Becoming Gutless Text pages 24/8/06 10:20 Page i
PROFESSOR TRIM’S BECOMING GUT LESS
Becoming Gutless Text pages 24/8/06 10:20 Page ii
PROFESSOR TRIM’S PROFESSORS Professor John Blundell PhD C Psychol. MBPS, Professor of Bio-Psychology, Leeds University, UK and Board Member of the International Association for the Study of Obesity (IASSO) Professor Wendy Brown BSc (Hons), MSc, Dip Phys Ed, PhD Professor of Physical Activity and Health, University of Queensland Professor Ian Caterson MBBS BSc (Med) PhD FRACP Boden Professor of Human Nutrition, Sydney University and Vice President, International Association for the Study of Obesity Professor Terry Dwyer MBBS, MPH, MD, FAFPHM Director Menzies School of Health Sciences Hobart, and University of Tasmania Professor Garry Egger MPH PhD MAPS Director, Centre for Health Promotion and Research Sydney Adjunct Professor of Health Sciences, Deakin University Professor Kerin O’Dea BSc, PhD Director of Menzies School of Health Research, Darwin Professor Stephan Rossner MD, PhD Director, Obesity Research Program, Luddinge Hospital, Stockholm, Sweden and Past President of the International Association for the Study of Obesity (IASSO)
Professor Boyd Swinburn MD, MBChB, FRACP Professor of Population Health and Nutrition, Deakin University
Becoming Gutless Text pages 24/8/06 10:20 Page iii
PROFESSOR TRIM’S BECOMING GUT LESS THE WEIGHT-LOSS PROGRAM
for men Dr Garry Egger By the originator of the ‘GutBusters’ waist-loss program
Becoming Gutless Text pages 24/8/06 10:20 Page iv
First published in 2003 Copyright © Garry Egger 2003 All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without prior permission in writing from the publisher. The Australian Copyright Act 1968 (the Act) allows a maximum of one chapter or 10% of this book, whichever is the greater, to be photocopied by any educational institution for its educational purposes provided that the educational institution (or body that administers it) has given a remuneration notice to Copyright Agency Limited (CAL) under the Act. Allen & Unwin 83 Alexander Street Crows Nest NSW 2065 Australia Phone: (61 2) 8425 0100 Fax: (61 2) 9906 2218 Email:
[email protected] Web: www.allenandunwin.com National Library of Australia Cataloguing-in-Publication entry: Egger, Garry. Professor Trim’s becoming gut less: weight loss for men. Includes index ISBN 1-7 4114-017-X 1. Weight loss. 2. Men—Nutrition. 3. Physical fitness for men. I. Title. 613.70449 Set in 11/12.5 pt Adobe Garamond by Midland Typesetters, Maryborough, Victoria Printed by Griffin Press, South Australia 10 9 8 7 6 5 4 3 2 1
Becoming Gutless Text pages 24/8/06 10:20 Page v
CONTENTS Introduction
vii
Part I: The how and why of weight loss Chapter Chapter Chapter Chapter Chapter
11: 12: 13: 14: 15:
Why should men worr y about their weight? Just what is fat anyway? A word about metabolism How do you know if you have a problem? What works and what doesn’t?
1 3 12 20 29 35
Part II: Putting it into practice Chapter Chapter Chapter Chapter
16: 17: 18: 19:
Changing habits Changing what you eat Not exercising–moving! Plateaus, motivation and trade-of fs: good news or bad? Chapter 10: Getting fur ther help Joining Professor Trim’s Medically Super vised Weight-Loss Program Appendix II: The exerselector questionnaire Appendix III: Some meal and desser t ideas for Becoming Gut Less
45 55 78 99 114
Appendix I:
123 125 129
Other books by Garr y Egger
135
Notes
137
Index
139
v
Becoming Gutless Text pages 24/8/06 10:20 Page vi
Appreciation is expressed to Rosemary Stanton for her contribution to the GutBusters Waist Loss Guide
vi
Becoming Gutless Text pages 24/8/06 10:20 Page vii
INTRODUCTION
GUTBUSTERS—NOT A ‘WAIST’ OF TIME In 1990, some colleagues and myself started the GutBusters ‘waist loss’ program. This was a different kind of weight-loss program. It was aimed primarily at men, and it included scientific aspects of weight control designed to change lifestyles and keep weight down over the long term. It wasn’t a diet or an exercise program; nor was it a ‘quick fix’ or a ‘magic cure’. We intended it to be ethically and scientifically valid in an era of weight control ‘con jobs’. We achieved our goals; our success was acknowledged in several international publications and we were invited to make presentations to esteemed international medical groups.1 GutBusters was originally developed in conjunction with the New South Wales Health Department. It grew from there to become the world’s biggest men’s waist loss program. Over the ensuing decade over 100 000 men signed up to lose their gut. GutBusters filled a gap in the market at the time; there were no such services available. While women could sign up for any number of health programs, including weight loss, men, who die on average seven years earlier than women and who lead women in the first fourteen main causes of death, were being almost totally neglected in the health stakes. In the meantime, much of my other work had been for bodies such as the World Health Organisation and the National Health and Medical Research Council, in weight control and obesity management and in educating medical practitioners about weight control. This included starting the world’s first Postgraduate Medical Certificate in Weight Control and Obesity Management through Sydney University’s School of Human Nutrition. So GutBusters was entering the medical arena. It appeared that the time was right for a new approach, for women as well as men: more medical, with greater ongoing supervision from a range of experienced disciplines, but no less scientific, and no less fun. It also seemed logical to focus the delivery of the program through that large army of dedicated doctors vii
Becoming Gutless Text pages 24/8/06 10:20 Page viii
BECOMING GUT LESS
(25% of the Australian general practice community) who had completed at least one-third of the Sydney University’s Weight Control Certificate course. Changes in the Australian health care system in 2000 made it possible, for the first time, for doctors to work closely with other health-care professionals, such as exercise physiologists and dieticians, to adopt a more comprehensive approach to health care.
DOCTORS ADD THEIR WEIGHT TO THE FAT-LOSS FIGHT There was much agonising over the name for the new program. GutBusters was such a good name. It meant serious business, but it also meant not taking oneself too seriously, as many weight-loss programs tend to do. But it wasn’t really inclusive of women, or others in the community. We tossed around dozens of alternatives, but finally settled on Professor Trim’s Medically Supervised Weight Loss Programs. So Professor Trim’s takes over from GutBusters. But it also takes GutBusters to a new level. Owing to demand among Australian women who have tried everything themselves and who liked what they saw happening to their men with GutBusters, the program has been expanded. Now, as well as this Becoming Gut Less program for men, Professor Trim’s (PT) has separate medically supervised programs for women and the whole family. Depending on your needs, there is a hierarchy of programs available through your participating GP, from simple and inexpensive Quick Start versions to ongoing personal supervision by a registered PT professional. For more details and to locate a PT doctor in your area, visit the PT website at www.professortrim.com. You can also get personalised attention through a PT weight coach, assigned to work with your doctor and the PT program.
LOSING WEIGHT AND KEEPING IT OFF All the best research shows that quick weight loss is easy. For men it’s usually easier than for women, but for both an initial loss usually presents no problem. Indeed, I can guarantee huge weight losses for anyone. All I have to do is lock them up and throw away the key! Of course they’ll regain what they lose, with interest, once they’re let back out into our modern ‘obesogenic’, or fattening, environment. The hard part, then, is not losing weight, but keeping it off. To succeed viii
Becoming Gutless Text pages 24/8/06 10:20 Page ix
INTRODUCTION
at this, you will need ongoing support as well as the best and latest information on food, physical activity and other psychological issues associated with weight management. Doctors are the logical choice and the most accessible practitioners for this role. But doctors haven’t typically been trained in dealing with lifestyle-based causes of disease, or with diet, exercise and behaviour. However, because they represent some of the smartest and most dedicated professionals in the community, doctors are keen to learn how.
PROFESSOR TRIM’S: AN EVOLVING IDEA Like the GutBusters program from which it sprang, Becoming Gut Less involves many novel ideas. This is the workbook that goes with the Professor Trim’s men’s program and it contains most of the main ideas for the program. You won’t have seen or heard of some of these in any other weightcontrol program. They include: • measuring (waist) as well as weighing • eating more often, rather than less often • eating more!—particularly bread, cereals, fruits and vegetables • drinking alcohol if you like—but balancing it with trade-offs • concentrating on ‘energy density’—not kilojoules, or even fat • moving more, but not doing any exercise you don’t like • eating more spicy foods • never missing breakfast • not trying to stay warm all the time. As you read through the first part of the book, you might also be surprised to find out that: • a potbelly can cause you to lose a leg (through diabetes) • fat on the belly is different from other fat: more dangerous but easier to shift • men can usually lose weight more easily than women • snoring often comes from being too fat and can predict diabetes • dieting, fasting and missing meals can make you fat • exercising before breakfast can help you lose more fat • it’s not a ‘beer gut’, but a ‘beer and peanuts’ or a ‘beer and chips gut • some people are genetically prone to get fat and stay fat. ix
Becoming Gutless Text pages 24/8/06 10:20 Page x
BECOMING GUT LESS
GETTING THE FACTS Most of the recommendations you’ll find here are based on scientific information. Again, some are new and not yet part of mainstream weightcontrol lore. Where advice is based on experience rather than proven scientific facts, I’ll tell you that, give you reasons for the position I’m taking and leave the decision up to you. If you want more purely evidencebased facts, you can look at the National Clinical Guidelines for Weight Control and Obesity Management,2 or the Experts’ Weight Loss Guide,3 which preceded them. However, all the information in this, the patient’s guide, is based on these detailed sources—albeit in more user-friendly terms. The Becoming Gut Less book, which goes with the more detailed Becoming Gut Less program obtainable through your doctor, is divided into two sections: Part I looks at some of the theory behind the program. You’ll see from this why most traditional weight-control programs don’t work and why weight control for men is quite different from that for women. If you can’t wait to do something about your problem, the practical side of the program is covered in Part II. You can skip straight to this and come back to Part I later. The plan outlined in Part II is based on simple, scientific logic and has five main themes: 1. Changing habits that encourage overeating and lack of exercise 2. Eating differently but not necessarily less 3. Moving more, throughout the whole day 4. Plateaus, motivation and trading off and what to do when you stop losing 5. Getting extra help from medication, surgery or very low energy diets. More detail about the full PT program for men, and an application form, can be obtained from the Professor Trim website at www.professortrim.com. If you’re reading this, you probably have a chronic health problem— hyperadiposity (or too much fat). Just like people with asthma or hay fever or multiple sclerosis, the problem might go away, but there’s always the risk that it will come back, and obesity can come back with a vengeance. So it’s long-term maintenance of weight loss that we try to achieve through the PT program and not quick losses that will be shortterm ones. Remember these goals as we proceed to see how we can achieve them. x
Becoming Gutless Text pages 24/8/06 10:20 Page xi
INTRODUCTION Reg had always avoided doctors. He believed, perhaps reasonably, that anyone who saw a doctor had to be sick. On a compulsory medical for a work promotion, however, he was advised that he was borderline diabetic, primarily because of his potbelly and lack of fitness. He was encouraged to join the GutBusters shared-care program with his doctor, and within three months he had lost his ‘gut’. He was also no longer borderline diabetic.
Calories or Kilojoules The traditional measure of ‘energy’ has been a ‘calorie’, which is the amount of heat energy required to raise the temperature of 1 g of water 1°C. As a calorie is a very small unit, we generally talk in term of 1000 calories, or a kilocalorie (written as 1 kcal). More recently, the metric measure of kilojoules is being used as a measure of energy: 1 kilojoule (written as kJ) = 4.2 kilocalories.
xi
Becoming Gutless Text pages 24/8/06 10:20 Page xii
Becoming Gutless Text pages 24/8/06 10:20 Page 1
PART I THE HOW AND WHY OF WEIGHT LOSS
Becoming Gutless Text pages 24/8/06 10:20 Page 2
Becoming Gutless Text pages 24/8/06 10:20 Page 3
Chapter 1 WHY SHOULD MEN WORRY ABOUT THEIR WEIGHT?
FROM FITNESS TO FATNESS By the beginning of the first millennium of the modern era we humans hadn’t evolved beyond the day-to-day struggle of securing enough food for survival. As far as we can tell, this constant imperative meant that being overweight or obese was practically unheard of (except for the very rich, in whom fatness was a sign of wealth and status). It’s ironic, therefore, that as we move into the third millennium, we have evolved a weight problem for ourselves. According to the World Health Organisation (WHO), obesity is 3
Becoming Gutless Text pages 24/8/06 10:20 Page 4
BECOMING GUT LESS
one of the four major pandemics (along with AIDS, heart disease and cancer) predicted for the 21st century. It’s no mystery how this has come about. Humans have always craved comfort. Throughout our (in evolutionary terms) brief but turbulent history we’ve struggled, with amazing success, to secure sufficient food while expending as little effort as possible. Considering everything we’ve done wrong, this is at least one area in which we have succeeded. The problem is that, as with most things in life, for every upside there’s a downside. The downside to technological advancement, which is not often recognised, is that those unreservedly living the good life will get fat. It’s inevitable, because fat was designed to help us save energy in the good times to get us through the bad times. The march of technology means that, at least in the western world, we’ve generally seen the back of the bad times— that is, in terms of the availability of high energy-dense food, and the need to be physically active to get it. In the early days, life was tough. Most men and women worked hard for a feed, and when they got one the energy it provided was quickly used up working for the next one. By the 1960s, for people in the affluent countries of the world, food was far more freely available for far less effort. Most people no longer had to work hard physically to make a living. Work became more sedentary and so did leisure. At the same time, there was a huge expansion in the food supply. Supermarkets expanded the number of foods available from around 600 to more than 10 000 different items. In some countries, even more foods are now available. Food was not only plentiful, but high in fat—a nutrient that, until recently in evolutionary terms, was relatively hard to come by. And as we know, you can eat less food in terms of volume but actually take in more fat and end up getting fatter.
TRENDS IN OBESITY As countries modernise, the pattern has typically been that adult women become overweight first. This is because women need to be able to survive the nine months of pregnancy in order for the human species to survive. So whenever there’s a surplus of energy in good times, women soak this up in case there are bad times around the corner. In terms of species survival, men are important for only one to two minutes—sometimes even less (or so I’m led to believe!). Therefore adult males get fat as the second phase of modernisation. After that comes overweight in adolescents, and then young children. 4
Becoming Gutless Text pages 24/8/06 10:20 Page 5
WHY SHOULD MEN WORRY ABOUT THEIR WEIGHT?
North America, Australia and some parts of Europe are currently in the final phase of this process, with the majority of their populations now rapidly becoming overweight. Indeed, survey figures from the 2000 Australian Diabetes Survey1 have shown that 67% of Australian men and 53% of Australian women are now overweight or obese, based on height and weight measures. Where waist circumference is taken (as a better measure of the health risk of being overweight), 55% of males and 56% of females are overweight or obese. The growth in obesity as measured by Body Mass Index (BMI), which is a measure of height over weight (squared), is shown for Australian men and women over time in Figure 1.1. Figure 1.1: Changes in overweight and obesity (BMI>25) in Australia over time
BMI>25 60 % of pop
Males 50 40
Females
30 1980
1990
2000
Various surveys of schoolchildren have shown that the incidence of obesity in children has doubled in the past 20 years. For the first time, Type 2 diabetes, once called ‘late onset’ diabetes because it usually occurs later in life, is being seen in adolescents. Type 2 diabetes is strongly associated with obesity, particularly abdominal obesity and inactivity. The myths of the tough American cowboy, the bronzed Aussie surfer and the wiry English explorer are dead. Today we’re faced with a portly generation of fat, unfit, potbellied men who would get tired flying over the Kokoda trail, let alone walking it! 5
Becoming Gutless Text pages 24/8/06 10:20 Page 6
BECOMING GUT LESS
GENDER DIFFERENCES You probably thought that weight gain and loss work the same for males and females. You were wrong! In reality, the two genders are like different species when it comes to gaining and losing weight. Women—at least in their reproductive years—tend to store fat around their hips and buttocks. Men store it around the waist—hence the male potbelly or beer gut. Male abdominal fat is easier to gain and lose. In scientific terms it’s more lipolytic; it passes from the fat cells around the waist into the bloodstream to be used as energy in the muscles more readily than does fat around the hips and buttocks. The downside of this is that because it circulates in the bloodstream, it can do more damage, by blocking the arteries the way mud blocks a hose. So abdominal fat is much more dangerous than the more benign gluteal fat of women. According to the swings and roundabouts principle, though, the big payback for men comes later in life when mother nature deserts the female of the species after menopause, but continues to allow men their reproductive rights into their twilight years! In women, the trend of increasing fatness might have been hidden to some extent by clothing manufacturers. For example, the average women’s dress sizes have increased a size and a half over the past 20 years. Cunningly, manufacturers have kept the old size numbers while increasing their measurements. So a size 12 in Australia, the ‘average’ size that used to fit women with waists of 85 cm and hips of 95 cm, is now 6 cm bigger in both places. You could be excused for thinking that a program that went by the name GutBusters was for older men with the traditional beer belly. Over the twelve years the program operated, however, the average age of the men involved decreased progressively, with the youngest being 14 years of age. (The oldest was 91, and confessed to wanting to lose weight because he claimed to ‘look crook in a swimming costume’.)
Young women often manage to stay slim—sometimes too thin for good health. It’s only when they reach their forties and fifties that a significant number of these women start to get too fat. For men, the picture is different. They start to get fat in their twenties and by their mid-thirties the potbelly is firmly in place. More than 50% of all Australian men in their late thirties are overweight or obese. Among women of the same age, more are underweight than overweight in Australia, although this is not the case in some other countries. The irony is that young women, many of whom are already thin, make the most effort to lose weight. Men tend to ignore their excess flesh. Why should this be so? And why worry anyway? 6
Becoming Gutless Text pages 24/8/06 10:20 Page 7
WHY SHOULD MEN WORRY ABOUT THEIR WEIGHT?
DOES SIZE MATTER AFTER ALL? There are two common beliefs among men. These are that: 1. Size doesn’t matter 2. I don’t have a problem anyway! Unfortunately, both are groundless. In the first place, size does matter. But it’s the size of a man’s waist that is important. If this is over 100 cm (measured at the navel), the risk of losing a leg, a kidney or your eyesight (through diabetes) or having a heart attack and leaving your family prematurely is increased dramatically. Worse still, this size waistline can affect your energy levels, cause snoring and lead to diminished bedroom athleticism . . . among other things. Second, if you think you don’t have a problem, try this little test. Write down your current trouser size (in centimetres). Now, remember what it was when you were twenty? If your current size is more than about 3 cm larger than your size at twenty, you have got a problem. Gradual increases in waist size after late adolescence are now regarded as just as bad as always having been overweight. In fact, the bigger the increase and the more weight cycling between gain and loss, the greater the likely health risk.
THE M AND M SYNDROME There are a number of problems associated with being overweight and, particularly, with increased abdominal fatness or a potbelly. As shown in Table 1.1, these ill effects can be of two types: first there are metabolic, or internal, problems, for example high cholesterol, high blood pressure and diabetes, which are caused by the disruption of normal physiology by excess fatness. Second, there are mechanical problems, such as sore knees, a sore back, breathing difficulties and fatigue, which result simply from carrying around excess weight for 24 hours a day. Dr Andrew Binns, a prominent general practitioner from Lismore in New South Wales, refers to this as the M and M syndrome. It describes the mechanical problems that come with the better-known metabolic syndrome—a cluster of risk factors known to be associated with increased weight and to lead to more serious disease risks such as diabetes, heart disease, stroke and even some forms of cancer.
7
Becoming Gutless Text pages 24/8/06 10:20 Page 8
BECOMING GUT LESS
Table 1.1 The M and M syndrome: metabolic and mechanical problems associated with being overweight Risk
Metabolic problems
Mechanical problems
Greatly increased • Type 2 diabetes (3+ times greater than • Gall bladder disease for someone lean) • Hypertension • Dyslipidaemia • Insulin resistance
• • • • •
Sleep apnoea Breathlessness Asthma Social isolation/depression Daytime sleepiness/fatigue
Moderately increased • Coronary heart disease (2–3 times greater) • Stroke • Gout
• • • •
Osteo-arthritis Respiratory disease Hernia Psychological problems
Slightly increased (1–2 times greater)
• • • • •
Varicose veins Musculo-skeletal problems Bad back Stress incontinence Oedema/cellulitis
• • • • • • • •
Cancer (breast, endometrial, colon, and others) Reproductive abnormalities Impaired fertility Polycystic ovaries Skin complications Cataract
TO SLEEP, PERCHANCE TO SNORE You might be surprised to know that having a potbelly can make you snore more! This is because the tongue is one of the first parts of a man’s body (along with the belly) to get fat. Once it does it can block your air passage, or pharynx, during sleep so that you sound like a lumberjack’s mate. It might drive your sleeping partner to distraction in the process. Snoring is part of a sleeping problem known as ‘obstructive sleep apnoea’ (OSA), which is common among overweight men. OSA involves suboptimal breathing at night, which can mean your body doesn’t get the oxygen it needs to keep you healthy. Your heart might have to work harder and this could push up your blood pressure. Because you run a very real risk of dying from lack of oxygen, your brain (one part of your body that, fortunately, is still working) will wake you up in brief spurts to get you breathing again. You might not be aware of it, but these little intervals of 8
Becoming Gutless Text pages 24/8/06 10:20 Page 9
WHY SHOULD MEN WORRY ABOUT THEIR WEIGHT?
disturbed sleep that snorers snuffle and grumble through can happen hundreds of times a night. And you wonder why you’re tired during the day! Fat men who are heavy snorers often think they’re great sleepers. They say they never suffer insomnia. And, of course, they’re right. They suffer from the opposite—hypersomnia, or the need for too much sleep. Because they wake unconsciously so often during the night, they’re asleep at their desks or at the wheel of their car or truck during the day while their body tries to make up for the disturbances at night. ‘Men rarely come to see a doctor about their weight or other non-medical problems,’ says Dr Andrew Binns. ‘When you do see them, however, such as through a program like Professor Trim’s, you can have an enormous impact. They find it much easier to lose weight than women, and can frustrate their partners by how easy it is for them.’
BEING FAT IS A PAIN IN THE . . . Backache is another problem for the fat-bellied man. The reason is fairly obvious. Try hanging a heavy bag on a stick of willow and see what happens to the stick. The trouble is that when the human spine bends, it doesn’t snap back like willow. It can pull on or pinch nerves and muscles that are designed to hold it upright. The only solution is to take the pressure off by getting rid of some of the weight. A similar thing happens to the knees. As major joints between the gut and the ankle, they have to take a lot of the weight, especially in the flexed position, when climbing stairs or walking up hills. The greater the bend in the knee, the greater the multiplication of the load it has to carry. And any self-respecting knee can only take so much. For some men this is selfdiagnosed as ‘arthritis’, which can cause them to reduce their activity level, supposedly to reduce the pain. This, in turn, can cause an even greater weight increase and even more knee pain, so it’s exactly the wrong thing to do! It’s the same with the feet: having extra weight forcing down on the two pads responsible for keeping the body upright is a bit like what would happen to two raisins on sticks expected to hold up a pumpkin. If the feet are enclosed in ‘non-breathing’ leather shoes and heavy woollen socks, they are likely to overheat and perspire. With no way to cool themselves the feet can develop rashes and skin problems. 9
Becoming Gutless Text pages 24/8/06 10:20 Page 10
BECOMING GUT LESS
Many fat people suffer from skin problems that they don’t relate to their excess flesh. Underneath that fold of fat so characteristic of an overhanging gut in a man, it can get hot and damp—a perfect breeding ground for lots of micro-organisms. Intertrigo is a type of eczema that can form under this fat layer, causing itching and rashes. The sex problems associated with having a potbelly hardly bear mentioning. It might be worth pointing out, though, that testosterone, the male hormone associated with ‘friskiness’, decreases with increases in belly size. So if your night sport activities are suffering, it could just be your girth size that’s doing it. In any case, even if it’s only from your partner’s point of view, getting rid of a belly is not going to be a disadvantage.
INTRODUCING MELVIN Health is, of course, related to longevity. So will getting healthier help you live longer? Or will it just feel longer? To explain this, we need to meet Melvin, our new kid on the PT block. Melvin stands for ‘Maximum Extended Lifespan, proVided you’re Interested and not too Naughty’. As you might have gathered, this is not a strictly scientific concept. But it will serve to answer the question posed above. Let me explain. How long you live on this earth (barring unexpected accidents or the taking of one’s own life) is determined primarily by your genes. The best measure is usually how long your parents, grandparents and other family members stick it out. However, this is only a general indication. Our lives can be shortened or lengthened by how we live them. And this is where Melvin comes in. In the current environment (few major life-threatening infectious diseases to contend with—AIDS, of course, being an exception), our potential to spend more time on terra firma can be increased by remaining healthy. Staying lean is one way to do this. Obviously, not being overly stressed, eating the right foods (and not overeating), not smoking and keeping active are other ways, but these are all part of keeping your weight down anyway. So getting rid of your gut can help extend your ‘Melvin’. Instead of dropping off the twig at 60 as your father’s genes might have dictated, you might stick around till 70, 80 or even 90 by being interested (which you obviously are, since you’re reading this book)—and not too naughty! Having a long Melvin is one thing. But what’s the point of living to a ripe old age if you’re hospitalised or bed-bound and can’t make the most of those extra years? It’s life in your years you want, not years in your life. So 10
Becoming Gutless Text pages 24/8/06 10:20 Page 11
WHY SHOULD MEN WORRY ABOUT THEIR WEIGHT?
you can have a HAPPY Melvin (where HAPPY stands for Healthy, Active, Potent, Productive and Youthful) or you can have a SAD Melvin (where SAD stands for Sick And Decrepit). The aim of the Becoming Gut Less program is to give you a long and happy Melvin. The rest of this book is designed to show you how to do this.
11
Becoming Gutless Text pages 24/8/06 10:20 Page 12
Chapter 2 JUST WHAT IS FAT ANYWAY?
You’re probably familiar by now with two types of fat: there’s the fat in food and there’s the fat on our bodies. What’s the difference? And what is fat anyway? There’s little difference between the fat we eat in foods and the fat we store in our bodies. Plants store fat as oils, animals usually in a more solid form, like the fat on a piece of steak. Plant fats (oils) are usually less saturated with hydrogen (hence their liquid form at room temperature) and are often seen as more healthy than the more saturated animal fats. However, all fats have the same energy value (9 kilocalories per gram), and to all intents and purposes should have the same effect on body weight. As we will see, some recent research is beginning to question this but, for the moment, reducing all fats in food is regarded as one of the best ways to reduce all fat on the body. 12
Becoming Gutless Text pages 24/8/06 10:20 Page 13
JUST WHAT IS FAT ANYWAY?
To answer our second question, fat is a form of energy that is stored in the body. Its main function is as a source of fuel, so we can say it’s like a pile of firewood that’s built up over the summer to be used to provide heat during the winter. Fat is stored in special fat cells, which are similar to other body cells except for a small pool, or reservoir, of fat, as shown in Figure 2.1. Figure 2.1: Fat cell cell wall cell nucleus
lipid (fat) pool
protoplasm
FAT AND FAT CELLS The fat cell then is the equivalent of the woodheap in which firewood is stored. But in the case of fat, it’s not all stored in one place. There are literally billions of fat cells all over the body, each of which stores only about 0.0005 of a micron of fat. Now a micron is only a very small amount, but multiply 0.0005 by over 50 billion (the number of fat cells in the average non-overweight person) and you can see that even someone of normal weight can store 20–25 kg of fat. At 9 kcals of energy per gram, and given that an average 80 kg man would require around 2000 kcals a day to survive—even lying in bed—this would provide enough energy for that man to live for 60 to 90 days without food. So fat is a very effective form of fuel. It also has other functions in the body, such as carrying certain vitamins and minerals around the body and making hormones. But our focus here is its function as a reserve source of fuel. The lipid pool in the fat cell increases or decreases in size depending on how much energy we use up staying alive and moving around and how much energy we take in from what we eat and drink. If there’s more energy coming in than is being used up—in other words the woodcutter is supplying more each day than is burned up in the fire each night—we get a build-up in the woodpile or in overall fat. Which of the many ‘clumps’ that make up the 50 billion fat cells receives this extra fat is determined by a number of factors, including genetics, gender and race. Men, for example, 13
Becoming Gutless Text pages 24/8/06 10:20 Page 14
BECOMING GUT LESS Because fat is such a good source of fuel, it enables us to survive for long periods without food. Castaways, for example, with only a moderate amount of body fat (say 20 kg or 20 000 g) would have 20 000 x 9 kcals = 180 000 kcals of energy to help them survive. At a low rate of energy use (around 2000 kcals a day) this would allow such a person to survive for 90 or so days without food (provided they have water). On the other hand, the body can store only about 2000 kcals of carbohydrate, ensuring only approximately one day’s survival without food.
store reserve energy as fat around the waist, whereas women store it around the hips and buttocks. A potbelly is nothing more than a huge mass of swollen fat cells. If you cut off all the white fatty bits on a big pile of T-bone steaks, put them in a plastic bag and tie them around your middle, you’d have a similar lump of fat. Horrible thought, isn’t it?
FAT LOCATION Where you store fat most readily is also affected by individual factors. Genes, for example, help determine your size and shape. You also inherit the ability to gain or lose fat easily. Obesity can run in families (more on this later). Sometimes it runs in families who all eat and drink too much. In other cases, obesity runs in families because their genes mean they don’t burn up excess energy easily. So it’s difficult to say where you are going to put on fat most when you gain, and lose it from most when you lose. One thing we do know, however, is that you will most likely lose it first from the last place you put it on. So while for most men this is the stomach, some might lose it from their neck, chest, buttocks or legs before it comes off their stomach. If you are one of these men, don’t despair. It will eventually come off the waist, it might just take longer to happen for you. In the meantime, you’re losing extra weight, in the form of fat, anyway. If the tape measure doesn’t pick this up, the scales should, as we’ll see in Chapter 3.
FAT AND PHYSIOLOGY When most of today’s doctors did their university training, they learned very little about fat. This is because fat was not regarded as very important, except in its role of energy reserve. Muscle and other tissue was thought to be more important, because it was much more metabolically active. 14
Becoming Gutless Text pages 24/8/06 10:20 Page 15
JUST WHAT IS FAT ANYWAY?
FAQs about FAT • Why is fat so easy to get but so hard to lose? Because, in evolutionary terms, it was vital to be able to store fat for survival in times of need. Therefore the metabolic ‘brakes’ are much lighter on weight gain than on weight loss. • Why am I finding it harder to lose weight as I get older? Because your metabolism slows gradually with age. This means you probably need to eat less and/or do more to stay the same weight and, since you are getting older, you most likely aren’t doing this. • Why do women find it easier to gain weight and harder to lose it than men? The answer lies in the different physiology of male and female fat. This is probably because, in terms of survival, larger energy reserves are more important for women to enable them to survive the nine months of pregnancy and thus ensure the survival of the human race. • What is a ‘healthy’ amount of body fat? In men, the healthy range is 12–24% of body mass as fat. In women, the figure is 15–35%. This can be measured using scales. These are now available for the home, using bio-impedance analysis (BIA). A simpler cut-off point to use is a waist circumference of 100 cm for men and 90 cm for women. • Why can’t I just take a drug to lose weight? While there are some drugs that can aid in weight loss, these only slightly increase the benefits that come from lifestyle changes and, indeed, don’t work unless lifestyle changes (regarding food and exercise, in particular) occur. To work, these drugs also need to be taken for life. • Is exercise or diet best for weight loss? It’s always easier to reduce kilocalories in the short term using diet. However, in the long term, the people who are leanest are those who have a regular exercise routine. Having said that, some people’s weight problem is caused mostly by diet, whereas for others it’s mainly inactivity.
In the past decade, however, fat has taken on a whole new importance. In fact, the medical speciality of endocrinology, which is based on the study of hormones and their effects on health, now includes fat as an endocrine organ, along with the thyroid, the adrenals, the sex organs and other endocrine glands. 15
Becoming Gutless Text pages 24/8/06 10:20 Page 16
BECOMING GUT LESS
We now talk of the ‘fat organ’. This means that fat cells can secrete chemicals (we now know of over 30) that send messages to other organs in the body. The hormone leptin, for example, which was discovered in 1994, communicates to the part of the brain associated with hunger that we have, or have not had, enough to eat. This then changes our level of hunger. A newly discovered hormone, gherlin, is produced in the gut and also seems to have an effect on hunger levels. We now also know that fat cells receive messages, which they act on in various ways. They are what is known as parocrine and exocrine organs, which receive messages from other nearby cells or other parts of the body. So the fat cell is much more active than was once thought and future endocrinologists are likely to be studying fat cells as much as the adrenal glands or the thyroid.
NOT IF YOU’RE FAT, BUT WHERE As we have seen, fat cells around the abdomen in men are different from those on the hips, buttocks and thighs of women. Abdominal fat cells are generally bigger and more active than fat cells elsewhere in the body. This means they inject fat into the bloodstream more readily when the body needs it and they take fat more readily from the blood and store it when there is more than the body needs to power muscles. Even more dangerous are fat stores known as visceral fat. Visceral fat is stored around the internal organs of the trunk, for example the stomach, liver, kidneys and intestines. Visceral fat has been shown to be several times more active than either gluteal (around the hips) fat or subcutaneous (under the skin) abdominal fat. This means it is released into the bloodstream even faster than other fats and is potentially even more dangerous. A bigger problem is that visceral fat is not obvious in the way, say, a potbelly is. However, it generally, although not always, correlates with abdominal fat. Like abdominal fat, it’s usually much easier to shift than female-type gluteal fat, but sometimes genetic and ethnic factors make it particularly intractable. The bad news is that fat-bellied men can have lots of extra fat lurking in their bloodstream. Hence, in large part, the increased risk of heart disease, diabetes, gallstones, high blood cholesterol and high blood pressure. (Indeed, the relative risk of contracting diabetes for an obese man can be up to 40 times that of someone of normal weight. In obese women, the risk is even higher, at up to 90 times.) This also explains why the potbellied man is generally unfit and unable to . . . well, do things. No fat-bellied man needs to be told that he can no longer move the way he could before he 16
Becoming Gutless Text pages 24/8/06 10:20 Page 17
JUST WHAT IS FAT ANYWAY?
began to look like a Christmas stocking half-full of melons. A kilogram of fat needs around 29 km of plumbing (blood vessels) to feed it. And because fat, unlike muscle, is not very active tissue, supplying this dead load with nutrients puts an extra strain on the main organ of the body—the heart. Imagine pumping air into a flat bicycle tyre with a foot pump. Now imagine doing the same with a flat tractor or truck tyre. The extra work your foot has to do is equivalent to the extra load on a heart that has to pump blood around an oversized body. If the muscles in the foot are weak, they will cramp, seize up and stop you from pumping. Similarly, if the muscles in the heart are weak, they too will seize up. It’s important to realise that you don’t have to be fat all over to be at risk. In fact, the lean man with a gut shaped like an apple is more at risk than the fat man without a gut but with big hips, who is shaped like a pear, or even the man who is big all over—shaped like the box the fruit comes in!
FAT IN YOUR GENES If your gene pool doesn’t have a shallow end, it’s certainly true that you might find it harder to slim down than someone with ‘lean genes’. That doesn’t mean, however, that slimming down is impossible. Fat genes are not like the genes for fair hair or blue eyes; they don’t mean that being fat is inevitable. They do mean that in the right circumstances—the wrong kind of food and not enough exercise—it will be easier for someone with ‘fat’ genes to put on fat than someone from a leaner background. So let’s not kid ourselves: it might be a little more difficult if you picked the wrong parents. But, remember, irrespective of your genes, we now live in an obesogenic (fattening) environment. Everything in modern society is designed to make things easier for us. But all this ease can also make us fat. It might not be as good as a gene test, but you can gain an idea of your genetic liabilities from the following test. If your particular weight problem is a potbelly, it’s more than likely that your major problem is not inherited fat but your lifestyle: what you eat and drink and how much you move. An imbalance in food, drink and exercise will give you the apple or android shape—a bit like a pregnant telephone pole. The man who is genetically fat is usually fat all over, with an ovoid or box shape. This problem is usually apparent early in life. However, there are some accurate yet simple ways to determine whether or not you actually have a problem, which we’ll look at in Chapter 4. 17
Becoming Gutless Text pages 24/8/06 10:20 Page 18
BECOMING GUT LESS
Testing your genes Answer the following four questions to see if you can blame genetics for your body weight. For measurement purposes here, the term ‘overweight’ means having a Body Mass Index or BMI* over 25, ‘obese’ means a BMI over 30 and ‘very obese’ a BMI over 40. *BMI = weight (in kg) divided by height (in metres)2 1. As far as you know, were either or both of your parents obese or very obese for most of their lives? Neither/Don’t know/No Yes, one parent Yes, both parents
Obese 0 7 14
Very obese 0 14 28
2. Do you have any members of your immediate family who have been obese for most of their lives? Score 2 points for every obese member of your immediate family, up to a maximum of 10 points. 3. How would you describe the average BMI of your siblings? BMI <30 0
Obese (>30) 6
Very obese (>40) 12
4. When did you first become overweight and/or obese? Never Before age 10 Before age 20 Before age 30
Overweight 0 20 10 5
Obese 0 30 20 10
Scores: <20: Your weight problem does not appear to be significantly related to genetics. This means it is related to lifestyle and therefore should be quite easy to solve if you are committed to doing so. 18
Becoming Gutless Text pages 24/8/06 10:20 Page 19
JUST WHAT IS FAT ANYWAY?
20–50: There appears to be a moderate hereditary component to your weight problem. This means you might find it a little harder to lose fat than some of your friends. You might need help from a dietician, but your problems should not be too difficult to overcome. 30–100: There appears to be a significant hereditary component to your weight problem. This means you might need special help and closer attention from a dietician. With the proper approach and a long-range plan, you should be able to overcome your bad start.
Genetics affects weight the way it affects characteristics in species of dogs. There are big dogs (such as St Bernards) and small dogs (such as Chihuahuas). And while you can’t turn a St Bernard into a Chihuahua, or vice versa, you can end up with a smaller St Bernard or a bigger Chihuahua by changing the dog’s diet and exercise routine. Once you realise this, it will be easier to accept the weight losses that are possible for you, as opposed to those you might desire.
19
Becoming Gutless Text pages 24/8/06 10:20 Page 20
Chapter 3 A WORD ABOUT METABOLISM
After genetics, metabolism is probably the most commonly cited cause of portliness in humans. If not ‘It’s in my genes’, doctors will hear ‘I must have a slow metabolism, Doc’. Women often take this further and suggest they have a thyroid problem, which translates into a slow metabolism. But just how likely to be valid are these excuses? The answer is most unlikely, at least where a slow metabolism is taken to be something that is fixed and unchangeable. Of course, it is possible to have a relatively slow metabolism and, therefore, to burn less energy than someone else. But it’s unlikely that this is determined at birth. The main determinant of metabolism is body size, and particularly whether that size 20
Becoming Gutless Text pages 24/8/06 10:20 Page 21
A WORD ABOUT METABOLISM
is constituted mainly by muscle or fat. Therefore, someone who has become fat or inactive early in life or who has been on a number of crash diets resulting in quick weight losses and gains could have a slow metabolism, which could then make it harder in the long term to lose weight. However, body size and metabolism are influenced by lifestyle, and so can be increased as well as decreased by lifestyle factors. A relatively slow metabolism is therefore rarely a fixed or unchangeable cause of weight gain or loss. Long-term changes in metabolism affecting weight gain are often characteristic of women who have been on constant crash diets since early adolescence. As a result, metabolic rate slows permanently, making long-term weight losses and weight-loss maintenance extremely difficult. Avoiding big swings in body weight is a vital preventive technique for long-term weight management.
The thyroid gland is the master gland for metabolism: it affects it through a number of hormones. The availability of these hormones can speed up or slow down the rate at which the body burns energy. Hypothyroidism, or a low output from the thyroid gland, could therefore be expected to regulate the metabolism downwards, which it does. However, except in clinically significant cases, which your doctor can test for, this is rarely enough to cause a significant slowing of metabolism in the absence of a fat-conducive lifestyle. Looking for a thyroid treatment to solve your weight problem is therefore being optimistic. Except in rare cases, this is not likely to be the problem. Although low thyroid levels are not uncommon in big people, particularly women, thyroid medication will not drastically reduce body weight. It can help arrest weight gain, however. Treatment should be discussed with an experienced doctor.
WHAT IS METABOLISM ANYWAY? Metabolism is the product of two processes in the body: anabolism, or the build-up of body tissue as a result of food and muscle-growing exercise (hence anabolic steroids), and catabolism, or the breakdown of body tissue owing to age and day-to-day wear and tear. Metabolism is therefore the amount of energy your body burns to keep you alive—to digest food, get blood to the muscles and organs, feed your brain, keep you warm and breathing, and so forth. Basically, it’s what is happening in your body while 21
Becoming Gutless Text pages 24/8/06 10:20 Page 22
BECOMING GUT LESS
your mind is making other plans. The energy required to do this at rest is called the Resting Metabolic Rate, or RMR. RMR can be thought of as a fire, with banked embers burning continuously. If the fire can be stoked up, it will use more energy. If it’s left to run down, it uses less. For the average-sized person, RMR is around 1 kcal (or 4.2 kJ) per minute. (For the technically minded, this is 70 W or about the same rate of energy usage as a 75 watt light globe). If you consider that a standard glass of beer is the equivalent of approximately 100 kcals (420 kJ), this means that the average person would need around 100 minutes at rest to burn the energy in one beer. Walking briskly, on the other hand, burns about 5–6 kcals (21–25.2 kJ) a minute, so, theoretically speaking, you could burn up a beer with 15 to 20 minutes of walking (although it doesn’t actually happen like this because of the body’s ability to adjust to changes in energy use). RMR accounts for about 70% of the total energy we use in a day, so it has serious implications for fat burning. If we can increase RMR—even by only around 10%—we will be closer to losing fat. Every kilogram of fat has the equivalent energy of about 3500 kcals (7700 kJ), so an increase in RMR of 10% would mean (again, theoretically) that you could lose about 7 kg of fat in a year—without doing anything! Contributions to total energy use Metabolic rate 70% Movement 20% Thermic (heat) effects 10% – food* – fidgeting# and so forth * Up to 25% of kcals from carbohydrate are used by the thermic effect of digestion, compared with only 3% when fat is eaten. It takes a lot of energy to convert carbohydrates to fat. # Fidget-type activity can add considerably to the thermic effect of movement. The scientific evidence on whether RMR can be increased by this much is a bit mixed. But there are positive signs in several areas. Some of the methods listed below will help your health, even if they don’t help decrease your gut. We’re confident, though, that they’ll also help do that. 22
Becoming Gutless Text pages 24/8/06 10:20 Page 23
A WORD ABOUT METABOLISM
Factors affecting metabolism • Total body mass. RMR is higher in big people. • Fat-free mass. RMR is higher in people with a high muscle to fat ratio. • Exercise. Exercise raises RMR not just while it is being carried out but for some time afterwards. • Food. The thermic effect of food (TEF) relates to the energy required to digest food after a meal. This suggests that several small meals a day will be better for weight loss than one or two large meals. • Certain types of food. While the effect might only be small, TEF is raised more by some foods than others. Spicy foods (chillies, curries, peppers) and caffeine fall into this category. • Climate. RMR is generally higher in the cold as the body uses up energy to stay warm. This makes a mockery of heat treatments such as saunas for fat loss. All that is lost is fluid in sweat, which is easily replaced. • Eating practices. Eating breakfast is important because it gets the metabolism going for the rest of the day and it means you’ll eat less later in the day. • Age. RMR decreases on average by 2% per decade from age twenty. Staying active and keeping your weight down will help minimise this drop. • Gender. Because women naturally have more fat and less muscle than men, their RMR is significantly lower. • Lactation. Breastfeeding can raise RMR, but since this book is for men, that’s a bit irrelevant. If you want some other ideas on raising metabolism, you’ll find them in the list below. It should be stressed that there are no scientific studies to show that you’ll lose more weight by doing these things. But we do know, for example, that making the body create some of its own warmth uses up extra energy. It also makes scientific sense, although you’re unlikely to read about it in many weight-loss programs. And even if staying cool doesn’t help your gut, it can help your skin. Many skin specialists now claim that common forms of overheating can be major causes of skin problems.1 Their recommendations for skin health could be just as useful for keeping metabolic rate up. 23
Becoming Gutless Text pages 24/8/06 10:20 Page 24
BECOMING GUT LESS
They include: • Avoiding continental quilts and electric blankets. A continental quilt can be the equivalent of six blankets, which can’t be shed gradually as you heat up. Go for blankets, including some cotton blankets, even in winter. • Not overdressing. Although it’s tempting to rug up in heavy, warm clothing in winter, you’re likely to use up more energy if you dress lightly—even if you are a little cool. Men with an overhanging mound of flesh around the middle can also suffer from problems with those areas of skin that never see the light, or air. Adding heavy clothing to trap in the heat is likely to make matters worse. • Avoiding heaters and air conditioning. If you can: much of our lives is spent in controlled environments that reduce the body’s ability to adapt. A little cool is not such a bad thing. • Reducing foot temperature. A lot of heat gets trapped around the feet, especially with modern footwear and heavy woollen socks. While ventilating your feet won’t dramatically alter your metabolic rate, it can help. It can also help prevent skin problems of the feet caused by excess weight bearing down on those little pinkies. If you don’t have good ‘breathing’ shoes and cotton socks, one way to increase ventilation is to punch half a dozen holes in the instep of your most worn shoes or boots with a hole punch. This might sound a bit stupid, but it works—anybody who is down close enough to your shoes to notice it is going to look even more stupid!
SMOKING AND METABOLISM There’s little doubt that cigarette smoking is an effective way to keep your body weight down. It does this by three mechanisms: 1. raising your metabolic rate, 2. diminishing taste sensation and therefore your desire for food, and 3. giving you something to do with your hands—other than put food in your mouth. There’s also little doubt that smoking causes cancer (and lots of other health problems). So, unless you want to be the thinnest stiff in the morgue, it’s not recommended as a weight-loss technique. Young girls, women and some men, however, continue to smoke to keep their weight down in the belief that one day they will give this up and by then they will have control over their weight. 24
Becoming Gutless Text pages 24/8/06 10:20 Page 25
A WORD ABOUT METABOLISM
Unfortunately, that is not how it works. Smoking causes a redistribution of fat from the fat stores in the lower body to visceral fat around the organs at the waist. This is much more dangerous than other fat types and therefore increases the immediate dangers of smoking, while giving the false impression that smoking is keeping the smoker lean. Quitting smoking is as conducive to weight gain as smoking is to keeping weight off. Research shows that the average weight gain after quitting is around 5 kg in the first year. Experience suggests that even for former smokers who have not smoked for several years, weight loss is much more difficult than for someone who has never smoked. Therefore, smokers are lining up for long-term problems not just in cancer risk but also in weight management, by taking up and keeping up the habit. If, on the other hand, you are a smoker and want to quit but are afraid of gaining weight, Swedish research2 shows that you might be better off going on a weight-loss program at the same time or even before you set a date to quit. This way you’ll feel healthier and more motivated to give up the evil weed, and you’ll run less risk of putting on weight in the process.
SMOKING AND CAFFEINE If you are a smoker and a heavy coffee drinker, your choices are more limited. For some reason that is not yet clear, cigarette smoke seems to dampen the effects of caffeine. When you quit (which anyone with half a brain would do), blood caffeine levels rise, even though you might not be drinking more coffee. The effects of this are increased nervousness, jitters and a desire to have—you guessed it—a cigarette. So quitting smoking should also mean quitting caffeine, at least until the withdrawal symptoms of nicotine have passed. The problem is that if quitting smoking can lead to weight gain (which we know it can) and quitting caffeine can lead to a drop in metabolic rate, the combined effect of quitting both is likely to do a double whammy on your weight. The way to get around this is to do even more of the other activities that increase metabolic rate, especially exercise. Most research shows that if quitting smokers want to avoid gaining weight, a combination of a low-fat diet and a moderate increase in exercise is the best way of doing so. Exercise can also act as a substitute for smoking and can diminish the desire for nicotine. Learning new habits might also help (see Part II of this book). If the problem is severe, shortterm drug treatment can be effective, but you’ll need to see your doctor for this. 25
Becoming Gutless Text pages 24/8/06 10:20 Page 26
BECOMING GUT LESS
Recommendations for quitters who want to lose fat • Start a weight-loss program (such as this) before, or at least at the same time as you attempt to quit. • Be aware of when and where you eat and try to avoid any increase in food intake. • Use a good, safe weight-loss plan, devised by qualified people. • Increase the small amounts of physical activity you do, such as walking more, not using the remote control for the TV, beating eggs by hand and using stairs instead of lifts. It all adds to the amount of energy burned up. • Slow down or cut back on your caffeine intake (mainly coffee, but be careful with tea and cola too), at least for the first three to four weeks. • Snack on fruit, vegetables or bread, or even small quantities of sweet foods without fat (such as jelly beans or meringue without cream) rather than sweet fatty foods. • Ask your participating doctor about the use of Zyban to help you quit smoking without gaining weight.
TESTING YOUR METABOLISM Metabolic rate can be tested accurately in a number of ways. The most common is the same technique that accurately measures cardiovascular fitness in a laboratory. With a sophisticated gas analysis machine, an experienced tester can measure the amount of oxygen you inhale and the carbon dioxide you exhale every minute you’re connected to the machine. Then a formula is used to work out your oxygen consumption per kilogram of body weight per minute. This is a reflection of the amount of energy your body is burning at rest to keep you alive. Nowhere near as sophisticated is our own little metabolism test, outlined below. Try this to get at least a rough idea of whether your metabolism is weighing you down as much as your belly. Then we’ll look at what’s likely to work to change this and what’s not.
26
Becoming Gutless Text pages 24/8/06 10:20 Page 27
A WORD ABOUT METABOLISM
Testing your metabolism 1. Do you currently participate in any regular activity or program, either on your own or in a formal class, designed to improve your fitness or keep your weight down? 1. Never 2. Rarely 3. Occasionally 4. Often (more than 3 times a week) 2. In the past twelve months, have you crash dieted or fasted (for more than a day)? 1. Yes, several times 2. Yes, once or twice 3. No 3. Do you eat breakfast . . . 1. Rarely or never 2. Occasionally 3. Often or always 4. Do you always try to avoid being even mildly cold in winter? 1. Yes 2. Not really 5. How many cups of coffee/tea do you drink in an average day? 1. None or more than 3 cups coffee and/or 6 cups tea 2. 1–3 cups coffee and/or 2–4 cups tea 6. How often do you eat spicy, low-fat foods (such as chillies or curries)? 1. Less than 3 times a week 2. More than 3 times a week 7. Are you . . .
1. Female
or
2. Male
8. And are you . . . 1. Under 35 or 2. 35 or over Scores: 0–12: Your metabolic rate might be lower than it could be for helping you lose fat and keep it off. You could benefit by ‘revving up the engine’ a little.
27
Becoming Gutless Text pages 24/8/06 10:20 Page 28
BECOMING GUT LESS
13–16: Your metabolic rate could probably be increased to help you in your fight against fat. 17+: Your metabolic rate is probably reasonably high for you. There is probably not a lot you can do to increase it—except, perhaps, more exercise. To sum up, metabolism is certainly an important factor when it comes to weight loss. However, the biggest determinant of metabolic rate is lifestyle, and particularly lifestyle in the developing (or teen) years. Avoiding crash diets, quick weight-loss treatments and large swings in weight gain and loss is the best way to avoid the debilitating drops in metabolism that can make long-term weight maintenance difficult.
28
Becoming Gutless Text pages 24/8/06 10:20 Page 29
Chapter 4 HOW DO YOU KNOW IF YOU HAVE A PROBLEM?
This might seem like a stupid question. If you had a problem with your weight, you’d know about it, right? You wouldn’t need someone to tell you that you look like a marshmallow when you walk. Strangely enough, though, while this is generally true of women—indeed they’ll often think they have a problem when in fact they don’t—it’s not always the case with men. Even a man with a belly hanging over his belt is often insulted when told by his doctor or a friend that he has enough spare energy in fat to power a small city. This is probably because men have not been subject to the social pressure women have to conform to a pre-set (and 29
Becoming Gutless Text pages 24/8/06 10:20 Page 30
BECOMING GUT LESS
usually unrealistic) body image. The pressure on women comes not just from themselves, women’s magazines and men, but from other women. As a rule, men don’t care all that much if they bear more resemblance to a beanbag than they do to a human being. But times are a’changing. With increased demands to perform—at the workplace and in the privacy of their own homes—men are, at last, beginning to take an interest in their health and their weight. Gone are the days when a real man would attend a doctor’s surgery only if his arm was hanging by a thread from his shoulder, and then tell the doctor that it’s just a flesh wound but he needs that hand to hold his beer while he’s fishing! Now a man is more likely to want a ‘Happy Melvin’, and to get one he needs to start to measure the extent of his problem.
MEASURING FAT For a man, weight as a measure of fatness can be misleading. This is because muscle is twice as heavy as fat. So you might be a short, muscular Mr Universe with low body fat, but come out as obese on standard measures of height and weight. If you exercise to lose fat (as you should), you might find yourself putting on weight in the form of muscle and the water that goes with it, while actually losing fat, particularly around the middle. For a man, waist is more important than weight. For this reason you’ll notice that we talk more about waist loss, than weight loss. We also talk about losing centimetres, rather than kilograms. In fact, we suggest that you put your scales where you can’t see them and resist the temptation to weigh yourself—except in a few exceptional cases, which we’ll discuss in a moment. To check your progress, you’ll generally only need your waist measurement.
WAIST CIRCUMFERENCE: HOW’S YOUR FIGURE? For a man, waist circumference is now regarded as the best measure of body fatness and potential ill-health. Not only is it a good measure of risk, it’s a good relative measure to use to assess how effective you are at losing weight. The cut-off point, or the point beyond which risk of disease increases dramatically, for a Caucasian male is 100 cm around the waist, irrespective of height. The cut-off point for Indian and Asian males, because they are genetically more prone to metabolic disease at lower levels of body fatness, 30
Becoming Gutless Text pages 24/8/06 10:20 Page 31
HOW DO YOU KNOW IF YOU HAVE A PROBLEM?
is 10 cm less, at around 90 cm. For Pacific Islanders, this limit can be up to 110 cm before risk starts to increase. Since 100 cm is a good cut-off point for risk, this should be set as the long-term waist-loss goal for all men, irrespective of height. The World Health Organisation uses a cut-off figure of 102 cm for Caucasian males. However, this is based on epidemiological findings and not on what men actually remember best. For determining risk, 100 cm, a nice round number, is a good enough approximation. So it’s what we use in this program. Since 100 cm is a good cut-off point for risk, this should be set as the long-term waistloss goal for all men, irrespective of height. Because abdominal fat stores are a man’s spare ‘lunch bag’, fat generally (but not always) comes off here first when he decides to lose weight. For this reason a waist measurement is usually enough to measure the success of a program such as this one. Over the first one to two months, you can expect to diminish your girth by around 7%. So a loss of 1% of waist size per week is a good short-term goal for men. Waist size, then, is regarded as the most significant measure of body fatness and fat loss. But what is the right way to measure it? . . . a loss of 1% of waist size per week is a good short-term goal for men.
MEASURING WAIST Get a tape measure, such as that supplied in Professor Trim’s Becoming Gut Less kit, and measure around your waist at the height of your navel. Again, the World Health Organisation recommends the mid-point between the lower rib and the top of the iliac crest or hip as the site for measurement of the waist. However, umbilicus or navel is much easier for men to find and so get consistent measurements. Make sure the tape is parallel to the floor. Relax and don’t breathe in. If possible, always measure at the same time of the day and, particularly, the same time after eating. Stomach distension after a meal can lead to false readings. If you’re working from Professor Trim’s Becoming Gut Less kit, log onto the website (www.trimscript.com), using your ID number, and record your weekly waist measurements on the program. You’ll get immediate feedback on how you are going and what you can do to improve your rate of loss if 31
Becoming Gutless Text pages 24/8/06 10:20 Page 32
BECOMING GUT LESS
it is not adequate. You’ll also have access to a toll-free help line you can call any time for advice. Remember that the long-term goal is to get your waist down to 100 cm (90 cm for Asians and Indians and 110 cm for Pacific Islanders), irrespective of your height. If you are very big, however, say 150–200 cm at the waist, this might be an unrealistic short-term goal, even though it might be possible in the ultra long term. A more reasonable long-term goal might be 120 cm, with a 1.5% loss per week as your short-term goal. The 100 cm mark might be the ultra-long-term (over your lifetime) goal. For the smaller man who comes in at less than 100 cm to start with and who still wants to shed fat, a waist of say 95 cm or even 90 cm could be your long-term goal. Wanting to get your waist any smaller than 90 cm is more of an aesthetic goal than a health one.
WAIST AND WEIGHT Most potbellied men can reduce their waist size relatively easily with a wellbalanced eating and exercise program. I should perhaps mention, though, that not all men lose fat from their waist first. As we have said, when it comes to individual differences in weight loss we can usually expect fat to come off first from the place it has most recently been put on. For some men, this might be the neck or jowls, for others the thighs or buttocks. Mike had been on a weight loss program for about two months when he rang the help line for advice because his waist circumference hadn’t decreased at all. When he was asked if he felt he had lost weight anywhere else, he observed that his shirts were looser and his tie didn’t feel as tight. He was advised to weigh himself again. He discovered that he had lost about 6 kg. Unlike most men, for whom initial losses would be at the waist, Mike had been losing fat elsewhere. He was advised that he would eventually lose fat from his waist and reminded that he had no control over where the fat was likely to come off first.
The implications here are that some men might not pick up early losses by just measuring their waists. This is why we now recommend that you take both weight and waist circumference measurements before starting a weight-loss program. Record both of these measures, then measure your waist circumference weekly. If you are achieving a steady reduction in waist size, don’t bother weighing again at all; your waist is your best indicator of success in this case. If, on the other hand, you achieve no reduction in waist 32
Becoming Gutless Text pages 24/8/06 10:20 Page 33
HOW DO YOU KNOW IF YOU HAVE A PROBLEM?
size after 3–4 weeks, weigh yourself to see if there is any change in this measure. If there is, continue to weigh yourself every now and then if there is no subsequent reduction in waist size. The recommended sequence is shown in Table 4.1 below:1 Table 4.1 Recommended system for measuring and weighing Before starting
Weeks 1–3
Week 4+
Weigh yourself and measure waist
Measure waist (weekly)
Weigh and measure waist
MEASURING FAT PERCENTAGE Because of advances in technology, it is now possible to measure an individual’s percentage of body mass as fat accurately using relatively inexpensive bathroom scales. The technique used for this is called bio-impedance analysis (BIA): it involves passing a small electric current around the body from a pair of electrodes on the feet of a set of bathroom scales. The current is not felt, but the speed of the current around the body is dependent on how much of the body is fat and how much is fat-free (mainly muscle) mass. Because of its better conductivity, muscle allows electricity to pass through it faster than fat does. Therefore the speed of the current is used in a pre-set calculation, based on height and weight, to measure the percentage of body mass that is fat. For the healthy man this is between 12% and 24% and for the healthy woman 15% and 35%. Knowing your percentage body fat can be useful, not only as a measure of risk but also as an extra indication of the effectiveness of your weight-loss program. Bio-electrical impedance is a technique that has been used for research purposes for many years, so it is no mere gimmick. Scales can be purchased at most home supply or sports stores.
A FINAL FAT TEST If, after trying all these measures of body fatness, you’re still not convinced you have a problem, try this final little test. Take off your clothes and stand in front of a mirror. Jump up and down about six times, then stop suddenly and stand still. If parts of you keep moving (not counting the dangly bits) after you’ve stopped jumping, face facts, pal. You’re fat! So stop kidding yourself in the typical male way and let’s start to look at why, and what we can do about it. 33
Becoming Gutless Text pages 24/8/06 10:21 Page 34
BECOMING GUT LESS
Rationalisations men make—and how to test them Men use any number of excuses to delude themselves into believing they’re not fat. But how can you tell without resorting to expensive medical technology? Here are some common excuses, and cheap ways to test them. ‘I’m not fat, just an XXL.’ One way of differentiating between muscle and fat is by having a skinfold thickness test. This is painless—a bit like a pinch test with callipers on your arm, leg or stomach. It takes only a couple of minutes and can be carried out by an accredited fitness instructor at any recognised fitness centre. Sports dieticians and a few GPs also use the technique. Some doctors and fitness centres might also have Bio-electrical Impedance Analysis (BIA) machines, which also measure body fat. ‘I’m not overweight, just undertall.’ Weight for height can be tested by using the BMI formula. Take your weight (in kilograms) and divide by height (in metres) squared. If your score falls between 20 and 25, you are in the normal range of weight for height. Unless you are short and heavily muscled, over 25 probably means you are fat and over 30, for men and women, probably means you are obese. ‘It’s not fat, it’s muscle.’ Muscle is firm, dense and anchored at both ends (to bone), even in the unfit. Fat, on the other hand, is loose, inert and floppy. If you pinch your arm at the bicep, the bit you can move between your fingers is skin and fat. The firmer, anchored bit underneath is the biceps muscle. ‘It’s not a fat stomach, it’s just a sunken chest.’ The ‘apple’ or android shape is highly associated with health risk. To measure this, take your waist circumference at the navel. If your score is over 100 cm, this is definitely not a sunken chest. It’s the other.
34
Becoming Gutless Text pages 24/8/06 10:21 Page 35
Chapter 5 WHAT WORKS AND WHAT DOESN’T?
Before we get down to the nitty-gritty of what works and what doesn’t, it’s sobering to take stock of what we know for sure in this area. In the box below is a list of proven facts, which are worth considering as a starting point. 35
Becoming Gutless Text pages 24/8/06 10:21 Page 36
BECOMING GUT LESS
Some indisputable facts about weight loss 1. All current (successful) approaches to weight loss and long-term maintenance of losses require some form of lifestyle or behaviour change. Despite innumerable promises to the contrary, there are no ‘quick fix’, easy solutions to weight loss. A limited number of medications have, usually inadvertently, been found to result in weight loss as a side effect and have then been promoted as weight-loss drugs. Even with these, though, behaviour change is necessary for long-term success. One of the most successful of all weight-loss techniques, lap-banding, will not work without a motivated patient, close supervision and adherence to a lifestyle change program both before and after surgery. 2. Any change that cannot be maintained for life is unlikely to be successful in the long term. Any change in eating or physical activity patterns can lead to a change in energy balance and to a decrease in total body weight. However, physiological adaptations designed to enable the human species to survive in times of hardship make long-term success unlikely, unless that change can be maintained for life. Therefore, before you take on a weight-loss program of any kind, ask yourself: ‘Can I maintain these changes for life?’ If the answer is no, the program is likely to result in long-term gains, rather than losses in body weight. 3. Any successful weight-loss treatment has to involve a negative energy balance. A negative energy balance means that there is less food energy being taken in than used up through exercise and metabolic rate. Irrespective of how it does this, any successful weight-loss program has to result in a negative energy balance. So if a remedy such as a drug or acupuncture helps you lose weight, it must do so through either reducing food intake (or the way in which food is processed in the body) or increasing energy expenditure, either voluntarily or through a change in metabolic rate. If in doubt about whether a program can be successful, the definitive question is how does it affect energy balance? 4. Plateaus are inevitable if weight loss continues. Plateaus are periods when weight loss stops—at least temporarily. Many people regard them as a sign of failure. However, if weight loss could occur in a linear fashion from the start of any form of energy imbalance, 36
Becoming Gutless Text pages 24/8/06 10:21 Page 37
WHAT WORKS AND WHAT DOESN’T?
life would not be worth much; humans would have disappeared in the first famine that came along. Plateaus are nature’s way of stopping the body wasting away. They occur because of a number of different physiological adaptations to changes in energy balance and they are inevitable if weight loss continues long enough. Anyone starving to death will not waste away at a steadily increasing rate, as the laws of physics might predict; they will lose mass in a series of stages defined by resistant plateaus. 5. There are big differences between individuals in rates of weight gain and loss and timing and length of plateaus. Given point 4 above, anyone on a weight-loss program will want to know when he or she will hit a plateau, how long it will last and how many plateaus will occur between start and goal weight. Unfortunately, there is no universal answer to this. Scientific research into plateaus has been scant, but we do know that there are big differences between individuals, and that these are determined by genetics, race, age, gender and a range of other factors. As we will see in Chapter 10, there are certain lifestyle factors, such as the number of times someone has lost weight and regained it and the length of time they have been overweight, that help determine the frequency and duration of plateaus. But even this is impure science at this stage.
PROMISES, PROMISES . . . Let’s face it, there’s no shortage of weight-loss programs in the world. And just about all of them work—for a while at least! If they didn’t, nobody would ever try them. The reason they work—for a while—is because anything that changes energy balance, or the ratio of energy eaten in food to energy expended in activity and metabolism, will lead to weight loss (albeit at different rates in different people). Unfortunately, though, the way this energy imbalance is brought about will determine how quick the loss is and for how long it is sustained. This is because the human body, unlike dry calculations, reacts dynamically to changes in food intake and energy expenditure. If it didn’t, we’d lose weight continuously at a rapid rate until we faded away and died—and being dead is not a healthy state to be in. 37
Becoming Gutless Text pages 24/8/06 10:21 Page 38
BECOMING GUT LESS
‘REACTIVE’ LOSSES In general, losses that are too big and too rapid will usually bounce back the fastest. For this reason, people who regularly swing from weight gain to loss, or ‘weight cycle’ (known in the trade as ‘the rhythm method of girth control’), wind up fattest later in life. The extra fat becomes harder and harder to shift as the body tries harder and harder to protect itself from the periods of starvation that it thinks come from some kind of famine.
WAYS OF LOSING Reducing energy intake in food can be done in a number of ways. You can decrease total calories—but counting calories can become an obsessive pastime, and this has its own problems. You can decrease your intake of carbohydrate, which is one of the currently popular ways of ‘dieting’. This will guarantee quick weight loss (from the 2.7 grams of water stored in each gram of carbohydrate or ‘sugar’ in the body). But because sugars from carbohydrates are the best source of real energy, you’re likely to get tired and lethargic after a month or two and not feel like carrying on with the exercise that will help you keep the weight off best. You can decrease your total calories by going for some of the crazy diets that do the rounds—the grapefruit diet, the Israeli Army diet, the Fit for Life diet, the Atkins diet, and so forth. But by definition being on a ‘diet’ means coming off it at some stage. It can’t last for life and so, once again, it will probably make you fatter in the long term.
WEIGHT LOSS—FOR A WHILE Without belabouring the point, any of these ‘programs’ or ‘diets’ work by decreasing total energy intake—for a while. But they can’t be kept up in the long term. And that’s what has to occur if you’re going to lose that gut and keep it off. It’s true, you can’t get away without change. But that change has to be permanent and therefore it has to be based on learning: what are the best foods, the worst foods, the best forms of movement, and what other factors, such as stress, need to be considered. We’ll look at just what this learning involves in the ensuing chapters.
WHAT DOESN’T WORK We can say with some conviction that what won’t work for permanent weight loss is just about all the pills and potions you’ll find at your chemist 38
Becoming Gutless Text pages 24/8/06 10:21 Page 39
WHAT WORKS AND WHAT DOESN’T?
or health food shop. While many have tempting rationales and make attractive promises, about the only thing they’ll lighten in the long term is your wallet. . . . what won’t work for permanent weight loss is just about all the pills and potions you’ll find at your chemist or health food shop. If they do work—and remember, anything can work, for a while— they’ll work through the diet and exercise program that goes with them, but that usually can’t be maintained for life. If you still want to believe and need more proof, check some of the medical reviews on the topic,2 which are available at the Professor Trim website. Ways not to lose weight: common mistakes men make • Skipping breakfast or lunch. Breakfast stimulates your metabolism so you burn up more energy (kcals) over the whole day. All meals require energy to be digested. Skipping meals means you burn kilocalories at a slower rate. • Giving up alcohol. If you give up something enjoyable, you’re likely to take it up again at some point and, when you do, everything else is likely to fall by the wayside. Alcohol itself is not fattening, so if you enjoy it, learn to live with it and keep your weight down too. • Drinking soft drinks or fruit juices. Most men think beer is fattening. They don’t realise that sugary soft drinks and even pure fruit juices have as many kilocalories as beer. • Cutting out carbohydrates. Potatoes and bread are good, low-fat, complex carbohydrate-rich foods. Cutting out carbs will just make you tired and depressed and make exercise more difficult for you, so shortterm losses achieved this way usually translate into long-term gains. Cutting out some types of processed carbohydrates, however, may be advisable as these just raise energy density, or the calories per gram of food. • Eating too much fat. Fats are far more fattening than anything else you can eat. They are also more ‘addictive’ than other foods. Cutting back on fats can decrease the appetite. 39
Becoming Gutless Text pages 24/8/06 10:21 Page 40
BECOMING GUT LESS
• Going on a diet. Going on a diet means coming off it at some stage, and when this happens more weight will probably be put back on than was lost. • Fasting or crash dieting. This can cause short-term weight (water) loss, but it slows your metabolism and increases your body fat in the long term. • Being inactive. Activity burns fat, not only while you are doing it but afterwards as well. • Concentrating on weight instead of fat. It’s abdominal fat most men should be concerned about. Weight can be misleading because it can be made up largely of muscle, with low body fat (such as in a male athlete). • Doing sit-ups to remove a fat stomach. These work the muscle under the fat, not the fat. They’ll leave you with a tight fat stomach instead of a loose fat one! Unless you do a couple of thousand a day, you’re better off walking than doing sit-ups to lose a gut.
WHAT DOES WORK Carbohydrate and protein each have only 4 kcals (17 kJ) of energy per gram. Alcohol has 7 kcals (30 kJ), but there’s no mechanism for converting alcohol to fat in the body and the process for converting carbohydrate to fat in the liver is not very efficient in humans. Fats and oils, on the other hand, have 9 kcals (38 kJ) per gram. So reducing these in the diet is likely to be the quickest way to arrive at an energy imbalance. Because fat can also be addictive, a decrease in fat can make it easier to maintain a low-energy eating plan for life. Research over the past decade has shown repeatedly that a combination of low fat and high fibre in the diet, without calorie counting or restrictive dieting, will lead to steady but constant weight loss. It’s this combination that we’ll look at when we examine dietary changes in Chapter 7.
WHO CAN YOU SEE TO HELP? Although it might seem simple, there are unfortunately not many professionals well versed in modern research on weight loss. Dieticians can be 40
Becoming Gutless Text pages 24/8/06 10:21 Page 41
WHAT WORKS AND WHAT DOESN’T?
expected to be experts in the field, but look for those who are affiliated with groups such as the Australian Society for the Study of Obesity (ASSO). By the nature of their discipline, many dieticians will concentrate on diet and might tend to neglect the exercise and psychological components of weight loss. Exercise and fitness specialists tend to the opposite extreme, and many still believe in the ‘if it doesn’t hurt it doesn’t help’ philosophy. Psychologists who specialise in weight control in Australia are about as common as underpants with pockets. Health food stores are usually interested only in selling a product. So who’s left? Fortunately, general practitioners in Australia have been making a determined effort to get up to date in this field. Several thousand have now completed at least part of the Certificate in Weight Control Management with Sydney University and are now involved in a care-share program with Professor Trim. Changes to the health care system now mean these doctors can work closely with other health professionals who are well versed in weight-control principles. Professor Trim’s fully qualified personal exercise–weight coaches are accessible to every Professor Trim doctor around Australia. Working with these professionals, your doctor and the program will guarantee maximum success.
41
Becoming Gutless Text pages 24/8/06 10:21 Page 42
Becoming Gutless Text pages 24/8/06 10:21 Page 43
PART II PUTTING IT INTO PRACTICE
Becoming Gutless Text pages 24/8/06 10:21 Page 44
Becoming Gutless Text pages 24/8/06 10:21 Page 45
Chapter 6 CHANGING HABITS
Not surprisingly, most weight-loss programs concentrate on information about diet and/or exercise. But few consider that how we eat and exercise become habits over time. Unless we recognise this and learn how to change these habits, all the knowledge in the world about the right foods to eat and the right exercise to do is likely to be useless. Life’s short, so we don’t have time to reflect on each and every thing we do. Habits stop us from having to do this. We develop habits so we don’t need to think through every action we carry out. They are ways of responding that become automatic and enable us to do, and think about, other things while we’re busy. Unfortunately, some habits, for example those relating to eating and exercise, can become liabilities for body weight. Eating in social situations, for example, or parking the car close to the 45
Becoming Gutless Text pages 24/8/06 10:21 Page 46
BECOMING GUT LESS
exit at a shopping centre are habits that develop over time and that can be counterproductive for weight loss. If we examine habits in general, we can get an indication of how to deal with particular types of habits. Alan was a steelworker at the BHP steelworks in Newcastle, who admitted that every night as he drove home, his car was ‘automatically’ pulled into McDonald’s by the big M sign, which he insisted must be a magnet. After ‘unconsciously’ consuming a couple of Big Macs he would drive home and eat his dinner. Alan’s problem was the habit as much as the food.
GETTING OFF ON YOUR HABITS There are two main types of habits. One kind seems mostly characteristic of men, and the other is more common in women. The first type, behavioural habits, are simply learned actions. They develop when a response to a stimulus is conditioned. Put simply, these are learned ways of acting. The second type of habit is a cognitive habit, which is a learned way of thinking. If it develops from a cycle of negative thinking it can become simply a bad way of thinking. From a health point of view, habits can be good and bad. Basic hygiene habits, such as cleaning your teeth or washing your hands, are good behavioural habits. But much of what we do in relation to food and exercise can become bad habits and cause increases in body weight. For example, we often eat not because of hunger but in response to cues that we have learned to associate with eating.
LEARNED ACTIONS This type of habit was amply illustrated by the Russian physiologist Ivan Pavlov. You’ll remember that Pavlov had a dog which used to salivate every time he brought out its meat. As a trial, he paired the ringing of a bell to the presentation of meat and found that, lo and behold, the dog would salivate just at the sound of the bell. In scientific terms, Ivan said the dog had learned to associate a conditioned stimulus (bell) with an unconditioned stimulus (meat) to get a conditioned response (salivation). An example of how this might occur in people is when an advertisement comes on midway through a television program. For some people, this is an opportunity to get up, stretch their legs, obey a call of nature, actually talk to the wife or kids and generally do things that they were too transfixed by the screen to do during the program. 46
Becoming Gutless Text pages 24/8/06 10:21 Page 47
CHANGING HABITS
. . . we often eat not because of hunger, but in response to the cues that we have learned to associate with eating. If you were to get up on a couple of occasions at an ad break and, without thinking, grab some food or a beer, Coke or ‘nibbles’ from the fridge and if you were to find the experience satisfying, the chances of your repeating the sequence the next time an ad comes on are increased. Soon you’ll associate ad breaks with eating or drinking. Most of us think of eating or drinking as a form of reward and, as psychologists know, being rewarded for a response very quickly conditions that response to its stimulus. In other words, in this case: ad break = going to fridge = food or drink = reward Therefore, in the future, through the process of conditioning: ad break = food It’s a bit like a rat in a Skinner box. A Skinner box is basically a rat cage where the rat learns that, when a light comes on, it will get food if it presses a bar. Psychologists call this operant conditioning, and it’s a way of forming an automatic habit very quickly. Pretty soon it’s the light, not pressing the bar, that becomes associated with eating, just as it’s the advertisement on TV, not hunger, that makes you want food. So every time there’s an ad on TV, you learn to eat—whether you’re hungry or not! Most people don’t eat when they’re hungry. They eat from force of habit. Ad breaks are, of course, only one example. There are a range of other actions we pair together every day that contribute to our getting fat: for example, always having a biscuit with a cup of tea, eating chips or peanuts with a beer, jumping in the car whenever we need to go anywhere or buying a chocolate bar when we pay for our petrol. They are all unconscious little habits that add kilocalories to the energy equation.
LEARNED THOUGHT PATTERNS The second type of habit, which is more characteristic of women, at least in relation to weight control, is cognitive habit. This can lead to a vicious 47
Becoming Gutless Text pages 24/8/06 10:21 Page 48
BECOMING GUT LESS
cycle of overeating, dieting, starving, then bingeing, as shown in Figure 6.1. This pattern is not common in men, but if it’s a problem for you, you’ll need to break the cycle to have any positive effect. Give yourself permission to eat, but eat mostly what we recommend here. Figure 6.1 The vicious cycle of cognitive habits Decide to restrict food Think ‘I'm fat and ugly’
Restrict food intake
Deprivation
Eat for comfort
Anger: ‘Why me?’
Feel guilty
Rebel against food rules
Feel out of control
Binge
Gorge Think: ‘All or nothing’
PATTERN INTERRUPTUS The key to breaking bad habits is pattern interruption, done regularly so that negative patterns of behaviour are undone. Again, we can use Pavlov’s dog as an illustration. Ivan broke the dog’s habit simply by presenting the bell several times without the meat. In other words, when the conditioned stimulus (CS) goes unrewarded it is no longer a CS. This leads to what psychologists call extinction of a behaviour. Let’s take the bad habit of eating every day at morning tea as an example. You might: • dissociate the food from the tea • not have morning tea at all • replace food with something else (such as a low-fat food) 48
Becoming Gutless Text pages 24/8/06 10:21 Page 49
CHANGING HABITS
until there is no longer an association between morning tea and eating. This approach involves removing the stimulus. There are four main strategies you can use to interrupt patterns: 1. Self-monitoring. Research shows that self-monitoring of eating- and exercise-related behaviour increases the likelihood of fat loss. We know that most people underestimate the amount of food they eat and overestimate the amount of exercise they do. The only way to become aware of this is to monitor yourself by writing down every item of food eaten and every exercise carried out. In some women’s programs this record even includes how the individual ‘felt’ when they ate (depressed, happy), but this element does not seem to be as important for men. Simply writing down EVERYTHING that is eaten or drunk and EVERY extra bit of exercise is enough. Another way of self-monitoring is using measurement devices such as pedometers to measure distance covered. A brand of pedometer now on the market even measures energy in (food and drink) and compares this with its automatic calculation of energy out from movement to arrive at an energy balance estimate at the end of the day. Pulse rates, waist size and other measurements can also be monitored regularly. Other self-monitoring techniques to consider are: • keep an eating diary and identify triggers for eating • keep an exercise diary • measure waist size, resting pulse and distance walked regularly • use exercise-recording devices such as pedometers • examine the patterns in your eating • chart your progress in an obvious place (such as on the fridge). 2. Stimulus control. As we have seen, it’s a conditioned stimulus that elicits an automatic, or conditioned, response. If the stimulus is absent, the response is much less likely. You can exert stimulus control by: • limiting your exposure to the stimulus (so if socialising causes you to eat more fatty foods, you might need to cut down on socialising) • manipulating the stimulus (for example, socialise at home, where fatty foods are not available) • interrupting the stimulus–response connection (for example, play with worry beads or chew gum when socialising so you don’t overeat). Here are some examples of stimulus control in various situations. 49
Becoming Gutless Text pages 24/8/06 10:21 Page 50
BECOMING GUT LESS
In social situations: • have a glass of water or a cup of tea instead of a second helping • have a drink that doesn’t go with a dessert, such as beer • go to restaurants where there are more low-fat choices (for example, Japanese, Thai) • park a way away from the restaurant and walk there and back • plan ahead to deal with high-risk situations. At home: • alter the stimulants or cues to eating • store foods out of sight • eat meals off a smaller plate (a bread and butter or entrée plate) • cover your plate with a napkin when finished • at a buffet, allow yourself only one trip to the food and/or use a small plate • distinguish hunger from cravings and ignore cravings. Drinking: • don’t start drinking until a set time (say, 6 p.m.) • have at least one or two AFDs (alcohol-free days) per week • keep worry beads/keys in your pocket to occupy your hands • keep peanuts or chips in a hard-to-reach spot. 3. Response management. This involves manipulating your response to a conditioned stimulus. The first stage of this is to become aware that the response is in fact associated with the stimulus. The second stage is to provide alternatives to that response (for example, if socialising causes drinking, substitute lower-calorie drinks or find something else to do with your hands). A third possibility is to force yourself not to carry out that response on repeated occasions until it becomes extinguished and is no longer automatically connected to the stimulus. Here are some more response management techniques you can try: • ‘stalk’ your habits by becoming more conscious and aware of them • interrupt your eating–behaviour chains • learn relaxation • put your knife and fork down between bites • have water/mineral water chasers with alcohol • have an alternative form of exercise planned for cold/wet days • organise a friend or partner to exercise with you so you can’t renege 50
Becoming Gutless Text pages 24/8/06 10:21 Page 51
CHANGING HABITS
• plan walking/exercise in advance (for example, arrange to meet a friend or neighbour for an early morning walk) • when it comes to relapses, ban the words ‘must’, ‘should’ or ‘ought to’ from your vocabulary. 4. Reinforcement. Reinforcement, or rewards, is a way of ensuring a more desirable response will become associated with a stimulus. Rewarding yourself for a good week (for example, by buying some new clothes or allowing yourself an extra drink on Friday night) will reinforce positive behaviour and reduce the chances of your going off the rails. To apply reinforcement in practice you might: • set short-term goals (for behaviour as well as progress) • set incentives for reaching these goals • involve your partner • tell your partner how to help • set incentives with your partner (sex, holidays and so forth) • reward yourself for doing things, not just achieving things.
THE WEEKLY DOWNWARD SPIRAL Behavioural habits don’t only manifest themselves in single acts; they sometimes form weekly and even yearly patterns. For example, a survey of eating patterns in Australia showed some interesting short- and long-term patterns in eating over the working week. The survey found that dietary patterns closest to what would be regarded as healthy (such as eating breakfast, eating low-fat and high-fibre foods and limiting alcohol consumption) are most common in men on Monday mornings. After that, it’s a downhill run to Sunday night. As the week progresses, men: • are less likely to eat breakfast • eat more takeaways • drink more alcohol and soft drinks • eat more sweets or desserts • eat more cakes and biscuits. Weekends are the time for higher consumption of: • bacon and eggs • alcohol: wine and beer • pizzas, hamburgers and other takeaways. 51
Becoming Gutless Text pages 24/8/06 10:21 Page 52
BECOMING GUT LESS
The same phenomenon would probably be observable from January to December. Early in the year is always the time for new starts. But as the year progresses, and particularly towards Christmas, the course for many is rapidly downhill, often culminating in the gross overindulgence of the Christmas festivities. Most weight-control programs designed for women aim for perfection; they try to make everyone perfect (and boring) for a week, a year, a lifetime! Naturally, they rarely work, as hedonism usually triumphs over masochism. Therefore, any program for men should take into account fluctuations in dietary restraint during the week and the fact that weekends seem to be associated with a release of inhibitions. Weekends appear to serve a psychological, perhaps even stress-relieving, function. If goals are set too high, they’re bound to remain elusive. Programs should be built into the weekly cycle, making headway where this is most likely to be possible (that is during the early part of the week) rather than attempting to counteract established lifestyle patterns. The realistic approach to weight loss—and to not becoming a boring old fart—is to trade off the excesses of the weekend by response modifications such as: • extending the week to Friday night • having at least two AFDs (alcohol-free days) early in the week • not drinking alcohol before 6 p.m. • trading off Sunday lunch (if you want to have it) with extra walking or reduced fat intake • trading off weekend evening indulgences with extra walking • limiting fatty breakfasts (such as bacon and eggs) to Sunday morning (if at all).
THE THREE D S OF MANAGING HEALTH BEHAVIOUR In his book Act Thin, Stay Thin, Dr Richard Stuart explains that we often confuse what we would like to do with what we actually do. Stuart lists three sources of delusion that can explain why some people sometimes overeat and underexercise without necessarily knowing that they are doing so. Denial is the first source of error. This is a useful defence mechanism because it helps us maintain a positive image of ourselves. We can’t live happily without it. But when denial becomes excessive, it can lead to selfdefeating behaviour. If someone denies their eating excesses, for example, 52
Becoming Gutless Text pages 24/8/06 10:21 Page 53
CHANGING HABITS
there’s little chance of correcting them. With eating, the main form of denial is denying you ate too much. With exercise it’s denying that you don’t do enough regular activity. The usual response is ‘I’m on my feet all day’. This form of delusion requires honest understanding and some objective measurements (such as pedometer scores and food diaries) that can’t be denied. Distraction occurs when other things are happening. It’s easier to eat too much, for example, while you’re having a drink or talking with friends. It’s easier to automatically eat while distracted by a TV program. Research has shown that overweight people are more vulnerable to distraction than people of normal weight. When the distraction involves aroused emotions, the effect is even greater. Watching television or dining with an attractive partner might be so distracting that the individual isn’t aware of what they are eating. Distortion refers to the way overweight people judge their eating behaviour. Studies recently reported in the UK using radio-isotopic methods to measure actual food intake and exercise output and bringing this into relation with reported food intake and exercise output have shown that overweight people underestimate food intake by around 30% (known as the eye–mouth gap) and overestimate exercise by around 40% (the foot–brain gap). This is not thought to be deliberate—even people of normal weight do it. It’s an unconscious distortion of the facts. Such people are simply unaware of the amount they actually eat. . . . you cannot make sound plans for effective behaviour change when you start from where you think you’d like to be instead of where you really are. Distortion with eating relates to a misperception of what is eaten. ‘I only had a small piece’ or ‘I only drink occasionally’. With exercise, distortion relates to a misperception of what exercise involves: ‘I play tennis twice a week’ (therefore I do a lot of exercise). According to Dr Tony Andrews, a long-time Sydney GP, the key to good health in men is getting to them before they develop the wrong habits. ‘A man can lose a leg from diabetes, just by not knowing how to reduce weight,’ he says. Now GPs can work closely with programs like Professor Trim’s to help men with weight problems.
53
Becoming Gutless Text pages 24/8/06 10:21 Page 54
BECOMING GUT LESS
Self-monitoring can help overcome the triple threats of denial, distraction and distortion because, according to Dr Richard Stuart, ‘you cannot make sound plans for effective behaviour change when you start from where you think you’d like to be instead of where you really are’. Understanding habits is the first step in this process. Understanding what and why we eat and how we move is the next important phase.
54
Becoming Gutless Text pages 24/8/06 10:21 Page 55
Chapter 7 CHANGING WHAT YOU EAT
Before we start to look at what we should be eating for weight loss, let’s make it clear that nutrition is not a perfect science. The confidence with which many people (usually not qualified nutritionists) will tell you that this food is ‘good’ and that food is ‘bad’ is usually not warranted by the available scientific evidence. True, we are learning more every day and there is a vast body of scientific research aimed at doing just that. But the complexity of nutrition makes it difficult to assume anything on the basis of research restricted to single foods, or even single ingredients, 55
Becoming Gutless Text pages 24/8/06 10:21 Page 56
BECOMING GUT LESS
when our diet consists of perhaps hundreds of foods and they in turn of thousands, perhaps millions, of ingredients, all of which can interact with each other. When it comes to weight control it’s fair to say that our learning curve is a gradual one. The base of knowledge gleaned from research carried out from the 1950s to date is being added to, bit by bit, so that legitimate changes are being made to our recommendations constantly. There are also some givens, which will never change. For example, body weight is determined by energy balance—the total amount of food energy taken in minus the energy expended in physical activity and metabolic rate. This is the second law of thermodynamics: energy is neither gained nor lost, it just changes form. Yet even here, the conclusion is not as clear-cut as it might seem. The equation fat = energy in – energy out is a ‘physics’ equation. It doesn’t take account of dynamic biological systems, which are able to change the relationship between energy in and energy out by, for example, changing metabolic rate, the rate at which we burn energy just to stay alive. So for anyone to claim that they have the definitive answer to weight loss in the form of a special ‘diet’, whether it be eating grapefruit, the ‘zone diet’ or a special way to ‘cleanse’ the body, would demonstrate their arrogance and scientific ignorance. There is no one ‘magic bullet’ way to lose weight, but there are many different ways in which energy balance can be changed. Changing the form of your food intake is one way of doing this: by following a diet low in carbohydrate, low in fat, low in protein or high in fibre, for example. It’s more a matter of the potential long-term effects and outcomes of each of these strategies than whether any approach will work in the short term. To this end, we should probably first define the qualities of a good eating plan for weight loss. Then we can go on to look at how this plan might be carried out.
A GOOD EATING PLAN FOR WEIGHT LOSS To be effective in the long term, an eating plan for weight loss should have the following features: 1. Sustainable—for life. To be sustainable for life the plan cannot be a ‘diet’, where food of a set type is prescribed in set quantities. While this might work in the short term, you won’t be able to keep it up indefinitely. 56
Becoming Gutless Text pages 24/8/06 10:21 Page 57
CHANGING WHAT YOU EAT
2. Long-term rather than short-term benefits. Quick weight loss is easy to achieve by restricting food intake, but in many cases doing so can result in long-term weight gain because restrictive eating plans can’t be maintained. 3. No obsessive calorie counting. Calorie counting, either in total or of particular nutrients, can’t be sustained and can lead to problems associated with obsessive and restricted eating, such as bingeing. 4. Nutritionally balanced. This means including all the vitamins, minerals and nutrients required for health. 5. Not based on one food or a limited number of foods. A diet consisting mainly of one food or one type of food is not likely to be sustainable, or healthy. 6. Based on genuine fat loss and not just weight loss. Because certain nutrients, such as carbohydrates, carry water, quick weight loss is characteristic of restricting these nutrients. However, this doesn’t necessarily imply fat loss, which is the main aim of such a program.
EATING DIFFERENTLY Given these requirements, it should be obvious that the ideal eating plan for weight loss is not a diet, as such. In fact, it should be a lifetime eating plan, where fattening foods are limited and filling, non-fattening healthy foods are encouraged. In general, this involves eating less foods that are high in dietary fat and more that are high in fibre. In addition, and in response to the findings of recent research, we also need to look at maintaining or increasing the proportion of protein, reducing portion sizes and amounts of foods that are high in energy density, and perhaps even those with a high glycaemic index (GI), which are absorbed quickly into the bloodstream, and increasing food variety to guarantee good health. The recommended sequence of dietary changes is shown in Figure 7.1. For many men, the first step in this sequence (that is, reducing fat, increasing fibre and maintaining or increasing the proportion of protein) will be enough. For others, it might involve going to the second, third, fourth or even fifth level, while all the time trying to maintain an increased variety of food to guarantee balanced nutrition. 57
Becoming Gutless Text pages 24/8/06 10:21 Page 58
BECOMING GUT LESS
Figure 7.1 Recommended dietary changes for weight loss 1.
Decrease Increase fat fibre Maintain or increase proportion of protein
2.
Decrease portion size
3.
Decrease energy density If this doesn’t work:
4.
Decrease alcohol
5.
Decrease total energy (calories) taken in
I n c r e a s e
V a r i e t y
Decreasing fat Despite some recent speculation in the popular media to the contrary, fat is still the most easily overconsumed fattening nutrient in modern societies. (Suggestions in the popular media that this is not the case are contradicted by every published national set of weight-control guidelines in the world.) The suggestion that reducing other nutrients should be the major goal of a weight-loss program derives largely from the US, where it has been proposed that an apparent reduction in dietary fat has not been successful in lowering obesity levels. The simplistic nature of this argument should, however, be obvious to anyone who has visited the US. While Americans might have reduced the percentage of fat in their diets (and this is debatable in view of food disappearance data), their total food intake does not seem to have decreased. Indeed, studies on portion size show that it has increased markedly over time.1 Try getting a small portion of a takeaway meal at most of the fast-food chains in America and you’ll probably wind up paying more rather than less for the inconvenience. In addition, the daily energy expenditure of most Americans, along with that of the rest of the developed world’s peoples, has decreased dramatically. Reducing dietary fat is an important first step in any weight-control 58
Becoming Gutless Text pages 24/8/06 10:21 Page 59
CHANGING WHAT YOU EAT
program, not just because fat is more energy dense (9 kcals or 38 kJ/g) than either carbohydrate or protein (4 kcals or18 kJ/g), but because fat can be passively overconsumed. It’s comparatively easy, for example, to fit in a slab of chocolate at the end of a meal, whereas it would be difficult to eat the same amount of energy in apples or oranges. Because fat doesn’t fill you up at the time of eating (although you might feel full later), you tend to eat more of it. Fat is also ‘appetitive’. Indeed, some scientists think that it might be addictive, and that the craving some people have for apparently sugary foods could in fact be a craving for fat. The ‘sweet tooth’ might be a misnomer. It might have been a ‘fat tooth’ all along. When you think about it, all the foods people commonly want to satisfy their sweet tooth—cakes, biscuits, pastries, desserts, chocolates, ice-cream—are high-fat foods. Hence, despite all the media hype to the contrary, it is the fat in food that is the big obstacle to weight control. When we eat fat, the body needs to go to very little effort to convert that fat into body fat (in fact, it takes only 3% of the energy of the fat consumed to do this). By contrast, when we eat carbohydrate, it takes much more effort (25% of the energy supplied by the carbohydrate) for the body to convert that to fat. In fact, under normal circumstances, the process of conversion of carbohydrate to fat in the liver, called de novo lipogenesis, does not play as big a part in humans as was once thought, particularly in males. Instead, the body will use extra carbohydrate to increase metabolic rate or warm the body (great if you’ve decided not to overdress) before it begins to turn it into fat. . . . despite all the media hype to the contrary, it is the fat in food that is the big obstacle to weight control. Conversely, going off fatty foods should decrease your appetite for fatty foods and, in turn, the amount of energy or number of calories you consume. Certainly the experience of individuals who have cut back on fatty foods suggests that one of the main results of doing so is a reduced desire for fat. This might not happen straight away; the effect might take several weeks to develop. Most people who don’t eat fatty foods regularly tend to find them sickening. For example, those who never eat the fat on meat find it revolting. Those who give up eating the fat on meat soon feel the same way about it—at least until it becomes a craved food again. 59
Becoming Gutless Text pages 24/8/06 10:21 Page 60
BECOMING GUT LESS
Some fats contain essential fatty acids and are therefore important. But too much fat can be a health hazard. Eating too much saturated fat increases your levels of blood cholesterol and triglycerides, can raise your blood pressure and might promote diabetes. Too much of almost any kind of fat, including polyunsaturated fats, increases your risk of gallstones and certain types of cancer. The safest fat is probably olive oil—a product that has been used for thousands of years. But olive oil has the same high energy content as any other fat. So it makes sense to buy expensive, strong-flavoured olive oil. The cost will stop you using as much and just a few drops will add flavour to foods such as salads. The oils in fish are also healthy, and less likely to be fattening. And that means all seafoods—including prawns, lobsters, crabs and oysters—provided they’re not fried, crumbed or battered. Hence one of the Professor Trim’s principles, as for the GutBusters program, is that you can eat anything that comes from the sea, apart from chips!
Finding fat in foods It can be difficult to identify foods that are high in fat. Although some fats are visible, much of the fat in modern foods is hidden—you wouldn’t guess how much fat they contain. For example, some fast-food burgers have over 60% more fat than a traditional Australian burger, yet they don’t seem fatty. And who would have guessed that a meal of quiche and salad can have six times as much fat as a piece of lean steak and some vegetables? Another common misconception is that vegetable oils are always less fatty than animal fats. Some are, but vegetable oils might come from palm kernels or coconuts, which have more saturated fat than beef dripping or lard. Other vegetable oils are partially hydrogenated during processing— this converts some of their original unsaturated fats into a form of saturated fats. Processing can also produce fats known as ‘trans’ fatty acids, which may be even worse for your health than saturated fats. Labelling products ‘no cholesterol’ is also confusing, as many of these foods are high in saturated fat and this can be made into cholesterol in the body. The main sources of fats in the Australian diet might surprise you. They are shown in Figure 7.2. The four main strategies for reducing fat in your diet are: 1. Exclusion. This means avoiding foods like: • butter and margarine 60
Becoming Gutless Text pages 24/8/06 10:21 Page 61
CHANGING WHAT YOU EAT
Figure 7.2 Sources of fat in the Australian diet
11% – Other sources
7% – Red and organ meats
23% – Dairy and ice-cream
12% – Processed meats 7% – Vegetables
9% – Confectionery 7% – Takeaway snacks
24% – Spreads and sauces
• sausages and luncheon meats • mayonnaise and oily dressings • pies, sausage rolls or pasties • fatty sweets such as chocolates, cakes, biscuits and pastries. 2. Modification. This involves: • trimming the fat off meat (before cooking) • taking the skin off chicken, turkey or duck • skimming the fat off soups and casseroles • draining fat off cooked mince • grilling, baking, roasting, dry-frying, microwaving or steaming instead of frying. 3. Substitution. Instead of your usual, use: • low-fat cheese • skim milk or low-fat milk • raw muesli instead of toasted museli • reduced fat ice-cream • turkey hams and salamis instead of meat versions • lean meats (such as veal) instead of fattier meats • fish or seafood instead of meat. 4. Replacement. This entails substituting: • lemon or vinegar for salad dressings 61
Becoming Gutless Text pages 24/8/06 10:21 Page 62
BECOMING GUT LESS
• yoghurt for cream • fruit snacks for cake and biscuits • vegetable stock for oil.
How much fat? While most of the world has become aware of the problem of excess fat in our diet, we don’t seem to be able to recognise just how much is too much. Australians have cut back their fat intake over the past twenty years, but Australian men still manage an average daily intake of around 100 g of fat and women around 80 g. For weight loss, a maximum intake of around 40 g is recommended for men and 30 g for women. This is slightly less than that recommended by health authorities for optimum health, but it is more likely to result in ongoing weight loss. In a quick test of fat intake by indigenous men involved in a GutBuster program in the Torres Strait Islands, it was found that this was as high as 300–400 g a day. This did not, however, involve an excessive intake of food. Most of the fat came from deep-frying scones and then layering them with butter, resulting in each scone contributing about 20–30 g of fat to the diet.
How do you know how much is 40 g of fat? A good idea is to purchase a Fat and Fibre Counter at your local chemist, or use the Ultimate Food Energy Guide included in the Professor Trim program and available at bookshops. Check the foods you are eating for one to two weeks until you get to know which foods are high in fat and which are not. As a general rule, it’s wise to become a ‘fat detective’ and avoid foods that have more than 10 g of fat per 100 g (or more than 10% fat). It’s also useful to be able to read food labels to understand not just the fat content but, as we’ll see below, the total energy density of a food. How much of a food you are likely to consume is also important. Fat content can seem low until you realise how much you’re eating. A store-bought tray of lasagne, for example, can be 8% fat, which is within the recommended limits. However, a 500 g tray is usually a meal for two, so the total fat intake per person is 20 g—for just one meal! To check your current fat intake, complete the dietary fat questionnaire below and see how you rate at the end. This will tell you not only whether you are currently eating too much fat, but also which foods are at fault. 62
Becoming Gutless Text pages 24/8/06 10:21 Page 63
CHANGING WHAT YOU EAT
Dietary fat questionnaire
1. How often do you eat fried food with a batter or breadcrumb coating? 4. 6 or more times a week 3. 3–5 times a week 2. Once or twice a week 1. Less than once a week 0. Never 2. How often do you eat gravy, cream sauces or cheese sauces? 4. 6 or more times a week 3. 3–5 times a week 2. Once or twice a week 1. Less than once a week 0. Never 3. How often do you add butter, margarine, oil or sour cream to vegetables, cooked rice or spaghetti? 4. 6 or more times a week 3. 3–5 times a week 2. Once or twice a week 1. Less than once a week 0. Never 4. How often do you eat vegetables that are fried or roasted with fat or oil? 4. 6 or more times a week 3. 3–5 times a week 2. Once or twice a week 1. Less than once a week 0. Never 5. How is your meat usually cooked? 4. Fried 3. Stewed or in a goulash 2. Grilled or roasted with added oil or fat 1. Grilled or roasted without added oil or fat 0. Eat meat occasionally or never
63
Becoming Gutless Text pages 24/8/06 10:21 Page 64
BECOMING GUT LESS
6. How many times a week do you eat sausages, devon, salami, meat pies, hamburgers or bacon? 4. 6 or more times a week 3. 3–5 times a week 2. Once or twice a week 1. Less than once a week 0. Never 7. How do you spread butter/margarine on your bread? 3. Thickly 2. Moderately 1. Thinly 0. Don’t use butter or margarine 8. How many times a week do you eat chips or French fries? 4. 6 or more times a week 3. 3–5 times a week 2. Once or twice a week 1. Less than once a week 0. Never 9. How often do you eat pastries, cakes, sweet biscuits or croissants? 4. 6 or more times a week 3. 3–5 times a week 2. Once or twice a week 1. Less than once a week O. Never 10. How many times a week do you eat chocolate, chocolate biscuits or sweet snack bars? 4. 6 or more times a week 3. 3–5 times a week 2. Once or twice a week 1. Less than once a week 0. Never 11. How many times a week do you eat potato crisps, corn chips or nuts? 4. 6 or more times a week 3. 3–5 times a week 2. Once or twice a week 1. Less than once a week 0. Never 64
Becoming Gutless Text pages 24/8/06 10:21 Page 65
CHANGING WHAT YOU EAT
12. How often do you eat cream? 4. 6 or more times a week 3. 3–5 times a week 2. Once or twice a week 1. Less than once a week 0. Never 13. How often do you eat more than a small serving of ice-cream? 4. 6 or more times a week 3. 3–5 times a week 2. Once or twice a week 1. Less than once a week 0. Never 14. How many times a week do you eat more than a small piece of cheddar, other hard cheese or semi-soft cheese such as camembert or cream cheese? 4. 6 or more times a week 3. 3–5 times a week 2. Once or twice a week 1. Less than once a week 0. Never 15. What type of milk do you drink or use on breakfast cereal or in cooking? 4. Condensed or evaporated 3. Full-cream 2. Full-cream and reduced fat 1. Reduced-fat 0. Skim 16. How much of the skin on your chicken do you eat? 2. Most or all of the skin 1. Some of the skin 0. None of the skin/I am a vegetarian 17. How much of the fat on your meat do you eat? 2. Most or all of the fat 1. Some of the fat 0. None of the fat/I am a vegetarian Scores: 0–17: Your fat intake is relatively low. Keep it that way. 18–39: Your fat intake is moderate to high. Reduce it if you want to lose weight. 40+: Your fat intake is high. You will have to reduce it if you want to lose weight, feel better and improve your health. 65
Becoming Gutless Text pages 24/8/06 10:21 Page 66
BECOMING GUT LESS
The good oil on the good oils Recent research has added to our knowledge about fats and oils. While we know that all fats (and oils, which are just liquid forms of fat) are 9 kcals (38 kJ) per gram, some have been found to have benefits for health, such as helping prevent cardiovascular disease. There is also a suggestion, although it is not yet totally proven, that some fats are oxidised, or burned up, more readily than others. This would imply that they have less of an effect on weight gain than other fats. Olive oil and canola (rapeseed) oils might fall into this category. Oils that are found in seafood might have similar properties (it is also possible that the oils in most seafoods are quite low in proportion to other components in seafoods). This suggests that if any oils are to be included in an eating plan proposed for weight loss, they should perhaps be olive or canola oils. However, until the scientific data become clearer, it is still wise to reduce the amount of all fats and oils in the diet. At the other extreme, it is now abundantly clear that saturated fats, which come mainly from animal foods (but are also contained in palm oil and coconut oil), are the worst type of fat for weight gain, as well as for health problems such as heart disease. For this reason, these should be reduced most in the diet. Where animal meat is part of the diet, choose meat from animals that have been active and are therefore themselves low in fat. Wild animals such as kangaroo, crocodile, rabbit, venison and free range chickens fall into this category. Another general principle is that lighter coloured meat (such as veal and chicken) is generally lower in fat. So what about nuts? Most nuts (at least in their unprocessed form) contain large amounts of healthy monounsaturated fats, which protect against heart disease. However, they are also energy dense and are therefore not recommended for anyone wanting to lose weight. Avocados fall into the same category. These are often promoted with a ‘cholesterol-free’ sticker, which is perfectly true. The main source of fat is the monounsaturated variety. Monounsaturated fat provides a lot of energy, which, for the overweight, is not going to help either weight or blood cholesterol levels. Once you’ve lost weight, though, and are able to maintain that weight loss, you may enjoy small amounts of foods such as nuts and avocados as part of a healthy diet.
INCREASING FIBRE Along with decreasing fat, the first step to eating properly for weight loss entails increasing dietary fibre. Fibre comes mainly from plant foods. 66
Becoming Gutless Text pages 24/8/06 10:21 Page 67
CHANGING WHAT YOU EAT
Unlike most of our food, we cannot digest dietary fibre in the small intestine so it passes through to the large intestine, where ‘good’ bacteria digest most of it, producing some valuable chemical effects in the process. Dietary fibre is usually described as insoluble or soluble. Both types tend to create a full feeling so you feel satisfied. High-fibre foods are rarely fattening, mainly because their bulk makes it difficult to eat too much of them. So increasing fibre-rich foods will automatically help you cut down on fatty foods. The ideal target for fibre intake should be around 30 g/day. Again, you can check in books such as the Ultimate Food Energy Guide to find out the fibre content of foods. Some practical hints for adding fibre to your diet are: • Use wholemeal or wholegrain bread. • Choose wholegrain cereals such as wholemeal pasta, brown rice, wholegrain crispbread and rolled oats and wheat, barley or oat breakfast cereals. • Add wheat bran, oat bran, rice bran, barley bran or mixed bran, or wheat germ, to cereals, to casseroles or soups or for thickening sauces. • Eat the skins of fruits and vegetables where appropriate, for example have potatoes in their jackets and eat the skin on apples. • Eat more vegetables and fruit (at least 3–4 pieces of fruit and 5 different vegetables a day). • Try wholemeal varieties of crumpets, muffins, scones, raisin bread and hot cross buns. • Eat more dried peas, beans and lentils (such as soy beans, kidney beans, baked beans, lima beans). • Eat fibre with protein (a chicken and salad sandwich, not just chicken). It would be difficult to eat enough fruit to make you fat. You can safely eat three or four or even five pieces a day without worrying. It is a good idea, however, to restrict fruit juices—because they’ve lost their fibre, it’s easy to drink your way through piles of fruit that has been juiced to yield all its kilocalories. It might not add to body fat directly, but it could inhibit fat loss. Fruit is also always best eaten whole, with all its fibre. Another GutBuster principle was ‘Never drink anything you can eat whole’ (of course, with the exception of low-fat cow’s milk!). Contrary to popular belief, bread is not fattening; it’s the spread that causes problems. Breads of all kinds, including English-style muffins, 67
Becoming Gutless Text pages 24/8/06 10:21 Page 68
BECOMING GUT LESS
bread rolls, pita bread, flat breads, raisin bread or even crumpets, are all low in fat (although some can be high in energy density, as shown on page 73). The idea that bread is fattening developed from crash diets where the aim was to achieve a lower reading on the scales rather than actually lose fat. By the same token, unlimited amounts of bread are not recommended—if you do this your body will never get round to burning its fat for energy. This is covered in more detail under ‘Decreasing portion size’, on page 71. Never drink anything you can eat whole (of course, with the exception of low-fat cow’s milk!). Rice and pasta are other good, low-fat forms of fibre that can be eaten in relatively large amounts, as long as they aren’t coated in fat. Steamed rice is fine. So is straight pasta. But some pasta dishes, such as lasagne and fettuccine with a creamy sauce, have heaps of fat. Unless a special low-fat recipe is used (see the Professor Trim recipe book for tasty, low-fat meals), it’s best to stick with sauces made from tomatoes, mushrooms, capsicums, other vegetables, herbs, some wine (if you like), plus seafoods, lean meat or chicken. Breakfast cereals (which can be eaten at any time of the day, of course) are also not likely to be fattening, unless they’re energy dense (see page 73) and total energy is an issue for you. Unfortunately, many breakfast cereal manufacturers have compensated for the lack of taste caused by the low fat level in cereals by loading them up with sugar. So simple cereals, such as corn flakes, are low in fat but extremely high in sugar. Mueslis are usually okay, but the toasted varieties have added oil that makes them high in fat. Choose cereals with ingredients that don’t include coconut oil, vegetable oil, palm kernel oil or other types of fat, and eat them with a low-fat or skim milk. If you can’t stomach low-fat milks, opt for 50% whole milk and 50% low fat to start with, and gradually increase the proportion of low-fat milk as your taste buds adapt. Potatoes are an excellent source of low-fat fibre. However, the thinner these are cut into chips and then crisps—the more surface area is available to soak up fat. So a potato, which has virtually no fat, becomes 6% fat as a thick chip, or ‘wedge’, 16% fat as a straw chip or French fry as sold in the takeaway stores, and 36% fat as a packet of crisps—way above the 10% recommended limit for this program. 68
Becoming Gutless Text pages 24/8/06 10:21 Page 69
CHANGING WHAT YOU EAT
What about the wind in the pillows? There is a downside to fibre: wind. When fibre and resistant starch are broken down by bacteria in the bowel, valuable acids and some gases are produced. The acids keep bowel cells healthy and resistant to bowel cancer and help stimulate the muscular action that moves food wastes along the length of the intestine. However, they do have to come out somewhere, and the closest exit is what you’re sitting on. These gases include hydrogen, oxygen, nitrogen, sulphur and, in some people, methane. Some people produce more gases than others, but eating more fibre can increase gas production in anyone. This might be socially embarrassing, but it’s quite healthy and, unless it’s really excessive or accompanied by pain, gas is not a medical problem. High fibre eaters can also be comforted by the fact that although fibre increases the amount of gas produced, it’s not the fibre that causes any associated odour. A high-protein diet, especially one containing a lot of meat, and spices are the main contributors to this. The ‘down’ side of a high-fibre diet has long been a source of annoyance and some mirth, as in the story of the Earl of Flatulence, of olde England, who took mashed peas for his breakfast and was renowned for loudly breaking wind when riding later on the fox hunt, all the while chastising his horse for the offence. While many had their suspicions, the Earl was never caught out in this ruse, indicating that he was indeed a very ‘fart smeller’. Those who suffer from excessive gas, or for whom there is any associated diarrhoea, bloating or pain, should see their doctor. The most common reason is an intolerance to lactose, the sugar present naturally in milk, but you can’t assume this is the problem in your case. Doctors can do special tests to diagnose lactose intolerance. In the meantime, there are other ways of reducing excessive flatulence; these are outlined by Rosemary Stanton and Dr Terry Bolin in their book Wind Breaks, and summarised in the box on page 70. Excess gas might not be the only problem associated with increased fibre consumption. Increasing fibre in the diet too quickly can cause stomach pains and diverticular problems. For this reason, you should increase the fibre in your diet gradually, over six to eight weeks, until the suggested goal of around 30 g of fibre per day is reached. An increase in fluid (or water) intake is also important in order to ‘flush’ the extra fibre through the digestive system.
Fibre and bowel motions Increased fibre in the diet should have an effect on bowel motions. More fibre increases stool frequency and quantity. High-fibre stools also float 69
Becoming Gutless Text pages 24/8/06 10:21 Page 70
BECOMING GUT LESS
Likely causes and possible cures for flatulence Cause Legumes (dried beans, peas)
Possible cure Increase consumption gradually Soak overnight, pour off soaking water Add 1/2 teaspoon mustard seeds to soaking water
Cauliflower, broccoli, Brussels sprouts
Reduce cooking time
Unripe fruits
Wait until they ripen
Fruit juices
Avoid, especially apple and pear juice
Fatty foods
Decrease consumption
Milk
Substitute calcium-enriched soy (low fat)*
* Check with your doctor that lactose intolerance is the problem. Small quantities of milk (up to half a cup) and yoghurt and cheese should not cause problems. more because they contain more air. This is normal and no cause for concern. It might sound a bit morbid to take note of what comes and goes from the body, but a bit less coyness about this would help lower the high incidence of bowel cancer. Blood in the stools or on the toilet paper and/or having a close relative with bowel cancer are warning signs: see your doctor—especially if you’re over 40! The most common cause of blood on the toilet paper is haemorrhoids (or piles), but this can sometimes be a smokescreen. Small growths called polyps can be growing in the bowel and possibly contributing to blood in the stools. A special test called a colonoscopy can find and remove polyps before they become cancerous. Bowel cancer is the most common internal form of cancer in Australia, but it can be treated if caught early. It’s particularly a male problem.
Maintaining or increasing the propor tion of protein While decreasing fat and increasing fibre are generally the first options in a long-term weight-loss program, an increase in the proportion of (lowfat) protein food can help to make eating more enjoyable. Protein has 70
Becoming Gutless Text pages 24/8/06 10:21 Page 71
CHANGING WHAT YOU EAT
important effects on satiety and may help decrease the total amount of food consumed. It is also important for muscle growth, which in turn can increase metabolic rate or (at least theoretically) reduce fat. Traditionally, humans have eaten up to 25–30% of their food intake as protein. Today, the proportion is as low as 15%. This can be increased by substituting low-fat protein sources such as seafood, lean meats, beans and legumes, for fatty foods or processed carbohydrates with a high level of rapidly absorbable sugars.
DECREASING PORTION SIZE A fourth nutritional factor that might need to be considered if changes in fat and fibre don’t lead to weight loss is your portion size at meals. Some men make the mistake of believing that total food intake is not important and that if they cut out the fatty foods, they can eat and drink as much as they like. In some cases this might well be true. For someone with a very high fat diet, for example the Torres Strait Islander men referred to earlier, cutting back from 300 g of fat per day to even 100 g could reduce daily intake by up to 1800 kcals (7500 kJ). Even if carbohydrate or protein intake are increased significantly, it’s unlikely that these increases will cancel out the decrease in fat. In general, short-term increases in carbohydrate or protein are usually burned off by increases in metabolic rate or heat loss, and therefore it is possible to eat a large amount of these in the short term. In the longer term, however, extra carbohydrate can be stored as fat, so a habit of large portion sizes can be counterproductive for weight loss. Portion size means simply the amount of food eaten at a meal. As most men’s bellies are bigger than their eyes, they tend to underestimate portion size and convince themselves they are not eating too much. A good practice is to pause between mouthfuls of food to allow the brain to catch up with the stomach and then never to eat beyond a feeling of mild satisfaction. For many people, every night is an exception. Don’t kid yourself that this is only one big meal and it that it doesn’t happen regularly. Denial is not just a river in Egypt! Situations that tend to lead to increased portion size and should therefore be guarded against include the following: • eating with others • eating out at restaurants • festive occasions 71
Becoming Gutless Text pages 24/8/06 10:21 Page 72
BECOMING GUT LESS
• weekends • when buying takeaways. Watch your portion size, and make sure it doesn’t cancel out decreases in fat and increases in fibre in your diet.
DECREASING ENERGY DENSITY Energy density (ED) is a relatively new concept that is being used more and more to explain why various weight-loss programs do or don’t work. As we have said, one immutable fact about obesity is that it results from a period of positive energy balance, that is, more energy (in the form of food) is being taken in than is being expended (mainly through physical activity and metabolism). Total energy (kilocalories) in food therefore becomes important, but even more important for someone trying to lose weight is the energy density (kilocalories per gram) of individual foods. Foods that have high energy density are usually (but not always) those that are high in fat, and/or low in water or fibre. A food that is low in fat, such as a soft drink or an ‘energy’ bar, can be high in energy density because it is loaded with sugar to make it more palatable. Energy density is calculated by dividing the total energy (kilocalories) in that amount of the food by a set weight of a particular food (say, 100 g). Hence 100 g of plain milk chocolate has 512 kcals (2156 kJ) of energy and therefore an energy density of 5.1 kcals/g (21.6 kJ/g). At the other extreme, 100 g of apple contains 54 kcals (228 kJ) of energy and therefore has an energy density of only 0.5 kcals/g (2.2 kJ/g). In the middle range, a 100 g slice of plain cake, which might have less than 10% fat, can have an energy density of 3 kcals/g (13 kJ/g). Foods can therefore be classified into three categories according to their energy density: low, medium or high. Based on the available research to date,2 we have put the following values on these three categories: Low ED = Medium ED = High ED =
< 1.8 kcals (7.5 kJ)/g > 1.8 kcals (7.5 kJ) and < 2.8 kcals(12 kJ)/g > 2.8 kcals (12 kJ)/g
Foods with a low ED can be eaten most often, those with a medium ED less often, and those with a high ED should be avoided. Low energy density is a characteristic of foods that make up the Mediterranean diet, and is now thought to contribute to its healthy effects, 72
Becoming Gutless Text pages 24/8/06 10:21 Page 73
CHANGING WHAT YOU EAT
as much as the use of olive oil. Traditional Mediterranean diets are high in fruits, vegetables and fibre such as pasta. The high water, high fibre and low fat content of these foods reduces any fattening effects of the relatively small amounts of olive oil that are also part of the diet. Energy density control is included as a backup to reducing fat and increasing fibre in the Becoming Gut Less program to help deal with those situations where concentration on fat and fibre is not enough. By double-checking foods on energy density, using Professor Trim’s Ultimate Food Energy Guide, for example, you can cut out or reduce the foods that might otherwise slip through the net. Examples of some low-fat, but high-ED foods from the Ultimate Guide are given in Table 7.3 below. Table 7.3 Some examples of low-fat but high energy dense foods Food
Fat g/100
ED kcals/g (kJ/g)
Biscuit, savoury crispbread, puffed and toasted
3.8
3.8 (16.1)
Biscuit, fruit, polyunsaturated, wholemeal
9.9
3.9 (15.9)
Bread, melba toast
4.9
3.8 (16.0)
Bread stick, hard
3.8
3.9 (16.3)
Breakfast biscuit, wholewheat, bran
7.6
3.5 (14.9)
Cereal (mixed grain, sugar >35% fortified)
4.2
3.8 (16.1)
Confectionery, carob-coated, sugar
9.9
4.2 (17.5)
Cornflakes
0.5
3.7 (15.6)
Fudge, not chocolate, plain
4.2
3.8 (15.1)
Muesli, toasted
9.8
3.9 (16.2)
Mousse, low-fat, chocolate, artificially sweetened
5.0
3.9 (16.3)
Popcorn, air-popped, no added fat
4.2
3.5 (14.8)
Pretzel, regular
7.2
3.8 (15.8)
Rice cake, natural, brown
3.4
3.7 (15.6)
Rice cake with corn and sesame
2.5
3.9 (15.0)
Turkish delight, chocolate coated
9.5
4.0 (16.6)
73
Becoming Gutless Text pages 24/8/06 10:21 Page 74
BECOMING GUT LESS
As you can see from Table 7.3, cutting out high energy dense foods could make serious inroads into your daily eating and enjoyment. For this reason, energy density should be considered only where the other strategies, such as reducing fat, increasing carbohydrate and reducing portion size do not seem to be working to help you lose weight, or where this might be necessary in the interests of your health.
. . . AND IF THIS DOESN’T WORK? If these measures don’t work you might need to consider two other options: decreasing alcohol and measuring and decreasing the total energy of foods consumed.
Decreasing alcohol You might be surprised to learn that there are no storage bins for alcohol in the body. Of the three biochemical means of metabolising alcohol, none results in the storage of alcohol as fat.3 So alcohol per se is not a cause of weight gain. However, if alcohol is taken regularly in conjunction with high-fat or high-energy food, that energy is ‘saved’ as fat and the alcohol is preferentially used as energy. (Other alcohol matters, and how it can be used without being abused, are covered in Chapter 9.) Alcohol therefore becomes important for weight loss only where it contributes to a high total energy intake. In most cases, reducing fat and/or other sources of energy in the diet is enough not to have to worry about alcohol. But if these initial measures have been taken and the problem persists, you might need to look at alcohol next. Patrick decided to try Professor Trim’s Becoming Gut Less program because he had heard he could lose his ‘beer gut’ without having to lose the beer. Although he didn’t really believe this, he found that he did lose a good 10 cm in the first couple of months by changing his eating pattern. More interestingly, he found he actually started to drink less voluntarily, and even admitted to having his first AFDs (alcoholfree days) in 42 years!
Total energy Even after all these changes, it’s still possible (although highly unlikely) that your total energy intake is still too high in relation to your energy expenditure. Verifying this requires a slightly more complex approach, involving estimating daily energy expenditure and comparing this with daily food 74
Becoming Gutless Text pages 24/8/06 10:21 Page 75
CHANGING WHAT YOU EAT
intake. Your participating doctor can show you how to do this or you can get the formula from the full Professor Trim program. If concentrating on all these things doesn’t work, there can be only two possible reasons: 1. You’re suffering from the eye–mouth gap, the exception rule or the foot–brain gap. The first of these means the eye is not really recording what is going into the mouth (in other words you’re kidding yourself!). The exception rule says that you think every session of overeating is an exception, whereas it’s much more likely to be the rule. The foot–brain gap means that the brain thinks the feet are moving more than they actually are. If this last diagnosis is correct and the first two rules are honestly not the issue, it can only mean that: 2. You need to concentrate more on energy expenditure. We’ll show you how to do this in the next chapter. There are, however, some other factors which can slow down your rate of weight loss: • Genetic factors: Some people’s bodies resist weight loss more stubbornly, probably due to genetic factors such as metabolic rate, hunger level, etc. If you are one of these people, it just means you’re very efficient at surviving in the lean times. • Being an ex-smoker: For reasons which are not clear (and not commonly written about) ex-smokers seem to often have more trouble losing weight than those who have never been smokers. There’s little you can do about this except persist, recognising that this may be what is slowing you down. • Some medications: Some prescribed medications make weight loss harder. Most diabetes drugs, for example, lead to weight gain, and hence cause a circular problem. Check with your doctor to see if this could be the problem for you.
INCREASING VARIETY The final suggestion regarding food intake made in Figure 7.1 is to increase variety. This has nothing to do with losing weight directly, but it can help guarantee a healthy and well-balanced food intake even with reductions in fat and total energy. Variety relates to the number of different foods eaten 75
Becoming Gutless Text pages 24/8/06 10:21 Page 76
BECOMING GUT LESS
each day. A tomato sandwich, for example, will consist of tomato, bread and perhaps (although let’s hope not) butter or margarine. These are three different types of foods. Research with different populations around the world suggests that those who eat a large number of different foods each day are likely to be the most healthy. If these foods also observe all the rules considered here (in other words low fat, low energy density and, especially, small portion size), the diet is likely not only to be healthy, but potentially weight reducing. Herbs, spices and other condiments can each be considered a different type of food in this calculation. On this basis, the Japanese have one of the most nutritious and non-fattening diets of any modern society. Studies show that they typically consume over 30 different foods a day. The recommendations for western societies vary, but a figure of 40 different foods a week is not a bad goal. You can check whether you meet this standard by writing down the number of different foods you eat (including herbs, spices and condiments) over one or two days. This will give you an idea of your general eating pattern.
FOOD PRACTICES Besides the food itself, food practices can be important for guaranteeing weight loss. Some tips here include the following: • Always eat breakfast. This kickstarts the metabolism and tends to lead to less total food intake over the rest of the day. Indeed, breakfast is probably the most important meal of the day. • If possible, be active before breakfast. As the body’s reserves of sugar decrease overnight during sleep, physical activity first thing in the morning tends to draw more on fat stores as a source of energy. However, if you are diabetic, or think you might be, exercising before eating could be dangerous. Check with your participating doctor. • Graze, don’t gorge. Try never to go for longer than about four hours without eating; this tends to increase genuine hunger and lead to overeating of the wrong types of foods. • Eat larger meals earlier in the day. Because the metabolic rate is higher earlier in the day, foods eaten then tend to be digested with less energy storage than later. The worst scenario would be to cut out breakfast and lunch then eat a big meal before retiring at night. • Don’t skip lunch. People who do so tend to snack more around 76
Becoming Gutless Text pages 24/8/06 10:21 Page 77
CHANGING WHAT YOU EAT
5–6 p.m. on tasty fatty foods, then eat a full dinner later—obviously not good practice. • Be careful eating out, or with friends. It’s well known that we all consume more when dining out or when eating with friends. This doesn’t mean you shouldn’t socialise—just be conscious of what you are taking in. • Be careful with takeaway foods. Typically, these are highest in fat and total energy. Yet buying takeaways often leaves one with the feeling of perhaps deserving more.
WHAT ABOUT PACKAGED, LOW-ENERGY MEALS? The surge in the incidence of obesity in recent years has led food manufacturers to look for ways of capitalising on weight-loss foods. Packaged lowfat meals are one way of doing so, while also catering for the time poverty of many in our modern society. In the past, packaged foods have been rather unexciting because of the technical problems of delivery. However, more recently, technological advances and the advent of experienced chef–nutritionists in the manufacturing process have led to an improvement in the quality of meals. Locally made packaged meals deliver lowenergy foods at different calorie levels, but with high levels of taste. These meals are frozen foods, generally delivered in a weekly supply, which sometimes actually costs less than a weekly home food budget. For anyone with time constraints or who is ‘food preparation impaired’, these offer an added opportunity for weight loss. However, they should be part of a total weightloss program that ensures that learning occurs and that changes in eating other than through laid-on foods can be maintained for a lifetime. For some sample meal and dessert ideas for Becoming Gut Less, see Appendix III.
77
Becoming Gutless Text pages 24/8/06 10:21 Page 78
Chapter 8 NOT EXERCISING—MOVING!
Strangely enough, the study of exercise is a much purer science than that of nutrition. Yet the vast majority of weight-control programs still focus on nutrition, and ‘diets’ in particular. Why is this? The obvious reason is that, in the short term at least, it’s easier to remove a large amount of energy from food intake than it is to add the equivalent amount to daily energy expenditure. For anyone eating 3000 kcals (12 600 Kj) of food a day, for example, it would be relatively simple to reduce this by 1000 kcals (4200 Kj) to 2000 kcals. However, to add 1000 kcals to the energy expenditure side of the equation would require the equivalent of walking around 16 km per day—a tough ask, particularly for someone who is fat and unfit. 78
Becoming Gutless Text pages 24/8/06 10:21 Page 79
NOT EXERCISING—MOVING!
Therefore ‘diets’ and reducing food intake will result in the greatest weight loss in the short term, let’s say up to three months. However, research has shown that those who succeed in keeping weight off in the long term are those who consistently increase their daily energy expenditure. This is probably because: • physical activity can be much more enjoyable and easier to sustain than a ‘diet’ (who ever enjoyed a diet?) • movement can be used to trade off food and drink intake (you don’t see too many fat marathon runners) • going ‘on a diet’ implies that sometime you have to come off it. Activity is something that can be made part of your life. . . . research has shown that those who succeed in keeping weight off in the long term are those who consistently increase their daily energy expenditure.
WHY THE NEED FOR MORE MOVEMENT? In the past, there would have been no need for a chapter like this on movement for weight loss. This is because throughout history people have generally been active enough to keep their food intake in balance with their energy expenditure. However, the industrial revolution of the late 19th century, the technological revolution of the late 20th century and the evolving cyberspace revolution of the 21st have meant that physical activity is no longer a prerequisite for survival. Indeed, if we had to blame someone for the world’s current obesity epidemic, Henry Ford and Bill Gates would certainly be on the shortlist, probably ahead of or at least vying for equal place with Ronald McDonald and Colonel Sanders. This has been verified in research carried out by a Dutch student working with me on a postgraduate research project in 2001. The project was reported in the Medical Journal of Australia in December of that year.1 Neeltje Vogels used a special measurement device, called a Tracmor, to measure the total daily movement of actors playing soldiers and convicts of over 150 years ago at Old Sydney Town, a historical theme park north of Sydney. For the project, the actors were asked to live in for a week and not use technology such as TVs, radios, cars and computers. Their total movement was then compared with that of a group of modern-day sedentary workers in Sydney, including accountants, information technologists and even some practising doctors. 79
Becoming Gutless Text pages 24/8/06 10:21 Page 80
BECOMING GUT LESS
The results were quite astounding. When converted to the equivalent of distance walked, it was found that people living 150 years ago ‘walked’ about 16 km a day more than the modern sedentary workers. This amounted to a difference of around 1000 kcals (4200 kJ) a day. And while this might sound extreme, it has since been supported by other, similar studies. One, carried out by Professor Steven Heymsfield and his team from Columbia University in New York,2 estimates we are now using about one-third less energy during the day than people in a non-industrial environment. This explains why Australians at the turn of the 19th century on average could have eaten up to 1000 kcals (4200 kJ) a day more than we eat today—and still have virtually no problem with their weight.
EXERCISE—OR MOVEMENT? The first point to make about exercise for fat loss, based on these historical changes, is that it is not necessarily the same as exercise for fitness. In fact, exercise is the wrong term. A better term is simply ‘movement’, or ‘physical activity’. Movement of any kind uses up energy. And, as we know, if energy is not replaced from food, it is taken from the body in the form of fat. Energy is measured in kilocalories (or kilojoules, if you prefer). Just staying alive burns up approximately 1 kcal (4.2 kJ) per minute for the average-sized (80 kg) man; walking a kilometre burns up roughly 60 kcals (252 kJ) and running a marathon burns up around 3000 kcals (12 600 kJ). But it’s wrong to think that it’s only the energy that’s used up during movement that helps the weight-loss process. You might read in popular magazines that walking a kilometre is the equivalent, in energy terms, of only a single slice of bread. But it’s the other things that go with activity that really count. Exercise can, for example, increase the metabolic rate by 10–20% over 24 hours. So while walking an extra kilometre a day might burn off around 70 kcals (294 kJ), the 24-hour effect of that could theoretically be a 10% increase in your metabolic rate, or more than twice the direct effect over a day. Also, while a planned exercise or fitness program will obviously burn fat, you don’t have to join a gym, take up aerobics, or even pound the pavement in a pair of joggers. It could simply mean walking a little more instead of going everywhere in the car, getting a little more active with the kids or mowing the lawn instead of paying someone else to do it. 80
Becoming Gutless Text pages 24/8/06 10:21 Page 81
NOT EXERCISING—MOVING!
ACCUMULATED OR CONTINUOUS ACTIVITY? It’s the little bouts of energy use that add up and become important. Not surprisingly, it’s also been shown that the overweight tend to take the easy way out when physical effort is required. Videos of overweight kids playing tennis show that they try to ‘grow a longer arm’ to hit a ball that’s out of reach rather than move their feet to get to the ball. Similarly, many people become overweight because they own every labour-saving device that comes onto the market: portable telephones, remote controls for everything, electric can openers and many others. But what do you do with the time you’ve saved? Most people spend their spare time sitting watching television and doing very little that’s active—apart from lifting food and drinks to their mouths. So they get fat. For the working man, the problem is built into the system. Even a decade or two ago, manual workers were much more active. They walked, lifted, carried or dug, all manually. Now there are few workplaces that aren’t mechanised, so that most actions are done by machine, without any need for the worker to move—apart from to pull levers or press buttons. There are very few ‘working men’ left, if ‘work’ is defined as an activity involving energy use. It should be clear from this that although the mind might desire it, the human body is not yet ready for the technological revolution.
SURVIVING HENRY FORD AND BILL GATES So how do we compensate for this? The sad fact of modern life is that what nature lets you win on the swings, it makes sure you lose on the roundabout. The human body was made to move. When it doesn’t move it gets fat. If you want to get rid of that fat—without going back to the days of few luxuries and scant convenience—you need to make a planned effort. And you have to do it yourself. Modern life won’t do it for you. As I’ve said before, this doesn’t mean you have to train like an athlete to be fit. Strange as it might seem, walking a kilometre burns roughly the same amount of energy as jogging a kilometre—roughly. It takes a little longer, admittedly, but if you don’t have to compete and you have the extra time to spare, why run when you can walk? You don’t have to ‘bust a gut’ to lose a gut. Vigorous activity can be quite dangerous for someone carrying too much fat. If your heart is weak (and a deconditioned heart often is) and you make it pump blood vigorously through all the extra ‘plumbing’ you’ve 81
Becoming Gutless Text pages 24/8/06 10:21 Page 82
BECOMING GUT LESS
developed to service large mounds of fat, the load can be fatal. So let’s forget bust-a-gut exercise and think about moving more, in big ways, little ways and all the time throughout the day. Movement: are you doing enough? Over 30% of people in the United Kingdom, the United States, Australia and New Zealand are currently totally sedentary. They participate in no physical activity other than the bare minimum required for survival. Test your own activity level by truthfully answering the following question: Do you currently participate in any regular activity or program, either on your own or in a formal class, designed to improve or maintain your physical fitness? If your honest answer is no, there’s a fair chance that your excess fat is due to your lack of movement. There’s certainly room for improvement. If your answer is yes, there might still be room for improvement, particularly if you like your food and would like to continue having a drink (see Chapter 10 on trading off ).
FREQUENCY, INTENSITY, DURATION—OR NONE OF THE ABOVE? In the past, exercise has generally been considered in relation to improving aerobic fitness. Aerobic fitness requires increasing all three of the components of a physical activity paradigm: frequency, intensity and/or duration. When it comes to weight loss, however, the main concern is the total volume of activity, where: Volume = frequency × intensity × duration Volume can be increased by increasing any or all of the three components. In very big people who are out of condition, aerobic capacity (sometimes referred to as fitness) is low. With increasing levels of activity, even at low levels of intensity, aerobic capacity increases, so that more intense activity can be carried out at a similar comfort level. Thus it becomes possible for someone who is fit (but perhaps still overweight) to reduce the duration and frequency of activity and achieve economies of 82
Becoming Gutless Text pages 24/8/06 10:21 Page 83
NOT EXERCISING—MOVING!
time by increasing exercise intensity. However, if you are doing vigorous activity you must take special care not to lower your activity levels for the rest of the day as a result of fatigue, because this negates the benefits of the shorter, but more intense bouts of activity. For this reason, changes in lifestyle levels of activity might be better than a structured exercise routine.
EXERCISE: LIFESTYLE
VS
THE GYM
Advances in human technology have lessened our need to move in order to stay alive. Presumably, we can make up for this by institutionalising exercise; by reintroducing it in a planned form by visiting the gym for a set time per day or planning a set amount of extracurricular activity, such as walking. However, as technological developments occur, the ambient level of activity required to stay alive in a modern society drops lower and lower. As we have seen from studies such as that mimicking activity levels of the past at Old Sydney Town, this could be as much as 1000 kcals (4200 kJ) a day. Admittedly, decreasing food input could cancel out some of the resultant energy imbalance. But this is difficult in an environment that is full of the tastiest and most energy dense foods that humans have probably ever had the good fortune to eat—with limited work (physical) effort required to get them. The Rev. Thomas spends a lot of time looking after his parishioners’ spiritual needs, but not enough looking after his own physical problems. He was diagnosed as diabetic when he started on a weight loss program with the author. After just three months of a regular walking program his blood sugars had returned to normal, even though he had lost less than 10% of his starting weight.
Research from the prestigious Cooper’s Aerobic Clinic in Dallas, Texas3 examined the effects of a planned exercise routine versus those of an increase in lifestyle activity levels, such as walking instead of driving, doing the gardening or becoming more involved in active leisure. This showed that the lifestyle approach is more effective and more sustainable than an intermittent program. Apparently this is explained by the drop in activity levels over the rest of the day in those people, particularly the elderly, who are prescribed an exercise routine. The overall decline in activity suggests that both a structured program, such as a regular daily walk, and a lifestylebased change in activity might be necessary to get the best long-term weight-loss effects. Of most importance, however, is the need for this to be 83
Becoming Gutless Text pages 24/8/06 10:21 Page 84
BECOMING GUT LESS
sustainable. Short-term changes in exercise levels, such as an enthusiastic commitment to join a gym, are not likely to be maintained and therefore should be seen as having limited value. Men often do this—they tend to be binge exercisers; women, on the other hand are more often binge eaters. Both can be counterproductive in the long term.
INCIDENTAL AND PLANNED ACTIVITY There are two main types of movement we’re interested in. The first is an increase in incidental movement carried out during the course of a normal day. The second is a planned program of increased physical activity. Incidental movement means moving your body during the day when you might otherwise take the easy way out. Walk up the stairs instead of taking the lift; walk to the shops instead of driving; mow the lawn instead of paying someone else to do it; even leave the remote control on top of the TV and change channels by hand (horror of horrors!). Increasing incidental movement requires a change of mindset. It requires rethinking movement—as an opportunity, not an inconvenience. So instead of parking as close as possible to the food pick-up point in your shopping centre and cursing the guy who gets in closer than you, park at the back of the car park and take the opportunity to burn off some extra fat. Start thinking of movement as an opportunity, not an inconvenience. Although it might not sound like much, the energy used up in incidental movement adds up. It can also help increase your metabolic rate, or the rate at which your body burns energy at rest. This means it could take much less time for you to lose those extra centimetres. Here are some other simple rules for incidental exercise: • Wherever you can, walk instead of driving. • Don’t sit when you could be standing. • Get things for yourself; don’t ask others to fetch them for you. • Use the stairs instead of the lift. • Use manpower instead of power tools. • Get off public transport before your stop and walk the rest of the way. • Park your car some distance from your destination and walk. 84
Becoming Gutless Text pages 24/8/06 10:21 Page 85
NOT EXERCISING—MOVING!
Incidental movement should form the base of your physical activity pyramid (see Figure 8.1). If you’re very big, have an injury or simply find it difficult to walk or do any other form of exercise, incidental movement might be all you need until you lose some weight, your injury has healed or you have more time. Provided it’s combined with the proper eating program, referred to in Chapter 7, and provided the incidental movement you do is more than you’re doing now, you have to lose weight. Never underestimate the power of incidental movement! Planned movement involves selecting an ‘aerobic’ activity you like and carrying it out at least on alternate days. Aerobic activities are those that use the large muscles of the body over an extended period. They include walking, jogging, swimming, cycling, rowing, aerobics, circuit training and callisthenics. Walking is probably the easiest, cheapest and most enjoyable aerobic exercise for most people—and the most underrated. The formula is simple: to ‘lose a gut’, walk (anywhere, anytime, with anyone) for 3–4 km every day. It doesn’t matter whether you go late at night or early in the morning, on a treadmill or on the road, with a mate or with your dog—just walk! Recent research shows that it doesn’t matter whether you do it all at once or in four lots of 1 km walks across the day. And speed is not important either. The main thing is the distance. Of course, as you get fitter, you’ll be able to (and probably want to) go faster. If so, go ahead, because this adds to the volume and can mean you can get economies of time by cutting back on frequency or duration. But to begin with, just make sure you cover the distance.
REASSESSING INTENSITY Most men have the mistaken belief that unless they exercise to the point of exhaustion, it’s not worth it. This is not true. A re-evaluation of data from exercise science research that I helped conduct for the National Health and Medical Research Council’s National Physical Activity Guidelines in 1999 showed that weight loss is related to the duration and frequency, not necessarily the intensity, of exercise. However, where intensity can be increased (i.e., in fit people), this can provide economies of time by allowing a decrease in frequency and duration. If you have injuries, or you’re too heavy for weight-bearing exercise such as walking (that is, carrying your own body weight), try some weight-supported or partially weight-supported activities such as swimming, cycling, walking in water or walking on a mini-trampoline 85
Becoming Gutless Text pages 24/8/06 10:21 Page 86
BECOMING GUT LESS
(available from any sports store). You can even watch TV while you do it. But remember, these types of weight-supported activities are never as good for fat loss as the weight-bearing types. Swimming, for example, is generally not as good a fat-loss exercise as walking, because the body’s weight is supported by the water and therefore less energy is expended (unless, of course, you can’t swim!). Still, any activity is better than no activity, so if that’s all you can do or all you like doing, do it—and try to cover about one quarter of the distance you would have walked, that is around 1 km a day. Walking or wading through water is good exercise. It also takes the pressure off damaged hips or knees, so give it a try if you live near a beach or shallow pool. Here are some other tips for planned movement: • Select only an aerobic activity or activities you enjoy. • If it’s walking (perhaps the best type of weight-loss activity) walk 3–4 km a day (or four lots of 1 km), or use a pedometer (see below) to carry out a certain number of steps every day. • If it’s some other activity, try to do it for at least 30 minutes (or three lots of 10 minutes) every day. • Be active BEFORE a main meal (with the exception of swimming, exercise reduces the appetite), if you enjoy it—otherwise, any time is better than no time. • Vary your activities (either different ones every day or a different route each day). • Carry out activities with a partner—you’ll keep one another motivated. • Record how much you do each day, in distance or time. • Plan ahead, and make sure you don’t miss out. • If it suits you, go for a walk before eating in the morning. You might burn more fat that way because your sugar stores have gone down overnight and your body will call more on fat for energy.
86
Becoming Gutless Text pages 24/8/06 10:21 Page 87
NOT EXERCISING—MOVING!
Figure 8.1 National Physical Activity Guidelines
If you are able, also carry out some regular vigorous activity
3–4 days/week
Put together at least 30 minutes of moderate-intensity physical activity on most days
Most days
Be active every day in as many ways as you can
Daily
Think of movement as an opportunity, not an inconvenience
Always
The value of various exercises (with ratings out of 10) for waist control for men are shown in the box below: Rating the value of exercise (out of 10) for waist loss in men* Walking Walking in water Jogging Circuit training (gym) Aerobics Cycling Tennis (singles) Rowing/canoeing Golf Skipping/stepping Surfing (body or board) Mini-trampolining Swimming Dancing (ballroom) Squash (average level) Gardening
10 9 8** 7 6 6 6 6 6*** 5** 5 5 5 5 4** 2 87
Becoming Gutless Text pages 24/8/06 10:21 Page 88
BECOMING GUT LESS
*
Ratings are based on levels of convenience, injury potential and enjoyment (for a set time each day), as well as effectiveness. Higher scores are best. ** These exercises are not recommended for the very overweight. *** Golf, as a form of walking, would be rated higher if it was carried out daily. The various forms of exercise all have their advantages and disadvantages, so you’ll need to find one that suits you. You can weigh them up by studying Table 8.1 below. Table 8.1 Advantages and disadvantages of different types of exercise for fat loss Exercise Walking
Advantages Comfortable, convenient, non weight-supportive and therefore high in energy use
Disadvantages Not good for knee, ankle, foot injuries, might be difficult in some large city areas
Jogging
Takes less time, can be addictive, good to do with mates
Can be uncomfortable, dangerous for overweight, can cause injury, too much like hard work
Swimming
Comfortable, few injuries, good for very overweight because weight is supported, good in summer
Doesn’t burn as much energy (because weight is supported), not as good for women (because their high fat level makes them more buoyant), can be taken too easily, cold in winter, sometimes inconvenient
Cycling
Enjoyable, comfortable for the very overweight (because weight is supported), can be done at different intensities
Not as good for fat burning as non weight-supportive exercise, can worsen knee, hip problems
88
Becoming Gutless Text pages 24/8/06 10:21 Page 89
NOT EXERCISING—MOVING! Exercise Tennis/Golf
Advantages Enjoyable, social, not too energetic, lots of walking (particularly if you’re not very good)
Disadvantages Might be difficult to play 18 holes of golf every day
Aerobics
Enjoyable, social, high rate of energy use, muscle tone as well as fat loss
Requires some coordination, needs good instructor, can be too hard (and dangerous) for the very overweight
Skipping
Convenient, high rate of energy use
Boring, can cause leg injury, needs coordination, difficult to carry out for long enough
Squash
High rate of energy use, enjoyable
Dangerous for the overweight, can cause back injury, too vigorous: recommended only for those who are fit and not overweight, not recommended for fat loss
Rowing
Good for those with lower body injury (knee, ankle, etc); can be portable (rowing machine)
Can be boring
MONITORING YOUR MOVEMENT Like the eye–mouth gap (discussed in Chapter 7) which is associated with overeating, there is a foot–brain gap associated with underactivity. The foot–brain gap relates to the phenomenon of the brain thinking that the feet are doing much more than they actually are. This is found particularly in overweight or obese individuals, as any amount of exercise is painful and therefore feels like much more than it actually is. An obese person walking a kilometre, for example, might feel it’s 3 km. He or she feels that they are being very active, but all the while they are not doing enough to matter, leading to an even greater increase in weight and a vicious cycle, as shown below. 89
Becoming Gutless Text pages 24/8/06 10:21 Page 90
BECOMING GUT LESS
Figure 8.2 The fatness–inactivity cycle Increased body weight
Inactivity
Joint problems
on
i vat oti
Inc rea s
ed
dm
ase
cre De
pai
n
Respiratory problems
Unlike the eye–mouth gap, there is a way of testing the foot–brain gap. Pedometers are small devices that can be attached to your belt or trousers and measure the number of steps you take each day. These can be purchased in any electronics store. They range from simple models, which only measure steps, to the more complicated and expensive versions that measure distance travelled and kilocalories expended. For the most part these sophisticated models are overkill. Steps are enough, provided you know how many you should be doing and provided the device is reliable and not a cheap model that breaks down or records inaccurately. Subscribers to the full Professor Trim program receive a reliable Omron pedometer in their package and a detailed program for using it. If you are doing it by yourself, there are two ways to set it up. In general, it’s thought that a total of around 9000 steps a day is necessary to keep body weight down, or to lose weight in the modern environment. For somebody starting from a low base, however, 9000 steps, even accumulated over the course of a day, might be a little ambitious. The alternative approach is to measure the baseline number of steps you take over a week and average this out for a per day measure. Then try to increase this average by around 1000–2000 steps per day for one to two months, or until you feel comfortable at this level. Keep increasing the step total 90
Becoming Gutless Text pages 24/8/06 10:21 Page 91
NOT EXERCISING—MOVING!
gradually, until you are taking over 9000 steps a day. If you’re really serious you can do more than 9000 and get greater weight loss benefits more quickly. And remember, this doesn’t have to be done in one session. Steps can be accumulated over the whole day, irrespective of what you are doing or how long or short each step is.
GETTING FEEDBACK: THE FATT PRINCIPLE We’ve said that moving to lose fat doesn’t have to be the same as exercising to get fit—you don’t have to get fit to lose fat. So training for fitness might be different from moving for trimness. Of course, once you start to lose some weight from any type of movement, you might start to get fit—and then you might want to do more. But at first, the main thing is moving against fatness, rather than exercising for fitness. The two different outcomes are explained by the acronyms in Figure 8.2. Figure 8.2 The FITT/FATT table Movement for fat loss (FATT) Frequency
Exercise for fitness (FITT)
Frequency
Intensity
Amount
Preferably Long duration, daily low-moderate intensity 3–4 days/wk i.e. 40–65% HR max 60–85% HR max
Time
30 mins (continuous)
Type
Aerobic + anaerobic exercise
Time
Type
Distance is more important than time i.e. walk 3–4 km (in total) or 9000 steps a day
‘Planned’ + ‘incidental’ aerobictype ‘movement’
Any increase in energy expenditure (EE)
For getting rid of fat, the acronym spells out the following: Frequency. Walking (or some other form of planned exercise) should be carried out on six, preferably even seven, days a week. 91
Becoming Gutless Text pages 24/8/06 10:21 Page 92
BECOMING GUT LESS
Amount. We’ve set the distance required at 3–4 km a day. An alternative would be 9000 steps, as measured on a pedometer. You could start by increasing a baseline number of steps as explained above. But remember, this doesn’t all have to be done in one session each day. For an average-sized (80 kg) man, around 25 steps is equivalent to 1 kcal (4.2 kJ) of energy burned. Time. Time is not important. The main thing is the distance covered, or the number of steps taken. However, when you get fitter, you might be able to cover the distance more quickly and free up more time for doing other things. It’s up to you. Type. Walking is the best and most convenient fat-loss exercise when it comes to energy use and safety and enjoyment. Failing that, other weightloss activities such as jogging, skiing, aerobics, skating or circuit training will do. These are all aerobic, which is important because it’s only during aerobic activity that fat is metabolised. Anaerobic exercise (such as sprinting, lifting weights or very vigorous short bursts of activity) should be reserved for sports training, not for fat loss, because it burns more sugar than fat. To anticipate your next question, sex is not an effective fat-loss activity unless you’re an extremely talented bedroom athlete, as it requires 30–40 minutes of elevated heart rate using the large muscles of the body— and don’t kid yourself! Weight training is also a great form of exercise for weight loss, but shouldn’t really be introduced until a significant amount of weight has been lost. The larger the muscle group involved, the greater the effort and therefore the greater the potential waist loss.
FAT LOSS FOR THE FIT Increasing fitness means that economies of time can be achieved by increasing the intensity component of exercise volume and reducing the duration or frequency components. Some of the principles of fitness training can therefore be useful in the fight against fat, particularly once the fat starts to peel off. These are also shown in Table 8.2. The acronym that’s often used for fitness training is FITT (frequency, intensity, time and type). So if it’s fitness as well as fat loss you’re after, check yourself against the menu outlined below: Frequency. Your planned activity program should really be carried out every day if you really want to lose fat, but at the least every second day. Make sure you don’t miss two days in a row. 92
Becoming Gutless Text pages 24/8/06 10:21 Page 93
NOT EXERCISING—MOVING!
Intensity. Intensity of effort can be gauged from your heart rate. This can be measured at the radial pulse at the wrist (at the base of the thumb). Count the heart beats for 30 seconds and then multiply by two to get a pulse rate per minute. The average resting pulse for a man should be around 72 beats per minute, for a woman 80 beats per minute. Resting pulse rate can be used as a form of feedback, because as you get fitter and lose fat, it is likely to decrease. You should carry out your organised exercise program at a pulse rate of around 120–130 beats per minute, for safety and effectiveness. As you get older, however, the required pulse rate decreases. So, for a sixty-year-old, a pulse rate of 100–110 is adequate for fat loss. Time. The amount of time set aside for exercise for fitness should be around 30 minutes a day. For greater benefits, spend more time doing gentle, aerobic exercise. However, the longer you exercise, the greater your risk of injury, so I suggest that, at least until you lose some weight, you take it easy and be content with 30 minutes. Type. The type of exercise necessary for fitness is both aerobic and anaerobic. This involves using the large muscles of the body in any activity over an extended period at a faster heart rate than occurs with gentle walking. For fitness, you’ll benefit from some anaerobic activity—that is, short bursts of vigorous activity—mixed with your aerobic exercise. Because this puts extra pressure on the heart, fitness-type activity is different from that needed for fat loss.
ENJOYMENT For a program of planned movement to be successful, it has to be enjoyable—something you will feel comfortable doing for life. So it’s important that you make the right selection from the start. If you haven’t exercised for years, it’s often hard to know what you like. There are two ways to cope with this. You could try a range of different activities: perhaps walk one day, swim the next, try a minitrampoline the next. That way you’ll soon find out what you like and don’t like doing. Or do the test in Appendix II called the Exerselector Questionnaire. Follow the instructions and fill out the scores to find out what exercise(s) you might be best suited to, even if it’s news to you. You can also test yourself on the scale below to make sure you’re doing the right thing. 93
Becoming Gutless Text pages 24/8/06 10:21 Page 94
BECOMING GUT LESS
Physical activity enjoyment scale Rate how you feel at the moment about the physical activity you’ve been doing: 1 2 3 4 5 6 7 I hate it I enjoy it 1 2 3 4 5 6 7 I feel bored I feel interested 1 2 3 4 5 6 7 I am not at all absorbed in it I am very absorbed in it 1 2 3 4 5 6 7 I find it tiring I find it energising 1 2 3 4 5 6 7 It’s very unpleasant It’s very pleasant 1 2 3 4 5 6 7 I feel bad physically I feel good physically while doing it while doing it 1 2 3 4 5 6 7 I’m very frustrated by it I’m not at all frustrated by it 1 2 3 4 5 6 7 It’s not at all stimulating It’s very stimulating 1 2 3 4 5 6 7 It doesn’t give me any sense It gives me a strong of accomplishment sense of accomplishment 1 2 3 4 5 6 7 I feel as though I would I feel quite happy rather be doing something else doing it Scores: <30: You’re definitely doing the wrong exercise routine (for you). Look for a change in routine before you lose interest completely. 30–50: Although you’re moderately suited to your routine, you could possibly find some other forms of exercise that would give you more satisfaction. 50+: Your exercise routine is suitable for you. Keep evaluating it to make sure it stays that way. 94
Becoming Gutless Text pages 24/8/06 10:21 Page 95
NOT EXERCISING—MOVING!
EXERCISE AND BODY SHAPE Different exercises have different effects on body shape. Basically, there are three main types: 1. those that result in a loss of body mass (or shrinking exercises) 2. those that result in gains in body mass (or bulking exercises) 3. those that result in a decrease of fat, but an increase in muscle (or toning exercises). The different types of exercise and their effects on body mass are shown in Table 8.2: Table 8.2 Exercise effects on body shape Body mass loss Shrinking exercises Walking Jogging Distance cycling Cross-country skiing Soccer Tennis (singles) Badminton Hockey Volleyball Dancing
Body mass gain Toning exercises Aerobics Circuit training Swimming Rowing Gymnastics Wrestling Canoeing Surfing Callisthenics Windsurfing
Bulking exercises Weight training Sprinting Shot putt Hammer Sprint rowing
As you can see from the arrows, combining exercises from different categories will have a particular effect, depending on which type of exercise is carried out most. For example, combining walking with aerobics will cause fat loss and muscle toning. The more walking, the greater the fat loss; the more aerobics, the greater the muscle tone. Combining a toning and a bulking exercise will cause an increase in body mass—such a strategy is of little value to the man wanting to lose fat. Fat loss will obviously be 95
Becoming Gutless Text pages 24/8/06 10:21 Page 96
BECOMING GUT LESS
greatest using a shrinking exercise. However, once you start to lose fat, you can use a toning exercise to help tighten up those parts of the body that used to wobble. For anyone with a potbelly problem, bulking exercises are likely to be of little benefit.
EXERCISE IN THE COLD It’s a popular myth that if you sweat a lot while you exercise, you’ll lose more fat. This leads a lot of men to jog or walk in a tracksuit, heavy clothing or a body wrap, or to try to exercise more in hot weather or during the hotter parts of the day. It might surprise you to know that this is exactly the wrong way to go about it. While any exercise burns energy, exercise in the cold is particularly efficient for using fat as an energy source (in contrast with carbohydrate), and results in more fat being burned than would similar exercise in a warm climate. The fat-burning effect of the cold is even more obvious in obese people. It’s thought that cold weather does this by stimulating the catecholamines (a type of hormone), which are involved in stress but also have a lypolytic, or fat-burning, effect. The combination of cold and exercise generates an effective level of catecholamines without excess physical stress in a person who is relatively unfit. Again, this doesn’t imply that you have to exercise in a cold room to get maximum benefit. It does mean, though, that the times you might feel least like exercising, such as early mornings in winter, might very well be the best in terms of fat loss. Certainly, you should dismiss any idea you might have had of doing yourself a favour by wearing thermal underwear or a heavy tracksuit while walking in the heat of a summer’s day. Also, if you’re planning on a weight-loss holiday to Hawaii (irrespective of what you eat) you might be kidding yourself—better to try Sweden, Switzerland or Antarctica. Indeed, the whole idea of ‘fat farms’ being located in the warmest parts of the country is off the beam. Weight-loss clinics of the future are more likely to be situated in the snowfields.
POTENTIAL PROBLEMS As we saw in Chapter 1, the M and M syndrome means that injury, resulting from excess body weight can lead to a lack of motivation to be active. This in turn means more weight gains, and so the cycle continues. Table 8.3 highlights some other problems that reduce activity levels and hence the effectiveness of your weight-loss program. It also suggests some solutions. 96
Becoming Gutless Text pages 24/8/06 10:21 Page 97
NOT EXERCISING—MOVING!
Table 8.3 Problems arising from increasing activity and some potential solutions Problem Chafing
Potential solution Wear lycra bike pants (under tracksuit trousers if you like; use Vaseline on the thighs
Leg pain
Change shoes, stretch more, see a podiatrist
Joint pain
Persist (provided it doesn’t get worse); walk in water or soft sand; try another type of activity
Back pain
Use a walking stick or Scandinavian walking poles; try a weight-supportive activity
Hypoglycaemia (in diabetics)
Talk to your doctor about reducing medication accordingly; carry some food or a carbohydrate drink
No time because of work pressures
Carry a micro-tape recorder and work while you walk; remember that an activity break can increase your productivity anyway.
Paul is an ex-first-grade rugby player who wanted to lose weight, but complained that he couldn’t walk because of damaged knees from playing rugby. A rugby teammate who is an orthopaedic surgeon had offered to operate but Paul wanted to try other options. He was advised to walk several laps a day in waist-deep water and to change his diet. This combination has helped him avoid the knife for over two years at the time of writing.
SUMMARY In summary, physical activity for weight loss is not necessarily the same as exercise for fitness. Basically, it boils down to movement—and the more the better. There is no maximum amount, but the minimum is considerably more than what you are doing now. Type of activity is also not so important, although exercise that involves the body supporting its 97
Becoming Gutless Text pages 24/8/06 10:21 Page 98
BECOMING GUT LESS
own weight (such as walking) or exercise at which you are less ‘efficient’ is going to use more energy than exercise where the body weight is supported (such as cycling, swimming and rowing) or where you have already developed a level of fitness or efficiency. Finally, a lifetime of regular movement has consistently been shown to be one of the most effective long-term weight-loss strategies. So go forth and get (more) active.
98
Becoming Gutless Text pages 24/8/06 10:21 Page 99
Chapter 9 PLATEAUS, MOTIVATION AND TRADE-OFFS: GOOD NEWS OR BAD?
If you’ve ever lost weight over an extended period, you will no doubt have reached plateaus, where weight loss appears to stop. This is perfectly natural. It’s nature’s way of stopping you from disappearing altogether. Still, many people give up at this stage, believing that their efforts have come to nothing. In fact, your body wouldn’t be working properly if you didn’t reach a plateau. It might happen after a week, or a month, or six months. But one thing is for sure. Unless you have only a little fat to lose, you’ll plateau at least once—and possibly several times over several months or years— before you get down to your goal weight. As we saw in Chapter 6, plateaus 99
Becoming Gutless Text pages 24/8/06 10:21 Page 100
BECOMING GUT LESS
are inevitable if weight loss continues over time. In addition, there are big differences between individuals in the rates at which plateauing occurs. (There is remarkably little on weight-loss plateaus in most weight-loss programs, and even in the scientific research. Most of the information discussed in this chapter comes from the experience of dealing with several thousand weight-loss cases.) If you look at the graph in Figure 9.1, you’ll see what I mean. Most diet programs assume that you’ll keep losing weight in a continuous fashion, as indicated by the straight line labelled ‘expected loss’ at the left of the graph. Of course, this is not so. Unless you have only a little to lose, you’ll come down in stages, as shown in both of the bent lines. As you will see from the top line, the longer you’ve carried the extra weight, the more likely it is that the decreases will be smaller and the plateaus longer. Although not always the case, females tend to lose more slowly, with longer plateaus, as indicated by the top line in Figure 9.1. Those who have only recently gained the weight they want to shed, on the other hand, can lose relatively quickly, with no plateaus or limited, brief plateaus, particularly if the gains in weight have been small. If you consider that the average Australian has been gaining around a gram a day since 1980,1 being on a plateau, while perhaps not ideal for someone itching to lose more, still means that you’re actually winning! It’s only if you start to put on weight that you begin to ‘lose’ again. The more Figure 9.1 Plateaus in weight loss
Actual loss (females and long-term obese)
Fat loss
Actual loss (short-term over fat)
Goal
Expected loss Time
100
Becoming Gutless Text pages 24/8/06 10:21 Page 101
PLATEAUS, MOTIVATION AND TRADE-OFFS
gradual the loss, the smaller the likelihood of plateauing and the smaller the likelihood of bouncing back fatter than ever. So don’t be disillusioned by a gradual but steady waist loss. Rather, try to understand pleateaus and how to break through them and continue losing.
DEALING WITH PLATEAUS A plateau is a period of adjustment during which the body adapts to changes you have made in terms of energy input (food) and/or energy expenditure (exercise). With exercise, for example, increased fitness and a decrease in body weight mean the body needs less energy to carry out a set activity than it did before the exercise began, with the result that it burns less fat. As weight decreases, less food is required to maintain that weight. If food intake isn’t decreased, a levelling of weight loss, or a plateau, is likely to occur. So body fat levels are designed to reach a point of equilibrium— this is to stop animals losing weight to the point of death. The key to success in any long-term fat-loss program is to understand that while you’re on a plateau you’re winning! If you think about it, this is a reasonable attitude for the body to have. It has, after all, helped us survive famines and droughts throughout our history and enabled us to secure food when it is scarce. Can you imagine, for example, chasing a kangaroo (or some other form of ‘live lunch’) for kilometre after kilometre if weight loss were directly proportional to distance travelled? By the time you eventually wore your quarry down, you’d be too emaciated to eat it! Increasing fatigue with increased effort is another form of physiological adaptation that prevents us from selfdestructing. George had been a big guy all his life. He started a weight loss program at 48 with a waist of 145 cm, but although he followed the program conscientiously he achieved no significant waist loss in the first six weeks. After being told he was on a plateau before he had even started to lose because his body was so good at defending the weight it had become so used to, he was encouraged to persist with what he was doing. As a result he dropped 20 cm in the next six months, demonstrating that although plateaus in weight loss can occur at any time, they can eventually be broken.
101
Becoming Gutless Text pages 24/8/06 10:21 Page 102
BECOMING GUT LESS
Because plateaus are a form of adaptation, getting off a plateau means doing something to oppose the body’s adaptation. This calls for change of some kind. It can be in the amount (and even type) of food eaten or the type, frequency, intensity or duration of exercise carried out. If you’ve been walking up to now, try swimming or cycling just to ‘unblock’ the system and break through that plateau. If you’ve been eating only local food, try some Mongolian or Lithuanian (low fat, of course). Once you’ve broken through the plateau, you can go back to doing what you were doing, albeit in different quantities. But remember, make sure it’s something you can do for the rest of your life.
MOTIVATION, PLATEAUS AND ‘DOWNERS’ Motivation is a key component of success in any weight-loss program. But motivation is a dynamic as well as an intra- and interindividual variable. Being dynamic means that it can, and generally does, change over time. In most cases, motivation can be expected to wane, and therefore have to be topped up every now and then with support or reinforcement. But this is not always the case. Significant gains in progress towards a goal can sometimes lead to both quantitative increases in levels of motivation and qualitative changes in the type of motivation required. Brian joined a weight-loss program at a time when he had gone bankrupt, one child was in trouble with the law and his wife was about to leave him. After making no headway in the early stages, he asked why nothing was happening. He was advised that this was not the right time in his life to think about managing his weight. He was referred for counselling to deal with his other problems and advised to take another look at his weight problem once they had been resolved.
For someone who is very out of condition and used to a high food intake, the early stages of change needed to turn things around for weight loss can be difficult. Certainly, there will be some discomfort with any new or intensified form of exercise. Therefore motivation might be difficult to maintain and might need to be extrinsic, or external to the individual, such as from peer and family support. As your program progresses, however, your weight begins to drop and your fitness to increase and motivation might become more intrinsic. Instead of working to incentives such as looking better or being able to fit into a new pair of trousers, you might find the actual process—eating more healthily and being more active—becomes 102
Becoming Gutless Text pages 24/8/06 10:21 Page 103
PLATEAUS, MOTIVATION AND TRADE-OFFS
rewarding in itself, making it easier to press on with the changes that will lead to more benefits. Feeling the effects of wellbeing can be enough reward in itself to stay on course. Table 9.1 Motivational self-statements Motivation is a state of mind. Here are some tips to help you achieve the right state of mind for weight loss: • Stick it up the rest of the world. This is for me, numero uno, premier don, number 1. • Imagine how good it will be to meet up with an old friend again. • Remember that life is just occupational therapy from birth till death (so don’t get hung up in the raffia used in the basket weaving). • Live each day as if it’s your last (because let’s face it, with your problems it could be). • Tell somebody close to you what you’re doing. • Think of all those people dependent on you (then think of yourself). • Everyone falls off the wagon from time to time. The ones who ultimately succeed get back on. • Set yourself a personal best (such as a certain number of steps per day). Then set out regularly to beat it. • Imagine how embarrassing it would be to have to go out in a coffin specially shaped to fit your gut. • If you can’t enjoy what you do, do what you enjoy. • Enjoy the journey and the destination will look after itself. • Think about what motivates you most and then think of it in terms of what you can gain from weight loss.
While motivation levels can, and usually do, change within an individual over time, the factors influencing motivation can also vary greatly between individuals. Physical appearance might be the motivating force behind the actions of one man, while being able to play with his kids might be the stimulus for another. Even so, motivational drive is likely to wax and wane, and while this might not be all that significant, it can be tricky if a waning, otherwise known as a motivational downer, coincides with a significant weight-loss plateau, as shown in Figure 9.2. 103
Becoming Gutless Text pages 24/8/06 10:21 Page 104
BECOMING GUT LESS
Figure 9.2 Plateaus and motivation Fat loss Fat loss plateau
Fat loss
Motivational downer
Motivation level
Danger period Time
A plateau coinciding with a downer is a real danger period in any weight-loss program. When this happens, however, it is important to recognise that it is neither permanent nor personal. It might go on for days. It might last for weeks, but it is unlikely to last forever. It is also something that happens to everyone, so it shouldn’t be thought of as something peculiar to you. Knowing this can help you refocus your attention on the business at hand and prevent you forfeiting all the benefits gained to date. Motivation varies between individuals. Geoffrey found it difficult to get motivated once he’d fallen off the wagon until a PT doctor he was working with realised money was his motivational soft spot. He put $200 he obtained from Geoff in an account and drew up a contract saying that if Geoff didn’t go to his gym at least three times a week for the ensuing month, he would lose the $200. He did go and he did manage to restore his motivation.
MOTIVATIONAL TIPS There are two main periods in any weight-loss program, during which motivation can be a key issue: early in the program, when the novelty of trying something new wears off and the difficulty of sustaining long-term behaviour change becomes apparent, and during a plateau, or levelling off of weight loss. Some tips to help you through these stages are given below. 104
Becoming Gutless Text pages 24/8/06 10:21 Page 105
PLATEAUS, MOTIVATION AND TRADE-OFFS
Motivational tips 1. Use the mate system. Having someone to share the ups and downs can lessen your chances of falling off the wagon. 2. Record your progress. Self-monitoring of food eaten and physical activity carried out is one of the most effective ways of ensuring behaviour change. 3. Reward effort. Reward yourself for reaching various milestones; they might be associated with the processes carried out (achieving a set number of steps per day, for example) or with outcomes achieved (a 5% reduction in waist size). 4. Emphasise short-term goals. Short-term goals such as a 1% decrease in waist size per week are more immediate and reinforcing than more unrealistic long-term goals. 5. Use variety. In any lifestyle change routine, boredom is likely to set in. One way of preventing this is to vary foods and meals and try new and/or different forms of exercise. Type of exercise is less important than amount. 6. Plan ahead. Planning for eating and exercising contingencies at least a day ahead means disruption of your routine will be less likely. 7. Use time wisely. Lack of time is a common excuse for not sticking to a lifestyle change program. Using time wisely, such as working with a hand-held tape recorder while walking, can help counteract this. 8. Understand your motivational ‘soft spots’. Motivation is different for everybody. A soft spot for some might be material reward; for others it might be personal gratification. Understanding your own soft spots can help you use them to best effect. 9. Be flexible. Being inflexible is a sure route to failure in weight control. Be flexible enough to try different approaches and enjoy what you are doing.
TRADING OFF The idea of not being able to enjoy a drink stops many a man from trying to trim down. And although alcohol itself is not likely to have caused their so-called beer guts, there are other reasons why alcohol might be counter105
Becoming Gutless Text pages 24/8/06 10:21 Page 106
BECOMING GUT LESS
productive. Alcohol can slow down the rate at which fat is burned in the body. And because it doesn’t take much energy to convert fat in the blood to fat on the body, alcohol in combination with a fatty diet can mean even more fat gets deposited on the belly. So instead of fat in the diet being used for energy, it fills the fat cell reservoirs around the waist. If there was no fat in the diet, there would be negligible fat stored in the fat cells. But because it’s almost impossible (and undesirable) to get rid of all the fat in the diet, there’s likely to be some available for storage if alcohol intake is high. Also, it’s easy to eat fatty foods (such as chips and peanuts or cabanossi and crackers) with alcohol. You’re not very likely to have an apple or a fruit salad with a beer, after all. If alcohol is consumed with sugary mixes (such as soft drink or fruit juice) the problem is made worse. The sugar in these, together with the alcohol, provides the body with so many kilocalories that any fat in the diet is sent for storage in the fat cells. These drinks are energy dense, and should be avoided in favour of diet drink mixes or non-calorific mixes such as water or ice. Alcohol also decreases your inhibitions and self-control. So while you might stoically refuse even to look at those crisps on the bar before you’ve had a drink, the more drinks you have the more tempting they’re likely to become. There’s also the compensatory effects of alcohol. While you’re drinking, you’re not likely to be moving. And it’s movement that burns up fat. Finally, for reasons as yet unclear, alcohol tends to increase subsequent cravings for fatty foods. Have you noticed how you never crave a fresh salad sandwich after a big night out? It’s always something more greasy, like bacon and eggs. And it’s this that causes the so-called beer belly. Reasons why alcohol can make you fat Alcohol per se is not fattening (no conversion of alcohol to fat takes place in the body). However, as alcohol is combined with food in the diet, there are indirect ways in which it can be fattening: 1. Alcohol is generally consumed with fatty foods. 2. Effects of added sugary mixes (such as soft drink, fruit juices). 3. Alcohol might slow fat metabolism. 4. Alcohol decreases inhibitions and control and so might lead to your eating and drinking more. 5. Movement levels are reduced while drinking. 6. Heavy drinking can lead to post-alcohol cravings for fatty food. 106
Becoming Gutless Text pages 24/8/06 10:21 Page 107
PLATEAUS, MOTIVATION AND TRADE-OFFS
Fortunately, you don’t have to give up all the good things in life. What’s the point of making your life miserable? You can enjoy a drink and lose weight. But it means making some trade-offs. We’ll look at these soon, but first let’s look at how much alcohol there is in different drinks and why you might need to cut back. Alcohol is measured in terms of a ‘standard drink’. A standard drink, whatever its volume, packs around the same alcoholic punch as other standard drinks—the volume of various drinks that all have the equivalent of about 10 grams of alcohol is shown below. Standard drink sizes and types Beverage
Serve
Low-alcohol beer Ordinary beer Table wine Fortified wine Spirits
2 × 285 ml (middie) 1 × 285 ml (middie) 1 × 120 ml (4 oz) 1 × 60 ml (2 oz) 1 × 30 ml (1 oz)
Alcohol g 10 (2 × 10-oz) 10 10 10 10
Alcohol isn’t the only component of a drink that determines its kilocalorie content. Some drinks are rich in sugar. As you can see from the following breakdown, some drinks are higher in kilocalories than others. Energy content of various drinks Beverage
Serve
Kcal
kJ
Low-alcohol beer Regular beer Regular beer Stout Table wine Fortified wine 1 nip spirits
285 ml middie (10 oz) 285 ml middie 370 ml can 285 ml middie 125 ml (4 oz) glass 60 ml (2 oz) glass 30 ml (1 oz) (with nothing added, except water or soda) 250 ml glass 370 ml can 370 ml can
70 105 140 160 85 80 60
294 441 588 672 357 336 252
90 160 200
378 672 840
Orange juice Cola (sugared) Orange-flavoured soft drink
107
Becoming Gutless Text pages 24/8/06 10:21 Page 108
BECOMING GUT LESS
Fruit juices, cordial and soft drinks, for example, are even higher in kilocalories than some alcoholic drinks. When they’re added to alcohol (for example, brandy and ginger ale, rum and cola, gin and tonic or champagne and orange juice), the calorie content is correspondingly higher. Even among beers, there’s a difference in kilocalorie content. Some people ask if they should switch from beer to spirits. Beer contains a little more sugar than spirits but so little that it’s irrelevant. However, spirits are often consumed with sugary mixer drinks. Some people find they drink less when they switch to spirits, others drink more because the drinks are smaller and less filling. Stick with whatever you’re able to drink in the smallest quantities. Wine is also a popular drink, and some people wonder if it matters which wine they choose. From the point of view of kilocalories, it makes very little difference. Sweeter wines have almost the same kilocalorie value as dry wines. To be able to enjoy a drink AND lose weight, you’ll need to do some trade-offs in the type of food you eat and the amount of exercise you do. As a rough guide, one 10 oz glass of beer is roughly equivalent to walking or jogging 1.5 kilometres (about a mile), although the effect of the exercise on metabolic rate might mean you don’t have to go quite that distance. Alternatively, a 10 oz glass of beer is equivalent to a couple of biscuits or a small piece of cake. To cancel out having up to four beers a day, you can decrease the amount of biscuits, cake or equivalent fatty food you eat or increase your walking. The chart below gives you an idea of what and how much you can trade off. Table 9.2 The beer drinker’s trade-off guide If you drink
you must daily
you should also
1 alcoholic drink a day (1 middie beer or 1 nip spirits with diet mixers)
• eat low-fat foods • reduce soft drinks and • fruit juices to 1–2 day
• walk 10 mins a day and • walk instead of drive • or ride •
2 alcoholic drinks
Do all the above PLUS: • cut out cakes/biscuits • with morning or after• noon tea • eat more fruit/vegies
108
• • • •
walk 20 min a day reduce fried foods and size of meat serve eat more fish
Becoming Gutless Text pages 24/8/06 10:21 Page 109
PLATEAUS, MOTIVATION AND TRADE-OFFS
3–4 alcoholic drinks a day*
• remove chicken skin and cut all fat off meat • do not add sugar—you can use sugar substitutes Do all the above PLUS: • do not skip meals and • walk (or do otherwise • never miss breakfast • aerobic exercise) • eat a light salad lunch • 40 mins a day • reduce meat/protein • walk up stairs (don’t • avoid sweets or substitute • use escalators) • fruit, and never eat • change TV channels • after dinner manually • use spreads (butter/ • don’t ask the kids to fetch • margarine) thinly things—get them yourself! • • have 2 AFDs (alcoholfree days) each week
* World Health Organisation authorities warn that more than four alcoholic drinks a day can be a health risk. Three drinks in an hour can also raise blood alcohol in men above levels safe for driving. Women’s blood alcohol levels will be too high for safe driving at lower levels than this and alcohol is a strong risk factor for breast cancer in women.
SOFT DRINKS AND FRUIT JUICES Many working men who want to lose weight fall into the trap of cutting back on alcohol and drinking soft drinks, such as cola, instead. Some men even skip breakfast or lunch to try to lose weight. It’s not uncommon for such men to have up to ten—or even twenty—bottles of coke in a day! Soft drink is often more of a problem for men wanting to lose weight than beer or alcohol. Most people think of fruit juices as healthy, and they are because they contain more vitamins than soft drink. But fruit is high in fruit sugars, and when juice is separated from the fibre of the fruit, the bulk is reduced and it becomes easy to take in all the sugar and kilocalories from three to four pieces of fruit in one drink. This might be fine for someone who’s not fat, but it’s not much use to anyone trying to solve a waist problem. 109
Becoming Gutless Text pages 24/8/06 10:21 Page 110
BECOMING GUT LESS
There’s no real need to drink fruit juices. The hype that says you must have orange juice for breakfast is a bit of a con. It’s better to eat a few pieces of fruit (say, three to four a day) and get your fibre intake up. Fruit cordials are even worse, because they have concentrated sugar in place of most of the nutrients of the fruit. The obvious solution is to cut back on, or cut out, regular soft drinks, fruit juices and cordials. Your best alternative is water or mineral water. They have no calories. If you can’t stomach these and you really want a sweet drink, diet drinks are the next best thing. They have no kilocalories, although some researchers have found that their artificial sweeteners might increase appetite so you end up eating more than you’ve saved by having the low-energy drink. For those who don’t find that these drinks increase their appetite, they might be useful. Fat is a great insulator, so an overweight man gets hot easily. When this happens, you sweat and then you need to replace the lost fluid. If you replace fluids with alcoholic drinks, soft drink or fruit juice, you’ll take in lots of energy. If you have a high fat content in your daily food intake on top of this, you’ll get fatter, sweat more, drink more of these drinks and continue in a vicious cycle. Alcohol is also a diuretic—it makes you lose more fluid in urine than the drink provides. Far from rehydrating the body, alcohol causes dehydration, as you’ll know from the amount of time you spend at the urinal in any pub. If you’re going to drink alcohol, always drink water first, especially if you’ve been sweating heavily. Water is not a diuretic (like alcohol) nor is it high in sugar (like fruit juices or cordials). Drinks intake questionnaire 1. How often do you drink alcohol? (circle a number) 4. Every day 3. 4–5 days a week 2. 2–3 days a week 1. 1–2 days a week 0. Never 2. When you drink alcohol how much do you usually drink ( 1 standard drink is a middie of beer, 1 nip of spirits or 1 glass of wine)? 4. More than 10 drinks 3. 5–10 drinks 2. 2–4 drinks 1. 1–2 drinks 0. None 110
Becoming Gutless Text pages 24/8/06 10:21 Page 111
PLATEAUS, MOTIVATION AND TRADE-OFFS
3. How often do you drink soft drinks (don’t count diet drinks)? 4. Every day 3. 4–5 days a week 2. 2–3 days a week 1. 1–2 days a week 0. Never 4. When you drink soft drinks (not counting diet drinks) how much do you usually drink? 4. More than 10 drinks 3. 5–10 drinks 2. 2–4 drinks 1. 1–2 drinks 0. None 5. How often do you drink fruit juices? 4. Every day 3. 4–5 days a week 2. 2–3 days a week 1. 1–2 days a week 0. Never 6. When you drink fruit juices how much do you usually drink? 4. More than 10 drinks 3. 5–10 drinks 2. 2–4 drinks 1. 1–2 drinks 0. None Scores: Multiply questions 1 × 2; 3 × 4; and 5 × 6. If you scored 1 or less than 1 on any combination, your weight doesn’t seem to be affected by your drink intake. If you scored from 1–4 on any combination your weight might be affected either by alcohol (Q1 × 2), soft drinks (Q3 × 4) or fruit juice (Q4 × 5). If you scored more than 4 on any combination, your weight is definitely affected either by alcohol (Q1 × 2), soft drinks (Q3 × 4) or fruit juice (Q4 × 5). 111
Becoming Gutless Text pages 24/8/06 10:21 Page 112
BECOMING GUT LESS
Having said all that, it is also important that if you’re a drinker and intend to make the most of the Becoming Gut Less men’s program, you should not go off alcohol (unless, of course, you really want to). You’re unlikely to remain abstemious for the rest of your life and, in line with the principles of this program, to lose your gut successfully you need to make permanent changes. Once you come back to drinking, everything else you have been doing will go out the window. So it’s important that you learn to live with and enjoy your drink. You will no doubt find it encouraging to remember that it’s not the alcohol but the food that goes with it that’s likely to make you fat. All this goes with the proviso that alcohol should not be used either before or immediately after any form of strenuous exercise. First, the bloodpressure lowering effects of alcohol can have dangerous consequences where exercise is carried out after drinking. Second, after exercise, the body can become dehydrated, and drinking alcohol before rehydrating with other fluids can lead to a higher level of intoxication, which involves risk, particularly if you are driving. Many sportsmen, particularly footballers, have come to grief by raising their blood alcohol content above the limit by drinking immediately after a game when they are dehydrated.
OTHER FLUID INTAKE Because the body is 70% water, which constantly needs topping up, a regular intake of water is advisable for any weight-loss program. This is particularly so with an increased fibre intake, because water will help pass undigested fibre through the system, thus avoiding potentially painful constipation problems. A regular intake of around eight glasses of water a day is often considered the ideal for good health. But this number varies considerably according to the weather and your age and gender. Fluid in some form, whether it be water, juice or any other liquid, is vital for life. It’s also an important part of the body’s cooling mechanism (through sweat) during exercise, so intake should be kept high during any weight-loss program that involves exercise. This doesn’t mean, however, that water in itself will promote weight loss. There’s nothing especially anorexic (weight reducing) about water, except when it is taken instead of other higher-energy fluids. Tea and coffee consist predominantly of water, and therefore can have value as fluids. They also provide a mild form of stimulation, which could have some value in weight loss. However, like alcohol, tea and coffee can have a diuretic effect, resulting in the need for even more fluid. Because 112
Becoming Gutless Text pages 24/8/06 10:21 Page 113
PLATEAUS, MOTIVATION AND TRADE-OFFS
excessive caffeine (about 10 strong cups of coffee a day) can cause irritability and jitters, any benefits of caffeine are counteracted if you drink too much. However, a moderate intake of either tea of coffee is no problem, and might even have some advantages for a weight-loss program. In summary, alcohol can be enjoyed in moderation while you continue to lose fat. The secret is to balance any extra energy intake (particularly soft drinks) with extra energy output, such as walking and a good, sensible, lowfat, high-fibre diet.
113
Becoming Gutless Text pages 24/8/06 10:21 Page 114
Chapter 10 GETTING FURTHER HELP
If you’re thinking that this is all too hard and you’d like a simple, effort-free way of losing weight, you might be tempted to go for a medical solution. Surely, in this age of magic pills and miracle cures, you might think there would be a simple answer to something as basic as being overweight. Unfortunately, your chances of a quick fix are slim (if you’ll pardon the pun). Being overweight, in the majority of cases, is a lifestyle problem, albeit with some genetic and a lot of environmental help. It usually takes years to develop. So expecting to cure it overnight is a bit much. However, there are a few medical approaches that do hold some promise, but only when used as adjuncts to changes in lifestyle. The most promising among these are considered below. 114
Becoming Gutless Text pages 24/8/06 10:21 Page 115
GETTING FURTHER HELP
PRESCRIBED DRUGS After almost 50 years of scientific experimentation, it’s hard to believe that we currently have only one or two drugs that can be honestly recommended for long-term weight loss—and even these can’t be expected to have a great impact by themselves. Like all the other medications in this area that have come and gone over the years, none of the drugs available at the time of writing started life as weight-loss medications. Xenical (orlistat) began as a cholesterol-lowering medication. It absorbs about 30% of fat eaten in the diet and passes this out through the stools. It is a type of new-generation ‘behaviour modification’ drug, where the side effects are the desired goal. These side effects help reduce total intake of fat in the diet. After experiencing the discomfort of having loose stools (otherwise medically known as steatorrhoea) from eating fatty food, those on the drug learn to abstain. Reductil (sibutramine) was prescribed as an antidepressant until the medical fraternity noticed that while it didn’t seem to work very well on depression, it did cause weight loss in depressed patients. This is not unusual for the modern generation of antidepressants known as SSRIs (serotonin sensitive re-uptake inhibitors) and SNRIs (serotonin and nor-adrenergic re-uptake inhibitors). Because stress, anxiety and depression cause many people to overeat and become inactive, some of these drugs have a weight-loss effect, supposedly by reducing hunger levels, but probably just as much because of their effect on parts of the brain associated with feelings of wellbeing. One problem with this approach, however, has been that since these are centrally acting drugs, unwanted side effects are common. Adifax (dex-fenfluarmine) was withdrawn from the market in a rush in the mid-1990s after several fatalities occurred in users. Reductil itself faces a rocky future. After being refused licensing in Australia twice because it is known to increase blood pressure in some people, the drug is again under suspicion after reported deaths overseas. It was withdrawn from the market in Italy in early 2002 and moves were being made in the US at the time of writing to have it withdrawn there. Because it has no centrally acting effects, Xenical is less likely to have the adverse side effects of antidepressants. Zyban (buproprion) seemed to be effective at helping smokers quit without large weight gains, but here, too, there are concerns about side effects if the drug is used too extensively. Two other amphetamine-like medications, Duramine and Phentamine, are still used by some doctors, but their addictiveness and the speed with which people taking them become tolerant (meaning that more and more is required to get the same effect) make these questionable in the long term 115
Becoming Gutless Text pages 24/8/06 10:21 Page 116
BECOMING GUT LESS
too. They also tend to be associated with a bounce-back effect of weight gains once they are discontinued. The efforts of pharmaceutical manufacturers to find a drug solution to being overweight will no doubt be redoubled because of the sizeable pot of gold at the end of that rainbow. However, repeated empty claims, such as with Leptin, the hunger-relieving hormone discovered in 1994, have made obesity experts a little more sceptical about this approach as a solution to the problem, particularly without major lifestyle changes.
INDICATIONS FOR PRESCRIBED DRUGS Weight-loss medication is one area in which manufacturers’ directions are not always to be taken as gospel. A good health professional might prefer to use the available medications under the following circumstances: 1. Xenical can be used as a learning drug for patients who might think they have a low-fat diet. As fat intake is usually low early in the day, the cost of the drug can be minimised by concentrating on the main meal, particularly when this is eaten out. 2. Although this is not indicated in the prescription information, Xenical and Reductil can both be useful in the short term to break through weight-loss plateaus. Using these drugs this way also means their costs won’t be prohibitive. 3. Other weight-loss drugs such as Duramine and Phentamine may be used on rare occasions in the short term to achieve a quick weight loss in patients where early success is important for motivation. However, this should be followed up with close and strict lifestyle supervision. 4. New medications are more than likely in the future. Because of the history of weight-loss medications, these should be regarded with scepticism, particularly in the absence of lifestyle changes.
OVER-THE-COUNTER (OTC) PREPARATIONS OTC preparations for weight loss abound. Indeed, as soon as one lot disappears (usually because of a lack of success), a new ‘miracle cure’ pops up. Most have herbal ingredients, and there is theoretical evidence that some of these might aid in weight loss. However, unlike prescribed medications, OTC products do not have to undergo any rigorous testing process and so there is little evidence, apart from manufacturer’s claims, that they work. While it is always possible that one of these products might be successful in 116
Becoming Gutless Text pages 24/8/06 10:21 Page 117
GETTING FURTHER HELP
the future or that an existing product does have some effect, there is currently no evidence that this is so. The dictum therefore is ‘buyer beware’.
VERY LOW ENERGY DIETS (VLEDS) Liquid diet formulae have been around for some time, but they are not universally recommended because of their variable nutritional value. Most that are sold without supervision are likely to have a counterproductive effect in the long term, with the patient putting back more weight than he or she loses. Under strict supervision and with the right professional assistance, however, the right type of formula diet can be useful, particularly where initial weight loss appears to be difficult or where a weight-loss plateau seems to be arresting progress. Low-energy diets, LEDs (that is, less than 1200 kcals (5000 kJ) a day) or very low energy diets, VLEDs (that, is less than 800 kcals (3300 kJ) a day), obviously can’t be used indefinitely. They also make socialising difficult and do little for food cravings that are psychological rather than physical. However, they can be used in short bursts, provided the follow-up is managed extremely carefully by an experienced professional. Careful re-feeding with gradually increasing amounts of food should follow the use of these products and an experienced professional, such as a Professor Trim doctor, should be consulted to ensure this is successful. Phil is a bachelor who, by his own admission, is no cordon bleu chef. He had lost about 10 cm (he started at 132 cm) but had plateaued at 122 cm and he was unable to lose any more. Because it was no great social restriction, Phil’s PT doctor prescribed a VLED for one month. In that time Phil lost another 10 cm, which he has been able to maintain thanks to a well-supervised gradual re-feeding program.
Indications for ver y low energy diets Low energy and very low energy diets can consolidate weight losses where: 1. they are used for short periods to help break through weight-loss plateaus 2. changes in diet and exercise do not appear to be working 3. the individual is willing to sacrifice normal eating for a while and is not likely to be placed under social pressure to eat 117
Becoming Gutless Text pages 24/8/06 10:21 Page 118
BECOMING GUT LESS
4. there will be close supervision by an experienced health professional who can provide a gradual re-feeding routine at the end of the dieting period.
SURGERY Surgery is a well-recognised last resort for very obese individuals with lifethreatening illnesses associated with their weight and with a history of failure on other programs. In the past decade, a surgical method known as laproscopic (lap) banding has become popular—and increasingly effective—in motivated patients who are closely supervised post-operatively. Lap banding is an ingenious technique involving the introduction of a small silicon band around the top of the gastro-oesophageal junction or the pipe channelling food from the mouth to the stomach. By leaving a small sack just under the skin the doctor is then able to inject or remove silicon with a needle, making the band around the oesophagus smaller or larger and thus letting more or less food pass into the stomach. This means the patient can eat only a certain amount of food without incurring discomfort. However for some reason, not yet known, the restriction of the band can also reduce hunger. With other supervisory help, this can result in weight losses of up to 35% of total body weight over one to two years and a significant cost saving for governments since the procedure reduces the need for medication (for example, for diabetes) for these patients while they are obese. Lap banding is now a relatively simple operation, but it is expensive (up to $5000) and there are long waiting lists for those who elect to have it. It’s also only for use in extreme cases where all other methods have failed. Finally, the motivation of the patient is paramount—there are stories about patients mulching chips or melting chocolate to get them past the lap barrier. Obviously, if you’re that desperate, nothing short of a cement block in your mouth will stop you eating. Swedish obesity experts have been doing surgery for obesity for over 15 years now. As a result, they are able to examine the long-term effectiveness and cost effectiveness of the significant weight losses (up to 35% of initial body weight) surgery can achieve. Their figures show a 50% decrease in medication in people who lose more than 15 kg, compared with those who lose less than 5 kg. So although the procedure is expensive, it proves itself in fact to be very cost effective within about five years.
118
Becoming Gutless Text pages 24/8/06 10:21 Page 119
GETTING FURTHER HELP
Indications for surger y Although other forms of surgery are available, lap banding is usually the preferred option and might be considered when: 1. everything else has failed 2. obesity is extreme and there are accompanying life-threatening morbidities such as diabetes and heart disease 3. the individual is sufficiently motivated to make appropriate lifestyle changes with the surgery 4. there is strict and close supervision by an experienced health professional during the ensuing years.
SUMMING UP AND FURTHER HELP While there are no over-the-counter drugs that have been proven to have any long-term effect on weight loss, prescribed medications with supporting research evidence do make an appearance from time to time. These can be useful aids to lifestyle changes but are not magic solutions in themselves. A Professor Trim doctor can recommend when and how to use those that are available, as they become available. New medications will no doubt come on the scene, but it’s a mistake to think that the obesity problem can be cured by pharmaceuticals alone, and the sooner this is appreciated by all concerned the sooner we can get down to the real solution. Low-energy (LEDs) and very low energy diets (VLEDs) can also be useful for some people, particularly where weight loss has stalled. It is vital, however, for these to be used in consultation with an experienced health professional. Personal use, without supervision, can result in even greater weight gains in the long term. Obesity surgery can be extremely effective, but it is usually a ‘last resort’, and only recommended for the morbidly obese who also have life-threatening illnesses. In these cases, however, the patient would do best to use an experienced surgeon—such as those linked with the Professor Trim program and listed on the www.professortrim.com website—and then keep to the program, working closely with a participating GP. Finally, with any large, sudden weight loss, a folate or multi-B vitamin supplement is recommended, to prevent any rise in the dangerous heart disease-related protein called homocysteine. These supplements should also be taken under the strict supervision of a health care professional experienced in weight loss. 119
Becoming Gutless Text pages 24/8/06 10:21 Page 120
BECOMING GUT LESS
All these techniques can be useful under the right circumstances. However, there is no escaping the fact that successful long-term weight loss usually involves the kind of lifestyle change outlined in the second section of this book and in the Becoming Gut Less program supervised by your doctor. Even then, weight loss needs to be seen as a long-term problem requiring a lifetime solution. Weight loss, when viewed as a short-term fix, can all too easily result in a worse weight problem down the track.
120
Becoming Gutless Text pages 24/8/06 10:21 Page 121
Becoming Gutless Text pages 24/8/06 10:21 Page 122
Becoming Gutless Text pages 24/8/06 10:21 Page 123
APPENDIX I Joining Professor Trim’s Medically Supervised Weight-Loss Program Becoming Gut Less is the workbook for Professor Trim’s Becoming Gut Less program for men. The program is run on a shared-care basis with accredited general practitioners around Australia. The program can be ordered directly, but is available at a significant discount through participating GPs, who have access to qualified weight coaches for personal training and advice, a very low energy diet program, and specialist obesity surgeons. Accredited GPs are listed by location on the Professor Trim’s (PT) website (www.professortrim.com). The full PT Becoming Gut Less program includes not only regular assistance from your doctor, but ongoing help through a packaged program, the Internet and a toll-free help line for one year. Ongoing maintenance is also available. Your at-home package includes: • 6 × 30-minute CDs with advice and instruction • 6 accompanying workbooks • a PT tape measure • an Omron PT pedometer • access to the PT Internet site with newsletters, updates and services and real-time feedback on your progress • PT toll-free help line for one year • the unique PT ‘stressometer’. To find out more about the full PT Becoming Gut Less medically supervised program, visit the website at www.professortrim.com or join directly by phoning 1800 100 550.
123
Becoming Gutless Text pages 24/8/06 10:21 Page 124
Becoming Gutless Text pages 24/8/06 10:21 Page 125
APPENDIX II The exerselector questionnaire
Skipping/ stepping
Cycling
Ball games
Personal details Age: Under 35 0 0 0 0 5 0 35–49 0 1 0 0 5 0 50–59 2 3 1 1 1 3 60+ 4 4 9 4 0 7 Body frame: Small/medium 0 0 0 0 0 0 Large 3 2 0 1 0 1 Are you . . . more than a little overweight? No 0 0 0 0 0 0 Yes 4 4 0 3 0 4 . . . an indoor or outdoor type of person? Indoor 7 0 0 0 0 0 . . . Outdoor 0 0 1 1 5 1 . . . self-conscious about exercising in public? No 0 0 0 0 0 0 . . . Yes 5 7 3 0 0 8 . . . competitive? very 3 8 1 2 4 1 moderately 0 5 0 1 3 1 not very 0 0 0 0 0 0 . . . prepared to pay more than $10 a week to exercise? Yes 0 0 0 0 0 0 No 0 4 8 0 1 8
Swimming
Aerobics to music
Minitrampolining
Circuit training
Weight training
Dancing
Walking/ jogging
Instructions 1 Circle the number under each exercise corresponding to the answer in each category. Add scores down the column for each exercise to get your TOTAL TEST SCORES.
0 0 0 0
0 3 5 8
0 0 3 7
0 4 5 6
0 0
0 4
0 0
0 2
0 0
0 5
0 3
0 6
4 2
0 5
6 1
4 0
0 4
0 0
0 4
0 5
3 3 3
8 5 0
5 4 2
0 2 8
0 1
0 0
0 2
0 4 125
Becoming Gutless Text pages 24/8/06 10:21 Page 126
Ball games
Cycling
Skipping/ stepping
Swimming
Aerobics to music
Minitrampolining
Circuit training
Weight training
Dancing
Walking/ jogging
BECOMING GUT LESS
. . . suffering limiting injuries to any of the following? Legs/ankles 9 7 1 5 3 9 1 9 4 7 knees shoulders/arms 1 2 6 4 0 7 3 4 2 5 hip 9 7 1 3 3 9 3 8 3 7 back 5 6 2 4 1 10 2 5 5 6 . . . NOT within easy access (say 15 mins) of any of the following? pool/lake/sea 0 0 0 0 0 0 10 0 0 0 park/open space 5 0 0 0 0 0 0 0 0 0 gymnasium 0 3 9 0 0 5 0 0 0 4 sports facilities 0 0 0 0 0 0 0 0 0 10 safe bike routes 0 0 0 0 0 0 0 0 10 0 . . . prepared to give up daily time 3–4 days a week? less than 20 mins 4 10 5 3 3 9 10 3 5 10 20–40 mins 0 2 0 0 0 2 4 0 1 4 more than 40 mins 0 0 0 0 0 0 0 0 0 0 . . . a person who prefers . . . exercising alone 0 5 0 1 0 10 0 0 0 10 exercising with a friend 1 0 0 1 6 9 2 3 2 0 exercising in a group 2 0 8 1 10 0 2 6 4 0 Total test scores 2 Calculate your INTEREST SCORE for each activity. If you think you’d enjoy carrying out the activity regularly, give yourself an INTEREST SCORE of 100. If you think you may enjoy carrying out the activity regularly, give yourself an INTEREST SCORE of 90. If the activity doesn’t appeal give yourself an INTEREST SCORE of 80. Interest score 126
Becoming Gutless Text pages 24/8/06 10:21 Page 127
APPENDIX II
3 Calculate a FINAL SCORE for each activity by subtracting the TOTAL TEST SCORE from the INTEREST SCORE for each activity. Final score 4 The activity with the highest FINAL SCORE will generally be the most appropriate aerobic exercise for you. If there are several activities at the top falling within about 5 points of each other, choose the one you think you would prefer, or combine them as part of the one program. Exerselector score sheet Write your FINAL SCORES for each exercise in the appropriate position and then rank these from highest to lowest. In the position marked ‘Your chosen exercises’, write the exercises ranked number 1 through 4. This (or these) exercise(s), is (are) the one(s) selected as most appropriate for you. Aerobic activity Walking, jogging Dancing Weight training Circuit, training Mini-trampolining Aerobics to music Swimming Skipping, stepping Cycling Ball games
Final score
Ranking
YOUR CHOSEN EXERCISE(S) 1 2 3 4 Motivation Your FINAL SCORE for your chosen exercise also tells you something about your level of motivation. If your FINAL SCORE was 90 or more, your motivation is high. You should have no trouble with your exercise program. 127
Becoming Gutless Text pages 24/8/06 10:21 Page 128
BECOMING GUT LESS
If your FINAL SCORE was between 80 and 90, your motivation is only average. You may need someone to help push you along, at least in the early stages. If your FINAL SCORE was less than 80, your motivation is low. You’ll definitely need someone to push you along, particularly in the early stages until you are fit enough to enjoy your chosen exercise, not for what it does for you but for itself.
128
Becoming Gutless Text pages 24/8/06 10:21 Page 129
APPENDIX III Some meal and dessert ideas for Becoming Gut Less DINNER IDEAS Vegetable Curry (serves 2) cooking spray curry powder to taste 1 cup chicken stock (or make from 1 teaspoon powdered chicken stock) 1 onion, diced 3–4 small potatoes 1/ 2 pumpkin 1 sweet potato
1–2 carrots 3–4 broccoli florets 1 small zucchini 3–4 cauliflower florets 250 g green beans 1 stick celery 1 capsicum 1 tbsp plain flour 2 tbsp water rice or noodles to serve
1. Spray cooking spray over a large wok. When wok is hot, sauté onion until translucent 2. Add curry powder and chicken stock 3. Dice, slice and chop the remaining vegetables into bite-sized pieces, add to the wok, cook until soft (to speed up the process, part-cook the hard vegetables (potatoes and carrots) in the microwave first) 4. Combine the flour and water, add to the vegetables and heat until the sauce boils and thickens 5. Serve with steamed/microwaved rice or noodles 0 gram fat
129
Becoming Gutless Text pages 24/8/06 10:21 Page 130
BECOMING GUT LESS
Pasta with Chick Pea Sauce (serves 2) 500 g penne pasta 1 tbsp olive oil 1 onion, sliced 1 bay leaf 1 teaspoon dried oregano
2 tbsp capers 1 capsicum 1 × 400 g tin peeled tomatoes 425 g chick peas (tinned or cooked) salt and pepper to taste
1. Cook the penne as per the instructions until al dente, then set aside 2. Meanwhile, heat oil in another saucepan 3. Add onion, herbs, capers and capsicum and cook until onion is translucent 4. Add tomatoes and chick peas 5. Bring mixture to the boil, then reduce heat and simmer for 10 minutes 6. Season to taste 7. Stir in the pasta and serve immediately 2 grams fat per serve Baked Fish Fillets (serves 2) 1 tbsp olive oil 1 onion 1 clove garlic (or 1 tsp crushed garlic) 1 × 400 g tin peeled tomatoes 1 tbsp lemon juice
1 tsp soya sauce 1 tsp black pepper 2 fresh fish fillets e.g., ling or ocean perch cooking spray sprig of dill (optional)
1. Oil a shallow pan dish (which can fit under the griller) 2. Mix all the ingredients except for the fish together and place in the bottom of the pan—this becomes the ‘gravy’ 3. Lay the fish pieces on top of the tomato mixture 4. Give the fish a light spray of cooking spray and bake under the griller, basting with the ‘gravy’ from time to time, for 5 minutes or until the fish begins to flake when prodded gently with a skewer or fork 5. Transfer the fish to a serving dish and spoon the gravy over the top 8. Garnish with a sprig of dill 2 grams fat per serve
130
Becoming Gutless Text pages 24/8/06 10:21 Page 131
APPENDIX III
Spring Vegetable Stir-Fry (serves 4) 1 tbsp olive oil 1 bunch baby carrots 8–12 fresh asparagus spears 1 cup snow peas
/2 cup bean sprouts 1 red capsicum 1/ 2 cup fruity white wine (e.g. Riesling) salt and pepper to taste 1
1. Preheat oil in a large non-stick pan or wok 2. Cut all the vegetables into evenly-sized pieces 3. Heat the oil, then stir-fry the carrots for 1–2 minutes 4. Add the remaining ingredients, and stir-fry until the wine is reduced, and the vegetables are tender 5. Season to taste 1.5 grams of fat per serve Stuffed Capsicums (serves 4) 2 large red capsicums, halved (lengthways), seeds removed 1 tbsp olive oil 1 tsp dried basil (or 1/4 cup chopped fresh basil) 1 small spring onion
2 egg tomatoes, diced 1 cup chopped mushrooms 1 cup cooked rice salt and pepper to taste 2 tbsp low-fat mozzarella cheese
1. While preparing the stuffing, place the capsicums under a hot grill for about 8 minutes, turning occasionally 2. Combine the oil, basil, spring onion, tomatoes, mushrooms, rice and seasoning in a non-stick pan, and stir-fry for 2–3 minutes on a medium heat 3. Divide the mixture evenly between the four capsicum halves, and sprinkle half a tablespoon of cheese on top of each 4. Place under the grill until the cheese begins to bubble and brown, approximately 2–3 minutes 5. Serve as a side dish, or with a garden salad 3 grams of fat per serve
131
Becoming Gutless Text pages 24/8/06 10:21 Page 132
BECOMING GUT LESS
SOUPS Mexican Tomato Soup (serves 4–6) 2 cloves garlic, crushed 1 onion, diced 250 g lean mince beef 1 capsicum (green or red), diced 1 × 300 g tin corn kernels
2 tomatoes, finely chopped 1 × 400 g can peeled tomatoes 1 tbsp tomato puree 1 × 300 g can red kidney beans 11/2 cups water 1 beef stock cube 2 tbsp sweet chilli sauce
1. In a large pot, cook the garlic, onion, mince and capsicum until the meat is brown. Drain off excess fat 2. Add remaining ingredients. Bring to the boil then reduce heat and simmer, covered, for 30 minutes 2 grams of fat per serve DESSERT Cappuccino Creme (serves 4) 3 tbsp custard powder 2 cups skim milk 1/ 2 cup sugar ground cinnamon to taste 3 tbsp top quality instant coffee (optional) 1. Mix the custard powder with a little cold water to form a paste 2. Combine the liquid custard powder and sugar in a saucepan then whisk in the milk. (Don’t do it the other way round as the mixture will go lumpy.) 3. Cook over a medium heat for 3 minutes, stirring constantly. Don’t let the custard boil 4. Dissolve the instant coffee mixture in 1/2 cup of warm water. Slowly whisk the coffee mixture into the custard. Cook over a low heat for 1 minute, stirring constantly, then allow to cool 5. Pour into 4 small bowls or ramekins and refrigerate for at least 2 hours. 6. Sprinkle with cinnamon (if desired) and serve with low-fat ice cream 1 gram fat, plus whatever is in the ice cream 132
Becoming Gutless Text pages 24/8/06 10:21 Page 133
APPENDIX III
Fruit Sorbet (serves 4) /3 cup boiling water /3 cup sugar
2 2
2 cups fruit puree (or 4 cups fresh: summer—peach, nectarines, apricot, passionfruit; winter—mixed berries, oranges, passionfruit)
1. Pour boiling water over sugar in a small bowl. Stir till sugar is dissolved. Cover and chill 2. Blend fruit either individually or together for a fruit salad taste 3. Sieve fruit puree, if necessary. Combine fruit with sugar syrup 4. Either freeze in ice-cream maker according to manufacturer’s directions or mix in an electric mixer (which gets the air in), then freeze until firm 0 gram fat Vanilla Cream (serves 4) /4 cup low-fat cottage cheese 3 tbsp low-fat buttermilk 3 tbsp non-fat plain yogurt 3
3 tbsp icing sugar /4 tsp vanilla extract 1/ 2 vanilla bean, split, seeds scraped from the pod 1
1. Combine all ingredients except vanilla seeds in blender or food processor and process until smooth 2. Add vanilla seeds and refrigerate until firm 1 gram fat per serve Strawberry and Rockmelon Fruit Crush (serves 4) 1 small apple, peeled and cored 8–12 strawberries, hulled
500 g rockmelon, seeds removed ice, cubed or crushed 8 mint leaves
1. Place the apple, strawberries, rockmelon and ice in a blender and process until smooth 2. Add the mint and blend until mint is finely chopped 3. Pour into glasses and serve immediately 0 gram fat 133
Becoming Gutless Text pages 24/8/06 10:21 Page 134
BECOMING GUT LESS
Baked Bananas (serves 6) 6 large ripe bananas, peeled and cut in half lengthways 1 cup sultanas 1/ 3 cup chopped pecan nuts
1 tbsp rum (optional) 1 cup maple syrup 1 tsp vanilla essence 1/ 2 tsp ground cinnamon non-stick cooking spray
1. Preheat oven to 180°C 2. Spray a baking dish with non-stick cooking spray. Place bananas in the baking dish, and scatter the sultanas and chopped pecan nuts into the dish 3. Mix together the rum, maple syrup and vanilla essence, and pour over the bananas. Sprinkle the cinnamon over the top and bake for 25 minutes, basting occasionally, until the bananas are golden 4. Serve with a small serving of low-fat ice cream or low-fat custard 5 grams fat per serve
134
Becoming Gutless Text pages 24/8/06 10:21 Page 135
Garry Egger is Director of the Centre for Health Promotion and Research in Sydney and Adjunct Professor of Health Sciences at Deakin University. He has been involved in health promotion for over 27 years and is the author of more than 25 books. Other books by Garry Egger Egger, G. 2003 Becoming Slimmer: Weight Loss for Women, Allen & Unwin, Sydney Egger, G. and Thorburn, A. 2002 National Clinical Guidelines for Weight Loss and Obesity, National Health and Medical Research Council Publication, Department of Health, Canberra Egger, G. and Binns, A. 2001 The Experts’ Weight Loss Guide, Allen & Unwin, Sydney Egger, G. and Freeman, D. 2000 GutBusters: Low-fat Quick Meals for Blokes, Allen & Unwin, Sydney Egger, G., Donovan, R., Swinburn, B., Corti, B. and Bull, F. 1999 National Physical Activity Guidelines for Australia, National Health and Medical Research Council Publication, Department of Health, Canberra Egger, G. and Albrecht, J. 1998 Gutbusters: Low-fat Barbecues, Allen & Unwin, Sydney Egger, G. and Cate, A. 1998 GutBusters: Low-fat Snacks and Desserts, Allen & Unwin, Sydney Egger, G. and Champion, N. 1998 The Fitness Leader’s Handbook, 4th Edition, Kangaroo Press, Sydney Egger, G. and Stanton, R. 1998 GutBuster Waist Loss Guide, 2nd edition, Allen & Unwin, Sydney Egger, G. 1997 Trim for Life, Allen & Unwin, Sydney Egger, G. and Swinburn, B. 1996 The Fat Loss Handbook: A Guide for Professionals, Allen & Unwin, Sydney Egger, G. and Stanton, R. 1995 GutBuster 2: The High Energy Guide, Allen & Unwin, Sydney
135
Becoming Gutless Text pages 24/8/06 10:21 Page 136
Becoming Gutless Text pages 24/8/06 10:21 Page 137
NOTES Introduction 1 Including International Conference on Obesity: British Medical Journal; International Journal of Obesity; Medical Journal of Australia; Pacific Scientific Convention; European Association for the Scientific Study of Obesity Annual Conference. 2 National Health and Medical Research Council, 2002. National Clinical Guidelines for Weight Control, Commonwealth Department of Health, Canberra. 3 G. Egger and A. Binns, 2001. The Experts’ Weight Loss Guide, Allen & Unwin, Sydney. Chapter 1 1 Australian Diabetes Institute, 2001. Diabetes and Associated Disorders in Australia, ADI, Melbourne. Chapter 3 1 For more details see H. Molly and G. Egger, 1999. Good Skin, Allen & Unwin, Sydney. 2 T. Daneilson, S. Rossner and A. Westner, 1999. ‘Open randomised trial of intermittent very low energy diet together with nicotine gum for stopping smoking in women who gained weight in previous attempts to quit’, British Medical Journal 319: 490–4. Chapter 4 1 From G. Egger and A. Dobson, 2000. ‘Clinical measures of obesity and weight loss in men’ International Journal of Obesity 24: 354–7. Chapter 5 1 G. Egger, R. Stanton and D. Cameron-Smith, 1999. ‘The effectiveness of popular, non-prescription weight loss supplements’, Medical Journal of Australia 171: 604–8. 137
Becoming Gutless Text pages 24/8/06 10:21 Page 138
BECOMING GUT LESS
2 D.B. Allison and others. 2001. ‘Alternative treatments for weight loss: a critical review’, Critical Reviews in Food Science and Nutrition 41(1): 1–28. Chapter 7 1 For example, see R. Young and M. Nestle, 2002. ‘The contribution of expanding portion size to the US obesity epidemic’, American Journal of Public Health 92(2): 246–9. 2 See M.Y. Yao and S.B. Roberts, 2001. ‘Dietary energy density and weight regulation’, Nutrition Reviews 1: 247–58. 3 For a detailed biochemical analysis of this see G. Egger and R. Stanton, 1998. GutBuster Waist Loss Guide, Allen & Unwin, Sydney. Chapter 8 1 G. Egger, N. Vogels and K. Westerterp, 2001. ‘Estimating historical changes in physical activity levels’, Medical Journal of Australia 3(17): 635–6. 2 M. Hayes and others. 2002. ‘Physical activity level in mammals’, American Journal of Clinical Nutrition 75(2S): 67. 3 For a summary of Cooper’s Aerobic Clinic research see C. Bouchard, 2000. ‘Physical activity and obesity’, Human Kinetics, III. 4 See National Physical Activity Guidelines, National Health and Medical Research Council, Canberra, 1999. Chapter 9 1 P. Magnus and S. Bennet, 1994. ‘Trends in cardiovascular risk factors in Australia’, Medical Journal of Australia 161(7): 519–27.
138
Becoming Gutless Text pages 24/8/06 10:21 Page 139
INDEX abdominal fat, 16, 31 active leisure, 83 actual versus reported food intake, 53 Adifax, 115 adolescents overweight, 4 aerobics, 89 age weight gain and, 6, 15, 23 alcohol, ix compensatory effects of, 106 decreased inhibitions, 106 decreasing, 58, 74 as diuretic, 110 fatty food and, 106 giving up, 39 mixers and, 106 post-alcohol cravings, 106 reduced movement and, 106 slowing effects on metabolism, 106 standard drinks, 107 trading off and, 105–9 anabolism, 21 assistance with weight loss, x, 114–20 Australian Diabetes survey, 5 see also diabetes Australian Society for the Study of Obesity, 41 awareness of being overweight, 29–34 avocados, 66 back problems, 8, 9 beer, 108 belly, 10 trade-offs for beer drinkers, 108 behaviour change, 36 Binns, Dr Andrew, 7, 9 bio-impedance analysis (BIA), 33
body image, 30 body mass metabolic rate and, 23 Body Mass Index (BMI) obesity and, 5, 18 body shape exercise and, 95–6 Bolin, Dr Terry, 69 bowel cancer, 70 bread, 67–8 breakfast importance of, ix, 23, 39, 76 breastfeeding metabolism and, 23 breathlessness, 8 butter, excluding, 60 caffeine, 25, 112, 113 calories counting, 57 decreasing, 38 defined, xi cancer, 8, 60 canola oil, 66 carbohydrates, 40 decreasing, 38, 39 see also bread, pasta, potatoes, rice catabolism, 21 cataract, 8 catecholamines, 96 cellulitis, 8 cereal, 68 charting progress, 49 children obesity levels in, 5 overweight, 4 cholesterol in blood, 16, 60
139
Becoming Gutless Text pages 24/8/06 10:21 Page 140
BECOMING GUT LESS Christmas eating and, 52, 71 climate effect on metabolism, 23 coffee, 112–13 see also caffeine confectionery, 61 cycling, 88 dairy products, 61 defence mechanisms, 52 denial, 52 depression, 8 diabetes, ix, 5, 7 Type 2, 5, 8, 16 dieticians, 40–1 diets, ix, 40 crash, 40 fad, 38 distortion, 53 distraction, 53 drinking, 50 see also alcohol, fruit juice, soft drinks drinks intake questionnaire, 110–11 drugs for weight loss, x, 15, 38, 115–17, 119 see also medication Duramine, 115, 116 dyslipidaemia, 8 ease of weight loss gender and, ix eating diary, 49 differently, x more, ix more often, ix patterns, 49 eating plan lifetime, 57 for weight loss, 56–7 eczema, 10 effect on weight, 4 energy balance negative, 36, 37 positive, 72 energy density, ix calculating, 72 controlling, 73 140
decreasing, 58, 72–4 high energy-dense foods, 73 energy expenditure increasing, 58, 75 energy intake decreasing, 58; reducing total, 74–5 energy levels weight and, 7 energy use contributions to, 22 essential fatty acids, 60 exclusion of fat, 60–1 exercise, 78–98 aerobic fitness, 82 before breakfast, ix, 23, 76, 86 body shape and, 95–6 dangers of vigorous, 81–2 diary, 49 duration, 82, 86 for fitness, 80 frequency, 82 with injuries, 85 intensity, 82, 85–6 meals and, 86 metabolism and, 23 with partner, 86 planned, 80 planning, 86 problems, 96–7 record-keeping, 86 temperature and, 96–7 value of various activities for fat loss, 88 value of various activities for waist loss, 87 variety, 105 for weight loss, 15 weight-bearing, 85, 97–8 weight-supported, 85–6 volume, 82 see also movement Exerselector Questionnaire, 93, 122–5 exocrine organs, 16 eye–mouth gap, 75, 89, 90 fasting, ix, 40 Fat and Fibre Counters, 62 fat storage gender and, 6
Becoming Gutless Text pages 24/8/06 10:21 Page 141
INDEX fat abdominal, 16 addictive, 59 appetitive, 59 calorie content of, 40 cells, 13–14, 106 content, 62 cravings for, 59 dietary fat questionnaire, 62–5 as energy, 13, 14 excessive, 39 exclusion of, 60–1 extra, 16 facts about, 14–15 in foods, 60–2 healthy amount of, 15, 62 hidden, 60 as insulator, 110 location of, 14, 16–17 loss, 14 loss for the fit, 92–3 measuring, 30 organ, 16 percentage, 33 plant, 12 reduction of, 12, 57, 58–60 saturated, 66 sources in Australian diet, 61 types of, 12–19 visceral, 16 wobble test for, 33 fat-conducive lifestyle, 21 fatigue, 8 fatness–inactivity cycle, 90 FATT principle, 91–2 feet impact of weight on, 9 fertility impaired, 8 see also sexual difficulties fibre bowel motions and, 69–70 dietary 57 flatulence and, 69–70 increasing, 58, 66–8 sources, 67 target intake, 67 fish oil, 60, 66 fitness specialists, 41 flatulence, 69–70
flexibility, 105 folate supplements, 119 food habits changing, 55–77 food intake decreasing, 58, 74 food practices, 76 foot–brain gap, 75, 89, 90 fruit, 67 fruit juice, 39, 67, 108, 109–12 gallbladder disease, 8, 16, 60 gender ease of weight loss and, ix, 15 fat storage and, 6 metabolism and, 23 general practitioners role of, 41 genetic factors in weight loss, ix, 4, 17–19, 75 gherlin, 16 glycaemic index, 57 goals setting, 51 short-term, 105 golf, 89 gout, 8 grazing, 76 GutBusters, vii habits behavioural see learned actions changing, x, 45–55 cognitive see learned thought patterns stalking, 50 haemorrhoids, 70 health food stores, 41 heart disease, 7, 8, 16 hernia, 8 Heymsfield, Professor Steven, 80 high energy-dense food availability of, 4 homocysteine, 119 hyperadiposity, x hypersomnia, 9 hypertension, 8 ice cream, 61 inactivity, 40 141
Becoming Gutless Text pages 24/8/06 10:21 Page 142
BECOMING GUT LESS incentives setting, 51 insulin resistance, 8 intertrigo, 10 jogging, 88 kilojoules defined, xi knees impact of weight on, 9 labour-saving devices, 80 laparoscopic (lap) banding, 118–19 lawnmowing, 80 learned actions, 46–7 learned thought patterns, 47–8 breaking, 48–51 cycle of, 48 leisure sedentary nature, 4 leptin, 16 lifestyle change, 36, 114 activity levels, 82, 83–4 patterns, 52 low energy diets (LED), 117, 119 lunch, skipping, 39, 76–7 M and M syndrome, 7–8, 96 maintenance of weight loss, viii–ix, x long-term, x, 36, 38, 56, 57 margarine excluding, 60 mate system, 105 meat light-coloured, 66 mechanical problems of being overweight, 7 medication effect on weight loss, 75 see also drugs Mediterranean diet, 72–3 Melvin, 10–11 metabolic problems of being overweight, 7 metabolism, 20–8 age and, 23 body mass and, 23 body size and, 20–1 breastfeeding and, 23 climate and, 23 142
defined, 21–4 exercise and, 23 factors affecting, 23 food and, 23 gender and, 23 long-term changes in, 21 muscle to fat ratio and, 23 raising, 23 slow, 20 smoking and, 24–5 temperature and, 23 testing, 26–8 modification of diet, 61 motivation, x, 102–4 levels, 103 physical appearance and, 103 plateaus and, 102–4 self-statements, 103 soft spots, 105 tips for, 104–5 movement, 78–98 accumulated, 81 amount, 92 changes in lifestyle, 83–4 distance covered, 92 enjoyment of, 93–4 frequency, 91, 92 impact of technology on, 79–80 incidental, 84–5 increased, x, 80 intensity, 93 monitoring, 89–91 as opportunity, 84 planned, 85 time, 92, 93 total volume of, 82 type, 92, 93 see also exercise multi-B vitamin supplements, 119 musculo-skeletal problems, 8 National Health and Medical Research Council, vii National Physical Activity Guidelines, 85, 87 nutritional balance, 57 nuts, 66 obesity trends, 4–5 obesogenic environment, 17
Becoming Gutless Text pages 24/8/06 10:21 Page 143
INDEX oedema, 8 oils calorie content, 40 olive oil, 60, 66 operant conditioning, 47 osteoarthritis, 8 packaged meals low-energy, 77 parocrine organs, 16 partner role of, 51 pasta, 68 pedometers, 49, 90 Phentamine, 115, 116 planning ahead, 105 plant fats, 12 plateaus, x, 36–7, 99–104 dealing with, 101–2 individual differences, 100 motivation and, 102–4 portion size, 57 decreasing, 58, 68, 71–2 potatoes, 68 potbelly, ix, 6, 14 risks of, 16–17 processed meats, 61 protein, 40, 57 increasing, 70–1 psychological problems, 8 psychologists, 41 rationalisations for excess weight, 34 recipes for weight loss, 126–31 recording progress, 105 red meats, 61 Reductil, 115, 116 reinforcement, 51 relaxation, 50 replacement in diet, 61–2 respiratory disease, 8 response management, 50 Resting Metabolic Rate, 22 rewards, 51, 105 rice, 68 rowing, 89 self-monitoring, 49, 54 sexual difficulties, 10 sit-ups, 40
size of meals time of day and, 76 skin problems, 8, 10 skipping meals, ix skipping, 89 sleep apnoea, obstructive, 8–9 see also hypersomnia, snoring smoking, 24–6 caffeine and, 25 ex-smokers, 75 metabolism and, 24–5 quitting, 25, 26 snacks, ix snoring weight and, ix, 7, 8–9 see also sleep apnoea social isolation, 8 social situations eating in, 45, 50, 71–2, 77 soft drinks, 39, 109–12 diet, 110 spicy foods effect on metabolism, ix, 23 squash, 89 Stanton, Rosemary, 69 stimulus control, 49–50 drinking, 50 at home, 50 in social situations, 50 stress incontinence, 8 stroke, risk of, 8 Stuart, Dr Richard, 52, 54 substitution in diet, 61 supermarkets, impact of, 4 surgery for weight loss, x, 118–19 swimming, 86, 88 takeaway foods, 61, 72, 77 see also snacks tea, 112–13 technology impact on movement, 79–80, 81, 83 television advertisements and eating, 47 eating habits and, 46–7 temperature effect on metabolism, 23–4 exercise and, 96–7 importance of, ix tennis, 89 143
Becoming Gutless Text pages 24/8/06 10:21 Page 144
BECOMING GUT LESS thyroid medication, 21 metabolism and, 21 time management, 105 Tracmor, 79 trading off, x, 105–9 alcohol and, 105–9 exercise for food, 79 trans fatty acids, 60 triglycerides, 60 varicose veins, 8 variety of food, 57, 58, 105 increasing, 75–6 vegetable oil, 60 waist fat storage around, 6 measuring, 31–2, 49 size of, 7, 30–3 weight and size of, 32–3 walking, 80, 84, 85, 86, 88 distance per day, 86 in water, 86 water, 112
144
weekends food and, 51–2, 72 weekly downward spiral, 51–2 Weight Control Certificate Course, Sydney University, viii weight loss cycle, 38, 48 individual differences in, 37 programs, 37, 45 reactive, 38 very low energy diets (VLED), x, 117–18, 119 visceral fat, 16 Vogels, Neeltje, 79 work sedentary nature, 4 World Health Organisation (WHO), vii, 3 waist size guidelines, 31 Xenical, 115, 116 Zyban, 115
