Surgical weight loss Guide:
Dr A Alphine Caroline Jenitha
Surgical weight loss Guide:
Surgical weight loss, also called bariatric surgery, refers to a number of procedures that can help morbidly obese individuals lose weight. These procedures have received a lot of attention in the media in recent years. This guide will help answer some of your questions about this type of surgery, including a discussion about who may be eligible.
Surgery can help reduce important health risks in obese individuals. However, the surgery itself has risks and should not be undertaken lightly. Before considering surgery, you should work with your physician to make lifestyle changes to lose weight. These include changes to your diet, eating habits, and level of physical activity. If these measures are not sufficient and you decide to have surgery, you still need to make lifestyle changes to help you lose the weight all and keep it off.
Understanding morbid obesity
Morbid obesity is a serious medical condition. If you are morbidly obese, it means that you are severely overweight, usually by at least 100 pounds. It also means that you have excessive amounts of body fat compared to healthy standards.
Fat thickness, which varies greatly from one person to another, depends on the size and number of your fat cells. Knowing whether or not you are morbidly obese is important.
This condition puts you at very high risk for a host of serious medical problems, including high blood pressure, type 2 diabetes, cancer, heart disease. Being morbidly obese may also hamper your ability to get around, expose you to possible discrimination or social stigma, and may lower your self-esteem.
If you are morbidly obese, you should remember three important points:
1. Morbid obesity does not mean weakness, laziness or gluttony. It is a serious medical condition with serious medical consequences. Current research suggests that many factors work together to influence your weight. These include genetics, your eating habits as a child and adult, hormones, and psychological and other factors.
2. You are not alone. About 65 percent of all Americans are considered overweight, about 25 percent are considered obese, and about 4 percent are considered morbidly obese. All of these numbers are on the rise.
3. There is hope. Resources are available to help you avoid the medical consequences of morbid obesity.
How do I know if I'm morbidly obese?
A good way to assess your weight is to calculate your body mass index (BMI). Your BMI estimates how much you should weigh based on your height.
Although your BMI is a simple way to evaluate whether your weight puts you at potential risk for health problems, other factors may also affect your health. These include:
• General health history
• Level of physical activity
• Waist measurement
• Smoking history
• Family health history
• Blood pressure
• Blood sugar
• Blood cholesterol levels
Weight gain in the area of the waist and above (apple type) is more dangerous than weight gained around the hips and flank area (pear type). Fat cells in the upper body have different qualities than those found in hips and thighs. Men should have a waist less than 40 inches. Most women should have a waist that is less than 35 - 37 inches.
The health risks of obesity
If you are morbidly obese, you have a much greater risk of developing a variety of serious medical conditions compared to individuals who are not obese. You may develop health problems at a younger age. Some of these conditions may include:
High blood pressure
High blood pressure is more common in obese adults.
Overweight people often have too much cholesterol and other fats in their blood. High cholesterol is linked to angina (a type of chest pain), heart disease, heart attack, and stroke.
Type 2 diabetes
Gaining as little as 11 - 18 pounds doubles your chance of developing type 2 diabetes. More than 80% of people with diabetes are classified as overweight or obese.
Your risk of arthritis increases by 9 - 13% for every 2 pounds of weight that you gain.
Osteoarthritis is a deterioration of cartilage and overgrowth of bone often due to "wear and tear." Rheumatoid arthritis is the inflammation of a joint's connective tissues, such as the synovial membranes, which leads to the destruction of the articular cartilage
Asthma and obstructive sleep apnea are more common in obese people.
During an asthma attack, smooth muscles located in the bronchioles of the lung constrict and decrease the flow of air in the airways. The amount of air flow can further be decreased by inflammation or excess mucus secretion.
Obesity may increase the risk of endometrial, breast, prostate, kidney, esophageal, and colon cancers. Women who gain more than 20 pounds between the age of 18 and midlife have double the risk of developing breast cancer after menopause.
Obesity increases the risk of diabetes during pregnancy, pre-eclampsia, delivery complications, and birth defects. Obese women have 10 times the risk of high blood pressure during pregnancy. Women who are obese and their babies have an increased risk of death during pregnancy.
About 300,000 deaths a year are due to the consequences of obesity. Obese people have a 50 - 100% increased risk of premature death.
Obesity is also linked to heart failure, back pain, bladder problems, gallstones, kidney stones, liver disease, gout, complications and infections after surgery, and menstrual irregularity and infertility in women.
Obesity can hamper your ability to get around. It can complicate your life with self-esteem and discrimination issues, and may lead to depression and eating disorders.
Take action now
The issues at stake are not about physical appearance. Morbid obesity is a life-threatening medical condition. Gaining control over this serious health problem requires a commitment of your time, attention, energy and efforts. Use the following suggestions to help get you on the right path:
• Define the nature of the problem. Are you overweight? Obese? Morbidly obese?
• Ask your physician to help you determine other risk factors you might have for developing serious medical diseases.
• Develop a plan of attack to control all areas of your life that might be contributing to weight and health problems.
• Use every possible method in your fight against obesity, including dietary changes, physical activity, and medical expertise.
• Schedule a medical consultation to help you determine your next steps.
Treatment of obesity
Many individuals who are morbidly obese have already tried various weight loss methods, including self-driven and commercial programs. If these methods haven't worked for you, it may be time to consult a structured medical weight loss program. These programs usually use a team approach, with care provided by professionals such as physicians, nutritionists, dieticians, exercise trainers, and counselors. These programs:
• Evaluate your health
• Identify obesity-related complications (such as high blood pressure, diabetes, heart disease) and work to treat them
• Help you establish your weight loss goals
• Work with you to design a comprehensive weight loss program that usually involves a combination of diet, exercise, and other lifestyle changes as well as psychological counseling and support
• Monitor your progress
• Help you consider whether you may be a candidate for additional treatment methods, such as medication or weight-loss surgery
When dieting, your main goal should be to learn new, healthy ways of eating and make them a part of your everyday routine. Work with your physician and nutritionist to set realistic, safe daily calorie counts that assure both weight loss and good nutrition. Remember that if you drop pounds slowly and steadily, you are more likely to keep them off. Your nutritionist can teach you about healthy food choices, appropriate portion sizes, and good methods of food preparation.
Exercise is a key component to any healthy lifestyle. Exercise can help you lose weight more quickly. It can help control some of the diseases associated with obesity, including high blood pressure, heart disease, diabetes, osteoporosis, and certain cancers. Exercise is also a major mood lifter, a great way to increase energy, and will help strengthen your bones.
It is extremely important to get approval from your doctor for your exercise program before or after your surgery. If you haven't been exercising before your surgery, start slowly. Walking is a great form of exercise. If you have arthritis or bad knees, you might want to start by walking in a swimming pool. Walking in water will help support you until you gain strength and endurance. Start out with just 5 - 10 minutes, and increase your daily time until you are up to 45 - 60 minutes daily.
Remember that your tolerance (and enjoyment) of exercise will increase as you build your stamina. So don't give up, even if the exercise seems daunting at first. You should soon begin to reap its many benefits.
It's important to look at how your habits may be influencing your weight. Are you watching a lot of television? Inactivity, coupled with snacking in front of the television set, could be contributing to your weight problem. Do you eat when you find yourself emotionally upset or stressed? Learning new ways to address the stress in your life may help you avoid soothing yourself with food.
Several simple behavioral changes can have an impact on your weight loss success:
• Eat only at the table. No snacking in front of the TV, in bed, while driving, or while standing in front of the open refrigerator.
• Learn about portion sizes. Our "Supersize-It" culture has misled an entire generation about the normal size of a portion.
• Consider learning meditation or yoga as a way of managing stress, rather than munching on snacks when the demands of your life begin to overwhelm you.
• Find ways to socialize and enjoy your friends and family that don't involve a meal or dessert.
• Consider keeping a diet and exercise journal. This may help you identify overeating triggers in your life.
• Find a support group or consider psychotherapy to help support you in the difficult but worthy goal of weight loss.
• Despite their best efforts, some people aren't able to lose weight through diet, exercise, and other lifestyle changes. You may wish to talk with your healthcare provider about prescription medication options that may be used to help with weight loss.
Never use over-the-counter or herbal weight loss preparations without first talking to your health care provider.
If you have been unable to lose weight through a comprehensive program that includes strict dietary management, physical exercise, other lifestyle changes, or medication, you may be a candidate for weight loss (bariatric) surgery.
To be accepted for weight loss surgery (such as gastric bypass or adjustable gastric band surgery), you need to meet certain criteria. In general, you should:
• Be morbidly obese with a BMI of 40 or more with associated complications. This is usually 100 pounds or more overweight. If your BMI is 35 to 40, you may be eligible for surgery if you also have some medical problems, such as diabetes, high blood pressure, sleep apnea, or arthritis.
• Be experiencing personal or occupational problems due to obesity.
• Have tried unsuccessfully to lose weight through a structured, medical weight loss program that included diet, exercise and lifestyle changes.
• Be willing and able to commit to long-term medical follow-up, as well as the rigorous, lifelong changes in eating, exercise, and lifestyle habits that will be necessary to meet and maintain your weight loss and health goals after surgery. Work with your health care team to understand the needed commitments.
Several different types of surgery are available. They involve modifying the stomach and/or intestines in order to decrease the amount of food that an individual can eat. Some procedures help prevent the normal absorption of fat calories.
Bariatric surgery can be an effective long-term method of weight control with established health benefits. Many bariatric surgery patients can lose about up to 50% of their excess weight within 1 to 3 years. While some weight rebound may occur, many patients can keep off much of the weight they've lost after surgery.
In addition, many of the serious health problems associated with obesity improve after weight loss, including diabetes, high blood pressure, sleep apnea, joint pain, and incontinence. Surgery may be associated with its own set of problems, such as infection; poor wound healing, and rarely even death. Therefore, you and your surgeon should carefully discuss the risks of your current health condition compared to the risks and benefits of surgery.
How weight loss surgery might help
Before considering surgery, you should work with your physician to make lifestyle changes to lose weight. These include changes to your diet, eating habits, and level of physical activity. If you still remain severely obese or still have complications from obesity, here are some of the ways weight loss surgery can help:
• Your stomach won't hold as much food. This will help you eat smaller portions and take in fewer calories. Prior to surgery, your stomach can hold about 6 1/2 cups of food. After surgery, your stomach pouch may hold about 1/2 to 1 cup of food, depending on the type of surgery you have.
• Food will pass more slowly from your stomach pouch to your intestine. This allows you to feel full much longer after eating. Other changes in the body's signaling mechanisms may also decrease the desire to eat.
• Depending on what type of surgery you have, you may absorb calories differently.
• Depending on the type of surgery you have, you could loose 40 - 80%, or more, of your excess weight within 2 to 3 years.
• Although some weight rebound may occur, many people can keep off about 100 pounds or maintain 50% of their weight loss for the long term.
• Many of the serious complications of obesity may resolve or improve after weight loss, including diabetes, high blood pressure, high cholesterol, sleep apnea, joint pain, and bladder problems.
Talk to your doctor about whether surgery might be right for you. And remember, after weight loss surgery, lifestyle changes are absolutely necessary to bring down your weight and keep it off.
Gastric bypass surgery
Weight loss surgery involves one or both of the following approaches:
• Restrictive procedures result in a smaller stomach pouch. Normally, the stomach can hold about 6 1/2 cups of food. Because a surgically modified, smaller stomach pouch holds less (usually about 1/2 cup), you must eat considerably smaller portions. Food then passes much more slowly from the stomach into the intestine. This allows you to feel full much longer after eating.
• Malabsorptive procedures alter the pattern of flow from your stomach to your intestine, decreasing the number of calories absorbed by the intestine.
The next few steps explain some of the most common forms of weight loss surgery.
Gastric bypass surgery
Gastric bypass surgeries use both restriction and malabsorption to achieve weight loss. Roux-en-Y gastric bypass is the most common type of weight loss surgery performed.
In Roux-en-Y gastric bypass, staples are used to permanently close off part of the stomach. This leaves only a small stomach pouch for the food you eat. Additionally, a Y-shaped piece derived from an upper portion of the small intestine is then attached to this small stomach pouch. As a result, food from your stomach pouch bypasses the rest of the stomach and the first part of the intestine, which normally would absorb wom calories and nutrients after eating.
Gastric bypass surgery can be performed using a traditional open technique or through laparoscopic surgery, depending on your circumstances and the decision of your surgeon. The traditional open technique involves an incision in the abdomen that allows the surgeon to visualize and access your stomach and intestine. Most gastric bypass surgery is doen with laparoscopic surgery, which uses smaller incisions and a small video camera that projects views of your stomach and intestine onto a monitor in the operating room. Both methods are routinely performed. Talk to your doctor about these two approaches and which would be appropriate for you.
Not surprisingly, there are numerous other variations on the gastric bypass approach. (Click here to learn more about biliopancreatic diversion, and biliopancreatic diversion with duodenal switch.)
Biliopancreatic diversion takes longer than gastric bypass, and is technically more difficult. The complication rate is similar to gastric bypass when an exeperience surgeon performs the procedure. After this option, people can enjoy a wider variety of foods and eat about half as much as they did before the operation, without fear of experiencing dumping syndrome. In addition, calcium loss does not follow the duodenal switch. Although some behavioral change is still needed, this procedure may offer better quality of life for some people.
The benefits of gastric bypass surgery
• The procedure is a proven, accepted long-term weight control tool with established health benefits.
• Gastric bypass surgery (malabsorptive techniques) tends to produce greater weight loss than do surgeries that use only restrictive techniques, such as the adjustable gastric band.
• Patients lose about two-thirds of their excess weight within a year. While some weight rebound may occur, most patients can keep off roughly 100 pounds of the weight they've lost over the long-term.
• Many of the serious complications of obesity may resolve or improve after weight loss, including diabetes, high blood pressure, sleep apnea, joint pain, and incontinence.
The potential complications of gastric bypass surgery
The risks include, but are not limited to, the usual risks of any surgery (which involves general anesthesia), including problems with:
• Breathing, pneumonia
• Blood clots
• Hernias at the site of the incision
• Heart problems
The risks from gastric bypass surgery include:
• Leaking or rupture along the stapled area of the stomach pouch and small intestine
• Gallstones with rapid weight loss
• Stomach ulcers
• Nausea and vomiting, especially if you overeat
• Dumping syndrome (a condition in which you eat too much sugar or fat, resulting in symptoms such as nausea, vomiting, diarrhea, dizziness, and sweating)
• Nutritional deficiencies (such as iron, calcium, vitamin B12, and folic acid)
• Blocked intestine (bowel obstruction)
• Stretching of the stomach pouch - if you repeatedly overeat, you may slowly increase the size of the stomach pouch, thus defeating the purpose of having undergone gastric bypass surgery in the first place, and therefore gain weight.
• Hair loss
• Excess skin after weight loss
The formation of gallstones is a possible risk following gastric bypass surgery.
Although you may not be able to avoid all complications, here is how to minimize risks after surgery:
• Closely follow recommended meal size.
• Take small bites.
• Chew slowly and thoroughly.
• Take 20 - 30 minutes to eat each meal.
• Follow recommended amounts of protein at each meal.
• Stay away from fatty foods and sugars.
• Consult a dietitian for how to maintain the most nutritious diet possible, advice on nutritional supplements, and information on taking fiber to avoid constipation.
Vertical sleeve gastrectomy
Vertical sleeve gastrectomy is surgery to help with weight loss. The procedure does not change the way your body absorbs and uses nutrients.
During the procedure, a surgeon will remove most of your stomach (about 80 - 85%). The remaining parts of your stomach are joined together with staples. As a result, a much smaller stomach, shaped like a banana, remains.
When you eat, this small pouch will fill quickly, so that you feel full after eating just a very small amount of food.
The benefits of vertical sleeve gastrectomy
• Losing enough weight after surgery can improve many medical problems you might also have. Conditions that may improve are asthma, type 2 diabetes, high blood pressure, obstructive sleep apnea, high cholesterol, and gastroesophageal disease (GERD).
• Weighing less should also make it much easier for you to move around and do your everyday activities.
• The average weight loss is 40 perecent of a person's excess weight. It usually takes 2 to 3 years to lose this weight.
The potential complications of vertical sleeve gastrectomy
In addition to the usual risks for any surgery involving general anesthesia, the risks specific to vertical sleeve gastrectomy include:
• Injury to your stomach, intestines, or other organs during surgery
• Leaking from the line where parts of the stomach have been stapled together
• Scarring inside your belly. This could lead to a future obstruction (blockage) in your bowel
• Gastritis (inflamed stomach lining), heartburn, or stomach ulcers
• Poor nutrition, although much less than what gastric bypass surgery may cause
• Vomiting from eating more than your stomach pouch can hold
As a result of this surgery, you must be able to make major changes in your lifestyle after surgery. You should visit a mental health provider to make sure you are emotionally ready.
Laparoscopic adjustable gastric banding
In this surgery, a silicone band that is placed around the upper part of the stomach. It creates a much smaller stomach pouch. The band also slows the passage of food from the stomach into the intestine. This allows you to feel full for a much longer time after eating.
A balloon within the band also wraps around the top of the stomach. This allows adjusting the opening of the band, so that it can be either tightened or loosened. The adjustable gastric band is designed to be left in place permanently.
During surgery, a port or reservoir is permanently positioned in your upper abdomen (under the skin, where it is not visible). The port is attached to the silicone band by tubing. The balloon within the band can be inflated by using a special needle to inject a saline solution into the port. This helps control the size of the opening of your stomach pouch:
• Inflating the balloon with the saline solution further restricts the opening through which food passes out of the stomach pouch. This reduces the amount you can eat and slows the passage of food. You feel full longer after eating.
• Deflating the balloon by removing some of the saline solution increases the opening through which food passes. This can be helpful if you develop problems, such as heartburn or vomitting of food.
The laparoscopic adjustable band is placed through small incisions in the abdomen. Each opening is usually less than half an inch in length. A miniature video camera is passed through one of these openings, allowing the surgeon to view your stomach on a monitor in the operating room. The rest of the surgical instruments are passed through the other tiny openings.
In rare cases, complications may require the banding system to be placed using a traditional open abdominal incision.
The benefits of the laparoscopic adjustable banding system
• The surgery doesn't require a large incision.
• The stomach itself is neither cut nor stapled during the procedure, though you will have sutures placed to keep the band from slipping.
• The band can be inflated and deflated by the surgeon in response to the patient's needs. This involves minimal discomfort and no need for another operation.
• Many of the complications of obesity may resolve or improve after weight loss. These include diabetes, high blood pressure, sleep apnea, joint pain, and urinary incontinence.
• The average person loses over 40% of excess weight and experiences a drop in BMI of more than 10 points. It usually takes 2 to 3 years to lose this weight.
The potential complications of laparoscopic adjustable banding system
In addition to the usual risks of any surgery involving general anesthesia, the risks specific to placing a laparoscopic adjustable banding system include:
• Erosion of the silicone band (wearing a hole in the stomach)
• Slippage of the stomach's position within the band
• Perforation of the stomach
• Balloon leakage
• Heartburn, regurgitation of food
• Eventually having the and removed due to problems
• Insufficient weight loss, despite a correctly placed and functioning band
• Nausea and vomiting, especially if you overeat
• Stretching of the stomach pouch: If you continually overeat, you may slowly but surely increase the size of the stomach pouch, thus defeating the purpose of having undergone the surgery in the first place.
• Problems with the port not staying in position, which requires a second operation to fix the port in proper position
Bariatric surgery may help you meet your weight loss, health, and lifestyle goals. However, once you've undergone bariatric surgery, you'll need to learn some new habits to make sure that you lose weight and keep it off. Remember this is NOT a diet but rather a lifestyle plan and dietary pattern.
Immediately after surgery, you'll be getting fluids through an intravenous line. When tolerated, you'll begin taking small sips of water. If this goes well, you'll be given other liquids while you're still in the hospital.
After you go home, your diet will depend on the type of surgery you had. If you had an adjustable gastric band, you may be on a liquid diet for 1 to 2 weeks, then slowly advance to eat soft foods. After a gastric bypass, you will most likely be on liquids for 1 to 2 weeks, then be advanced slowly to a diet of pureed food. You'll probably leave the hospital on this pureed diet and stay on it for several weeks.
This approach will help you feel satisfied without increasing the risk of food obstruction and vomiting. It will also allow you to have more comfort and less stress as you begin eating at each meal.
Some foods will give you problems, and you will want to avoid them. You may find through experimentation what works best for you. In general, breads and tough meats usually will give you problems. Moistened food is usually best.
Regardless of the type of surgery you've had, you'll need to spend some time with a nutritionist to construct a healthy diet plan. You'll be creating a plan for your new life, therefore it is important to follow it permanently for the sake of protecting your health, losing and weight, and keeping it off.
You'll need to:
• Learn about appropriate portion sizes. Learn exactly how much you should eat at every meal, because you don't want to overeat. Overeating can cause vomiting. If you continuously overeat and vomit you can stretch your stomach pouch, which will allow more calories to be taken in and therefore slow or diminish your weight loss. When you begin eating solid food after surgery, you'll probably be able to eat about 1/4 to a 1/2 cup per meal.
• Learn how to eat very, very slowly. You may be advised to time yourself, so that you take at least 30 minutes at each meal. You should chew all solid items extremely thoroughly. This will help prevent the opening between the stomach and the intestine from becoming blocked. It will also help you stop eating when you feel full, so that you don't accidentally overeat. You should take your fluids first, eat without added fluids, and wait 60 to 90 minutes after your meal before you start taking fluids again.
• Follow a nutritionally sound diet. Your portions will be considerably smaller, and your body may process nutrients differently after surgery. Therefore, make sure that what you eat is highly nutritious. Most nutritionists recommend that bariatric surgery patients follow a low-fat, low-sugar, high-protein diet, consisting of a nutritionally balanced diet program. After having a gastric bypass, you will need to take daily multivitamins, iron, calcium, and vitamin B12 supplements indefinitely. You'll need to be checked regularly to make sure that you aren't deficient in these vitamins and minerals (such as iron) and don't have anemia.
• Avoid fats and sugars. Fats and sugars are very high in calories, so they're NOT recommended for anyone who is working to maintain a healthy weight. In fact, if you've had gastric bypass surgery, eating foods that are high in fats or sugars may actually cause a condition called "dumping syndrome." Dumping syndrome will make you feel physically ill, with stomach pain and cramping, vomiting, weakness, shakiness, and sweating.
• Be careful with alcohol. Because of the calories in alcohol, regular use can make you gain weight again. After gastric bypass surgery, you will absorb alcohol more quickly than before. you will feel the effects after drinking only a small amount. Even one glass of wine may be too much for you to drive.
Dumping syndrome occurs when the contents of the stomach empty too quickly into the small intestine after gastric bypass surgery. The partially digested food draws excess fluid into the small intestine causing nausea, cramping, diarrhea, sweating, faintness, and palpitations. Dumping usually occurs after the consumption of too much simple or refined sugar in people who have had surgery to modify or remove all or part of the stomach.
• Avoid drinking beverages with meals. Your new stomach pouch will only hold food or drink, but not both! Drink water either half an hour before or after meals, but not with meals. Drinking beverages with meals can the food to empty out of the pouch more quickly. This can make you feel hungry again soon after eating. Instead, drink small sips of water regularly throughout the day. Don't drink large amounts at any one time. Avoid carbonated and sugared beverages, which can make you feel bloated and uncomfortable.
Remember that 80% of all people who have bariatric surgery consider the surgery successful because they are able to meet and maintain their weight and health goals. The 20% who consider the surgery a failure generally have not committed to the lifelong dietary plan and physical activity that are necessary for success.
Exercise is a key component to any healthy lifestyle. Exercise can help you lose weight more quickly. It can help control some of the complications of obesity, including high blood pressure, heart disease, diabetes, osteoporosis, and certain cancers. Exercise is also a major mood lifter, a great way to increase energy, and will help strengthen your bones and muscles.
It is extremely important to get approval from your physician for your exercise program before or after surgery. If you haven't been exercising before your surgery, start slowly. Walking is a great form of exercise. If you have arthritis or bad knees, you might want to start by walking in a swimming pool. Walking in water will help support you until you gain strength and endurance. Start out with just 5 - 10 minutes, and increase your daily time until you are up to 45 - 60 minutes daily.
After surgery, you should avoid certain types of exercise. You can do aerobic exercise, such as walking, in the first month after surgery. You should NOT, however, do weightlifting or abdominal crunches. They might interfere with your surgery before you can heal. Talk to your health care provider before you start any exercise program.
Remember that your tolerance (and enjoyment) of exercise will increase as you build your stamina. So don't give up, even if the exercise is difficult at first. You should soon begin to reap its many benefits.
Post-surgical lifestyle changes
Bariatric surgery is a major life-changing experience. You'll have a whole new set of lifestyle rules for maintaining your weight loss and health goals. In the years leading up to the surgery, you may have struggled with the physical, medical, emotional, social, and professional consequences of obesity. Bariatric surgery may signify the beginning of your healing process in these areas.
Some people who have bariatric surgery find that it's helpful to attend therapy sessions with a counselor. Talking to a professional about your previous struggles with obesity and your current struggles with your new post-surgery lifestyle can help you understand more about yourself, and help you stay focused on your goals.
You may also find that being involved in support groups with other people who have experienced similar struggles can be extremely helpful. Support groups can help you stay motivated.
Carefully following the prescribed diet after surgery is essential both to protect your body and to ensure weight loss.
After gastric bypass surgery, for the first several days after surgery the diet will consist only of clear liquids (water, broth, high protein fruit drinks, or other clear liquids). After this initial period, the diet will transition to pureed or blended foods (yogurt, pudding, cream soup, liquid supplements). After a week or so, you will be able to gradually begin adding soft foods to your diet -- about 1 ounce of a new soft food every 2 or 3 days:
• After 1 week: scrambled eggs, cottage cheese, low-fat refried beans, mashed potatoes, hot cereal
• After 3 weeks: tuna salad, ground turkey, baked fish, canned vegetables, bananas, seedless watermelon or cantaloupe
By a month after surgery, some normal foods can become a regular part of the diet, although limiting food selections may become permanent. You might need, for example, to avoid steaks and chops, apple skins, citrus fruit membranes, incompletely chewed raw or fibrous vegetables, and fresh bread (because of the tendency to form a solid "bread ball" in the stomach pouch -- toasting may prevent this problem).
Although each person is different, and there are different recommendations depending on the specific type of weight loss surgery you have, some of the basic recommendations include:
• You will need to adjust portion size. In general, a small stomach pouch will hold only about 2 ounces of food at a sitting.
• Food choices will need to be blended, soft, or easily chewed. Limit foods that are dry (turkey, roast beef), sticky (peanut butter), gummy (fresh bread), or stringy (fibrous fruits or vegetables).
• Eat a balanced diet that is low in fat, high in protein. Protein is important for healing directly after surgery, and it's also important during weight loss in order to help you preserve muscle mass. About 60 g of protein is recommended daily.
• Avoid foods that contain sugar, especially if you've had gastric bypass surgery. Eating foods that have concentrated amounts of sugar may cause an uncomfortable reaction called dumping syndrome (sweating, low blood pressure, dizziness, abdominal cramping, and diarrhea).
• Don't drink fluids just before or with your meals. Drink well before or at least 30 minutes afterwards.
• Eat slowly (at least 20 minutes per meal), and chew your food very thoroughly.
Surgical weight loss: Key points
• Morbid obesity is a serious medical condition with serious medical consequences.
• Roughly 65 percent of all Americans are overweight or obese, and 4 percent are morbidly obese. Morbid obesity means that you are severely overweight, usually by at least 100 pounds with excessive amounts of body fat. Know your body mass index (BMI). This is an estimate of how much you should weigh based on your height. You also need to know your waist size. This may be even more important in predicting health problems. Most men should have a waist less than 40 inches (ideally 35 inches), while most women should have a waist less than 35 -37 inches (ideally 32.5 inches).
• Being morbidly obese puts you at a high risk for a host of serious medical problems, including high blood pressure, diabetes, heart disease, cancer, and many others.
• Being obese increases your chance of dying. You have a greater risk of dying from heart disease, the most common killer in the U.S. You also have an increased risk of dying from cancer. In addition, obesity increases your risk of dying from all causes.
• The main goal when dieting is to learn new, healthy ways of eating and make them a part of your everyday routine. If you drop pounds slowly and steadily, you are more likely to keep them off. DO NOT use over-the-counter or herbal weight loss preparations without the knowledge and consent of your health care provider.
• Exercise is a key component to any healthy lifestyle. Exercise can help you lose weight more quickly. It can also keep your muscles strong after surgery.
• Despite their best efforts, some people aren't able to lose weight through diet, exercise, and lifestyle changes alone.
• If you are morbidly obese and other methods (like self-driven and commercial diet programs) have not worked, consult a structured weight loss program. These use a team of qualified professionals (physicians, nutritionists, exercise trainers, and counselors) to provide care.
• Medication or surgery may be considered if you are morbidly obese and other methods have not worked. There are very specific criteria to determine if you are a candidate for weight loss surgery.
• Weight loss surgery modifies the size of your stomach. This will decrease the amount of food you can eat, allow you to feel full much faster than usual, and possibly prevent the normal absorption of fat calories.
• There are risks and complications associated with these surgeries.
• Talk to your physician, the health care professionals at a structured weight-loss program, and a weight-loss surgeon to determine if you are a candidate for surgery. Also discuss whether the benefits outweigh the risks for you, and which type of surgery would be best for you.
• After surgery, lifestyle changes are still ABSOLUTELY necessary to bring down your weight, keep it off, and help prevent complications related to the surgery.
Exercise can greatly reduce your risk of many chronic diseases and improve your overall health. For many people, however, getting more physically active -- or sticking with it -- is difficult. How can you make regular exercise a part of your life?
Physical fitness is essential to good health and is one of the best things you can do for your body, mind, and spirit. Exercise improves the way your body works -- and it can make you look better, feel better, and even live longer.
If you do not currently exercise, you may feel intimidated about starting. Exercise can be a tough adjustment to your lifestyle, but the rewards are great, and the obstacles become easier to overcome as you continue. Besides, you are giving yourself the best gift in the world: improved strength, endurance, and the satisfaction of taking care of yourself.
The benefits of exercise
Exercise begins to have a positive effect almost as soon as you start. For one thing, exercise makes your brain release "endorphins" -- hormones that make you feel good. This can help you enjoy the exercise and may improve your mood for several hours after your workout. Another benefit is that your muscles, having worked hard, can relax more easily. This helps you feel relaxed all over. And, of course, you'll probably feel good about what you are doing for yourself.
The benefits of being in shape
In addition to the immediate rewards, there are many possible long-term benefits to reap from a more active lifestyle. Over time, your muscles will get stronger. Your heart and lungs will get stronger, too, and work more efficiently. Your bones will become denser, helping to prevent osteoporosis. Endurance increases, making most physical activities easier. And balance improves, lowering the risk of falls and fractures as you get older. You are also likely to experience less anxiety and depression and feel more self-assured.
Prevent and manage chronic diseases
Regular exercise can help PREVENT high blood pressure, high cholesterol, heart disease, type 2 diabetes, and, possibly, stroke. Research has also shown that exercise benefits people with mild-to-moderate depression.
Exercise can also help you manage certain chronic conditions, such as arthritis, osteoporosis, heart disease, Alzheimer's disease, and depression. Further, your blood pressure, cholesterol, and heart rate all may drop to healthier levels. Talk to your doctor about what is safe and best for you.
Exercise helps you shed extra pounds, particularly from fat, and, more importantly, tone muscles to increase your body's fitness. You're likely to experience less hunger. In addition, your metabolism will probably increase (the system that regulates how many calories you burn while resting), making it easier to stay lean.
Before you begin
Exercise can help just about anyone feel and look better. However, some people should be cautious about beginning an exercise program. A doctor can help assess your risks and plan a program that is safe for you.
If you do not currently exercise, speak to your doctor before you begin,
See a doctor if you have any of the following conditions:
• Any serious medical condition like diabetes, asthma, emphysema, cancer, or a history of blood clots in your legs or lungs.
• Pain or pressure in the chest, neck, shoulder, or arm during or right after activities such as walking.
• Bone or joint problems, including arthritis or osteoporosis (especially arthritis that has flared up so that one or more of your joints is red, swollen, or painful).
• A heart condition, angina (chest pain), high blood pressure, or high cholesterol.
Also, see a doctor if any of the following apply to you:
• Over age 40 or 45, and have not been active.
• Feel very breathless after mild activity.
• Tend to get dizzy, lose consciousness, or are subject to falls.
• Have experienced a feeling of your heart racing, skipping, or fluttering.
• Have had recent surgery, particularly to the eye or hip.
• Have an active infection or fever.
• Are experiencing any other unusual symptoms, such as unexplained weight loss
• You smoke.
How much exercise is enough?
The U.S. Surgeon General recommends that everyone should get a moderate amount of physical activity on most, if not all, days of the week. Physical activity is any activity that causes your body to work harder than normal. However, the actual amount of physical activity you need depends on your individual fitness goals, whether you are trying to lose weight, and how fit you currently are.
Here are some more specific guidelines for maintaining heart health and for losing weight.
For heart health
To keep your heart healthy and maintain general fitness, you need to perform cardiovascular exercise (also called aerobic exercise, described more in the next step). This type of exercise gets your heart beating fast over a sustained period of time.
No matter how hard you exercise, your heart has a maximum rate, a limit to how fast it can beat. When you perform aerobic exercise, you want to keep your heart beating at 60 - 80% of its maximum rate -- this is called your target heart zone.
You benefit most when your heart beats in your target zone for at least 30 minutes total per day, for at least 3 days per week. Your target heart zone is high enough to condition your heart, but does not put too much stress on it.
Monitoring your zone
At first, you may only know if you're within your target heart rate by taking your pulse or wearing a heart rate monitor.
As you continue, you should become more familiar with your body's signals. Generally, your body will tell you if you are working too hard. Here are some warning signs that you might be overdoing it:
• You feel breathless. (You should be breathing deeply, but you should not have to gasp for air.)
• You cannot comfortably carry on a conversation.
• You feel weak, dizzy, or lightheaded.
Note: if you have pain or pressure in your chest, neck, shoulder, or arm during exercise that lasts more than 10 minutes, you must stop exercising and see a doctor right away. The concern is that this pain may be caused by too much strain on your heart, which could lead to a heart attack.
Not everyone can exercise within their target zone at first. Remember that some physical activity is better than none. If you are starting from a sedentary lifestyle, any amount of activity or exercise that you do is going to help both your heart and your waistline. If you cannot yet reach your target heart rate, or cannot sustain activity for very long, do what you can. As you get more comfortable exercising, you will improve and be able to work harder and longer.
You lose weight when your caloric expenditure (physical activity) is greater than your caloric intake (food and drinks). If your goal is to lose weight, try to get 60 minutes of physical activity equivalent to brisk walking each day. This does NOT necessarily have to be aerobic exercise. The goal is to burn calories, and you can do that countless ways, such as using the stairs instead of the elevator, parking your car in the farthest parking space, or mowing the lawn or gardening.
If you are doing an activity that takes more effort, like running, then 45 minutes a day should be sufficient. Or if you are doing something that takes about half the effort of brisk walking, like gardening, you'll have to do it twice as long -- 2 hours.
Having trouble doing your exercise all at once? That's no problem. Spread it out throughout the day in 10 minute chunks of activity. Doing this 3 - 6 times per day can still strengthen your heart and burn calories.
Types of exercise
There are three major types of exercise, and each contributes something different to overall fitness. In general, a balanced program would include all three types.
• Cardiovascular training -- also called aerobic training, this type of exercise builds endurance by keeping the heart pumping for an extended period of time. It helps increase the pumping ability of your heart, relaxes blood vessels, improves cholesterol, strengthens bones, and helps you lose weight. Once you have worked up to it, shoot for 3 - 4 hours in your target zone per week, spread out through the week. Some aerobic exercise is considered "low to moderate impact," which most people in reasonably good health can perform -- examples include brisk walking, swimming, and climbing stairs. These can all be very beneficial, so it is not necessary to work up to "high-impact" aerobic activities like running, dance exercise, and tennis.
• Flexibility training -- these exercises help your muscles stretch farther in a given direction. Flexibility training helps prevent cramps, stiffness, and injuries, and can give you a wider range of motion. These exercises also emphasize proper breathing, balance, and alignment. Some forms of flexibility training, such as yoga, pilates, and tai chi, include meditation and breathing techniques that can reduce stress.
• Weight training -- also called strength or resistance training, these exercises build up your muscles and help maintain bone density. Strength training involves performing repetitions ("reps") that move specific muscles in the same pattern repeatedly against a resisting force. Aim for 30 - 45 minutes of strength training 2 - 3 times per week. Consider finding a trained professional (like a physical therapist or a personal trainer) who can teach you how to use weights safely and effectively.
Why use weights?
Weight training doesn't just make your muscles stronger; it also works on your tendons, ligaments, and bones. It has a variety of benefits, including:
• Making your joints stronger -- allowing the joints to withstand more weight or stress when, for example, you exercise more vigorously
• Helping prevent osteoporosis by increasing bone mass
• Promoting weight loss by adding muscle mass and losing fat
• Weight training makes your muscles stronger through a series of breakdown and rebuilding cycles. When you force your muscles to lift more weight than usual, your muscle fibers literally tear. During the 1 - 3 days afterwards, your body repairs these microscopic tears, in part by adding more muscle tissue to the fibers. This process increases muscle mass and strength; it also strengthens tendons, ligaments, and bone.
• Many people (especially women) fear that lifting weights will make them "bulky" or look like a body-builder. In general, using lighter weights and doing more repetitions ensures strength and toning without building bulk.
• Because it takes a few days for your muscles to "recover" from weight training, wait at least 2 days before you attempt to use weights to train the same muscles. Fitness professionals often recommend training the upper body (arms, shoulders, and chest) and lower body (back, legs, abdomen) on alternate days.
Exercise both your upper and lower body with weights to get the maximum benefit
Who should lift weights?
Just about everyone can benefit from moderate weight training, especially people who are at risk for osteoporosis. Women who do not regularly do weight-bearing exercise against the resistance of gravity may benefit in particular. (Non-exercisers, swimmers, and cyclists: This means you!)
Since your individual circumstances dictate what you need from a weight-training program, consult a fitness professional, along with your primary care provider, to help you develop a specific set of exercises.
Warm up, cool down, and stretch
Warming up, cooling down, and stretching are an extremely important part of any workout. These steps help your body adjust to changes in activity and, most importantly, help to prevent injury.
You should not go from rest one minute to intense exercise the next. Spending a few minutes warming up your body and your muscles before you begin intense exercise is extremely important. By letting your body adjust gradually to the demands of exercise, you avoid injuring your muscles and put less strain on your heart. You may also find exercising easier and, therefore, more enjoyable when you warm up first.
You can warm up with any simple, comfortable movement. Most people find it convenient to warm up by doing their chosen activity at a slower pace. For example, if you are going for a run, you can walk during your warm up.
Cooling down after a workout to slow your heart and respiration (breathing) rate back to normal is also very important. The reverse of warming up, cooling down should gradually bring your body back to its resting state. If you don't cool down, your blood pressure may drop too quickly, which can cause dizziness or lightheadedness.
Cool down by slowing your activity, but not stopping it completely. Keep going at the reduced pace for about 5 minutes, gradually slowing down every 1 - 2 minutes, until you are ready to stop.
Don't forget to stretch
Stretch after your warm up and again after your cool down to help your muscles recover from what you have just done. (Don't stretch BEFORE you warm up!) Stretching after exercise is very effective because your muscles are more flexible when they are warm. This helps to avoid injury the next time you work out.
When you stretch, you should just feel a gentle tension in your muscle. You should not feel pain in either the muscle or joint. If you do, ease up the degree of stretch or strain. Hold each stretch for 10 - 20 seconds without moving the muscle. Don't bounce! Bouncing during a stretch may tear the muscle. And remember to breathe, which brings oxygen to the muscles and can help you deepen the stretch safely.
Hamstring (back of leg) stretch
Extend one leg in front of you with the foot flexed. Bend your other knee, and lean back slightly. Your pelvis should be tilted forward. Keep your upper body upright as you hold the stretch for 10 - 20 seconds, then switch sides.
You should feel the stretch up the back of your extended leg (all the way up your calf and thigh).
NOTE: Your supporting leg may get tired, as you have to balance your weight on it.
Groin (inner thigh) stretch
Stand with your legs wide apart.
Shift your weight to one side, bending your knee somewhat. Do not let your knee bend beyond your ankle. In other words, you should be able to look down and still see your toes. You should feel the stretch in your opposite leg, which remains extended. Both of your feet stay flat on the ground, facing forward.
Hold for 10 - 20 seconds, then lean to the other side
Triceps (back of arm) stretch
Bring one of your elbows across your body, towards the opposite shoulder.
Use your other hand to bring your elbow closer to your shoulder. Hold for 10 - 20 seconds, then switch sides.
Raise your arm over your head and bend your elbow all the way so your hand is behind your neck. Use your other arm to stabilize your elbow.
Hold for 10 - 20 seconds, then switch sides. You should feel either of these stretches in the back of your arm.
Stand with one foot in front of you, your weight equally distributed between your feet.
Bend both knees, and lift your back heel off the ground. Bring your pelvis forward so your back is flat. (You can lean against a wall or column for balance.)
Hold for 10 - 20 seconds, then repeat on other side. You should feel the stretch in the front of the hip and into your abdomen.
Quadricep (thigh) stretch
Hold on to something for balance.
Standing on one leg, grasp the foot of the other leg. Keep your knee pointing down. Pull up with light pressure. You do NOT need to pull up all the way to your buttocks. If it feels uncomfortable or painful, you are putting too much strain on the knee joint.
Hold your foot behind you for 10 - 20 seconds, then switch sides. You should feel the stretch in the front of the thigh.
Upper Arm and Chest Stretch
Clasp your hands behind your back with your palms facing up. Pull your hands down and press your shoulder blades together. Your chest should stick out. Hold for 10-20 seconds.
You should feel the stretch in your upper arms and chest.
Exercise is good for you, but make sure you enjoy it as much as possible by staying safe. We don't want to put a damper on your enthusiasm, but it is important to be aware of potential dangers, including crime, traffic, and injury. Use your common sense and good judgment while exercising, and you should be fine. Here are a few tips:
• Avoid crime by exercising with someone else, or stay in populated, well-lit areas. Carry a whistle in case you have a problem.
• Always obey traffic rules when exercising near streets or intersections. If you can, try to use sidewalks, parks, or pedestrian paths. These "exercise friendly" places take you out of the way of traffic and are much safer than the street.
• If you choose to exercise at night, wear a reflective vest or sash. This will help drivers see you in the dark.
• Do not wear headphones -- they distract your attention and obstruct your ability to hear traffic.
• Carry identification and a small amount of cash, just in case you need them.
• The risk of injury increases if you do weight-bearing exercises more than five days per week. If you exercise every day of the week (physical activity every day is good), reserve at least 1 - 2 days per week for non-weight bearing activity.
• When cycling, skating, or rollerblading, always wear a helmet and knee pads.
• Always warm up before your workout, and cool down after it. Don't forget to stretch when you are done.
• Don't do the same kind of exercise day after day. You want to avoid putting too much stress on one part of the body while neglecting the others. Don't continue to exercise on joints that hurt -- stop or change your activity.
Dehydration and overheating
• Drink plenty of water or sports drink before, during, and after you exercise. This is important at all times of the year, but especially when exercising in warm weather.
• Take it slow and be cautious about pushing your limits. Don't push yourself too hard, especially in the heat. Remember that you still need to replenish fluid even when you don't feel thirsty. If you do feel dizzy, lightheaded, or sluggish -- stop, rest, and drink fluids immediately!
• Heat stroke is a medical emergency. It may decrease your level of consciousness or even cause a seizure. If you experience any of the more serious symptoms -- such as nausea, headache, confusion, clamminess, trouble focusing, fever, or sudden lack of sweating -- you should go to the hospital right away. You should also promptly see a doctor if your heavy breathing, dizziness, and excessive fatigue reamin after you have rested and replenished fluids.
• If heat, humidity, or pollution make exercise too hard, exercise indoors or during cooler hours.
Heat emergencies include heat exhaustion and heat stroke. For immediate treatment, remove the victim from the heat and have the person lie down. Apply cool compresses, have the victim elevate their feet and drink fluids. Use a fan if available to blow cool air. Seek medical help.
Just getting out the door
You know regular exercise can help you live longer, feel better, and be more productive at home and work, right? So what's keeping you from getting out there and doing something RIGHT NOW?
A big part of what keeps people from exercising is fear. Fear of failure, fear that you can't do what you used to do, or fear that you will never be as good at it as you want to be. YOU ARE NOT ALONE. Even experienced exercisers have to overcome their fears on a regular basis. Try not to be too hard on yourself if exercising does not come naturally to you -- changing your behavior is one of the hardest things you can do. It can be especially difficult if the people around you, such as members of your family, do not exercise.
What motivates you?
For many people, the hardest part of exercising is getting out the door. Just about everyone who exercises struggles with this once in a while -- getting motivated each day can be really tough! And what motivates your friend to go running each day may not work for you.
We asked people what gets them going, and below is a sample of their responses:
• "I feel a lot better after exercising -- it leaves me more positive, happier, and less stressed."
• "Exercise helps me sleep better, which in turn gives me more energy the next day. I hate feeling tired at work."
• "I enjoy spending time by myself first thing in the morning."
• "I have family members who've had heart attacks, and I am doing what I can to keep that from happening to me."
• "I want to be healthy as I get older. I don't want to lose my ability to stay active."
• "There are several people I exercise with, and I enjoy their company. It gives us something to do together on a regular basis."
• "I feel the results immediately -- I feel like I have more energy."
Know what to expect
Exercise is different for everyone, but there are a few experiences we all have in common. Knowing what to expect can make exercise less intimidating:
• The first few minutes of any activity are usually the hardest. If you can continue to exercise past this initial discomfort, you may be surprised at how much easier it becomes.
• You will sweat.
• You will get tired the first few times you do a new activity.
• You will breathe heavily (but you shouldn't work so hard that you have to gasp for air).
• You will make rapid progress at first, then level off (or plateau). If you continue to exercise, you will continue to improve, just not as quickly as in those first few weeks.
• You may get a "stitch" -- a pain in your side that goes away after you stop exercising. (This often happens when you push yourself beyond your limits. Slow down and breathe deeply until it goes away. If the stitch does not go away after you stop exercising, or recurs during rest, seek medical attention.)
Even moderate physical activity can help you live longer and better. The more active you are, the greater the benefits to you. Take it slow, and don't push yourself too hard.
Exercise must be a priority. But how do you fit working out into your already jammed schedule? With some careful planning, almost everyone has time to fit in some amount of exercise as part of their regular routine.
Keep track of how you spend your time on several typical days -- during the week and on the weekend. Then, think carefully about what you currently do with your time, and how you might fit in exercise. Try getting up earlier, going out after work, skipping television, or exercising during the day in ten-minute chunks. Think it's too boring? Invite a friend to go with you or watch a movie while you use the treadmill.
Here are some of the most common reasons for not exercising and alternative ways to think about them:
"I don't have time." Almost everyone has some time they can devote to exercise, even in the busiest of schedules. Get creative and find ways to be more active throughout the day.
"I'm too tired." Exercise will give you more energy, not less. You may be surprised at how much more energy you have when you exercise.
"It's boring." There are lots of ways to make exercise more fun. For tips, click here.
"I'm not good at sports." You can do lots of activities without competing against others. Try walking with a friend, shopping, or ice-skating. Just go out there and have fun!
"It's too hot or cold outside." If you dress appropriately, the weather should not affect your ability to exercise. For more on how to dress, click here.
"It's too hard." Everyone has different abilities when it comes to physical activity. Do what feels right to you, and slow down if it feels too hard.
"I'm not fat." The benefits of exercise go way beyond weight control -- EVERYONE needs exercise to be healthy.
Deciding to exercise is one of the best things you can do for yourself. But deciding must lead to doing, and this is where many people stumble. Fortunately, you can easily integrate exercise into your life if you are a little creative:
• Break it up -- You get the most benefit from exercise if you do it for at least 60 minutes a day for 5 - 6 days a week. But you do not have to do 60 minutes in a row. Studies suggest that you get the same benefits if you work out for 20 minutes 3 times a day as you do during a longer session.
• Do what you like -- Any activity that raises your heart rate counts as exercise. If you don't enjoy traditional sports, then wash your car, go dancing, mow the lawn, or any of hundreds of other things.
• Some exercise is better than none -- True, everyone should work out at least three times a week, but you will still benefit from less frequent or less intense exercise.
• Mix it up -- You do not have to do the same exercises day after day. In fact, most fitness professionals recommend varying your activities so you can work different parts of your body. This can help you avoid injury and keeps your exercise program fresh.
• Be a free agent -- While health clubs offer a variety of equipment, weights, and classes, none of that is necessary. Thousands of people exercise every day with no more than a solid pair of sneakers. Some people prefer the fitness center environment, but you do not need a gym to get fit.
Exercise: Key points
• The goals of exercise include building strength and endurance, reducing body fat, enhancing movement of joints and muscles, and improving your sense of well-being.
• The U.S. Surgeon General recommends "a moderate amount of physical activity most, if not all, days of the week."
• Most experts agree that you need at least 30 minutes of moderate exercise per day to improve your health and 60 minutes of physical activity per day to lose weight.
• You know that you are being physically active if your heart beats faster, your muscles contract, and your temperature rises.
• Try to incorporate all three types of exercise into your routine: cardiovascular (also called aerobic or endurance), weight (strength), and flexibility (stretch) training.
• Learn your target heart zone and exercise within that range. The target heart zone is 60 - 80% of your maximum heart rate.
• Physical activity can protect your heart as well as lower your cholesterol, blood pressure, and chance of getting type 2 diabetes.
• Exercise should be fun. Choose a physical activity that you enjoy.
• Avoid injury by varying your workout, warming up and stretching, cooling down adequately, and taking a day off once in awhile.
• Drink plenty of fluids before, during, and after exercise. This is important no matter what the temperature is outside.
• Some exercise is better than none. It's ok to break up your 30 - 60 minutes each day into 10- or 20-minute intervals, or exercise 3 days a week if you can't exercise more often.
• Have realistic expectations, and recognize when you are working too hard.
• Make the time for exercise to be a part of your regular routine, no matter what your age.
• People lose 20 - 40% of their muscle mass -- and, along with it, their strength -- as they age. Strength training throughout your life can help prevent this loss.
• Starting out slowly and being consistent may be the best way to successfully make exercise a habit.
What you wear while exercising can make a big difference in how comfortable you are.
• Shoes and socks -- Always wear comfortable sneakers that support your feet. Consult an expert to find out what type of sneaker is best for you. Each person has a different foot structure that affects walking, running, and other activities. Finding the right athletic shoe can help avoid undue strain on your joints and prevent injury. Socks help cushion your feet and prevent blisters.
• Hat -- A light colored, lightweight hat will prevent your scalp from absorbing heat in warm weather and protect you from the sun. Similarly, a hat protects you from losing too much heat in cold weather.
• Tops and bottoms -- Dress for weather that is about 10 degrees warmer than the actual temperature outside. As you exercise, your body temperature increases. If you are wearing too many clothes, you may become uncomfortable. While exercising in colder weather, wear layers you can take off easily when you warm up and replace during your cool-down. If possible, wear clothing that removes moisture from your body.
• Warm weather caution -- Avoid prolonged exercise when the temperature outside is very hot. This is particularly true for people over age 65. If you begin to feel nauseous, light-headed, or have muscle cramps, you should stop, drink fluids, and get into a cooler place, out of the sun.
Home aerobic exercise machines are available to meet any fitness level and can be used day or night. Before investing in any exercise machine, however, it is wise to test it out first at a gym, especially with supervised training to reduce the risk of injury. Read reviews of various brands in fitness magazines and on the Internet.
Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may have computers to record calories burned, speed, and mileage. While their readouts may provide motivation and gauge the intensity of a workout, they are not always accurate. You might also consider buying a used machine, because it is common for people to buy a machine and then sell it when they realize they aren't getting much use from it. Of course, you can't return it if there's a problem.
Also, realize that there are very affordable ways to perform aerobic exercise. Shelling out money for an expensive machine may not have any impact on whether you actually exercise, although you might be tempted to think it will. A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise, and an aerobics stepping board and accompanying videotape will also give you a good workout. (Jumping rope should be done on surfaces that have some give to avoid joint injury. A good floor mat is important to provide cushioning for all home exercises.)
For burning calories, the treadmill has been ranked best, followed by stair climbers, rowing machines, cross-country ski machines, and stationary bicycles.
Elliptical trainers are also great for elevating your heart rate, burning calories, and increasing oxygen consumption.
Stationary bikes and stair climbers condition leg muscles. Stationary bikes are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity. Stair machines offer very intense, low-impact workouts and may be as effective as running with less chance of injury. Rowing and cross-country ski machines exercise both the upper and lower body.
Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost much either. Dumbbells and resistance bands are inexpensive, portable, and effective.
Ankle weights strengthen and tone muscles in the lower body. (Such wearable weights should not be worn during high-impact aerobics or jumping.) Handgrips strengthen arms and are good for relieving tension.
A pull-up bar can be mounted in a doorway for chin-ups and pull-ups. More elaborate and expensive home equipment for working body muscles is also available.
Exercise and motherhood
If you're pregnant or have just given birth, you're probably concerned how to get the extra weight gained off. The natural solution is to get exercise. Good news: research shows that women who exercise during pregnancy and after giving birth experience not only an improvement in physical well-being but better mental health as well.
In addition to weight management, the advantages of exercising during and after pregnancy are numerous. During pregnancy, exercise can help you feel better and cope with a dramatically changing body. Exercise has been shown to:
• Increase energy
• Improve posture
• Relieve backaches and leg cramps
• Lower stress, anxiety, and depression
• Aid digestion and relieve constipation
• Prepare your body for labor
After pregnancy, exercise may help prevent a dropped uterus, regain and maintain vaginal and abdominal muscle tone, and prevent urinary incontinence and lower back pain. One study reported that women who practiced "vigorous exercise" 3 times a week after giving birth had an easier adjustment to motherhood, greater involvement in social and leisure activities, and more overall satisfaction with their lives.
Some women are concerned that exercise may cause them to deliver early. However, even vigorous exercise has not been shown to increase the risk of pre-term delivery. In fact, highly conditioned exercisers have the same rate of timely deliveries as their unconditioned peers. In addition, experts say that healthy women should exercise during pregnancy without fear of compromising fetal growth and development. Consult your Doctor regarding excessive during the first trimester.
Talk to your doctor
You should discuss your exercise goals with your doctor during and after your pregnancy and be sure to get approval for any exercise program before you start. You should, of course, avoid exercise that may cause you to fall or be jostled, such as horseback riding, skiing, and rollerblading. Otherwise, there are some basic guidelines to follow:
• If you are unable to talk normally during exercise, it's too strenuous.
• After 20 weeks of pregnancy, avoid doing any exercises lying on your back.
• Avoid strenuous exercise in hot, humid weather or when you have a fever.
• Wear comfortable clothing that will help you stay cool.
• Wear a well-fitting, supportive bra.
• Drink plenty of water to prevent dehydration and overheating.
• Be sure to get the extra 300 calories a day required during pregnancy.
Stop exercising if you experience any of the following:
• Abdominal pain
• Vaginal bleeding or fluid discharge
• Dizziness or feeling faint
• Difficulty walking
• Uterine contractions or chest pain
For your baby and your body, the evidence is clear: exercise will help you both greatly.
Exercise reduces falls among the elderly
A study in the British Medical Journal found that exercise is superior to home hazard modifications and vision correction when it comes to reducing the number of at-home falls among the elderly.
Researchers at the Accident Research Center in Victoria, Australia, conducted the study among 442 people 70 years and older and living in their own home or apartment. The subjects were randomly assigned to receive at least one of three interventions: a weekly hour-long exercise class, supplemented with daily home exercises; home hazards modification done by the participants or the city's home maintenance program; or vision improvement treatment.
Some subjects received two interventions, one group received all three, and a control group had no interventions. In all, eight groups were studied over an 18-month period. All participants submitted a monthly postcard, on which they recorded their falls.
Exercise was the most effective
The study found that among individual interventions, exercise had the greatest impact on reducing falls. Patients who had their homes modified or their vision corrected had a minimal reduction in their annual fall rate of 3.1% and 4.4%, respectively, compared with the exercise group, which had a significant 6.9% reduction. The group who had all three interventions fared the best, with an estimated reduction in annual falls of 14%.
Exercise improves balance
Patients who took the exercise class were able to reduce their rate of falling primarily by improving their balance, the authors said. The other two interventions may have been less effective because they were not as intense as they needed to be.
The findings lend further support to the importance of exercise in helping elderly people maintain physical function. A study in the American Journal of Preventive Medicine reported that inactive elderly adults showed improvement in physical function after taking an hour-long tai chi class twice a week for 6 months. The improvement was most pronounced among the previously least active participants.
According to the authors of the British Medical Journal study, this research together suggests that exercise programs involving balance improvement might benefit elderly people. More research on the cost effectiveness of such programs are needed to determine whether such programs are worthwhile in helping to prevent falls among the elderly.
Help your child stay active
Children are becoming less physically active than they were in the past. Many are staying indoors longer to watch TV and play videogames, and parents may be less eager to have their children running around outside due to fear of abduction or traffic accidents. As these trends have increased (and as diets have become less healthy), there has been a dangerous rise of obesity in children in recent years.
Childhood obesity should be taken very seriously -- many obese children develop type 2 diabetes, high cholesterol and blood pressure, sleep apnea, orthopedic problems, and other conditions that can last into adulthood.
The remedy for obesity is a nutritious diet and at least 60 minutes of moderate physical activity on most days of the week. Children may, however, need as much as 2 hours of physical activity a day. Adolescents may need 1.5 hours of physical activity a day.
Your child can jump, play basketball, participate in running games, bike, or find any other way to be active and have fun. For the health of your child, the Agency for Health Care Policy and Research makes the following suggestions to help develop good physical activity habits.
• Encourage your child to participate in physical activities, including sports.
• Encourage involvement in activities that can be enjoyed into adulthood (walking, running, swimming, basketball, tennis, golf, dancing, and bicycle riding).
• Plan physical activities with family or friends. Exercise is more fun with others.
• Limit the time your child spends watching TV to less than 2 hours per day. Encourage going out to the playground, park, gym, or swimming pool instead.
• Physical activity should be fun. Don't make winning the only goal.
• Many communities and schools offer exercise or sports programs. Find out what is available for your child.
Remember, your children learn many of their habits from you. Try to set a good example and give them plenty of encouragement. You will be helping to give them a lifelong gift of good health.
The chances for heart disease may start to develop in children as early as elementary school. Children who exercise at least 2 hours a day, however, have a lower risk for heart disease than those who do not exercise. Adolescents who exercise at least 1.5 hours a day have a lower risk for heart disease.
Exercise is fun!.
Here are a few suggestions to vary your workout and make it more interesting.
• If you are at home, listen to music or watch television (listening to music is not recommended if you are an outside runner). If you get bored exercising at home, go to the gym. Watching other people training and socializing can help you work out.
• Exercise in a park, along a trail, or in a new location.
• Exercise with a friend.
• Challenge yourself by trying to exercise "harder" than you did the last time.
• Do an activity you do not usually do.
• Exercise in a public place (where you can look at others).
• Make a day of it -- bring everything you'll need (within reason) for a day of hiking, biking, swimming, etc.
• Take an aerobics, swim, or dance class.
• Consider getting a dog so you have a built-in excuse to walk every day.
• Join a running or walking club
The stages of change - where are you?
For a person to successfully adopt a healthier behavior -- whether it's to exercise, lose weight, or stop smoking -- it may not be as simple as just deciding to do it. Behavior change expert James Prochaska and his colleagues developed a theory, which has been supported by numerous studies, showing that people cycle through a variety of stages before a new behavior is successfully adopted over the long term.
It may help you to understand how this works. As you read the description of each stage -- specifically as it relates to exercise -- you may find yourself nodding and saying to yourself, "Yes, that's me!"
Stage 1: Pre-Contemplation
People at this stage have no plans or desire to exercise. They aren't even considering exercising. People at this stage are generally unaware of the specific benefits that exercise can bring -- exercise may seem more like a hassle than something worth doing. Or, they may simply have "failed" in the past and have given up.
There's no point in talking about how to start an exercise program if you are at this stage. Instead, it is important to think about why exercise might be good for you personally -- by helping you to lose weight, feel better, have more confidence, live longer, sleep better, or have less stress. The benefits must be identified before a person will consider exercise.
If you are at this stage, a good activity is to ask four friends or family members why they exercise. That may unveil real-life benefits and inspire enough interest to compel you to take the next step.
Stage 2: Contemplation
A person at this stage is thinking, "I think I should probably exercise, but I need help getting started." People at this stage know that exercise is good for them, but it seems like a daunting task or they don't think they can pull it off. Some may have tried and "failed" in the past, but they are still receptive to another go-round.
It's important for people at this stage to consider some of the truths and falsehoods of exercise. For example, it is helpful to know that there are many forms of physical activity to select from, and that you can do your exercising in small chunks. It is not true that exercise has to be painful, or that you either succeed or fail. There is no such thing as "failure" -- people become more or less active at different stages of their lives, and it is never too late to get moving again. And people at this stage should find assurance that an exercise plan can be very simple.
If you are at this stage, a good activity is to write down (brainstorm) all your potential roadblocks -- the things that you believe make exercise difficult -- and to learn strategies for overcoming or side-stepping those hurdles. Many ideas are available on the Internet.
People at this stage might benefit from making a pledge, contract, or other commitment that they are going to get more active in the near future.
Prochaska and his colleagues write that people in this stage are "aware of the pros of changing but are also acutely aware of the cons. This balance between the costs and benefits of changing can produce profound ambivalence that can keep people stuck in this stage for long periods of time. We often characterize this phenomenon as chronic contemplation or behavioral procrastination."
Thus, the goal is to get un-stuck by identifying the roadblocks, ways to overcome these hurdles, and making a commitment.
Stage 3: Preparation
These folks are primed and motivated. They are ready to give exercise a try. The goal of this stage is to create a specific action plan that takes all factors into account, so that the "launch" is successful.
People at this stage need to know how much they should be exercising, their target heart rate, and the types of exercises. They should explore the different kinds of exercises and decide on which ones to try. At this stage, they'll evaluate exercise machines and health plans, pick the proper clothing or accessories, and consult a physician if necessary. And they need to think about how they are going to fit their exercise plans into their daily and weekly schedule.
If you are at this stage, you should also consider some backup plans -- what to do if it rains, or if you don't feel like exercising. That way you are prepared to overcome that hurdle when it happens. And you should be aware of what to realistically anticipate at the beginning (for example, you should understand that weight loss takes time, but the health benefits of exercise begin immediately).
Stage 4: Action!
People at this stage have just started exercising. This stage is where the most behavior change occurs -- these folks have started to exercise but it is not yet a long-term, ingrained habit. Prochaska notes that this stage requires significant commitment and energy.
If you are at this stage, keep talking to friends and family for inspiration. Review your backup plans. Reward yourself for small achievements. And give yourself notes and reminders to exercise. If you can find a friend to exercise with, that can be a huge support as you get through this stage. You want to build and maintain momentum, because it gets easier once it is a habit!
Stage 5: Maintenance
The folks at this stage have been exercising at least 6 months. At this point, exercising has started to become a habit. The goal here is to prevent relapse.
If you are at this stage, identify ways that you can fine-tune your program. Continue to identify roadblocks and improve your backup plans. Think about what you have found most enjoyable about exercising. What benefits have you gained? Keep reminding yourself of these perks.
If challenging yourself was part of your initial motivation, set new goals and give yourself new challenges. If you risk getting bored with your routine, find ways to vary it. Or maybe you have found a comfortable routine that you enjoy -- if it's working, great! Then no need to change it.
You might want to read or learn more about your method of exercising and develop a deeper level of understanding about it. Soon you'll be a pro!
Let's do it again
One point about the theory is that people do not proceed from one stage to another in a simple, step-by-step fashion. They actually cycle or spiral back and forth, so that they may move from stage 1 to 2 to 3, and then back to 2 again. They may stay in maintenance mode for years and then fall back to stage 2.
Remember that this is normal -- if you tried exercising in the past and didn't stick with it, don't consider yourself a failure. Just know that it's time to try again!
Types of exercises
The list below is just a sampling of the many options for exercising. Scan it for ideas about what you might like to try. This list is just a starting point, especially regarding exercise machines and accessories. There are many more than what is listed here. It's likely that there are at least a couple of exercises that you would find interesting and that meet your needs. Also included are household activities that can contribute to your fitness. Ask friends and family for suggestions on what exercises they like best.
Aerobic exercises -- outdoors
• Cross-country skiing
• Running (jogging)
• Walking (brisk)
Aerobic exercises -- indoors
• Cross country ski machine
• Dance exercise (aerobics) with stepping board, videotape
• Elliptical machine
• Jumping rope
• Punching bag (boxing)
• Rowing machine
• Stair climber
• Stationary Bicycle
• Carrying small children
• Cleaning house
• Grocery shopping
• Weeding the garden
• Mowing the lawn
• Raking leaves
• Exercise balls
• Tai chi
Exercise for strengthening and toning muscles
• Abdominal bench
• Back machine
• Bench press for chest (barbell free weights)
• Chin-ups (need pull-up bar) for back and triceps
• Curls for biceps (dumbbells free weights)
• Leg raise machine
• Leg press
• Squats (with free weights)
• Wear several layers, including gloves and a hat. Remove layers when you warm up, and replace them during the slower portions of your workout.
• If it is snowing or icy, be extra careful to not fall.
• Remember, you can still become dehydrated in cold weather -- so you still need plenty of fluid before, during, and after exercise.
• Wear light-colored, lightweight clothing.
• Drink plenty of fluids before, during, and after you exercise. This is important at all times of the year, but especially when exercising in warm weather.
• Take it slow, and be cautious about pushing your limits. Don't push yourself too hard, especially in the heat. Remember that you still need to replenish fluid even when you don't feel thirsty. If you do feel dizzy, lightheaded, or sluggish -- stop, rest, and drink fluids immediately!
• Heat stroke is a medical emergency. It may decrease your level of consciousness or even cause a seizure. If you experience more serious symptoms -- such as nausea, headache, confusion, clamminess, trouble focusing, fever, or sudden lack of sweating -- you should go to the hospital right away. You should also see a doctor promptly if your heavy breathing, dizziness, and excessive fatigue remain after you have rested and replenished fluids.
• If heat, humidity, or pollution make exercise too hard, exercise indoors or during cooler hours.
Weight Loss Guide
Most people know that being overweight is not healthy, yet losing weight can be difficult. This guide will help you through the weight loss process by explaining how successful weight loss really happens. If you've tried to lose weight before, don't view past efforts as failure. Instead, learn better weight-loss strategies, try again, and make this time different!
The benefits of a healthy weight
People come in different shapes and sizes. While differences are normal, more than 60% of American adults weigh more than they should. In addition, more than 30% of American children are overweight. A chronic condition known as obesity -- where a person has excessive body fat -- has reached epidemic proportions in both men and women of all ages and races.
Experts agree that being too heavy is bad for your health. Having too much fat can lead to serious health problems. More than 300,000 lives could be saved each year if everyone in America maintained a healthy weight! Next to smoking, obesity is the most common preventable cause of death in the United States.
What are the potential consequences of being overweight?
Being overweight puts you at higher risk for many significant health problems, such as:
• Type 2 diabetes
• Heart disease
• High cholesterol
• Sleep apnea
• Varicose veins
• Breast, endometrial, prostate, and colon cancers
• Gallbladder disease
• Rashes and other skin abnormalities (such as warts)
• High blood pressure
Clearly, losing weight can have many potential health benefits. If you are overweight and have decided to shed some extra pounds, congratulations! You have already taken an important step toward improving your health and feeling better. Even losing 5 -10% of your body weight can begin to lower your risk of serious chronic diseases.
What is your ideal weight?
"Ideal weight" does not mean having an ideal body -- almost everyone has physical features they would like to change. Rather, ideal weight is a medical term that refers to how much you should weigh, based on your height, gender, and age. Doctors use a few different methods to determine whether you are overweight. The main approaches are measurements of your body mass index (BMI), your waist circumference, and your waist-to-hip ratio.
Body mass index (BMI)
BMI is a number calculated from your height and weight and represents what you should weigh based on how tall you are
A healthy BMI for an adult generally falls between 18.5 and 25. If your BMI is over 25, you are probably overweight. If it is 30 or higher, you are considered obese, and 40 or higher, extremely (or morbidly) obese.
BMI is not always an accurate way to determine whether you need to lose weight. Here are some exceptions:
• Body builders: Since muscle weighs more than fat, people who are unusually muscular may have a high BMI.
• Elderly: In the elderly it is often better to have a BMI between 25 and 27, rather than under 25. If you are older than 65, for example, a slightly higher BMI may help protect you from osteoporosis.
• Children: While an alarming number of children are obese, do not use this BMI calculator for evaluating a child. Talk to your child's doctor about what an appropriate weight is for his or her age.
Waist circumference and waist-to-hip ratio
Your waist circumference indicates how much fat is collected around your midsection. Doctors aren't sure why, but fat around your middle (called central obesity) is more dangerous than fat around other parts of the body, like your hips. People who have a high waist circumference and a high waist-to-hip ratio are more at risk for many diseases associated with being overweight, particularly heart disease and diabetes.
Weight gain in the area of the waist and above (apple type) is more dangerous than weight gained around the hips and flank area (pear type). Fat cells in the upper body have different qualities than those found in hips and thighs.
• To measure your waist circumference: Wrap a tape measure around your middle at the level of your belly button. The risk of heart disease and diabetes increases if your waist circumference is more than 35 inches (88 cm) for a woman and more than 40 inches (102 cm) for a man. You should strive for a waist size less than 31.5 inches if you are a woman and less than 37 inches if you are a man.
• To measure your waist-to-hip ratio: Measure your hip circumference at the level of the two bony prominences felt in the front of your hips. Then, divide your waist circumference by your hip circumference. Your waist-to-hip ratio should be below 0.8 for a woman and below 1.0 for a man.
Remember: Some people don't need to lose weight!
In our culture of thinness, some people strive to lose weight when they don't need to, or they strive to lose more weight than they should. Besides the obvious dangers of anorexia and bulimia, being underweight can cause bone loss, low blood pressure, and other extremely serious problems.
Before you decide to lose weight, assess yourself honestly. Do you really need to lose weight? Do others express surprise or concern that you are considering weight loss? Do you have expectations for weight loss that go beyond improving your health? If any of these apply to you, a professional counselor may be appropriate to help with body image issues.
Causes and medical considerations
You gain weight when the fat cells in your body either expand (because they are storing extra calories), or when they increase in number. Each of us is born with a certain number of fat cells, as determined by our genes. This impacts your weight for the rest of your life. However, if you overeat and do not get enough physical activity -- particularly during childhood and adolescence -- you can actually develop MORE fat cells.
When you lose weight, your fat cells contract -- but unfortunately you don't lose any! This is one reason why it is easy to gain weight back. This is also why it is important to keep children from becoming overweight in the first place
When you don't burn as many calories as you consume, the body stores the extra calories in fat cells. These cells function as energy reservoirs, and they enlarge or contract depending on how you use this energy.
The most common cause of weight gain is fairly simple: your energy input (the calories you eat) is greater than your energy output (the calories you burn). In fact, even with a medical condition that may increase the likelihood of becoming overweight (see below), one of these two factors is generally present before you gain weight -- namely, you eat too many high-calorie, high-fat foods or you don't get enough physical activity.
There are, however, certain medical conditions that increase your chances of becoming overweight or obese:
• Hypothyroidism (an underactive thyroid) -- generally causes only mild-to-moderate weight gain
• Taking certain medications including steroids, tricyclic and serotonergic antidepressants, drugs for seizures, and drugs for schizophrenia
• Tumors of the pancreas
• Brain injury from trauma or surgery
• Certain birth defects
• Hormonal imbalances, such as Cushing syndrome (where your body produces high amounts of steroids) and polycystic ovary syndrome
• Seeing a doctor
• See your doctor to determine if there are any underlying reasons for your weight gain. Your doctor can also make sure you are healthy enough to begin a weight loss program and check what activities you can safely do. Your doctor may tell you to avoid certain exercises that put too much stress on your body, like jogging or high-impact aerobics, particularly early on.
• You also may have specific nutritional needs (for example, if you have diabetes). Your doctor will want to make sure you get adequate nourishment -- including a balance of important vitamins and minerals -- while you lose weight and keep it off.
If any of the following is true, it is particularly important that you involve your doctor in your weight loss decisions:
• You are pregnant.
• You smoke.
• You have diabetes.
• You are an older adult.
• You have heart disease.
• You have any other significant medical condition.
How to lose weight the healthy way
You've heard it all before -- to lose weight you must burn more calories than you consume. But anyone who has ever tried to lose weight knows it's not that easy! In fact, about two-thirds of people who lose weight will regain it within a year.
For many people, efforts to lose weight mean intensive dieting, obsessive calorie counting, self-deprivation, and hunger. This type of dieting usually leads to failure because you suffer through it. For the most part, people who lose weight and manage to keep it off do so by adopting healthy habits that stay with them for the rest of their lives. Weight loss is not an isolated, one-time activity, but part of a lifetime of better health.
Take it slow and steady
Start with realistic, achievable goals. Don't expect to become "thin" overnight. Experts agree that slow, steady weight loss is healthier than a quick fix or remaining overweight. You should try to lose no more than a couple of pounds per week.
While this can be frustrating, slow and steady weight loss is the only way to avoid "yo-yo dieting," where you lose a great deal of weight, only to regain it within a few months or years. There are no miracles in weight loss; go for steady progress toward a healthier life.
You want to maintain that healthy weight once you have reached your goal. If you change habits and lifestyle behaviors slowly, they'll be more likely to stick.
Healthy weight loss:
• Occurs slowly
• Promotes long-term healthy habits
• Fits into your lifestyle
• Includes physical activity
• Reduces calories but maintains a balance of nutrients
Modify your diet
Calories are the basic unit of energy within food. When you eat, your body converts calories into energy. Your body uses what it can and stores the rest in the form of fat. You should eat a low-calorie diet if you want to lose weight.
A calorie is a calorie, whether it comes from a brownie or a serving of raw broccoli. The difference between them is the number of calories, nutrients, fat, and other ingredients in a typical serving.
Some diets involve calorie counting -- figuring out the number of calories in each food item you eat, then adding up the total at the end of the day. This method shows:
• How quickly calories add up
• Where most of your calories come from
• What time of day you tend to eat the largest amount
This can be valuable information, particularly when you first start your weight loss program. The method allows you to make adjustments to your food consumption on a particular day or over time.
Counting calories, however, quickly becomes tedious, and it does not necessarily train you to eat a healthy balance of foods. It is easy to become obsessed with the numbers and forget that the point is to eat healthily and vary your foods.
Eat less, or eat healthy?
Obviously, you can reduce calories simply by eating less. For example, if you usually eat french fries with lunch, order a smaller portion or throw some of them out. Although in theory this method should help you lose weight, it is not the healthiest or most successful.
First of all, you are not eating a balanced, nutritious diet, nor are you lowering your risk for chronic conditions like diabetes and heart disease. Furthermore, people who simply try to eat less, rather than changing food types, tend to get hungrier faster and snack more in between meals.
Instead, replace unhealthy and fattening foods with healthier alternatives -- eat the same amount of food as before but eat lower-calorie foods with a healthier balance of nutrients. Using the example above, you would replace the french fries with a baked potato, carrots, an apple, or another healthier and lower-calorie food. Again, you are eating fewer calories, but you are also filling your stomach and adding variety to your diet.
Hints for eating nutritious foods
• Choose fresh fruits and vegetables over canned or processed foods. Food often loses its natural vitamins and minerals during processing. Fresh food is also more flavorful, so you will feel more satisfied.
• Lower your fat intake by eating a plant-based diet. Animal products tend to be higher in saturated fat (and therefore calories) than most plant products.
• Choose products (like breads and pasta) with whole grains over those with white flour. These have more fiber, are more likely to fill you up, and are more nutritious. The fiber may even help lower your cholesterol.
• Allow yourself an occasional treat, so you don't feel deprived. It can be easier to change your habits if you know you can still have your favorite dessert or snack once in awhile.
• Eat fish instead of meat. Fish is a healthy, lean protein. Also, it contains a type of fat called "omega-3," which may help protect the heart.
• Some foods are especially bad for weight loss. Foods that contain a high number of calories without providing important nutrients are referred to as "empty calories." Sugary snacks and soda, for example, can dramatically increase the number of calories you consume without providing any nutritional value. They should be consumed only in small quantities.
• One step at a time
• Changing eating patterns can be extremely difficult. Food plays so many roles in our lives, and we've formed our eating habits over many years. It may be easier to make one food substitution at a time -- for example, switch from whole milk to skim milk, then eliminate butter from your diet. Once again, gradual progress is the key to successful weight loss and maintenance.
• Since most Americans eat too much fat and sugar (both of which contribute to weight gain), replacing these with whole grains, fruits, and vegetables should lower your intake of calories and provide rich sources of vitamins and minerals at the same time. Also, protein should come from low-fat sources like fish, beans, chicken, and soy.
Create healthy food habits
Chances are, you have some food habits that are "good" and some that are "bad" -- to lose weight, you must examine these behaviors and replace the bad habits with healthier ones. Here are some guidelines for developing better food habits.
Always eat regular meals, including breakfast
Skipping meals delivers a double whammy to your weight loss efforts. When you skip meals, your body goes into "starvation mode," signaling your body to conserve as much energy as possible -- this builds up body fat. Skipping meals is also likely to make you very hungry for your next meal, which could cause you to eat more. In fact, eating smaller amounts more frequently -- as often as six times per day -- may be best for losing weight. Bottom line: Eat meals and snacks at about the same time every day.
Eat only in the dining room or at the kitchen table
Don't eat in the bedroom or while watching TV. Confining yourself to the table will help you be more disciplined about eating. Keep food out of sight so you won't be tempted to eat it between meals. Don't "reward" yourself with food or use it for comfort.
Start with small portions
You can always get more later, but your compulsion to "clean your plate" may encourage you to eat more than you should. And don't worry about wasting food, either -- it's better to leave food on your plate than to overeat. Don't automatically reach for seconds or thirds. Finally, keep in mind that if you are used to eating large meals, your stomach will signal hunger until its size reduces, over weeks and months, from eating smaller meals. In other words, it will be tougher to stick to smaller meals at the beginning, but that won't last.
Eat your vegetables first
Then go on to the rest of your meal. This will help you fill your stomach with relatively few calories and lots of fiber. You may be less hungry for the more fattening parts of your meal.
It takes time for your body to recognize you have eaten and for the feeling of hunger to go away. Eating too quickly may cause you to eat more food over the same period of time. Savor your food. Not only does it take longer to eat when you fully enjoy each bite, but you may find eating to be more satisfying.
Substitute healthy foods for unhealthy ones
Instead of snacking on potato chips, try carrot sticks, fresh fruit, or yogurt. Sample different kinds of food for variety. Don't put butter or cream sauce on vegetables or a lot of dressing on your salad.
Drink plenty of water
Drink water or another calorie-free drink while eating. This will help you feel full sooner.
Finally, don't forget to take a walk after dinner!
Exercise is vital to living a healthy life and losing weight. If you exercise regularly, you are more likely to sleep better, get sick less often, have more energy, and experience a host of other benefits in your physical and mental well-being. In the process, you will grow stronger, gain stamina -- and may even enjoy it!
Exercise is especially important if you are trying to lose weight:
• To lose weight, you must burn more calories than you eat. Exercise is the best way to do this.
• When you exercise regularly, you build stronger muscles, even if you do not work out with weights. Muscles use more calories than fat throughout the day, even while you are resting. This contributes to what is commonly called a "faster metabolism."
Any increase in physical activity will have a positive impact on your health and your efforts to lose weight. It does not have to be formal exercise. Raking your yard or cleaning the house can qualify, if you do it long enough and with enough intensity.
If you are considered obese (your BMI is 30 or higher), start with a low- or no-impact activity such as swimming, walking, or cycling. High-impact activities (such as running, dancing, and most team sports) put more stress on your joints, which can significantly increase your risk for injury. If you like high-impact activities, ask your doctor if they are okay for you. As you lose weight, you should be able to engage in these more strenuous activities.
Speak to your doctor before you begin, especially if you have any of the following conditions:
• A heart condition, angina (chest pain), high blood pressure, or high cholesterol.
• Any serious medical condition like diabetes, asthma, emphysema, chronic bronchitis, cancer, or a history of blood clots in your legs or lungs.
• Pain or pressure in the chest, neck, shoulder, or arm during or right after activities such as walking.
• Bone or joint problems, including arthritis or osteoporosis (especially arthritis that has flared up, so that one or more of your joints is red, swollen, or painful).
Also, see a doctor if any of the following apply to you:
• You are over age 40 to 45, and have not been active.
• You smoke.
• You feel very breathless after mild activity.
• You tend to get dizzy, lose consciousness, or are subject to falls.
• You have experienced a feeling of your heart racing, skipping, or fluttering.
• You have had recent surgery.
• You have an active infection or fever.
• You are experiencing any other unusual symptoms, such as unexplained weight loss
• How do you get started?
• If you do not currently exercise, the first step is to choose an activity and a "start date." Choose an activity (or several activities) with which you are comfortable. Many people start with walking because it is convenient, inexpensive, and easy. If you prefer, take a dance class, play catch with your kids, or find another activity that fits with your life.
• Once you decide what you will do and when you will start, practice your activity. That is, go out and do it one time. At first, don't worry about how you will fit the activity into your daily life -- just be proud of what you did. And no matter what you choose, start slowly.
• As you increase your fitness, increase the time you spend exercising each day, as well as the intensity. Building up slowly is the key. To lose weight, your ultimate goal should be to get a total of 60 minutes of physical activity equivalent to brisk walking each day. But, you are not going to get there in just one day. Remember that any amount of activity or exercise is going to help reduce your waistline, especially if you are starting from a sedentary lifestyle.
• Plus, physical activity does NOT necessarily have to be aerobic exercise. The goal is to burn calories, and you can do that countless ways, such as using the stairs instead of the elevator, parking your car in the farthest parking space, mowing the lawn, or gardening.
• If you are doing an activity that takes more effort than walking, like running, then 30 minutes a day should be enough. Or if you are doing something that takes about half the effort of brisk walking, like gardening, you'll have to do it twice as long -- 2 hours.
• Having trouble doing your exercise all at once? That's no problem. Spread it out throughout the day in 10 minute chunks of activity. Doing this 3 - 6 times per day can still strengthen your heart and burn calories.
• Once you are comfortable with your exercise routine, consider exercising with others, or adding different activities to keep it interesting. Remember, the important thing is that you get out there and do something!
• Drink plenty of fluids before, during, and after you exercise to make sure that you stay hydrated. This is as true in cold weather as it is in warm weather.
• Don't get discouraged if you miss a session -- just pick it up again the next day.
• Outdoor conditions may impact how you feel while exercising. Heat, humidity, or pollution may make exercise harder. In these conditions, exercise indoors or during cooler hours.
• Bored with your usual exercise routine? Meet a friend and exercise together. You may exercise longer or harder with another person than you would alone.
• Everyone has good days and bad days when it comes to exercise. Don't let the bad days discourage you from going out in the future.
• Use your imagination -- just about any physical activity can count as exercise.
• Don't work too hard. If you cannot comfortably carry on a conversation while exercising, slow down!
Small steps add up
For significant weight loss, you need to make sure you are burning more calories than you consume. This usually requires commitment to a disciplined exercise program. However, there are also many small, simple steps that can help your weight loss efforts every day.
Anything you do to consume fewer calories or burn more calories can help. Small steps count in weight loss, and believe it or not -- they add up! For example, instead of sending an email to your co-worker, go to his or her desk and talk face-to-face. Just that little bit of movement might burn one or two calories. By the end of the day, this could add up to 10 or 20 calories -- or more.
Simple but effective strategies
There are other quick and easy things that can really help. For example, brush your teeth after every meal. You may be less likely to snack, especially on sweets, when you have that fresh, clean feeling in your mouth. And another quick tip -- don't shop for groceries when you are hungry!
Here's another easy step: define your portions. Serve your ice cream in a bowl instead of eating it from the carton; put your chips on a plate instead of eating them from the bag. If you aren't keeping track, it is easy to eat more than you wanted.
When you start a weight loss effort, write down everything you eat. This will help you evaluate your diet and may help you eat less. Be honest with yourself. This isn't a test. You won't be graded. The feedback is for you only. Many people badly misjudge how they eat (underestimating high-calorie foods or overestimating low-calorie foods). When the notes aren't accurate, people tend to gain weight when they think they are dieting.
Make it automatic
To lose weight or maintain a healthy weight, everyone must make daily, even hourly, decisions about what is consumed and how to be physically active. In time, these decisions can become automatic and easy. To develop these automatic behaviors, try to develop a "pro-health" mentality rather than a "sacrifice" mentality.
The more active you are, the more successful you will be, but don't worry about doing it all right away. Over time, you will add more exercise to your routine and eat a more balanced diet. Until then, concentrate on what you can realistically do.
You can do it!
If this isn't the first time that you've tried to lose weight, you are not alone. For most people, weight loss takes multiple attempts before getting it right. Losing weight is a significant undertaking; long-term success is a huge accomplishment as well as a lifetime commitment.
Throughout the process of weight loss, it is natural to feel self-doubt or defeat. It's OK to feel down once in a while, but the main thing is to stay focused on your goals. Excess weight poses a threat to your life and health, and the struggle against it is always worthwhile. Remind yourself of the many reasons why weight loss and exercise are worth it!
It may help to think about how far you have already come. You do not have to measure that by the number of pounds you have lost. For example, think about how much farther or faster you can walk, jog or cycle compared to before you started. If good health is your goal (and it should be), you can measure success in many ways.
When can I stop?
The changes you make to lose weight should stay with you throughout your life. This doesn't mean that you have to stick to it with the same intensity after you have lost the excess pounds. But you should continue most of the habits you learn during this process. If you don't, there is a good chance you will regain what you've lost.
Eating right and exercising are the keys to a healthy life for everyone. Not enough people -- even thin people -- respect their bodies enough to follow through with these important lifestyle habits. When you stick to achieving your weight loss goals, you will have accomplished more than many other people, and you will have something to be truly proud of!
Choosing a weight loss program
You do not need to join a program to lose weight. However, if you're having trouble losing weight on your own (and many people do), a weight loss program may be helpful. Weight loss programs can have a number of advantages, such as providing peer support, guidance from professionals, and helping you focus on your goals. However, be careful about which program you choose -- some programs promise more than they can deliver.
What to look for in a program
How do you know which group to join? Ask the following questions about any weight loss program that you are considering:
• What does the program promise? If the program claims that you can lose a lot of weight quickly, it is not a good program.
• Does the program encourage you to keep a balanced diet? Everyone should keep a diet that includes all types of foods. Be careful if the program emphasizes one type of food over the others, such as high-protein diets.
• Does the program encourage physical fitness? Physical activity is key to living healthfully, and you should strive to be active throughout your life. Plus, physical activity is a cornerstone to losing weight.
• Does the program teach you to be self-sufficient? You won't want to pay for a weight loss program your whole life, and when you leave, you should be able to maintain your weight on your own. For example, programs that require you to buy food from them do not teach you how to shop, cook, or order from restaurants on your own.
• Does the program provide what you are looking for? Consider your needs. Why do you want to join a program in the first place? Different groups offer different things. Choose one that is a good fit with your life.
• Does the program push weight loss medications? You should consider taking a weight loss medication ONLY if you are medically obese (BMI higher than 30) and have not been able to lose weight by making adequate and appropriate lifestyle changes. If you are considering medication to help you lose weight, make sure you are working with a doctor who knows your medical history.
• Does the program screen you for health risks? Only join a program that assesses your health status before you begin. A program that is willing to take anyone, regardless of their health, could be dangerous.
• Are you attracted to the program because of a celebrity endorser? Celebrity endorsements can be a powerful draw. Remember that most celebrities are not health experts. These programs are not necessarily poor choices, but you should look carefully at what they can do for you and if they can fulfill your needs.
Many popular diets sound very appealing because they tend to offer a "quick fix." Remember that no specific diet is a magic cure. Again, there are two key guidelines in any successful diet program:
Go slow and steady to win the weight loss race.
Develop habits that stick with you for the long term
Many popular diets are just a fad. A fad diet is any gimmick that does not provide the proper balance of nutrients or can only be sustained for a short period of time. In addition, fad diets are NOT based on proven science, even though almost everyone knows someone who did well on a given diet. Beware of claims like "Lose 30 lbs in 30 days!", "Scientific miracle - medical breakthrough!" or "Keep the weight off for good -- just $39.99!" While such statements are tempting and play off your emotions, they are usually made by companies wanting to get rich off your desire to lose weight, so keep them in perspective.
Examples of some popular diets include:
• Food combining diets -- These diets claim that eating foods in specific combinations or only at certain times of day promote weight loss. There is no scientific merit to food combining diets.
• Liquid diets -- Liquid diets are a short-term answer to a long-term problem. Liquid diets cannot provide all of the nutrients you need to stay healthy, and are ultimately unsustainable. Have you ever tried eating nothing but liquid for any length of time? Most people can't do it, and nobody should! Liquid protein diets have been associated with heart abnormalities and sudden death. However, some liquid diets, when combined with eating healthy solid foods and done under the supervision of a health care provider, have been shown to promote and sustain weight loss over a 2-year period.
• High protein diets -- High protein diets work by reducing your intake of carbohydrates like pasta, rice, and sugar. While it is important to eat fewer of these simple carbohydrates, on these diets you make up for their absence by replacing them with protein. It is extremely difficult to eat large quantities of protein without consuming too much fat and too few vitamins and minerals. You need protein in your diet, but only in moderation, along with a healthy balance of other nutrients. Eating too much protein can be dangerous, as it can cause damage to your kidneys and your bones. Scientific studies are just beginning to examine the high protein diet approach to determine if it is truly effective for losing weight, or if it is safe, particularly if followed for a long time. Despite the recent popularity and media attention of such high protein diets, most scientific organizations advise against this approach and recommend the tried and true approach of lean protein, whole grains, lots of fruits and vegetables, and low fat dairy.
Medication and surgery
In general, your physician will only consider drugs or surgery if you are clinically obese (your BMI is at least 30) or you are at high risk for developing diseases associated with being overweight, and you have not been able to lose weight after at least 6 months of lifestyle changes. It is important to know that these methods do not replace diet and exercise, but can enhance them for some individuals.
Weight-loss drugs that require a physician's prescription include:
• Sibutramine (Meridia) -- boosts metabolism, enhances energy level, and promotes a feeling of fullness; studies have found it to be effective for weight loss, but side effects include dry mouth and insomnia. If you have a history of high blood pressure (hypertension), stroke, seizures, or heart, liver, or kidney diseases, you should talk to your doctor if your are considering this medication.
• Orlistat (Xenical) -- is taken with meals to prevent your body from absorbing the fat in food. However, it may also block the absorption of certain essential vitamins. If you are taking Orlistat, you should also take a vitamin supplement that contains vitamins A, D, E, K, and beta-carotene at least 2 hours before or after taking the medicine to replace these fat-soluble vitamins. Other side effects may include bloating, diarrhea, nausea, and other gastrointestinal symptoms. If you have a history of kidney stones, you should talk to your doctor if your are considering this medication.
• Phentermine (Adipex, Ionamin, Fastin, and many others) -- suppresses appetite. Serious potential side effects, including heart valve defects and pulmonary hypertension, have been reported when used in combination with fenfluramine (often called fen-phen). Medications containing fenfluramine have been removed from the market. Phentermine should NOT be taken with antidepressant medication.
• Amphetamine derivatives -- including benzphetamine, diethylpropion, phendimetrazine, and mazindol -- elevate mood and reduce weight moderately if taken for short periods of time (3 - 12 weeks). They can cause agitation, insomnia, and addiction. Therefore, these medications are not recommended.
The long-term effects of most of these medications have not been established. Many lose their effectiveness over time, and none of these drugs deal with the underlying problems that may be causing obesity. Except under rare circumstances, pregnant or nursing women should never take diet medications of any sort, including herbal and over-the-counter remedies.
Over-the-counter herbs and medications
There are several medications available without a prescription. However, the scientific evidence from medical studies regarding their effectiveness is not very convincing.
Formerly, phenylpropanolamine (PPA) was a popular over-the-counter appetite suppressant. The Food and Drug Administration (FDA) has removed PPA from drug products because it increases the risk of a bleeding stroke.
Another ingredient that used to be in some over-the-counter medicine is ephedrine, which the FDA no longer allows. Ephedrine was linked to severe effects, such as high blood pressure, heart attacks, stroke, and seizures. As of May 2004, herbal products that contain ephedra became illegal as well. (Ephedra and ephedrine are essentially the same substance.)
Surgery for weight loss is recommended only if you are severely obese (your BMI is more than 40) and all other available options have been unsuccessful. Before weight loss surgery, you will undergo a psychological evaluation. After surgery, the doctor will require you to have appropriate social support.
If you are considering weight loss surgery, think carefully! This kind of surgery greatly increases your risk of developing gallstones, abdominal hernias, nutritional deficiencies, and other possible complications.
Surgeries for weight loss include the following:
• Restrictive operations (often called gastric banding) -- These operations limit the amount of food you can eat by creating a small pouch at the top of the stomach. The pouch can hold about one ounce of food, and when it is full you do not feel physically hungry. Because the pouch fills up quickly and empties slowly, you eat less food than you would otherwise.
• Malabsorption operations (also called gastric bypass) -- These operations limit both how much you can eat and how much of what you eat is absorbed into your body. Like the restriction operation, the surgeon creates a small pouch in the stomach. Next, your digestive tract is re-routed, so it "bypasses" the first part of your small intestine. As a result, you are not able to use all the food you consume. And, after the surgery you will need regular replacement of certain nutrients, including calcium, folate, and vitamin B12.
• Liposuctions -- This procedure removes fat from specific areas of your body. Surgeons typically perform liposuction on people of normal weight who have pockets of fat (for example, under the arms). It is not recommended as a tool towards overall weight loss. It is used as a way to shape the body, not reduce weight.
• Abdominoplasty (also called abdominal wall surgery) -- This procedure is an optional surgery to treat flabby, stretched-out abdominal muscles and skin to improve appearance and strength. Excessive fatty tissue and loose skin are removed from the middle and lower sections of the abdomen and the abdominal muscles may be tightened. Abdominoplasty may be helpful when diet and exercise have not corrected severe muscle weakness (which may occur after multiple pregnancies), or the skin and muscle cannot regain its normal tone (which can occur with massive obesity in young people and slight obesity in older people). Abdominoplasty should not be used as a substitute for weight reduction.
Weight loss: Key points
• More than 60% of American adults and over 30% of American children weigh more than they should.
• Find out your BMI (body mass index), waist circumference, and waist-to-hip ratio to determine if you are overweight.
• Being overweight puts undue strain on your heart and contributes to serious health problems, like high blood pressure, type 2 diabetes, gallstones, and sleep apnea.
• To lose weight, you must burn more calories than you consume. This sounds simple, but it is not easy.
• Changing your lifestyle is essential for losing weight and keeping weight off. There is no way around this, even with medicine or surgery.
• Making slow, progressive changes leads to new and lasting habits.
• Belief in yourself and in your weight loss approach are important first steps towards successfully losing weight.
• Treat each attempt to lose weight as a new beginning, a fresh start, and learn from your former attempts.
• Avoid yo-yo dieting and fads. To lose weight in a healthy way and keep it off, aim for no more than two pounds per week and be sure to include physical activity.
• Exercise is essential for weight loss. Start out with low-impact activities to protect your joints. Build up slowly, adding more vigorous activity as you shed the pounds.
• When losing weight, you must not only eat fewer calories, but make sure that your diet has a balance of essential nutrients, including vitamins and minerals.
• Substitute whole grains, fruits, and vegetables for fat and sugar.
• Keep track of what you are eating and when, especially in the beginning. This can help you identify problem foods and problem times of day. Counting calories, however, quickly becomes tedious and does not guarantee a healthy, balanced diet.
How many calories should you cut?
Cutting down the number of calories you consume in a day is the cornerstone of losing excess weight. As a rough rule of thumb, here is how calories translate to weight:
• One pound of fat equals about 3,500 calories. Therefore, one could lose a pound a week by cutting about 500 calories a day. Naturally, the more calories you cut, the faster the weight loss. However, very-low calorie diets have been associated with some serious health consequences. (See below.)
• To determine your own personal daily calorie requirement, multiply the number of pounds of your target (ideal) weight by 12 - 15 calories. This gives a range that lets you adjust for gender, age, and activity levels. For instance, a 50-year old woman who wants to maintain a weight of 135 pounds and be mildly active might require only 12 calories per pound (1,620 calories a day). A 25-year old female athlete who wants to maintain the same weight might require 25 calories per pound (2,025 calories a day).
Warning on extreme diets
Extreme diets of less than 1,200 calories per day carry health risks and are often followed by bingeing or overeating and a return to an obese state. Such diets often have insufficient vitamins and minerals, which must then be taken as supplements. Most of the initial weight loss is in fluids. Later, fat is lost, but so is muscle, which can account for more than 30% of the weight loss.
No one should be on severe diets longer than 16 weeks or fast for more than 2 or 3 days. Severe dieting has unpleasant side effects, including fatigue, intolerance to cold, hair loss, gallstone formation, and menstrual irregularities. There have been rare reports of death from heart arrhythmias when liquid formulas did not have sufficient nutrients. Those whose diets include a high intake of fluids and much reduced protein and sodium are at risk for hyponatremia (low sodium), which can cause fatigue, confusion, dizziness, and in extreme cases, coma.
Dietary fats explained
Fats are organic compounds that are made up of carbon, hydrogen, and oxygen. They are a source of energy in foods. Fats belong to a group of substances called lipids and come in liquid or solid form. All fats are combinations of saturated and unsaturated fatty acids. Fats can be called saturated or unsaturated depending on their proportions.
Fat is one of the three nutrients (along with protein and carbohydrates) that supply calories to the body. Fat provides 9 calories per gram, more than twice the number provided by carbohydrates or protein.
Fat is essential for the proper functioning of the body. Fats provide essential fatty acids, which are not made by the body and must be obtained from food. The essential fatty acids are linoleic and linolenic acid. They are important for controlling inflammation, blood clotting, and brain development.
Fat serves as the storage substance for the body's extra calories. It fills the fat cells (adipose tissue) that help insulate the body. Fats are also an important energy source. When the body has used up the calories from carbohydrate, which occurs after the first 20 minutes of exercise, it begins to depend on the calories from fat.
Healthy skin and hair are maintained by fat. Fat helps in the absorption, and transport through the bloodstream of the fat-soluble vitamins A, D, E, and K.
The types of fat
• Unsaturated fats: Fats that help to lower blood cholesterol if used in place of saturated fats. However, unsaturated fats have a lot of calories, so you still need to limit them. There are two types: mono-unsaturated and polyunsaturated. Most (but not all) liquid vegetable oils are unsaturated. (The exceptions include coconut, palm, and palm kernel oils.)
• Mono-unsaturated fats: Fats that help to lower blood cholesterol if used in place of saturated fats. However, mono-unsaturated fats have a lot of calories, so you still need to limit them. Examples include olive and canola oils.
• Polyunsaturated fats: Fats that help to lower blood cholesterol if used in place of saturated fats. However, polyunsaturated fats have a lot of calories, so you still need to limit them. Examples include safflower, sunflower, corn, and soybean oils.
• Trans fatty acids: These fats form when vegetable oil hardens (a process called hydrogenation) and can raise LDL (“bad”) cholesterol levels. They can also lower HDL (“good”) cholesterol levels. Trans-fatty acids are found in fried foods, commercial baked goods (donuts, cookies, and crackers), processed foods, and margarines.
• Hydrogenated: refers to oils that have become hardened (such as hard butter and margarine). Foods made with hydrogenated oils should be avoided because they contain high levels of trans fatty acids, which are linked to heart disease. (Look at the ingredients in the food label.) The terms "hydrogenated" and "saturated" are related. An oil becomes saturated when hydrogen is added (i.e., becomes hydrogenated).
• Partially hydrogenated: Refers to oils that have become partially hardened. Foods made with partially hydrogenated oils should be avoided because they contain high levels of trans fatty acids, which are linked to heart disease. (Look at the ingredients in the food label.)
• Saturated fats: These are the biggest dietary cause of high LDL (“bad”) cholesterol levels. When looking at a food label, pay very close attention to the percentage of saturated fat and avoid or limit any foods that are high. Saturated fats should be limited to 10% of calories. Saturated fats are found in animal products such as butter, cheese, whole milk, ice cream, cream, and fatty meats. They are also found in some vegetable oils -- coconut, palm, and palm kernel oils. (Note: most other vegetable oils contain unsaturated fat and are healthy.)
• Eating too much saturated fat is one of the major risk factors for heart disease. A diet high in saturated fat causes a soft, waxy substance called cholesterol to build up in the arteries. Too much fat also increases the risk of heart disease because of its high calorie content, which increases the chance of becoming obese (another risk factor for heart disease and some types of cancer).
A large intake of polyunsaturated fat may increase the risk for some types of cancer. Reducing daily fat intake is not a guarantee against developing cancer or heart disease, but it does help reduce the risk.
• Choose lean, protein-rich foods -- soy, fish, skinless chicken, very lean meat, and fat free or 1% dairy products.
• Eat foods that are naturally low in fat -- like whole grains, fruits, and vegetables.
• Get plenty of soluble fiber -- with oats, bran, dry peas, beans, cereal, and rice.
• Limit your consumption of fried foods, processed foods, and commercially prepared baked goods (donuts, cookies, and crackers).
• Limit animal products like egg yolks, cheeses, whole milk, cream, ice cream, and fatty meats (and large portions of meats).
• Look at food labels, especially for the level of saturated fat. Avoid or limit foods high in saturated fat.
• Look on food labels for words like "hydrogenated" or "partially hydrogenated" -- these foods are loaded with bad fats and should be avoided.
• Liquid vegetable oil, soft margarine, and trans fatty acid-free margarine are preferable to butter, stick margarine, or shortening.
• Children under 2 years of age should NOT be on a fat restricted diet because cholesterol and fat are thought to be important nutrients for brain development.
It is important to read the nutrition labels and be aware of the amount of different types of fat contained in food. It is recommended that everyone over 20 have their cholesterol checked.
Talk to your health care provider about how to cut down your fat intake and to have your cholesterol checked.
Most people today have less time to select, prepare, and eat food than their grandparents did. Fast foods are very appealing because they are quick, reasonably priced, and readily available alternatives to home cooking. While convenient and economical for a busy lifestyle, fast foods are typically high in calories, fat, saturated fat, sugar, and salt.
Fast food chains have modified some of their selections to respond to public concern about the fat content of their food. For instance, many fast food restaurants once switched from beef tallow or lard to hydrogenated vegetable oils for frying. However, hydrogenated oils (which contain trans fats) also increase the risk for heart disease. Some cities have banned or are trying to ban the use of trans fats. As a result, many restaurants are now trying to prepare foods using other types of fat. Meanwhile, some restaurants offer low-calorie choices like salad bars with low-calorie dressing, low-fat milkshakes, whole grain buns, lean meats, and grilled chicken items.
Despite these changes, however, in order to maintain a healthy diet, it is necessary to choose fast foods carefully.
Maintaining nutritional balance is not easy with fast food because there is no control over how they are cooked. For example, some are cooked with a lot of oil and butter, and some fast-food restaurants may not offer your food selection with reduced fat. The large portions also encourage overeating. Fast foods also tend to be short on fresh fruits and vegetables.
In general, people with high blood pressure, diabetes, and heart disease must be much more careful about choosing fast food due to the high content of fat, sodium, and sugar.
Knowing the number of calories and the amount of fat and salt in the fast food can help you decide which items are better choices. Many fast food restaurants have published the nutrient content of their foods. These are often available on request. You can plan a convenient yet healthful diet with this information. Make better choices when eating at fast food restaurants. In general eat at places that offer a variety of salads, soups, and vegetables.
Consider these general tips:
• Pizza: Ask for less cheese, and choose low-fat toppings such as onions, mushrooms, green peppers, tomatoes, and other vegetables.
• Sandwiches: Healthier choices include regular or junior size lean roast beef, turkey, or chicken breast, or lean ham. Extras -- such as, bacon, cheese, or mayo -- will increase the fat and calories of the item. Select whole grain breads over croissants or biscuits because the latter contain lots of added fat.
• Hamburgers: A single, plain meat patty without the cheese and sauces is the best choice. Ask for extra lettuce, tomatoes, and onions. Limit your intake of french fries.
• Meat, Chicken, and Fish: Look for items that are roasted, grilled, baked, or broiled. Avoid meats that are breaded or fried. Ask for heavy sauces, such as gravy, on the side.
• Salads: High fat food items such as dressing, bacon bits, and shredded cheese add fat and calories. Choose lettuce and assorted vegetables to make up the majority of your salad. Select low-fat or fat-free salad dressings, vinegar, or lemon juice when available. Ask for the salad dressing, on the side, or avoid them altogether.
• Desserts: Choose low-fat frozen yogurt, fruit ices, sorbets, and sherbets. Occasional indulgent desserts add fun to a carefully selected, well-balanced diet.
Try to choose smaller sized servings. Consider splitting some fast food items to reduce the amount of calories and fat. Ask for a "doggy bag," or simply leave the excess on your plate.
To help supplement and balance the fast food meal, make nutritious options such as fresh fruits, vegetables, and yogurt available as snacks.
When chosen carefully and not used in excess, fast foods can offer reasonably good quality nutrition to your diet. By being aware of what you eat and paying attention to how it affects your health, you can set an example and teach your children to eat healthy as well. As always, variety and moderation are the key principles in providing a healthy diet for children as well as adults.
Severe obesity is a chronic condition that is difficult to treat through diet and exercise alone. Gastrointestinal surgery is a good option for people who are severely obese and cannot lose weight by traditional means or who suffer from serious obesity-related health problems. The surgery promotes weight loss by restricting food intake and, in some operations, interrupting the digestive process. As in other treatments for obesity, the best results are achieved with healthy eating behaviors and regular physical activity.
People who may consider gastrointestinal surgery include those with a body mass index (BMI) above 40 -- about 100 pounds overweight for men and 80 pounds for women (see our BMI chart). People with a BMI between 35 and 40 who suffer from type 2 diabetes or life-threatening cardiopulmonary problems, such as severe sleep apnea or obesity-related heart disease, may also be candidates for surgery.
The concept of gastrointestinal surgery to control obesity grew out of results of operations for cancer or severe ulcers that removed large portions of the stomach or small intestine. Because patients undergoing these procedures tended to lose weight after surgery, some physicians began to use such operations to treat severe obesity.
The first operation that was widely used for severe obesity was the intestinal bypass. This operation, first used 40 years ago, produced weight loss by causing malabsorption. The idea was that patients could eat large amounts of food, which would be poorly digested or passed along too fast for the body to absorb many calories. The problem with this surgery was that it caused a loss of essential nutrients and its side effects were unpredictable and sometimes fatal. The original form of the intestinal bypass operation is no longer used.
How does surgery promote weight loss?
Gastrointestinal surgery for obesity, also called bariatric surgery, alters the digestive process. These operations promote weight loss by closing off parts of the stomach to make it smaller. Operations that only reduce stomach size are known as restrictive operations because they restrict the amount of food the stomach can hold.
Some operations combine stomach restriction with a partial bypass of the small intestine. These procedures create a direct connection from the stomach to the lower segment of the small intestine, literally bypassing portions of the digestive tract that absorb calories and nutrients. These are known as malabsorptive operations.
There are several types of restrictive and malabsorptive operations. Each one carries its own benefits and risks.
Restrictive operations serve only to restrict food intake and do not interfere with the normal digestive process. To perform the surgery, doctors create a small pouch at the top of the stomach where food enters from the esophagus. Initially, the pouch holds about 1 ounce of food and later expands to 2 - 3 ounces. The lower outlet of the pouch usually has a diameter of only about 0.75". This small outlet delays the emptying of food from the pouch and causes a feeling of fullness.
As a result of this surgery, most people lose the ability to eat large amounts of food at one time. After an operation, the person usually can eat only 0.75 to 1 cup of food without discomfort or nausea. Also, food has to be chewed well.
The most frequently done restrictive operation for obesity is adjustable gastric banding (AGB).
Adjustable gastric banding
In this procedure, a hollow band made of special material is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach. The band is then inflated with a salt solution. It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of salt solution.
Malabsorptive operations are the most common gastrointestinal surgeries for weight loss. They restrict both food intake and the amount of calories and nutrients the body absorbs.
Roux-en-Y gastric bypass (RGB)
This operation is the most common and successful malabsorptive surgery. First, a small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This bypass reduces the amount of calories and nutrients the body absorbs.
Biliopancreatic diversion (BPD)
In this more complicated malabsorptive operation, portions of the stomach are removed. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the duodenum and the jejunum. Although this procedure successfully promotes weight loss, it is less frequently used than other types of surgery because of the high risk for nutritional deficiencies.
A variation of BPD is a "duodenal switch." This operation leaves a larger portion of the stomach intact, including the pyloric valve that regulates the release of stomach contents into the small intestine. It also keeps a small part of the duodenum in the digestive pathway.
Malabsorptive operations produce more weight loss than restrictive operations, and are more effective in reversing the health problems associated with severe obesity. Patients who have malabsorptive operations generally lose two-thirds of their excess weight within 2 years.
In addition to the risks of restrictive surgeries, malabsorptive operations also carry greater risk for nutritional deficiencies. This is because the procedure causes food to bypass the duodenum and jejunum, where most iron and calcium are absorbed. Menstruating women may develop anemia because not enough vitamin B12 and iron are absorbed. Decreased absorption of calcium may also bring on osteoporosis and metabolic bone disease. Patients are required to take nutritional supplements that usually prevent these deficiencies. Patients who have the biliopancreatic diversion surgery must also take fat-soluble (dissolved by fat) vitamins A, D, E, and K supplements.
RGB and BPD operations may also cause "dumping syndrome." This means that stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness, and sometimes diarrhea after eating. Because the duodenal switch operation keeps the pyloric valve intact, it may reduce the likelihood of dumping syndrome.
The more extensive the bypass, the greater the risk for complications and nutritional deficiencies. Patients with extensive bypasses of the normal digestive process require close monitoring and life-long use of special foods, supplements, and medications.
Explore the benefits and risks
Surgery to produce weight loss is a serious undertaking. Anyone thinking about surgery should understand what the operation involves. Patients and physicians should carefully consider the following benefits and risks.
• Right after surgery, most patients lose weight quickly and continue to lose for 18 - 24 months after the procedure. Although most patients regain 5 - 10% of the weight they lost, many maintain a long-term weight loss of about 100 pounds.
• Surgery improves most obesity-related conditions. For example, in one study blood sugar levels of 83 percent of obese patients with diabetes returned to normal after surgery. Nearly all patients whose blood sugar levels did not return to normal were older or had lived with diabetes for a long time.
• Ten to 20% of patients who have weight-loss surgery require follow-up operations to correct complications. Abdominal hernia was the most common complication requiring follow-up surgery, but laparoscopic techniques seem to have solved this problem.
• Some obese patients who have weight-loss surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss, your risk of developing gallstones increases. Taking supplemental bile salts for the first 6 months after surgery can prevent gallstones.
• Nearly 30% of patients who have weight-loss surgery develop nutritional deficiencies such as anemia, osteoporosis, and metabolic bone disease. These deficiencies usually can be avoided if vitamin and mineral intakes are high enough.
• Women of childbearing age should avoid pregnancy until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus.
Helping your overweight child
In the United States at least one child in three is overweight, and the number of overweight children continues to grow. Over the last 2 decades, this number has increased by more than 50 percent, and the number of "extremely" overweight children has more than doubled.
A doctor determines if children are overweight by measuring their height and weight. Although children have fewer weight-related health problems than adults, overweight children are at high risk of becoming overweight adolescents and adults. Overweight adults are at risk for a number of health problems, including heart disease, diabetes, high blood pressure stroke, and some forms of cancer.
Did You Know That...
• Obese children and adolescents have shown an alarming increase in the incidence of type 2 diabetes, also known as adult-onset diabetes.
• Many obese children have high cholesterol and blood pressure levels, which are risk factors for heart disease.
• One of the most severe problems for obese children is sleep apnea (interrupted breathing while sleeping). In some cases this can lead to problems with learning and memory.
• Obese children have a high incidence of orthopedic problems, liver disease, and asthma.
• Overweight adolescents have a 70 percent chance of becoming overweight or obese adults.
What causes children to become overweight?
Children become overweight 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. In rare cases, a medical problem, such as an endocrine disorder, may cause a child to become overweight. Your doctor can perform a careful physical exam and some blood tests, if necessary, to rule out this type of problem.
• Genetic Factors: Children whose parents, brothers, or sisters are overweight may be at an increased risk of becoming overweight themselves. Although weight problems run in families, not all children with a family history of obesity will be overweight. Genetic factors play a role in increasing the likelihood that a child will be overweight, but shared family behaviors such as eating and activity habits also influence body weight.
• Lifestyle: A child's total diet and their activity level both play an important role in determining a child's weight. The increasing popularity of television and computer and video games contributes to children's inactive lifestyles. The average American child watches 4 hours of television each day, time that could be spent doing physical activity.
Is my child overweight?
If you think that your child is overweight, it is important to talk with your child's doctor. A doctor is the best person to determine whether your child has a weight problem. Physicians will measure your child's weight and height to determine if your child's weight is within a healthy range. A physician will also consider your child's age and growth patterns to determine whether your child is overweight.
For example, it is normal for boys to have a growth spurt in weight and catch up in height later. It is best to let your child's doctor determine whether your child will "grow into" a normal weight. If your doctor finds that your child is overweight, he or she may ask you to make some changes in your family's eating and activity habits.
One of the most important things you can do to help overweight children is to let them know that they are okay whatever their weight is. Children's feelings about themselves often are based on their parents' feelings about them. If you accept your children at any weight, they will be more likely to accept and feel good about themselves. It is also important to talk to your children about weight, allowing them to share their concerns with you. Your child probably knows better than anyone else that they have a weight problem. For this reason, overweight children need support, acceptance, and encouragement from their parents.
Focus on the family
Parents should try not to set children apart because of their weight, but focus on gradually changing their family's physical activity and eating habits. Family involvement helps to teach everyone healthful habits and does not single out the overweight child.
Increase your family's physical activity
Regular physical activity, combined with healthy eating habits, is the most efficient and healthful way to control your weight. It is also an important part of a healthy lifestyle. Some simple ways to increase your family's physical activity include the following:
• Be a role model for your children. If your children see that you are physically active and have fun, they are more likely to be active and stay active for the rest of their lives.
• Plan family activities that provide everyone with exercise and enjoyment, like walking, dancing, biking, or swimming. For example, schedule a walk with your family after dinner instead of watching TV. Make sure that you plan activities that can be done in a safe environment.
• Be sensitive to your child's needs. Overweight children may feel uncomfortable about participating in certain activities. It is important to help your child find physical activities that they enjoy and that aren't embarrassing or too difficult.
• Reduce the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games.
• Become more active throughout your day and encourage your family to do so as well. For example, walk up the stairs instead of taking the elevator, or do some activity during a work or school break-get up and stretch or walk around.
The point is not to make physical activity an unwelcome chore, but to make the most of the opportunities you and your family have to be active.
Teach your family healthy eating habits
Teaching healthy eating practices early will help children approach eating with the right attitude -- that food should be enjoyed and is necessary for growth, development, and energy to keep the body running. The best way to begin is to learn more about children's nutritional needs by reading or talking with a health professional and then to offer them some healthy options, allowing your children to choose what and how much they eat.
Don't place your child on a restrictive diet
Children should never be placed on a restrictive diet to lose weight, unless a doctor supervises one for medical reasons. Limiting what children eat may be harmful to their health and interfere with their growth and development.
To promote proper growth and development and prevent overweight, parents should offer the whole family a wide variety of foods from each of the food groups.
• Most of the foods in your diet should come from the grain products group (6 - 11 servings), the vegetable group (3 - 5 servings), and the fruit group (2 - 4 servings). (See chart for suggested serving sizes.)
• Your diet should include moderate amounts of foods from the milk group (2 - 3 servings) and the meat and beans group (2 - 3 servings).
• Foods that provide few nutrients and are high in fat and sugars should be used sparingly. Fat should not be restricted in the diets of children younger than 2 years of age.
One Serving* Equals
BREAD, CEREAL, RICE, PASTA GROUP
• 1 slice of bread
• 1 ounce of ready to eat cereal
• 1/2 cup of cooked cereal, rice, or pasta
MILK, YOGURT, CHEESE GROUP
• 1 cup of milk or yogurt
• 1 1/2 ounces of natural cheese
• 2 ounces of processed cheese
• 1 cup of raw vegetables or 1/2 cup of frozen leafy vegetables (cooked)
• 1/2 cup of other vegetables -- cooked or chopped raw
• 3/4 cup of vegetable juice
MEAT, POULTRY, FISH, DRY BEANS, NUTS GROUP
• 2 - 3 ounces of cooked lean meat, poultry, or fish
• 1/2 cup of cooked dry beans or 1 egg counts as 1 ounce of lean meat
• 2 tablespoons of peanut butter or 1/3 cup of nuts count as 1 ounce of meat
• 1 medium apple, banana, or orange
• 1/2 cup of chopped, cooked, or canned fruit
• 3/4 cup of fruit juice
*NOTE: Serving sizes are for children and adults ages 2 years and older. A range of servings is given for each food group. The smaller number is for children who consume about 1,300 calories a day, such as 2 - 4 years of age. The larger number is for those who consume about 3,000 calories a day, such as boys 15 - 18 years of age. For more information on healthy eating for children, visit the U.S. Department of Agriculture's food pyramid web site at www.mypyramid.gov.
If you are unsure about how to select and prepare a variety of foods for your family, consult a physician or registered dietitian for nutrition counseling. You may also want to refer to the readings and organizations listed at the end of this fact sheet for more information on healthy eating.
Carefully cut down on the amount of fat in your family's diet
Reducing fat is a good way to cut calories without depriving your child of nutrients. Simple ways to cut the fat in your family's diet include eating low-fat or nonfat dairy products, poultry without skin and lean meats, and low-fat or fat-free breads and cereals. Making small changes to the amount of fat in your family's diet is a good way to prevent excess weight gain in children. Major efforts to change your child's diet, however, should be supervised by a health professional. In addition, fat should not be restricted in the diets of children younger than 2 years of age. After that age, children should gradually adopt a diet that contains no more than 30% of calories from fat by the time the child is about 5 years old.
Don't overly restrict sweets or treats
While it is important to be aware of the fat, salt, and sugar content of the foods you serve, all foods-even those that are high in fat or sugar-have a place in the diet, in moderation.
Guide your family's choices rather than dictate foods
Make a wide variety of healthful foods available in the house. This practice will help your children learn how to make healthy food choices.
Encourage your child to eat slowly
A child can detect hunger and fullness better when eating slowly.
Eat meals together as a family as often as possible
Try to make mealtimes pleasant with conversation and sharing, not a time for scolding or arguing. If mealtimes are unpleasant, children may try to eat faster to leave the table as soon as possible. They then may learn to associate eating with stress.
Involve children in food shopping and preparing meals
These activities offer parents hints about children's food preferences, teach children about nutrition, and provide children with a feeling of accomplishment. In addition, children may be more willing to eat or try foods that they help prepare.
Plan for snacks
Continuous snacking may lead to overeating, but snacks that are planned at specific times during the day can be part of a nutritious diet, without spoiling a child's appetite at mealtimes. You should make snacks as nutritious as possible, without depriving your child of occasional chips or cookies, especially at parties or other social events. Below are some ideas for healthy snacks.
Fresh, frozen, or canned vegetables and fruit served either plain or with low-fat or fat-free cheese or yogurt
Dried fruit, served with nuts or sunflower or pumpkin seeds
Breads and crackers made with enriched flour and whole grains, served with fruit spread or fat-free cheese
Frozen desserts, such as nonfat or low-fat ice cream, frozen yogurt, fruit sorbet, popsicles, water ice, and fruit juice bars
Warning: Children of preschool age can easily choke on foods that are hard to chew, small and round, or sticky, such as hard vegetables, whole grapes, hard chunks of cheese, raisins, nuts, and seeds, and popcorn. It is important to carefully select snacks for children in this age group.
Discourage eating meals or snacks while watching TV
Try to eat only in designated areas of your home, such as the dining room or kitchen. Eating in front of the TV may make it difficult to pay attention to feelings of fullness, and may lead to overeating.
Try not to use food to punish or reward your child
Withholding food as a punishment may lead children to worry that they will not get enough food. For example, sending children to bed without any dinner may cause them to worry that they will go hungry. As a result, children may try to eat whenever they get a chance. Similarly, when foods, such as sweets, are used as a reward, children may assume that these foods are better or more valuable than other foods. For example, telling children that they will get dessert if they eat all of their vegetables sends the wrong message about vegetables.
Make sure your child's meals outside the home are balanced
Find out more about your school lunch program, or pack your child's lunch to include a variety of foods. Also, select healthier items when dining at restaurants.
Set a good example
Children are good learners, and they learn best by example. Setting a good example for your kids by eating a variety of foods and being physically active will teach your children healthy lifestyle habits that they can follow for the rest of their lives.
If you need to make changes to your family's eating and exercise habits, but are finding it difficult, a registered dietitian (RD) may be able to help. Your physician may be able to refer you to an RD, or you can visit the National Center for Nutrition and Dietetics of The American Dietetic Association (ADA) at the ADA's website: www.eatright.org.
If your efforts at home are unsuccessful in helping your child reach a healthy weight and your physician determines that your child's health is at risk unless the child loses weight steadily, you may want to consider a formal treatment program. To locate a weight-control program for your child, you may want to contact a local university-based medical center.
Look for the following characteristics when choosing a weight-control program for your child. The program should:
• Be staffed with a variety of health professionals. The best programs may include RDs, exercise physiologists, pediatricians or family physicians, and psychiatrists or psychologists.
• Perform a medical evaluation of the child. Before being enrolled in a program, your child's weight, growth, and health should be reviewed by a doctor. During enrollment, your child's weight, growth, and health should be monitored by a health professional at regular intervals.
• Focus on the whole family, not just the overweight child.
• Be adapted to the specific age and capabilities of the child. Programs for 4-year-olds are different from those developed for children 8 or 12 years of age in terms of degree of responsibility of the child and parents.
• Focus on behavioral changes.
• Teach the child how to select a variety of foods in appropriate portions.
• Encourage daily activity and limit sedentary activity, such as watching TV.
• Include a maintenance program and other support and referral resources to reinforce the new behaviors and to deal with underlying issues that contributed to overweight.
The overall goal of a successful treatment program should be to help the whole family focus on making healthy changes to their eating and activity habits that they will be able to maintain throughout life.
High-carb diets may be better than low-carb diets
In contrast with popular reports that low-carbohydrate diets are safe and effective for weight loss, a study by researchers at the U.S. Department of Agriculture found that people consuming a high-carbohydrate diet are more likely to have low body mass index (BMI) values.
More than 10,000 U.S. adults were asked to recall in detail all that they have eaten in the last 24-hour period. The researchers looked at carbohydrate intake, nutritional quality, and BMI. The group was divided into four groups: very low carbohydrate (30% or less of total energy intake), low carbohydrate (31 - 45%), moderate carbohydrate (46 - 55%), and high carbohydrate (more than 55%).
Results showed that while those in the high-carbohydrate group ate the same amount of food (calculated by weight) as those in the other groups, they actually consumed 200 - 300 fewer kilocalories and less fat. Women in the high-carbohydrate group had significantly lower BMIs than those in the lower carbohydrate groups. Men on the high-carbohydrate diet also showed a tendency toward a lower BMI, but this was not statistically significant. There was also greater intake of vitamin A, carotene, vitamin C, folate, calcium, magnesium, and iron among the high-carbohydrate group, and a lower amount of vitamin B12, zinc, and sodium.
The study authors concluded that "adults who obtained more than 55% of total dietary energy from carbohydrates had [a lower calorie], yet nutritious diet." High carbohydrate diets tend to include foods high in fiber and water content and low in fat, such as grains, fruits, vegetables, and reduced-fat dairy products. In contrast, authors warn that the low-carbohydrate diets popular among the public may not be low enough in calories and may be devoid of essential micronutrients.
Exactly what type of diet is best for losing weight is still unclear, however. Other studies suggest that many kinds of diets can help you lose weight -- as long as you stick to the diet. Most dieters know how hard this is. But take heart: Studies have also shown that some people do keep dieting when they see positive weight-loss results and know that they may be reducing their risk for heart disease.
Vegetarian diets can be healthy because they are often lower in saturated fat and cholesterol and higher in fiber. Choosing a vegetarian diet with a low-fat content can be helpful for weight loss. But vegetarians -- like non-vegetarians -- can also make poor food choices, like eating large amounts of junk (nutritionally empty) foods. Candy, chips, and other high-fat, vegetarian foods should be eaten in small amounts.
Vegetarian diets need to be as carefully planned as non-vegetarian diets to make sure they are nutritious. Vegetarian diets can provide the recommended daily amount of all the key nutrients if you choose foods carefully. Plants, especially fruits and vegetables, are the main source of nutrients in vegetarian diets.
Some types of vegetarian diets (like those that include eggs and dairy foods) contain animal sources, while another type (the vegan diet) has no animal foods. Nutrients normally found in animal products that are not always found in a vegetarian diet are iron, calcium, vitamin D, vitamin B12, and zinc.
Here are some foods that have these nutrients:
• Iron: cashews, tomato juice, rice, tofu, lentils, and garbanzo beans (chick peas).
• Calcium: dairy products, fortified soymilk, fortified orange juice, tofu, kale, and broccoli.
• Vitamin D: fortified milk and soymilk, and fortified cereals (or a small amount of sunlight).
• Vitamin B12: eggs, dairy products, and fortified soymilk, cereals, tempeh, and miso. (Tempeh and miso are foods made from soybeans. They are low in calories and fat and high in protein.)
• Zinc: whole grains (especially the germ and bran of the grain), eggs, dairy products, nuts, tofu, leafy vegetables (lettuce, spinach, cabbage), and root vegetables (onions, potatoes, carrots, celery, radishes).
Vegetarians must eat a variety of plant foods over the course of a day to get enough protein. Those plant foods that have the most protein are lentils, tofu, nuts, seeds, tempeh, miso, and peas.
Source: Ministry of Health