Useful Information On Obesity

Useful Information On Obesity
Over one-half of all Americans (about 97 million) are overweight or obese. If you are
overweight or obese, carrying this extra weight puts you at risk for developing many
diseases, especially heart disease, stroke, diabetes, and cancer. Losing this weight help to prevent and control these diseases.

Obesity is a condition of excess body fat. It is the most common form of malnutrition
in the Western world. It is important to note that no "diet or weight loss formula" works
independently of an eating plan based on the Dietary Guidelines given by the mainstream
nutrition and health institutes. So if you are obese throw away all those "special
formulas", supplements, and pills, stop eating more calories than you need, become more
physically active and adopt a healthy eating plan.

Severe overweight increases the risk for high blood cholesterol,
high blood pressure, and diabetes and, hence, for diseases for which
these conditions are risk factors (diabetes, coronary heart disease,
high blood pressure, neurologic disorders, cancers, and kidney
diseases). Obesity thus contributes to premature mortality. Of all
obesity-related diseases, noninsulin dependent diabetes is most clearly
and strongly associated with obesity.

Obesity is associated with too many adipose cells (hyperplastic obesity), adipose cells
that are too large (hypertrophic obesity), or both. While changes in the size of adipose

cells may occur at any age, the number of adult cells are fixed and determined by weight
gain during certain periods of childhood development; fat cell numbers are established by

late adolescence and, once established, does not decline.

Women generally have more subcutaneous fat than men, but men appear
to suffer a greater cardiovascular risk from a given degree of fat than
women. The distribution of body fat may be an indicator of this
difference. Men accumulate more fat cells in the abdominal region than
women (high waist-to-hip ratio). This distribution around the abdomen,
referred to as upper body obesity, is associated with increased
cardiovascular risk factors. Lower body obesity is more typical in
women, who tend to accumulate fat in the hips, gluteal regions, and
extremities, a distribution that does not appear to be associated with
increased cardiovascular risk factors.

Regardless of gender, a high waist-to-hip ratio predicts an increased risk for
cardiovascular disease and diabetes. The mortality ratio has been shown to increase

with the degree of obesity, and with its duration.

Obesity is the net result of an excess of energy consumption over expenditure. Factors
that must be considered as contributing to causation are: heredity, overeating, altered

metabolism of adipose tissue, defective or decreased thermogenesis (the process by which
calories are converted to heat), decreased physical activity without an appropriate

reduction in food intake, and certain prescribed medications.

Overeating is clearly a prominent contributor to obesity. Feeding
behaviour occurs in response to hunger and to appetite inducedby the
presence of food. Satiety and the resulting cessation of eating occur
in response to certain hormones, nervous impulses, and absorbed
nutrients signalling the brain.

To loose weight, one must decrease caloric intake, increase caloric expenditure, or do
both. Thus, the chief approaches to weight reduction involve behaviour change related to

diet and exercise. Weight loss reduces health risks in the obese. Because obesity is a
condition requiring continuous attention, any behaviour changes required to maintain

weight loss must be life long.

With so many complex mechanisms causing a person to eat more than is needed, it is
acceptably difficult to follow a strict recommended weight-loss program.

Key Recommendations

(From the Expert Panel on the Identification, Evaluation, and Treatment of Overweight

and Obesity in Adults)

• Weight loss to lower elevated blood pressure in overweight and obese persons with
  
  high blood pressure.



• Weight loss to lower elevated levels of total cholesterol, LDL-cholesterol, and
  
  triglycerides, and to raise low levels of HDL-cholesterol in overweight and obese persons
  
  with dyslipidemia.



• Weight loss to lower elevated blood glucose levels in overweight and obese persons
  
  with type 2 diabetes.



• Use the BMI to assess overweight and obesity. Body weight alone can be used to
  
  follow weight loss, and to determine the effectiveness of therapy.



• The BMI to classify overweight and obesity and to estimate relative risk of disease
  
  compared to normal weight.



• The waist circumference should be used to assess abdominal fat content.



• The initial goal of weight loss therapy should be to reduce body weight by about 10
  
  percent from baseline.
  
  With success, and if warranted, further weight loss can be attempted.



• Weight loss should be about 1 to 2 pounds per week for a period of 6 months, with
  
  the subsequent strategy based on the amount of weight lost.



• Low calorie diets (LCD) for weight loss in overweight and obese persons. Reducing
  
  fat as part of an LCD is a practical way to reduce calories.



• Reducing dietary fat alone without reducing calories is not sufficient for weight
  
  loss. However, reducing dietary fat, along with reducing dietary carbohydrates, can help
  
  reduce calories.



• A diet that is individually planned to help create a deficit of 500 to 1,000
  
  kcal/day should be an intregal part of any program aimed at achieving a weight loss of 1
  
  to 2 pounds per week.



• Physical
  activity should be part of a comprehensive weight loss therapy and
  weight control program because it: (1) modestly contributes to weight
  loss in overweight and obese adults, (2) may decrease abdominal fat,
  (3) increases cardiorespiratory fitness, and (4) may help with
  maintenance of weight loss.



• Physical
  activity should be an integral part of weight loss therapy and weight
  maintenance. Initially, moderate levels of physical activity for 30 to
  45 minutes, 3 to 5 days a week, should be encouraged. All adults should
  set a long-term goal to accumulate at least 30 minutes or more of
  moderate-intensity physical activity on most, and preferably all, days
  of the week.



• The combination of a reduced calorie diet and increased physical activity is
  
  recommended since it produces weight loss that may also result in decreases in abdominal
  
  fat and increases in cardiorespiratory fitness.



• Behavior therapy is a useful adjunct when incorporated into treatment for weight
  
  loss and weight maintenance.



• Weight loss and weight maintenance therapy should employ the combination of LCD's,
  
  increased physical activity, and behavior therapy.



• After
  successful weight loss, the likelihood of weight loss maintenance is
  enhanced by a program consisting of dietary therapy, physical activity,
  and behavior therapy which should be continued indefinitely. Drug
  therapy can also be used. However, drug safety and efficacy beyond 1
  year of total treatment have not been established.



• A weight maintenance program should be a priority after the initial 6 months of
  
  weight loss therapy.

Some people lose weight on their own; others like the support of a structured program.

Overweight people who are successful at losing weight, and keeping it off, can reduce

their risk factors for heart disease. If you decide to join any kind of weight control

program, here are some questions to ask before you join.

Does the program provide counseling to help you change your eating
activity, and personal habits? The program should teach you how to
change permanently those eating habits and lifestyle factors, such as
lack of physical activity that have contributed to weight gain.

Is the staff made up of a variety of qualified counselors and health professionals such

as nutritionists, registered dietitians, doctors, nurses, psychologists, and exercise

physiologists?

Is training available on how to deal with times when you may feel stressed and slip

back to old habits?

Is attention paid to keeping the weight off? How long is this phase?

Choose a program that teaches skills and techniques to make permanent changes in eating

habits and levels of physical activity to prevent weight gain.

Are food choices flexible and suitable? Are weight goals set by the client and the

health professional?

The program should consider your food likes and dislikes and your lifestyle when your

weight loss goals are planned.

How Nutrition Can Effect Our Behavior

How Nutrition Can Effect Our Behavior
The disciplines of nutrition and behavior are not usually
considered to be closely related, but there are infact several key
areas of overlap between these fields. Behavior factors determine the
choice of foods in the diet, and any attempt to change dietary patterns
must necessarily involve the central nervous system and may be
associated with mood changes.

That diet influences behavior is an ancient human belief. Primitive
people attributed friendly and unfriendly feelings to plants and
animals and expected these feelings to be transferred to anyone who ate
such foods. In religious teachings, the behavior of mankind was said to
change instantly when Eve ate the apple. Solomon, suffering the pangs
of love, was confronted with apples. The ancient Greeks proposed that
the body is composed of four "humors" - hot, cold, wet, and dry - that
control health, feelings, and behavior. Such ideas have carried forth
to the present day, when many cultures believe in hot/cold or yin/yang
approaches to food and health.

Systematic study of cultural influences on food intake began early
in this century as anthropologists examined the use of food in isolated
cultures and ethnic groups. Even in contemporary times, foods are
endowed with magical powers and are believed to symbolize feelings such
as those of satisfaction and security.

The reduction of behavioral risk factors for chronic disease, an
improvement of the food choices and dietary practices of individuals,
and the development of effective means to do so is the key to diet and
good health.

Behavioral determinants and aspects of eating disorders

Although infants do not begin life with a choice of foods, some of
the most obvious reflexes at birth are those associated with eating.
Infants learn to associate eating with security and relief from
anxiety, tension, and distress. Later, children eat in conformance to
cultural and familial standards. These ingrained meanings attached to
the roles of food in society suggest reasons that food habits can be
changed only with difficulty.

Although the choice of certain foods as opposed to others may
greatly affect nutritional status, food selection includes multiple
environmental, cultural, genetic, social, and sensory variables that
interact in complex ways. One exception appears to be an innate
preference for foods that are sweet. This preference is acquired in
early childhood and continues throughout life.

Selection of foods for nutritional or health reasons is a learned
behavior. Infants have not been shown to have an inborn ability to
select a balanced, nutritious diet. Variety of foods available has an
important effect on food consumption; the more the available foods are
varied, the more of them people will eat.

Behavior change is a key element in reducing the risk for chronic
disease. Eating behaviors are acquired over a lifetime, to change them
requires alterations in habits that must be continued permanently -
beyond any short-term period of intervention.

Dietary advice is often restrictive and viewed as depriving or
unpleasant. It may also be incompatible with cultural or familial
standards. Furthermore, environmental factors such as peer pressure,
advertising of high-calorie foods and alcoholic beverages may strongly
counteract recommended changes.

Despite these difficulties, considerable evidence supports the
effectiveness of nutrition education in changing dietary intake to
reduce risk factors for conditions such as coronary heart disease,
diabetes, hypertension, and neurologic disorders.

Obesity

Obesity is the excessive accumulation of fat in the body. The cause of obesity is quite simple - fat accumulates when more calories are consumed than are expended.

Obesity is often a familial disorder, obese parents tend to produce
obese offspring. Obesity is more common among women than among men, and
its prevalence increases with age but decreases among individuals of
higher socioeconomic status and greater levels of physical activity.

Once obesity is established, food choices and caloric intake are no
longer normal, and personality differences between obese and
normal-weight individuals may be due to results of physiologic changes,
social discrimination, or dieting.

Disparagement of body image affects a larger percentage of obese
persons than nonobese persons who characteristically dislike their own
bodies. Such feelings are closely associated with self-consciousness
and impaired social functioning.

Although weight reduction ought to confer great benefits upon obese
persons and be simple to accomplish, clinical experience has shown
obesity to be remarkably resistant to treatment. The basis of weight
reduction is deceptively simple: Establish an energy deficit by
consuming fewer calories than are expended or expending more calories
than are consumed. Most such treatment is carried out under the
direction of nonmedical groups and counsellors in programs that pose
some hazard and are of uncertain long-term effectiveness.

Treatment measures should be specified and outcomes evaluated;
treatment should be individualized; and treatment effectiveness should
be assessed. Behavioral weight control programs usually include group
participation at weekly meetings for periods of two months or more, and
involve techniques of stimulus control, eating behavior, reward,
self-monitoring, nutrition education and physical activity.

Obese patients who participate in regular peer group meetings
following the completion of formal treatment maintain their weight loss
better than those who do not participate in such meetings.

It is important to make a note about obesity and the numerous
"weight loss formulas" that are currently marketed. These products
range from diet pills to drinks that supposedly will make weight loss
happen without any other dietary changes.

There is not a single, safe formula available that will cause
permanent weight loss without any adverse effects on the health of the
user. The proof of this is the fact that irrespective of the amount of
products that come and go, obesity still exists among about one third
of the population - millions of people. If there was one product that
was successful, obesity would no longer be a problem and the "inventor"
of this product would probably be the richest person in the world.

Do not take any "formula" for weight loss, you are wasting your
time, money, and probably health by doing so. Rather, follow the
dietary guidelines found in this book to achieve a desirable weight and
healthy lifestyle.

Anorexia Nervosa

Anorexia nervosa is a condition characterized by extreme weight
loss, amenorrhoea, and a constellation of psychologic problems that
have been described as "the relentless pursuit of thinness". [Bruch, H., Eating disorders: obesity, anorexia nervosa and the person within. New York. 1979.]

The most common cause of the disease is a single episode with full
recovery, but anorexia nervosa can be episodic or unremitting until it
causes death by starvation.

Unlike many other psychiatric disorders, anorexia nervosa tends to
occur in intact families and is often precipitated by seemingly minor
events during adolescence. Most theories of anorexia nervosa focus on
psychologic trauma or unempathetic and overly domineering mothering as
underlying causes of the disease. Socio-cultural theories suggest that
the disease represents an exaggeration of the current inordinate weight
consciousness of adolescent girls at a time when high-calorie foods are
readily available and fewer calories are expended through exercise.

Typical symptoms of the disease include depression and
obsessive-compulsive behaviors, it is not clear if these psychiatric
problems preceded weight loss or occur as a result of semistarvation.
Depression is often the first visible sign of anorexia nervosa.
Abnormal hormonal patterns characteristic of starvation also occur.

The clinical features of anorexia nervosa are personality
characteristics such as rigidity or perfectionism, fear of obesity
preceding the onset of the disorder, and the symptoms of starvation
accompanying it. Serious body image disturbance is common, manifested
by a lack of recognition of the severe emaciation and a belief that one
is too fat. Individuals are often preoccupied with food, thinking about
it much of the time, and often engaging in bizarre eating rituals. Many
anorectics engage in very extensive physical exercise. The disorder is
also associated with a pervasive sense of personal ineffectiveness.

Anorectics are divided into two types, "restricters" who confine
their eating disorder to restricted food intake, and "bulimics" who
engage in bingeing and subsequent vomiting and purging. Bulimic
anorectics tend to be older, manifest other impulsive behaviors such as
kleptomania, alcohol and drug abuse, and sexual promiscuity.

Anoretics deny their weight-losing behaviors and the existence of
any illness and avoid treatment even when they have become severely
emaciated. Family members often have to insist on medical treatment.
Some anoretic persons effectively hide their weight-losing behaviors
even after they are forced to seek medical assistance.

Most persons with anorexia are resistant to entering treatment
because of their fear of weight gain and are usually brought, by family
members, under protest. Because starvation plays a significant role in
the clinical portrayal of anorexia nervosa, clinicians begin treatment
with a period in hospital designed to restore body weight. Such
treatment that removes the patient from the environment may permit the
use of behavioral rewards for weight gain and provides the opportunity
to work on issues of control. Some medications have been helpful in the
treatment of anorexia nervosa. These include cyproheptadine (an
appetite stimulant), chlorpromazine (sedative, used in the treatment of
psychotic conditions), and antidepressant medication.

Bulimia

Bulimia is an eating disorder characterized by recurrent episodes of
binge eating in which large amounts of food are consumed over a short
period of time. These episodes are usually terminated by abdominal
pain, self-induced vomiting, sleep, or the appearance of another person
on the scene.

Bulimia occurs among persons of normal weight but is present in half
the patients with anorexia nervosa. The severity of binge eating ranges
from occasional episodes of morbid overeating at a party to the severe
form of the disorder, bulimia nervosa, in which the vomiting or purging
follows frequent episodes of binge eating.

There are many similarities between persons with anorexia nervosa
and bulimia. Both occur primarily in young women, although bulimia
occurs in slightly older individuals, both may relate to the current
preoccupation with thinness and dieting.

The symptoms of depression in the majority of bulimic patients and
the presence of biologic markers of depression suggest that bulimia may
represent a variant of mood disorder. Treatment of bulimia is
cognitive-behavioral and pharmacologic. Behavioral treatment include
modification of the behavioral program designed for obese patients and
a combination of cognitive-behavioral and insight-oriented approaches.

Pica

Pica is the intentional and compulsive consumption of non-food
substances. It occurs worldwide and is common among people of either
sex and of all ages and races. Pica is often associated with
nutritional deficiencies or toxicities, and is of special concern among
young children and pregnant women.

Geophagia is the consumption of earth and clay. Amylophagia is the
consumption of starch and paste, and pagophagia is the eating of ice.
The fourth category includes the consumption of ash, chalk, antacids,
paint chips, plaster, wax, and other substances.

People appear to be driven to consume these substances by
nutritional deficiencies, but pica is not necessarily correlated with
poor nutritional status. The nutritional hazards most frequently
associated with pica are lead poisoning and iron deficiency anaemia.

Hypoglycaemia

Hypoglycaemia (low blood
sugar) can occur either after a fast (fasting hypoglycaemia) or several
hours after the consumption of a meal (reactive hypoglycaemia). Many
individuals have symptoms of weakness, confusion, and irritability
after eating sugars or other carbohydrate foods.

True reactive hypoglycaemia is diagnosed when symptoms of sweating,
tremor, anxiety, and irritability occur at the same time as the
documented low blood sugar level. Such a diagnosis may indicate the
early presence of a disease such as diabetes.

Hyperactive behavior

Hyperactivity is a childhood problem often discussed in relation to
nutrition. This condition is characterized by problems of inattention,
excessive motion, impulsivity, learning disabilities, and related
problems of conduct.

Food additives, especially artificial dyes and colours, can cause hyperactivity.

Implications for Public Health Policy

Studies in patients with eating disorders and other chronic disease
conditions emphasize the importance of modification of diet-related
behavior in these conditions. Although evidence linking dietary
caffeine, refined sugars, and food additives to behavioral disorders is
uncertain, their elimination from thediet will not impair nutritional
status and can be recommended to patients on an individual trial basis.

Nutrition Programs and Services

Food Labels:Evidence related to the role of dietary factors in behavioral disorders holds no implication for food labeling policies.

Food Services:Evidence related to the role of dietary
factors in behavioral disorders holds no special implications for
changes in policies related to food programs beyond the dietary
guidelines suggested by Department of Agriculture and the Department of
Health and Human Services. [The Surgeon General's Report on Nutrition & Health, 1988.]