enjoyment of sharing a satisfying meal with
friends or family.
When you go on a fad diet and exclude necessary nutrients, you're
putting yourself at risk for becoming ill. Getting too little of any
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nutrient may not cause an immediate problem. But if it's lacking

for a long time, you may find you have health problems.
Practice Portion Control
Food servings have grown larger and larger over the years. And
fast-food restaurants aren't the only places you'll find supersized
meals.
A cup of fruit should be no larger than your fist.
An ounce of meat or cheese is about the same as the size of your
thumb from base to tip.
3 ounces of meat, fish, or poultry (a normal serving) is about the
size of your palm.
1 to 2 ounces of nuts equals your cupped hand.
Here are some simple tricks to scale back your portions (and
calories):
Serve your meals on salad plates instead of large dinner plates.
Store snack foods in tiny sandwich bags. When ordering out,
share your entre with a friend.
Ask for a kids' meal or small size at a fast-food restaurant.
Never go for a supersized portion.
Then, Follow These Simple Strategies
Eat a variety of foods. Make sure your diet includes
lean protein; complex carbohydrates such as whole grains,
fruits, and vegetables; and "good" fats like omega-3 fats from
fish and monounsaturated fats from avocados, nuts, and olives
or olive oil. When you go on a fad diet and exclude necessary
nutrients, you're putting yourself at risk for becoming ill.
Getting too little of any nutrient may not cause an immediate
problem. But if it's lacking for a long time, you may find you
have health problems
Say no to bad fats. Minimize how much saturated fat you get
from animal sources, and eliminate trans fats from the fried
foods, snacks, and fast-food products you eat.

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Get five a day. Eat at least five servings of fruits and

vegetables each day. Choose different colors of fruits and
vegetables to ensure optimal nutrition.
Exercise at least 150 minutes each week. This can be divided
into smaller blocks of time. For example, you could do a brisk
walk for 10 minutes three times a day for 5 days to reach 150
minutes.
Clean out the kitchen! Toss out high-calorie, high-fat, sugary
foods that will tempt you to overeat -- chips, cookies, crackers,
ice cream, candy bars, and the like. Then, fill your fridge and
cupboards with lean protein, fruits, vegetables, whole grains,
legumes, nuts, seeds, good fats, and fat-free or low-fat dairy
products.
Eat smaller meals more frequently. Aim for five to six minimeals per day. Space your meals every 3 to 4 hours. Try taking
low fat cheese and whole-grain crackers to school or work for a
snack, or eat a tablespoon of peanut butter with one slice of
whole-grain bread. Find foods that are healthy and that keep
you full.
Fill up on the good stuff. Pile on the salad and super servings
of green beans, broccoli, cabbage, kale, or other low-calorie
vegetables instead of high-fat foods, breads, pasta, and desserts.
If youre still hungry after a meal and you want seconds, go for
veggies.
Snack on berries. Dark berries (blueberries, blackberries,
cherries, and raspberries) are rich in healthy antioxidants.
Theyre also low in calories and fat and high in fiber.
Avoid "empty calories." Steer clear of sugar-containing sodas
and fruit drinks.

410

PART VI
ENERGY
EXPENDITURE

411

ENERGY EXPENDITURE
Diet plays a role in the etiology and prevention of many chronic
diseases such as coronary heart disease, diabetes, and cancer.
Accurate estimation of dietary intake is essential for assessing the
effect of diet on health, as well as the effectiveness of weight loss
and other lifestyle interventions of which diet is an important part.
Because total energy intake is a determinant of both the nutrient
content of the diet and individual nutrient requirements, it is crucial
to obtain accurate estimates of intake.
For a variety of practical reasons, nutritional data in most
epidemiologic studies are obtained from self-report or intervieweradministered dietary assessment methods. One such method, the
24-hour dietary recall interview (24HR), is commonly used both as
an intensive method of assessment for intervention studies and as a
comparison method for validation/calibration studies of structured
assessments such as food frequency questionnaires. Some large
epidemiologic studies may collect 24HR data as part of a
validation sub study; more rarely, they may collect one or two days
of 24HR data as part of the general assessment protocol.
As diets vary considerably from day to day, the ability of a
single 24HR to provide an accurate estimate of long-term energy
intake is limited. However, the degree to which energy intake
estimates improve with increasing number of recalls is not known.
Several studies have attempted to answer this question, with
varying results. Researchers have suggested that 3, 4, 5, or 7 days
are necessary to adequately estimate energy intake.
In addition, the number of recalls required may differ by age,
ethnicity, or other characteristics due to variability in eating habits.
Because neither an objective criterion, such as the doubly labeled
water (DLW) method, was employed nor were subjects followed
up under highly controlled laboratory conditions, true energy
intake is unknown in these studies. Therefore the intra412

individual/inter-individual variance ratio is often used to estimate

the number of recalls needed.
The objectives of the present study were to 1) evaluate effect of
call sequence on estimates of energy intake and 2) calculate the
number of 24HRs needed to accurately estimate the group mean
energy intake. Energy expenditure (EE) was determined by the
DLW method, which is the gold standard for assessing energy
intake. For individuals in weight balance (i.e., neither gaining nor
losing body weight), EE equals energy intake; therefore EE
provides an accurate estimate of true energy intake.
REE (Resting Energy Expenditure)
Resting energy expenditure represents the amount of calories
required for a 24-hour period by the body during a non-active
period. Energy expenditure can be estimated by numerous
published formulas. There are nearly 200 published energy
expenditure formulas dealing with various conditions, disease
states, age, presence of obesity and other additional factors.
One of the most frequently used formulas for predicted energy
expenditure are the Harris-Benedict equations. These were
established in 1919 and took into account gender, age, height and
weight. However, these formulas are skewed towards young and
non-obese persons.
Harris-Benedict Equations (calories/day):
Male: (66.5 + 13.8 X weight) + (5.0 X height) - (6.8 X age)
Female: (665.1 + 9.6 X weight) + (1.8 X height) - (4.7 X age)

weight in kilograms, height in centimetres, age in years

The Harris-Benedict equations have been found to overestimate by
6% to 15% the actual energy expenditure measurements done by
indirect calorimetry. There is a large variation between individuals,
when comparing their measured energy expenditure to the
calculated amount. These equations have limited clinical value
413

when tailoring nutrition programs for specific individuals for

weight loss purposes or acute as well as chronic illness feeding
regimens.
Energy expenditure can be measured directly by putting a
person in a calorimeter and measuring the amount of heat produced
by the body mass. This is expensive and very impractical in the
clinical setting. Energy expenditure can be measured indirectly
with a metabolic cart by analysis of respired gases (usually
expired) to derive volume of air passing through the lungs, the
amount of oxygen extracted from it (i.e., oxygen uptake VO2) and
the amount of carbon dioxide, as a by-product of metabolism,
expelled to atmosphere (CO2 output ? VCO2) ?all computed to
represent values corresponding to 1 minute time intervals.
With these measurements the resting energy expenditure (REE)
and respiratory quotient (RQ) can be calculated.The RQ represents
the ratio of carbon dioxide exhaled to the amount of oxygen
consumed by the individual. RQ is useful in interpreting the results
of the REE. The abbreviated Weir equation is used to calculate the
24-hour energy expenditure. These measurements are printed out
by the metabolic cart after completion of the indirect
calorimetry test.
Abbreviated Weir Equation:
REE = [3.9 (VO2) + 1.1 (VCO2)] 1.44
VO2 = oxygen uptake (ml/min)
VCO2 = carbon dioxide output (ml/min)
Respiratory quotient (RQ) = VCO2/VO2
Benefits Of Using REE In The Clinical Setting
The REE is useful to prevent under and overfeeding of individuals,
especially in the acute care hospital setting. Excessive calories or
inadequate feeding regimens can have detrimental effects on
clinical outcomes of patients' care. Malnutrition can result from
feeding a patient less than his/her metabolic requirements leading
414

to reduced respiratory muscle strength, increased risk of infection,

poor wound healing and impaired normal body function. The REE
measurement is especially beneficial in the ventilator dependent
patient population during the process of weaning the individual
from mechanical ventilation to resume (re-establish) spontaneous
breathing.
Interpreting the REE
Interpreting the measured REE includes comparing the results to
the predicted level of energy needs for that individual. Determining
the 24 hour calorie intake of that individual from either an oral diet
or specialized nutrition therapies (through feeding tubes into the
gastrointestinal tract or intravenous administration) is required.
It is important to assess the RQ to make certain it is
within physiological range and consistent with the person's calorie
intake and medical history. The physiological range of RQ is 0.67
to 1.3. This value represents the combination of carbohydrate, fat
and protein being used for energy. If the RQ is greater than 1.0,
decrease the total calorie intake and adjust the carbohydrate to fat
ratio. If the RQ is less than .81 increase the total calorie intake,
dependent on the goal for the nutrition therapy. Food sources and
conditions have specific RQ values that are useful when
interpreting the REE and making recommendations for changing
dietary goals and feeding regimens.
Energy Source/Condition RQ
Prolonged
fat
underfeeding
protein
mixed
carbohydrate
fat

ketosis

energy
storage

415

<0.7
0.70
<0.71
0.80
0.85
1.00
>1.00

Use Of REE In Conjunction With Weight Management

Programs
In weight management programs, when an individual has trouble
losing weight a frequent comment is that ones metabolism is slow.
This can result in failure of the individual to adhere to a weight
management program incorporating a reduction in total daily
calorie intake. However, once the actual REE is done, there is no
longer need to speculate about the normalcy of metabolism for that
person.
Successful maintainers of weight loss report continued
consumption of a low-energy and low-fat diet. Efforts to improve
weight loss and maintenance need to focus on strategies to increase
calorie expenditure through exercise and an appropriate diet based
on measured energy needs.
It is important that an individual have a framework for making
healthful food choices to obtain realistic weight reduction and
maintenance goals. The challenge is to balance adequate nutrient
intake with the individual's desire to lose weight rapidly and to
address the numerous myths concerning diet modification. The
REE takes the guesswork out of determining the goal for the
calorie intake to achieve the desired outcome.

416

PART VII
WEIGHT LOSS
SERVICES

417

BARRIERS TO WEIGHT LOSS

Most people will confront some sort of challenge as they try to
reach their weight loss goal. The ones who are successful at losing
weight are the ones who have learned to overcome weight loss
barriers.
DIFFERENT TYPES OF WEIGHT LOSS BARRIERS

The first step to addressing the challenges that come up in the

weight loss process is to understand each barrier. Once you can
identify each challenge it becomes easier to develop the skills
necessary to move past it. It is also helpful to understand that the
challenges you confront are the same barriers that many other
dieters confront as they try to eat well or stick to an exercise
program.
Some weight loss barriers are perceived barriers, meaning that
the barrier is based on the thoughts or feelings of the dieter.
Perceived barriers can be just as significant and real as concrete
barriers which might include a health condition or physical
limitation. Whether the challenge is perceived or concrete, most
barriers can be divided into three main categories: physical,
environmental and emotional.
Physical Barriers To Weight Loss
Common physical barriers to weight loss include fatigue,
discomfort, and underlying medical issues. While these barriers
can be significant, there are ways to get around them and still lose
weight.
Tips for Overcoming Physical Barriers to Weight Loss
Communicate with your physician. Talk to your doctor if you
can't lose weight. There may be a medical cause. Weight gain
can be caused by medication, as well as hormonal imbalances,
thyroid disorders, or menopause.

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Expand your health care team. Work with your primary care
physician to get referrals to a dietician or physical therapist who
can tailor services to meet your needs. Often, if a physician
referral is provided there is a greater chance that insurance will
help cover the cost of the service.
Do your homework. Investigate different exercise plans or
healthy cooking tips so that weight loss habits become more
manageable. For example, non-weight bearing activities, such
as water aerobics, are often more comfortable for people who
are obese or who have joint problems. To make dieting less
difficult, consider signing up for a cooking class to learn new
ways to prepare healthy vegetables or lean meats.
Environmental Barriers To Weight Loss
These barriers involve time and life style. Sometimes the reason
that you don't lose weight is
that your environment doesn't
support your diet and exercise plan. Environmental barriers can
include lack of access to healthy foods or to exercise facilities, lack
of social support, or lack of time due to social, family and
professional pressures.
Tips For Overcoming Environmental Barriers To Weight Loss
Talk to the people around you. Get support from family and
friends by communicating your needs. Be specific about the
ways in which they can help you to make your plan a success.
Your spouse may be willing to take on extra tasks; your kids
can help around the house. Your employer may even be willing
to support your diet and exercise plan by providing some
flexibility to your work schedule. After all, a healthy employee
is more likely to be a productive employee.
Get creative about exercise. If going to the gym is out of the
question, rent or purchase exercise DVDs, check your television
schedule for fitness programming or use the resources right
outside your door to get in shape. Walking is a great way to
exercise. Walk neighbourhood paths, climb the stairs in your
office or apartment building or plan a family hike for the
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weekend. Many shopping malls even offer special hours for

walkers who want to exercise before the crowds take over.
Emotional Barriers To Weight Loss
It would seem likely that if you want to lose weight, the last thing
holding you back would be your own feelings about weight loss.
But emotional barriers to weight loss are well documented and can
be significant. These barriers may include scepticism about your
ability to lose weight, a negative physical activity history, stress, or
lack of motivation.
Tips For Overcoming Emotional Barriers To Weight Loss
Enlist the help of a qualified professional. Many behavioural
health specialists including social workers, therapists and
psychologists specialize in dealing with emotions related to
weight loss, weight gain and obesity. If you have investigated
medical causes for your inability to lose weight, consider
speaking to a therapist about an emotional cause.
A certified personal trainer may also be able to help.
Learn to motivate yourself. Motivation is a skill that can be
learned. Techniques such as positive self-talk and journaling are
two techniques that experts use to boost motivation.
Use stress reduction techniques. Stress from a lack of weight
loss results, from a medical condition or just from everyday
annoyances can lead to emotional eating and to weight gain.
Learn a few stress reduction techniques such as deep breathing,
meditation, or journaling and schedule them into your day.

420

PART VIII
WEIGHT
MANAGEMENT FOR
SPECIAL
POPULATIONS

421

WEIGHT MANAGEMENT FOR SPECIAL

POPULATIONS
The NSCA Certified Special Population Specialist (CSPS)
credential was established in 2012 to address the fitness needs of
individuals afflicted by chronic or temporary health conditions.
Anyone interested in pursuing a CSPS must first understand the
types of health conditions that require special exercise intervention.
Health conditions are typically categorized according to the
body system and physiological implications involved:
Cardiovascular: Myocardial infarction, angina, peripheral
vascular disease, congestive heart failure, revascularization, heart
valve disorders, and/or conduction disorders.
Pulmonary: Chronic obstructive pulmonary disorder, chronic
restrictive pulmonary disorder, pulmonary hypertension, and/or
asthma.
Metabolic: Diabetes (Type I and II), overweight/obesity, prediabetes, metabolic syndrome, thyroid disorders, and/or end-stage
renal disease.
Immunological: AIDS/HIV, fibromyalgia, chronic fatigue
syndrome, anemia, autoimmune disorders (e.g., lupus, rheumatoid
arthritis), and/or blood clotting disorders.
Musculoskeletal: Osteoporosis, limb amputations, osteoarthritis,
lower back conditions, frailty, joint disorders, joint replacements,
sarcopenia, posture disorders, and cystic fibrosis.
Neuromuscular: Stroke, brain injury, spinal cord disorders,
multiple sclerosis, cerebral palsy, Downs syndrome, Parkinsons
disease, epilepsy, balance disorders, and muscular dystrophy.
Cancer: Multiple body systems affected.
Psychological/behavioural: Disordered
disorders, depression, and chemical
422

eating, body image

dependency. Special

populations also include those groups of people with unique traits

that are not necessarily afflicted by a chronic or temporary health
condition.
Ethnic minorities in the United States experience higher rates of
obesity than do whites. These higher rates are accompanied by an
increased prevalence of obesity-related diseases. In addition to
higher prevalence of obesity, African Americans, Mexican
Americans, and American Indians have disproportionately high
rates of low income and low educational attainment.
These factors have been shown to lead to behaviours and/or
environments that negatively affect diet and physical activity
patterns. The circumstances strongly support the importance of
finding effective weight management strategies for use with these
groups. Although there is no evidence to support one particular
treatment over another with these groups, lifestyle behavioural
programs that focus on making gradual changes over time offer the
most promise, as short-term interventions have not been beneficial
for weight loss with minority groups.
Lifestyle programs also allow for the inclusion of individual
food and activity preferences, especially important when working
with low-income or minority groups.Tailoring the intervention to
address food restrictions, price, and cultural preferences is
necessary to effectively intervene with special populations.
In general, lifestyle programs offer strong empirical support for
weight loss. They can be used in a variety of settings with diverse
populations. Lifestyle approaches will continue to be useful as
intervention strategies; however, a number of issues need to be
addressed to enhance the impact of this approach.
Although lifestyle programs are a viable option for weight loss,
the majority of individuals who lose weight eventually regain
most, if not all, of their lost weight. Advances in adjunct treatments
such as pharmacotherapy and meal replacements may improve the
maintenance of weight loss. Finding ways to extend treatment
beyond structured interventions (eg, 16-26 weeks) will be
423

necessary to prevent weight gain over time. Providers will likely

have to develop creative solutions to address no adherence and
patient dropout.
Many lifestyle programs are expensive, making them available
only to the individuals who can afford them. This is problematic
because low-income groups are at increased risk for obesity.
Although managed care reimbursement for obesity treatment has
been discussed, it is still not available through most carriers. The
need for lifestyle interventions that are affordable for economically
diverse populations is clearly indicated.
Treatments are typically offered in clinics or medical canters.
This may severely affect many people's ability to access treatment.
Although there are options for making lifestyle interventions more
easily available (eg, phone and Internet), the use of these strategies
has yet to be fully realized. Programs that take place within
communities or work settings will improve the likelihood of
reaching those who need them.
There is strong support for the use of lifestyle interventions not
only for weight loss but also to improve health.The Look AHEAD
trial that is currently underway will provide additional data
regarding the effectiveness of lifestyle interventions for reducing
cardiovascular morbidity and mortality in obese individuals with
type 2 diabetes.
The prevalence of obesity is on the rise, and without effective
treatments, the problem will continue to increase. Lifestyle
interventions provide an option for delivering treatment to a broad
array of populations, but intervention alone will not resolve the
growing crisis of obesity in this country. Public health and policy
solutions will likely facilitate opportunities for incorporating
lifestyle changes.

424

WEIGHT MANAGEMENT FOR PREGNANT

AND POSTPARTUM WOMEN
A person with a disability can avoid overweight or obesity with
various strategies. People with disabilities may find it hard to
maintain a healthy weight. Exercise is difficult for people with
limited mobility, but help is available to manage your weight.
Some people with a disability who are prone to overweight or
obesity may find it hard to maintain a healthy weight. For example,
they may have reduced muscle tone or may find it difficult to
exercise. There are several ways that a person with a disability can
successfully manage their weight to avoid unwanted weight gain.
See your doctor or a dietitian for expert advice.
Contributing Factors
Many people in the community have problems with overweight or
obesity. However, for people with a disability, there may be
particular challenges they need to overcome. Some of the
contributing factors that may lead to unwanted weight gain may
include:
A particular medical condition that affects the bodys
metabolism
Reduced mobility and lack of regular exercise
Reduced muscle tone (making it difficult to exercise and
reducing the rate of metabolism)
Medications that may increase appetite
Eating habits that may be affected by depression, anxiety,
boredom or frustration
Dependence on family members or carers to provide meals
Poor knowledge of nutrition and weight management.
Calculating A Persons Appropriate Weight
There are different ways to calculate a persons ideal weight for
their height (such as the body mass index, or BMI), but these
methods dont always apply to people with a disability. For
example, a person with a physical disability may weigh less than is
425

recommended for the general population, but the guidelines do not

take into account any reduced muscle mass in their legs or arms.
Generally, for someone who is overweight or obese, a helpful
guide is the waist to hip ratio if your waist measurement exceeds
your hip measurement, you may need to lose weight. The benefits
of losing just 510cm off the waist can significantly reduce the risk
of many conditions, including diabetes and heart disease. Always
see your doctor or a dietitian for help in calculating your ideal
weight range and for strategies on achieving a goal weight.
Healthy Diet Suggestions For People Who Want To Lose
Weight
Its a good idea to see a dietitian for advice on how to achieve a
slow, healthy weight loss. Some suggestions include:
Eat a healthy, balanced diet breads, cereals, vegetables and
fruits should make up the bulk of your diet. Meats and low fat
dairy foods should be eaten in smaller portions.
Restrict high fat and high sugar foods for special occasions
these include fried foods, pastries, cakes, crisps, chocolate, soft
drink and lollies.
Increase fibre high fibre foods offer a sensation of fullness
and satisfaction without the kilojoules. Aim for around 30g of
fibre each day.
Dont overeat excess kilojoules lead to an increase in weight.
It is best to eat foods that are lower in fat and sugar and to avoid
eating when you are not hungry.
Read labels packaged foods include nutrition information on
their labels. Make a habit of reading these labels when shopping
and choose foods that are lower in fat and sugar.
Exercise regularly any type of regular exercise program will
boost your metabolism and help burn kilojoules.
Find An Eating Style That Suits You Best
Maintaining a healthy weight is only possible in the long term if an
eating style is chosen that suits the person. For example, some
426

people prefer eating three main meals each day, while others prefer
to eat more regularly and include snacks as well as meals. Talk to a
dietitian about your dietary preferences so they can draw up an
eating plan that you will be able to sustain.
Exercise Is Important
Proper weight management relies on exercise too. People with
certain disabilities may have reduced mobility, but it is important
to remember that any degree of activity is helpful. For example, a
person who uses a wheelchair can still lead a very active lifestyle.
Exercising in water is often easier for people with certain
disabilities, as the buoyancy offers support. Even gentle stretching
can prevent muscle contraction and wasting.
Gerber, of the Jesse Brown VA Medical Center in Chicago, says
regular 30-minute targeted phone calls from a trainer can result in
significant weight loss for disabled persons. The finding is from a
study Gerber worked on along with Dr. James Rimmer of the
University of Alabama at Birmingham (UAB).
Gerber says providers often dont know exactly what to tell
disabled patients about exercise. From a providers perspective,
we might tell a patient to walk 30-minutes a day or to eat a certain
kind of diet, but for someone with paraplegia, that recommendation
becomes a lot more complicated. There also might be competing
health priorities, says Gerber. Who grocery shops and prepares
the meals, mobility limitations, pain, depressionall of that plays
a role.
All that is part of why people with disabilities have a 66 percent
higher rate of obesity than the general population. Intrigued by the
challenge, the researchers set out to develop a program to make
exerciseand weight lossmore practical and attainable for the
disabled population.

427

One Call Per Week

Their study, published in the December 2013 issue of
the American Journal of Physical Medical Rehabilitation, involved
more than 100 participants, each with a mobility-limiting
disability. The conditions included spinal cord injury, multiple
sclerosis, spina bifida, cerebral palsy, stroke and lupus. People with
disabilities can exercise, lose weight and achieve their goals.
A second group received the toolkit, POWERS calls and
nutritional advice. The third group received the physical-activity
toolkit only after the study completed and no phone coaching.
Gerber notes that the approach may be a way to reduce not only
weight, but health care costs. Something like this is relatively
low-cost, We can do health behaviour promotion and
intervention by telephone. Thats an easy, cheap, and accessible
mechanism to use. He adds the benefits might be especially
applicable in VA, with its large population of Veterans, many in
rural areas, who have disabilities and other chronic health
conditions.

428

WEIGHT MANAGEMENT FOR SENIORS

Putting on excess weight is very common for a number of reasons
that we'll explain. But it's not an inevitable part of the aging
process, and it could put your health at risk. If you understand why
you tend to gain weight more easily as you get older, you can do
something about it. And doing something about it is what this book
is all about.
You can blame a lot of your weight gain on your metabolism.
Beginning as early as your mid-twenties, body fat begins to
increase while muscle mass decreases. And less muscle mass
translates into a slower metabolic rate.
Muscle mass decreases from about 45 percent of your total body
weight in your youth to about 27 percent by the time you reach age
70. And the drop in hormones that accompanies menopause also
precipitates a decrease in muscle mass, triggering even more
weight gain for women. Your body fat, meanwhile, can double,
even if your weight remains the same.
The bottom line is that you burn fewer calories in your 50s, 60s,
or 70s doing the same activities, and the same number of them, that
you did in your 20s, 30s, or 40s. The key to preventing weight gain
is to compensate by adjusting your food intake, exercising, and
generally becoming more physically active.
Assessing Your Weight As A Senior
The best way to determine if you're carrying around too much
weight (and probably not enough muscle) is to calculate your body
mass index (BMI). BMI is just one indicator of good health, but it's
a good place to start. A lower BMI indicates you're more likely to
be healthy.
Here's how to figure your BMI:
1. Weigh yourself first thing in the morning, without clothes.
2. Measure your height in inches.
3. Multiply your weight in pounds by 700.
429

4. Divide the answer in #3 by your height.

5. Divide the answer in #4 by your height again.
6. The answer in #5 is your BMI.
What Your BMI Means?
18.5 or less is underweight
18.5-24.9 is a healthy weight
25-29.9 is overweight
30 or more is obese
Most experts say that 2,000 to 2,600 calories a day should meet the
energy needs ofmen older than 50 who are lightly to moderately
active.
For women over 50 who are lightly to moderately active, 1,600
to 1,800 calories a day should do it. However, these are just
ballpark figures. Individual calorie needs can differ greatly
depending on muscle mass, physical activity, and genetic
differences. While it's true that the more calories you cut, the
quicker you'll lose, don't make the mistake of cutting back too
much.
If you go too low (below 1,600 calories a day), you won't get
enough nutrients, you'll be fatigued, and your body will simply
compensate by slowing its metabolic rate even further so that each
calorie is used as efficiently as possible.
Preparing To Lose Weight As A Senior
Managing your weight doesn't just mean counting calories and
figuring out your BMI. It also means taking control of your
emotions and your food cravings. Most of us discover sooner or
later that its usually emotions and cravings (sometimes triggered
by emotions), not an insatiable appetite, that make us overeat.
Anger
If anger (especially suppressed anger) sends you seeking comfort
food, then you're managing your anger by overeating. While food
430

may seem like your most dependable source of comfort, it

ultimately leaves you more out of sorts than before. Face the
source of your anger head on. Once you've done that, it's less likely
to blow up and compel you to eat -- and overeat.
Stress
First, make sure you get enough sleep. You're more susceptible to
stress when you're not rested. Try different relaxation techniques,
such as deep breathing, yoga, reading, or listening to soft music -whatever works for you. Try to find other, more positive outlets for
your stress.
Boredom
There's nothing on TV tonight, you've already finished reading that
novel, and you certainly don't feel like washing dishes or sweeping
the kitchen floor. The refrigerator sure looks good right about now!
Before you find yourself rummaging through the freezer for ice
cream, do whatever it takes to shift the focus away from food.
Take a shower, paint your nails, throw out old newspapers, or take
one last look through that magazine before you toss it. Make a list
of your favorite diversions and keep them posted on the fridge.
Depression
We're talking here about the blue mood that takes hold of everyone
now and then. The blues not only prevent us from doing the things
we want to do; sometimes they make us do things we'd rather not - such as overeat. Instead of letting that funk make you overeat,
view it as a call to action. Getting active is one of the best ways for
lifting a black cloud. Physical activity may raise levels of
endorphins, which are compounds in the brain that promote a sense
of well-being.
Happiness
Yes, it's true. Even happiness can make you fat. Who doesn't feel
like celebrating when something good happens? And celebrations
often involve food. That doesn't mean you should never celebrate

431

because you might overeat. Just learn to compensate. If you

overeat at a celebratory dinner, simply cut back the next day.
Demystifying Food
Before you can take control of your eating habits, you have to take
away the power that food has over you. Think moderation, not
elimination. Figure out what's important and what's not. Learn to
eat less of the high-fat, high-calorie foods you enjoy the most.
Knowing you can still look forward to your favorite foods makes
the process something you can live with for a lifetime.
Eat regularly in response to real hunger. Learn to listen to
your body's cues. By eating healthful, balanced meals and
snacks when you're hungry, you're less likely to get caught up in
out-of-control eating that you'll regret later.
Say good-bye to calorie counting. Switch your focus from
calories to good nutrition. Make your healthful eating changes
gradual, so you don't get overwhelmed.
Picture portions. It's hard to manage your food intake if you
don't have a clue what a 1/2 cup serving of pasta looks like or
what a 6-ounce glass of juice is. When you start out, measure
your food until you've learned to judge portion sizes accurately.
If portion sizes start creeping back up, return to measuring and
weighing for a while.
Disconnect with the scale. Don't focus on a number, instead
use how you feel and the way your clothes fit to measure
success. If you just can't give up the scale, make your weigh-ins
less frequent. Weighing yourself once a week is adequate.
If you're determined to succeed at losing weight, simply
cutting calories won't guarantee success. Physical activity is as
essential to achieving long-term weight loss as a healthful diet,
according to the National Institutes of Health (NIH). By
themselves, neither exercise nor diet can get you to your goal as
effectively or as fast as the two of them can together. That's
especially true for people over age 50.

432

Anti-Aging Bonus
Researchers have recently learned that regular physical activity can
have a powerful effect on age-related declines in metabolism. One
study out of Tufts University Center for Physical Fitness found that
strength training by itself increased the metabolic rate of
postmenopausal women by 15 percent.
Regular exercise offers a trifecta of good health: It burns
calories, builds muscle, and improves your overall health. Experts
on aging say that the body is better able to repair itself and perform
efficiently if it is properly conditioned by exercise and good
nutrition. And the calorie-burning rewards of exercise are not
limited to your workout time. Some research suggests that your
revved up metabolic rate stays elevated for several hours after you
stop exercising.
While weight management may be your number one priority
now, think fitness not thinness. Just look at all the other health
bonuses experts attribute to being physically active:
Regular physical activity reduces your risk of developing:
heart disease
some kinds of cancer
high blood pressure
osteoporosis
diabetes
obesity
It also can reduce the symptoms of:
arthritis
anxiety
depression
insomnia
And it boosts and builds:
the immune system
your energy level
your muscle mass
blood flow to the brain, which helps keep you mentally sharp
433

Triad Of Physical Activity

Recent research has found that when it comes to exercise, you need
a combination of three types to reap the most health benefits -weight training for strength, aerobic exercise for strength and
endurance, and calisthenics (stretching, bending, and twisting
exercises) for flexibility.
Studies have found that extreme physical exertion is no more
useful to gaining and maintaining fitness than is moderate exercise.
What's more, you place yourself at risk for injury or a heart attack
if you're not already in good physical shape. So start off slowly and
increase your activity gradually. Get your doctor's okay before
beginning a new physical activity if you haven't exercised in years
or have a medical condition.
The Benefits of Walking
One of the easiest ways to get physically active is to walk at a pace
that makes you breathe a little harder and work up a mild sweat for
30 minutes to 1 hour three days a week. This kind of walking will
keep your heart, lungs, and vascular system in good working order
and strengthen your bones and muscles.
If you just don't have time for a 30-minute walk each day, experts
say that walking about 10,000 steps a day (the equivalent of about
five miles) while doing your normal activities should keep you fit.
Haven't a clue how much walking that is? Try using a pedometer.
It's a small battery-operated gizmo about the size of a matchbox
that you attach to your waist so it can monitor your every step. By
keeping track of your movements all day, you can easily see how
far you've gone and how far you have yet to go to reach your goal.
Swim Your Way to Fitness
If you have arthritis that makes some movements painful,
swimming is an excellent way to get aerobically fit. It offers some
of the same benefits as walking or other aerobic exercises without
putting stress on joints that may be unable to repair themselves like
healthy joints would. The one benefit swimming can't provide,

434

however, is strengthening bones because it is not a weight-bearing

exercise.
Weight Training for seniors
If you think lifting weights is just for 20-somethings in spandex,
think again. It's a little-appreciated fact that muscle tissue burns
more calories than fat tissue does, even when at rest. The more
muscle you have, the more calories you burn.
Since muscle mass declines with age -- typically about five percent
per decade beginning in your late twenties or early thirties -- it's to
your advantage to try to increase your muscle mass through
strength training. The older you get, the greater the potential
benefit. So, as the saying goes, use it or lose it.
Research from the United States Department of Agriculture
(USDA) recently confirmed that the gradual loss of muscle mass
that occurs with age means a decreasing need for calories -- and
sometimes a creeping weight gain if you don't lower your calorie
intake. The more you can do to minimize the effect of muscle loss,
whether it's due to age, inactivity, or both, the easier weight loss
will be.
But before you start trying to bench-press your own body weight,
it's important to distinguish between true weight lifting and
strength training. Weight lifting is about bulking up so you can lift
heavy weights swiftly. Strength training, on the other hand, is
about firming by repeatedly lifting weights in a very slow,
controlled way.
It's a good idea when you first get started to have a trainer show
you exactly how it should be done to avoid injury. Your training
can be done with free weights, such as barbells, or with specially
designed equipment that works specific parts of the body.
You should do a set number of repetitions with each exercise as
you slowly progress to your goal. Muscle strengthening exercises
should be done for at least 20 minutes, three times a week.
Where to Get Started
Don't want to fork over the cash for a high-class health club? Many
kinds of organizations, such as the YMCA and YWCA, junior
colleges and universities, senior and community centers, and adult
435

and continuing education programs, offer inexpensive classes in

sports, exercise, dance, and weight training.
When you're increasing your physical activity, don't drastically cut
your calorie intake. Of course, you have to cut calories to lose
weight -- just don't get carried away. Fewer than 1,600 calories a
day may not leave you with enough energy to make it through a
regular day, much less a day filled with more physical activity than
you're used to.
Need More Protein :
It's a myth that you need more protein if you're going to be more
active and build muscle. Only serious athletes require more protein
than the rest of us, and even then it's not a lot more. Most of us can
get all the protein we need in a day -- about 46 to 56 grams -- from
about five ounces of cooked lean meat, poultry, or fish, plus two to
three 8-ounce glasses of low-fat milk.

436

WEIGHT MANAGEMENT FOR PERSONS WITH

DISABILITIES
A person with a disability can avoid overweight or obesity with
various strategies. People with disabilities may find it hard to
maintain a healthy weight. Exercise is difficult for people with
limited mobility, but help is available to manage your weight.
Some people with a disability who are prone to overweight or
obesity may find it hard to maintain a healthy weight. For example,
they may have reduced muscle tone or may find it difficult to
exercise. There are several ways that a person with a disability can
successfully manage their weight to avoid unwanted weight gain.
See your doctor or a dietitian for expert advice.
Contributing Factors
Many people in the community have problems with overweight or
obesity. However, for people with a disability, there may be
particular challenges they need to overcome. Some of the
contributing factors that may lead to unwanted weight gain may
include:
A particular medical condition that affects the bodys
metabolism.
Reduced mobility and lack of regular exercise.
Reduced muscle tone (making it difficult to exercise and
reducing the rate of metabolism).
Medications that may increase appetite.
Eating habits that may be affected by depression, anxiety,
boredom or frustration.
Dependence on family members or carers to provide meals.
Poor knowledge of nutrition and weight management.
Calculating A Persons Appropriate Weight
There are different ways to calculate a persons ideal weight for
their height (such as the body mass index, or BMI), but these
437

methods dont always apply to people with a disability. For

example, a person with a physical disability may weigh less than is
recommended for the general population, but the guidelines do not
take into account any reduced muscle mass in their legs or arms.
Generally, for someone who is overweight or obese, a helpful
guide is the waist to hip ratio if your waist measurement exceeds
your hip measurement, you may need to lose weight. The benefits
of losing just 510cm off the waist can significantly reduce the risk
of many conditions, including diabetes and heart disease. Always
see your doctor or a dietitian for help in calculating your ideal
weight range and for strategies on achieving a goal weight.
Healthy Diet Suggestions For People Who Want To Lose
Weight
Its a good idea to see a dietitian for advice on how to achieve a
slow, healthy weight loss. Some suggestions include:
Eat a healthy, balanced diet breads, cereals, vegetables and
fruits should make up the bulk of your diet. Meats and low fat
dairy foods should be eaten in smaller portions.
Restrict high fat and high sugar foods for special occasions
these include fried foods, pastries, cakes, crisps, chocolate,
soft drink and lollies.
Increase fibre high fibre foods offer a sensation of fullness
and satisfaction without the kilojoules. Aim for around 30g of
fibre each day.
Dont overeat excess kilojoules lead to an increase in weight.
It is best to eat foods that are lower in fat and sugar and to avoid
eating when you are not hungry.
Read labels packaged foods include nutrition information on
their labels. Make a habit of reading these labels when shopping
and choose foods that are lower in fat and sugar.
Exercise regularly any type of regular exercise program will
boost your metabolism and help burn kilojoules.

438

Find An Eating Style That Suits You Best

Maintaining a healthy weight is only possible in the long term if an
eating style is chosen that suits the person. For example, some
people prefer eating three main meals each day, while others prefer
to eat more regularly and include snacks as well as meals. Talk to a
dietitian about your dietary preferences so they can draw up an
eating plan that you will be able to sustain.
Exercise Is Important
Proper weight management relies on exercise too. People with
certain disabilities may have reduced mobility, but it is important
to remember that any degree of activity is helpful. For example, a
person who uses a wheelchair can still lead a very active lifestyle.
Exercising in water is often easier for people with certain
disabilities, as the buoyancy offers support. Even gentle stretching
can prevent muscle contraction and wasting.

439

ESTABLISHING A WEIGHT LOSS BUSINESS

HOW TO OPEN A WEIGHT LOSS CENTRE OR CLINIC

Imagine owning a fun and financially rewarding business helping

people to lose weight and get healthy. You can when you open a
weight loss centre. Opening a weight loss centre (also known as a
diet clinic, weight control centre, or weight management clinic)
lets youmake a difference in people's lives while starting your
own business in a recession-resistant industry.
Weight loss is, literally, a huge industry. In early 2009, the
National Centre for Health Statistics, which is part of the Centres
for Disease Control and Prevention, released the results of a survey
that found two-thirds of the population (66.7% of Indians)
are overweight or obese.
It's no wonder a recent Gallup Poll found 56% of Indians (49%
of men and 63% of women) said they want to lose weight.
When you open a weight loss centre, you can provide a place for
people to come for help with their weight loss andweight
management. Plus, as the owner of a weight loss centre you can
have the freedom to choose the types of services and products you
want to offer.
Depending on your interests and background, you might offer
individual weight loss counselling or consulting. You could
organize group meetings. You could join a popular weight
loss franchise or come up with your own style of counselling your
clients.
You can also help your clients in their weight loss efforts
andincrease your income by offering a variety of products for
sale -- from cookbooks to nutritional supplements tomotivational
CDs.

440

How to Start a Weight Loss Centre?

How to create a business plan for your weight loss centre
(includes a sample weight loss centre business plan)
Deciding what kind of weight loss centre to open
An overview of options for your weight loss business:
Buying an established weight loss business (including how
to find weight loss businesses for sale).
Buying a weight loss franchise.
Opening a new weight loss centre.
Choosing a name for your weight loss centre.
Where to get start-up financing for your weight loss business
(includes sample start-up budgets).
Deciding on the best legal structure for your weight loss
business (incorporation, partnership, and others).
Information about important business matters that can affect
your weight loss centre including insurance and licenses.
How much space (square footage) you need to open your
weight loss centre.
What to consider when choosing a location for your weight loss
centre, including information about permits and leases.
Equipment and supplies you need to start a weight loss
business and where to get them.
Interior and exterior design of your weight loss centre.
Managing Your Weight Loss Business
How to develop effective systems for running your weight loss
centre on a daily basis?
Setting your weight loss centres hours of operation.
How to find great weight loss centre staff?
Paying your staff (including typical salaries and commissions).
Setting prices for membership fees (includes sample fees)
Ways to increase sales
Accepting payment from your clients
Buying and selling weight loss products
441

An overview of products you can sell to increase your profits

and how to find suppliersfor those products.
How to buy products for resale at a discountwith tips on
negotiating the best payment terms.
Keeping track of your inventory.
Developing promotional materials and a website to
market your weight loss centre.
Ways to attract weight loss centre clients through
advertising and free publicity.
Advice on preventing "no shows".
How to get referrals for your weight loss business.
Plus you will find even more resources and advice, including:
Valuable samples and checklists, including:
Sample business plan for a weight loss centre
Sample floor plan for a weight loss centre
Sample lease agreement
Sample start-up budgets for a weight loss centre
Sample daily sales report
Sample interview questions for weight loss centre employees
Sample list of supplies
Sample weight loss centre brochure
Sample press release
Checklist to evaluate competing weight loss businesses
Checklist to evaluate potential locations
Checklist for weight loss centre operations
Checklist of weight loss centre equipment
How to organize your weight loss centres grand opening?
An overview of opportunities for future growth for your weight
loss business including opening additional locations and
franchising.
Satisfaction Guarantee: We are so confident that the weight loss
centre business guide can help you achieve your dreams, we will
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give you a refund if you decide within 30 days of purchase that you
are not satisfied with the information contained in the guide.
Customer Needs
Growing your weight loss centre business involves giving your
clients what they want -- an easy, enjoyable way to lose weight.
Some want to simply buy your food and supplements. Others need
moral support and community, or like the competition of weekly
weigh-ins. Consider how you can provide for these customer
desires in addition to giving them what you believe they need.
Increase revenues from your current customers by adding new
products such as aromatherapy, skin care lines and other spa
products that your customers would find appealing, and train your
staff to cross-sell these items when dealing with clients.
Controlling Attrition
Attrition happens when a client reaches the goal weight and stops
using your products and services. It also happens when a client
fails to lose weight through your system and quits out of
disappointment. Your successful clients are excellent sales reps for
your clinic, so it's important to keep them involved and looking
good. This is done through maintenance programs and recognition.
Create a "Winners Circle" and offer free attendance at weekly
meetings combined with discounts on product purchases.
Attracting New Clients
Establish referral partnerships with local doctors, bridal boutiques,
gyms and beauty shops. Compensating your referral partners and
current clients for referrals also provides them the incentive to get
their customers and friends involved in your program. Create a
sense of community with a regularly emailed newsletter to your
past and current clients. Hold events in your clinic to attract new
potential customers.
The events can provide weight loss information or deal with
other topics of interest such as wedding planning, cosmetics,
health, parenting or fitness presented by your referral partners.
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Also consider a social media campaign, with a business site on

Facebook and targeted Facebook ads to augment your website
traffic. Social media sites usually have consultants to help you set
up a marketing campaign.
Advertising
Ads in local newspapers and fliers reach a large number of people,
but an incentive such as a coupon for a free consultation or a
discount on products or services makes those ads much more
powerful. A booth at a local farmers market can attract healthconscious clients. A booth at a holiday bazaar can sell gift
memberships.
Use your creativity to put your weight loss clinic in front of as
many potential customers as possible, in different venues that each
attract a specific group of people you may not be reaching through
your other promotional efforts. In nearly every corner of life, there
is someone who is thinking about losing weight. Placing your
clinic promotions where they can see them is how you bring in
new business.

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REFERENCE
www.shape.com/weight-loss/weight-management/5-musthave-diet-book
www.webmd.com/diet/dietitian-picks-8-favorite-diet-book
www.livestrong.com Weight Management
www.metaboliceffect.com/top-weight-loss-books-for-2014
www.oprah.com/health/best-dieting-tips-new-weight-loss-books
http://ihfe.net/?page_id=612
https://en.wikibooks.org/wiki/Fundamentals_of.../Weight_mana
gement
https://books.google.co.in/books?isbn=1572246251
www.fatswitchbook.com
www.ifnotdieting.com.au
www.e-booksdirectory.com Health, Mind & Bod
https://www.swselfmanagement.ca/uploads/.../ObesityBook
www.womenshealthmag.com/weight-loss/read-this-lose-weightdiet-book
www.surreysportspark.co.uk Fit for Living
homeopathie-wijtenburg.nl/pdf.php?66275
www.saragottfriedmd.com/dr-sara-book-club-visualization-forweight
www.bestselfatlanta.com/.../food-expert-alton-brown-talksabout-weight
https://www.atkins.com/.../simplified-diet-book-the-new-atkins
www.thieme.com/books.../1844-encyclopedia-of-bodysculpting-after-m.
https://patients.mwlc.com/book_consultation.php
www.healthfirstandweightloss.com/book
www.huffingtonpost.com/dr.../dr-phils-family-weightlo_b_6246180.ht.
http://www.va.gov/health/newsfeatures/2014/march/weight-lossfor-those-with-disabilities.asp#sthash.65lQtIbb.dpuf

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