Professor Trim's Becoming Slimmer

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PROFESSOR TRIM’S BECOMING SLIMMER

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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

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PROFESSOR TRIM’S BECOMING SLIMMER THE WEIGHT-LOSS PROGRAM

for women Dr Garry Egger By the originator of the ‘GutBusters’ waist-loss program

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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 slimmer: weight loss for women. Includes index. ISBN 1-74114-018-8 1. Weight loss. 2. Women—Nutrition. 3. Physical fitness for women. I. title. 613.7045 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

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CONTENTS Preface

vii

Chapter 1 The hype vs the reality

1

Chapter 2 Biology matters

5

Chapter 3 Behaviour matters

19

Chapter 4 Environment matters

38

Chapter 5 Nutrition news

48

Chapter 6 Moving and losing

84

Chapter 7 Maintaining your losses

106

Chapter 8 The good, the bad and the ugly

123

Appendix

143

Other books on the subject by Garr y Egger

145

Notes

146

Index

157

v

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PREFACE

h t . r l e a o u s d c i f v y n m T g h p l a o r t s c e x m d n f y b i , r v h w o t l e a A m . — g i d n s y o t b e r u c q l a f , n p m i s ’ v h e t o A . r c x l y d p n m i a s g t o h e W E C A F R P Weight control is a simple yet complex matter. At one level it’s simple, because all it requires is to eat less and move more. At another level, however, it is one of the most complex aspects of human physiology. There are so many factors other than eating and exercise that can influence body weight—many of them beyond the control of the individual. To complicate matters, weight management varies between individuals, according to their genes, ethnicity, gender, behaviour and other, often unknown, factors. For many women, in particular, the problem can become a cyclical one: dieting to lose weight causes anxiety and depression; anxiety and depression lead to overeating; and overeating to more weight gain. So knowing all about nutrition and exercise is often not enough. Ironically, weight loss often involves giving yourself permission to eat. As with forbidden fruit, food often becomes an object of desire, irrespective of the biological drive to eat. For some women, early experiences such as physical or sexual abuse or undue pressure to conform to an unrealistic body image lead to an obsession with weight, which more often than not results in gaining rather than losing weight. As a member of the World Health Organisation’s program for obesity management in the developing world and of several Government committees on weight control and obesity management in Australia, I realised many years ago that women and men were like different species when it came to gaining and losing body weight. For the survival of the species, it is much more important for women to be able to store fat and maintain it under circumstances in which men would lose it rapidly. Women’s role in reproduction means they have to last the nine long months of pregnancy. For most of this time, men are more or less immaterial to the process. Men’s fat stores around their potbelly are simply an extra packet of sandwiches designed to get them through hard times when there’re no vii

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kangaroos to catch. As such, this fat comes and goes easily. When I started the GutBusters program for men in 1990, I avoided the more difficult physiological, sociological and psychological issues involved in why women get fat and concentrated on the pure education of men—giving them the information and letting them get on with it. However, the success of GutBusters led to many partners of GutBuster men asking for a ‘women’s version’ of the program. Although the name is hardly feminine, these women claimed that they had tried all the other women’s programs and just wanted what they saw happening to their men folk. Yet we at GutBusters knew that our program would only work for a small proportion of women. If we were to do it right, we would have to incorporate the knowledge base of the GutBuster program in a program that was much more psychologically and physically attuned to women. This approach was initially developed as part of a program called Trim for Life, for which this book was originally written. The time came, however, for GutBusters to move on. It became obvious by the turn of the millennium that men and women need to be involved in managing obesity, the world’s biggest epidemic. It also became clear that the best mechanism for conducting a nationwide program would be to enlist the support of those trained to provide the first step in primary health care— the nation’s general practitioners. As I had been involved in teaching over 25% of the country’s GPs in a program on Weight Control and Obesity Management developed through Sydney University, here was the ideal opportunity to offer a shared-care approach to weight control for men, women, families, diabetics, pregnant mothers and others with specific needs. The overall initiative goes by the name of Professor Trim’s Medically Supervised Weight Loss Programs, with Becoming Slimmer the program designed for women and Becoming Gut Less the one for men. Within these programs women and men can work with a specially trained GP on a full year’s program of instruction and guidance, including the services of a medically selected personal trainer. This book represents only a part of the women’s Becoming Slimmer program. You can apply for the full program through your GP or via the Internet at www.professortrim.com, or you can simply use this book as a guide to inform and help you improve your own diet and lifestyle. Becoming Slimmer is designed to complement the information on the CD and in the workbooks in the Becoming Slimmer program. The book follows a model of weight control developed by myself and Professor Boyd Swinburn of Deakin University, providing a range of up-to-date scientifically supported facts to help you lose weight and maintain that loss in the viii

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PREFACE

long term. While the book alone is not meant to constitute a weight management program as such, I think you will find that it presents you with new things to consider and perhaps incorporate in your own approach to weight management. I wish you all the best.

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 terms 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 kilocalorie = 4.2 kilojoules (written kJ).

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Chapter 1 THE HYPE

VS

THE REALITY

WHY LONG-TERM WEIGHT LOSS IS SO ELUSIVE Everywhere you turn there’s someone trying to sell you something, usually cloaked in technical jargon and promising ‘amazing’, ‘fantastic’ or ‘unbelievable’ results from a product or program with a previously undiscovered ‘magic’ or ‘secret’ ingredient. Little wonder the average consumer is bewildered. Like all health fads, weight control promises follow the course of least resistance. Everybody wants to be slim. Moreover, they want it overnight. However, the creeping pandemic of obesity in modern western societies has meant that most of us are slowly getting fatter instead. The average rate of weight gain in the western world over the past 15 years, for example, has been 1 g per day, or roughly 1 kg every three years. Now 53% of women and 67% of men in Australia—and even more in North America—are regarded as overweight or obese, and these percentages are increasing by around 1% per year. Weight control scams have always been ubiquitous. But under these conditions, they’re almost as prolific as the problem they claim to solve. The simple fact that the population is getting fatter suggests that nothing that has been tried to date works—at least not on a large scale. This, in turn, suggests that we’ve been looking at the problem in the wrong way. Just maybe our stock solution and our knee-jerk reaction to needing to shed weight, dieting, is the wrong way to approach the problem. More to the point, it could very well be one of the causes. Similarly, all our ideas about exercise for fitness and sports performance might not bear sufficient relation to the type of exercise needed for fat loss. If this is the case, maybe we’ve been barking up the wrong tree entirely. Perhaps all our beliefs about weight loss need a good shake-up. To some extent this is already happening. The body of scientific research in the field of obesity and body fatness has grown enormously in recent times. So much so that it would not be untrue to say that there has been 1

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more published scientifically on the topic in the past two decades than in all of modern history before that. As a result, we’re learning heaps. But much of this information lies locked up in universities and research establishments, while quick-buck marketers have a field day with pseudo-science confusion.

CHANGING THE MODEL FOR WEIGHT LOSS What is clear is that the old model of body weight, which was based simply on energy balance—the difference between the amount of energy taken in (food) and the amount of energy used up (exercise)—is wrong. This is a physics-type model, which admits of no flexibility, and no reaction of the human body to change. Notions such as calorie counting and dieting, which have evolved from this way of thinking, are equally outdated. It might be comforting for you to know at the outset that the vast majority of popular magazine ‘diet of the week’ programs are not only useless, they can be downright counterproductive! A new model has to consider the dynamic adjustments that the body makes any time there’s a change in energy balance, and which, in the long term, often serve to prevent any long-term loss of weight. These are adjustments such as increases in appetite with increased exercise, or decreases in metabolic rate with decreased food intake. Changes like this are designed to maintain the status quo in the face of changing conditions—an obviously desirable characteristic in times of scarcity, but not so useful in times of excess. A new model for conceptualising weight management has to take into account the total environment as well as the genetic and behavioural characteristics of the individual. We know that genes are important, but we also know that the genetic predisposition to obesity is unlikely to be fully manifest in an inhospitable environment. . . . the vast majority of popular magazine ‘diet of the week’ programs are not only useless, they can be downright counterproductive! Finally, a new approach has to consider recent nutrition and exercise research, which shows that it’s the type more than the amount of food eaten that is important, and the duration rather than the intensity of exercise performed that has the greatest overall impact on energy balance and burning up fat stores. A model incorporating all of these components is shown in Figure 1.1. 2

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THE HYPE

VS

THE REALITY

Figure 1.1: An ‘ecological’ paradigm for weight control

INFLUENCES Biology + Behaviour + Environment Body = fat stores

Fat/energy Fat/energy – expenditure intake MEDIATORS

x

Physiological adjustment MODERATORS

Source: Egger, G. and Swinburn, B. 1997. ‘An “ecological” approach to the obesity epidemic’, British Medical Journal, 315: 477–80.

This book is a collection of accepted scientific principles within each of the components of the model in Figure 1.1. Each chapter represents a different component of the model and corresponds to a session of ‘Professor Trim’s Becoming Slimmer’ program. I’ve avoided the faddist practice of preaching ‘amazing’ results from any of the suggestions within this book. All of them need to be considered carefully within the context of a healthy lifestyle, and I afford no special prominence to any particular tip.

MAKING CHANGES TO LOSE WEIGHT To lose weight, by definition, requires change. And there are really only two types of change that are effective. These are eating differently and moving more. All weight gains are effected through changes in energy balance, so that more energy is taken in (food) than is expended (exercise and metabolic rate). However, these changes in energy balance can be activated by mechanisms that might seem totally unrelated to diet and exercise. Depression, for example, can lead to eating more and moving less; lack of activity can cause a drop in metabolic rate, which leads to an increase in fat storage. Unduly restrictive dieting can lead to intense hunger, which is then overcompensated for by binge eating. Therefore, while psychological and other 3

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factors play a significant role in weight gain, the final outcome depends on changes in eating and exercise. . . . there are really only two types of change that are effective. These are eating differently and moving more. You’ll notice that eating differently and moving more don’t imply eating less or exercising more, in the traditional sense of these statements. Within these two approaches there are numerous recommendations that can help to effect a lasting change in energy balance. This book presents a select group of recommendations, which have convincing scientific support. Each tip presented is meant to stand on its own. So if you want to pick up the book at meal time, between kids’ baths or even while in the smallest room of the house, you can dip into it anywhere. Of course, conforming to all of the principles in the book might be tough, but it will guarantee a good, healthy, long-term body weight, as well as all the secondary benefits you will get as a result of incorporating techniques that work—changes that do improve your weight and overall health. But, if adhering to them all proves too much, then certainly take what you can comfortably use . . . and perhaps build on the changes to your eating habits and lifestyle one at a time. You’ll probably find that just having a better (and correct!) understanding of what influences your weight and health will act as motivation for you to take up more and more of these changes.

4

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Chapter 2 BIOLOGY MATTERS

INTRODUCTION There are some things in life you can change, and some you can’t. Biology falls largely in the latter category. However, knowing how biology affects body weight might help you to understand why your body reacts as it does to your attempts to keep your weight under control, and why the next person’s reaction could be completely different. In the first place, there are genetic differences. Not only do we know that we inherit general characteristics from our parents, but recent advances in molecular biology have isolated many of the genes that actually cause this effect in relation to body weight. By the turn of the millennium, over 50 genes had been specifically identified as being associated with obesity.1 The scramble is now on to synthesise some of their products (proteins, which usually have a ‘signalling’ role in the body) so a magic elixir can be produced in the form of a tablet. So far, this result has been elusive, but science is full of surprises. Gender is the second biological influence. Because of their important reproductive function, females have been privileged by nature to be more efficient than males at storing and conserving energy-rich body fat. Fat is stored in different parts of the body in females and males, and responds to attempts to reduce it in different ways. There are some tricks that might help to negotiate these obstacles but, again, just knowing that this is so might be enough to make some women feel more comfortable with their existing dimensions. Gender is also important when it comes to particular gender-related life phases, such as pregnancy and contraception. You will find some tips on managing these stages in this chapter. A third biological factor we need to consider is aging. Physiological changes with aging make fat easier to gain and more difficult to lose. However, there are also gender-based differences in aging, with older (postmenopausal) women shifting their pattern of body fatness from primarily on the lower body to the upper body. These and other changes mean we 5

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Testing your genes Answer the following four questions to see if your genes can be blamed for your body weight. For measurement purposes here, the term ‘overweight’ means having a BMI (where BMI = weight (in kg) divided by height (in metres), squared) over 25, ‘obese’ means a BMI over 30 and ‘very obese’ a BMI over 40. For example, someone 170 cm tall and weighing 75 kg would have a BMI of 26 (75 ÷ (1.7)2 = 26). 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 first-degree relatives who have been obese for most of their lives? Score 2 points for every obese immediate family member up to a maximum of 10 points. 3. How would you describe the average BMI of your siblings? Not obese (<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 genetically related. This means it comes down to lifestyle and therefore should be quite easy to solve if you are committed to doing so. 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 dietitian, 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 dietitian. With the proper approach and a long-range plan, you should be able to overcome your bad start. 6

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must employ different techniques for body fat reduction and weight loss at different stages in life. Let’s look at some scientifically based approaches to examining the impact of genes, gender and aging on weight.

GENETIC FACTORS Check your genetic limitations Although it’s not a guaranteed measure of heritability, the test2 on p. 6 will give you an indication of whether or not genes influence your weight level and why weight loss might be so difficult for you.

Change the things you can change, accept those you can’t Despite the hype surrounding weight-loss programs, there are only two kinds of influences on body fat levels: those that can be changed and those that can’t. These are listed in Table 2.1 below. Table 2.1 Factors influencing body fat levels Things that can be changed Food:

Fat Sugar Alcohol

}

Things that can’t be changed Genes:

Fat/lean Active/inactive

Energy density

Drink:

Soft drink Fruit juice

Age:

Middle-aged Old

Movement:

Work Leisure Recreation

Gender:

Male Female

Metabolism Habits Stress

Even within the group that can’t be changed, individuals differ in the degree to which these factors are unchangeable.3 Genetic differences in appetite levels, for example, can make it much harder for one person to resist food than another. Some of this might be genetically determined 7

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(which puts it in the group that can’t be changed, at least not yet), some might be behaviourally determined, and so open to modification. The importance of individual differences, however, is now appreciated much more at the scientific level. We can infer from this that we are not always to blame for our own excess fat.

Racial dif ferences in fat stores and fat loss Of the factors known to influence weight loss, race has probably been dealt with least. Yet simple observation shows that there are big differences in body shape between different racial groups.4 African-American women store fat more around the hips and buttocks. This probably reflects the revolutionary advantage of having extra energy reserves for pregnancy. African Americans have been shown to lose fat less readily than white Americans. Asian women are known for their narrow hips. So a waist:hip ratio (WHR), used as a measure of health risk in Caucasians, is not generally relevant for these women, because they have WHR measures more characteristic of men. The upper limit waist circumference for an Asian or Indian woman needs to be about 10 cm smaller than the 90 cm prescribed for Caucasian women. In Pacific Islanders, this might be 10 cm bigger, at 100 cm. The rate at which fat is deposited can also differ between racial groups. It’s thought that the Chinese, for example, first put on fat at the waist before they fill out all over. Island races like Samoans and Tongans seem to gain fat just by looking at food—at least when that food is the modern western variety. Even on a traditional diet they’re still known to be big people. But that fat is stored more evenly over the body, ensuring a lower health risk. With the intermixing of the world’s peoples, rates and locations of fat gain and loss are likely to become less predictable. In the meantime, science is making us more aware of the reality of racial distinctions. In the future it might require a quick look at the family tree to see how easily fat loss will occur for you.

GENDER FACTORS Hips are healthy The classic female form throughout history has been the hour-glass shape— a narrow waist and broad hips. Recently, however, the ascendancy of the supermodel has led to greater interest in the narrow-hipped female, despite our knowledge that fat storage around the hips and buttocks 8

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in women is a nature’s way of allowing for extra energy reserves for childbirth. Natural or not, it is difficult in these times for the ample-hipped woman to be convinced of the advantages of her more feminine form. But collaborative research from Sweden, Denmark and the Netherlands reported at the 11th European Congress on Obesity might help to sway her.5 Researchers worked on the assumption that a large waist size is predictive of later health problems, both for women and men. Large waist size was assessed until recently using the waist:hip ratio (WHR). The bigger the waist in relation to the hips, the greater the health risk. The researchers found that waist size by itself was sufficient as a measure of health risk. The hip measure was dropped altogether to avoid introducing error by taking two measures. However, another European research group questioned the wisdom of discarding what might be a more significant measure. They measured a large group of women aged 38–60 years almost 40 years ago. They then measured the rate of heart attacks suffered in the group over the ensuing years and looked for any association between body measurements and heart disease. Interestingly, they found that hip size was an independent predictor of good health. Women with larger hips tended to have far fewer health problems than those with narrow hips—and this was independent of the waist measurement. They also found that hip size as a measure of good health was more significant than waist size as a measure of poor health. In fact, women with the broadest hips ran up to one-third of the risk of those with the narrowest hips of developing diabetes or heart disease. Hence their suggestion that in addition to using waist size as a predictor of possible adverse health outcomes, hip size should be used to indicate good health.

Appropriate gains during pregnancy ‘Eating for two’ might pose problems for pregnant women who are prone to gaining excess weight. Researchers from the Obesity Unit at the Karolinska Institute in Sweden studied obese women to see if their weight gain was connected with pregnancy.6 Of the 128 obese women studied, 73% had retained 10 kg or more of pregnancy-related gains. In another study of 1428 women of normal weight, only 14% gained more than 5 kg after pregnancy. Normal weight gain during pregnancy is, according to the Swedish researchers, around 12.5 kg. About 3–6 kg of this is maternal adipose tissue, providing energy for the child during lactation. But these reserves might only be needed if food is not readily available during lactation—a rare occurrence in today’s affluent societies. 9

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In the Swedish study, women who gained more than 5 kg after delivery were more likely to: • have had a larger initial weight • have had greater weight gain during pregnancy • have given up smoking • have less structured eating habits • be disinclined to eat breakfast and lunch • eat larger meals and snack more • have less leisure time/physical activity after pregnancy. Contrary to the findings of other studies, the age and number of children in the family had little or no effect on weight gain. The researchers claimed that although gaining too little weight during pregnancy entails the risk of low birth weight for the infant, this should be weighed against the adverse effects of overweight and obesity. The weight of the baby at birth also doesn’t seem to be greater where maternal weight gain exceeds 10 kg. Since birth weight increases up to a certain level and then plateaus, it might well not be necessary to ‘overeat for two’.

The dangers of gestational diabetes A form of diabetes known as Gestational Diabetes Mellitus (GDM) occurs in many women during pregnancy and requires special attention from a doctor. The condition generally disappears after childbirth, but in about 50% of cases it can recur later in life.7 If insulin is required during or after pregnancy this can cause added problems, because insulin can actually increase body weight and make it harder to lose. GDM is therefore much better avoided through (a) maintaining a healthy exercise program during pregnancy, (b) eating well but not too much and (c) not gaining excessive weight. Since GDM is more likely in women who have relatives with diabetes, women in this group should take special care.

Multiple pregnancies and weight gain For many women, having a baby means a certain increase in weight. And although this is by no means universal, there’s increasing evidence to suggest that there is a causal link.8 For example, women in low socioeconomic areas of Mexico City were recently found to increase their body weight significantly after having two or more children. The age of the mother was an important factor, with older mothers likely to get fatter more easily. Whether this is a natural phenomenon or is caused by changes in lifestyle 10

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is difficult to assess. However, it’s generally conceded that women who record the biggest gains during pregnancy are likely to maintain a greater body weight afterwards. New mothers should guard against gaining too much weight after giving birth and be cautious about changing their activity levels and increasing their food intake to cope with the stresses of caring for a new baby.

Breastfeeding helps Female body fat stores are specifically designed to provide energy for childbirth and child rearing. Estimates show that the daily energy cost of breastfeeding to a mother is up to 500 kcals (2100 kJ)/day. Any of this not supplied by excess food intake is taken from the body’s fat stores which, under non-lactating circumstances, are difficult to mobilise. Research carried out in New York has shown that mothers who breastfeed for six months or longer stay leaner—for up to two years—than mothers who don’t breastfeed.9 Even when non-breastfeeding mothers are given a diet and exercise program after pregnancy, mothers who breastfeed and who eat up to 300 kcals (1260 kJ) a day more than the non-breastfeeding mothers tend to lose more weight in the six months after giving birth. This doesn’t happen just by breastfeeding. New mothers should be aware that they have to control their food intake below the extra 500 kcals if they are to get any results.

Low-dose contraception options In its early days the benefits of using the contraceptive pill were offset by reports that it caused weight gain in young women. Since then, scientific advances have meant that lower doses of hormones can be used in contraceptive medications, which has reduced the risk of weight gain. Low-dose oestrogen contraceptives were recently put to the test in Israel.10 Body measures indicating fat distribution, as well as weight changes, were monitored in a number of women who used the medication over three and six treatment cycles. Compared with women in a control sample, no impact on weight, body composition or fat distribution was found in any of the subjects, suggesting an easing of concern is warranted at least among women on low-oestrogen varieties.

Menopause milestones The body fat and fat distribution patterns of pre-menopausal women are known to be determined largely by female hormones, particularly oestrogen. After menopause, women lose the benefit of these hormones 11

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and their fat stores begin to equate more with those of males. Women experience an increase in upper body fat; unfortunately, there is little corresponding decrease in the fat in cells established in the lower body.11 In women, as in men, fat in the upper body is more mobile than that in the lower body, which explains why older women are better able than men to manage their extra weight with extra energy output and by controlling their food intake, particularly fat. It’s important, however, if you are an older woman, to be aware of the changes that occur naturally with menopause, so that you can manage them effectively.

Hormone replacement therapy (HRT) and weight gain Hormone replacement therapy (HRT) works to restore female hormone levels after menopause. This has been shown to reduce the incidence of heart disease in post-menopausal women, particularly those with a family history of the problem.12 The association of heart disease with abdominal fat stores perhaps explains HRT’s protective role; the therapy is thought to help older women reduce upper body fat levels. These notions have not been convincingly proven by research to date, possibly because of the varying mix of hormones in different HRT medications and women’s idiosyncratic response to these. Some research has shown HRT to have a positive effect on body weight levels, but more needs to be done. Recent research has also indicated possible health problems with HRT, making its use a decision that needs to be made between a woman and her doctor.

The limitations of exercise In the wake of the fitness boom of the 1980s, it’s almost heresy to suggest that exercise won’t lead to fat loss. But this is now the opinion of several scientists, at least in relation to exercise in women. This could begin to explain the extreme difficulty many women have in trimming down—even with regular pounding of the pavement. The exercise debate was sparked by a review in the journal of the American College of Nutrition, in which exercise scientist Dr Gilbert Gleim showed that in a range of research studies of women, most show only limited effects of exercise on weight loss, particularly when compared with those achieved by men.13 Gleim’s conclusion was: ‘. . . as an isolated weight loss modality . . . exercise should not be counted on to produce desired weight reductions [in women] unless the woman is committed to many hours of exercise a day.’ 12

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We don’t know exactly why this is so. But here are some suggestions: •

•

•

•

•

Errors in dietary reporting. Women tend to underestimate the increase in their food intake that seems to occur as a result of an increase in exercise. Even so, men have been shown to lose weight while training, even with an increase in food intake. Body size and fitness. The size and greater muscle mass of men mean that a man will use more energy than a woman to walk or run the same distance, even if they do it at the same relative intensity. For example, an average-sized man will use about 40% more energy than an average-sized woman walking a kilometre. Fat cell differences. Female and male fat cells have different densities in the receptors that respond to hormones that in turn influence fat burning and fat storage. These hormones, particularly those from the adrenal glands, are largely responsible for the fat-burning effects of exercise. Fat cells in females are consistently more efficient at conserving fat than those in males. Body fat distribution. Women tend to store fat around their hips and buttocks, whereas men store it more on their stomachs. Lower body fat cells are known to be much more resistant to fat loss in general, and especially in response to energy losses (exercise, diet), than upper body fat cells. Sex steroid differences. When the going gets tough, female hormones might specifically prevent the loss of body fat in the hips and buttock regions in order to preserve energy for the female’s biologically important function of gestation and childbirth. . . . recent research shows that if food intake is restricted too much in women, resistance to fat loss can increase even further.

This is not to suggest that exercise is useless for weight control (or for good health in general) in women. When combined with reduced food intake, it can be effective. However, other recent research shows that if food intake is restricted too much in women (say to around 50% of daily requirements), resistance to fat loss can intensify even further. Very long, slower activities (such as walking for up to one hour a day) are likely to be best for any woman serious about fat loss. It is also now accepted that while exercise may not be as effective as food restriction in initial weight loss, it is perhaps the main factor in successful weight loss maintenancce. 13

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AGE FACTORS Weight training and older women There’s controversy about the benefits of weight training for fat loss. Some exercise scientists suggest it might be better than other forms of exercise, such as walking, because it helps maintain, or even increase, muscle mass. This, in turn, can increase the metabolic rate (because muscle is ‘active’) and, theoretically at least, burn more energy. In practice, the answer is less clear. Many studies on weight training have found no corresponding positive effect on fat loss. Others record results, but only for certain groups, such as younger men. Many groups of researchers have tested the effects of weight training on older women and men, all of them recording improvements in strength and fitness.14 Weight loss effects have been less absolute, but this might be because of appetite increases that have coincided with the programs (other reasons are also discussed in Chapter 6). In any case, there is some support for the use of weight training for maintaining body composition in later life. New findings also suggest that regular weight training using the large muscles of the body could perhaps alleviate, or even prevent, the symptoms of diabetes.

Body fat increases with age It’s natural for the body to gain a little fat with the advancing years—even in people as young as 40. The reasons for this, scientists think, are: • • • • • •

a decreased sensitivity of fat cells to the hormones that stimulate fat breakdown (probably owing to a decrease in the number of receptors on fat cells) a slower overall metabolic rate reduced muscle mass a decrease in a muscle protein that helps bind fat into muscle for use as energy less spontaneous physical activity, or activity normally carried out throughout the day more eating (although this is often underreported).15

The good news is that moderate fat gains associated with ageing don’t appear to be as dangerous as fat gains in the young. They can be worse, though, if they are excessive (more than 8 kg over an individual’s weight at age 20), so some caution is still needed. 14

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OTHER FACTORS Beware the bounce-back ef fect Traditionally, fat cells have been thought to be relatively inert, with little communication between them and other cells of the body. However, recent research has established that fat cells could have a hormonal function and be involved in two-way communication with the eating centres of the brain.16 It’s been known for some time that people who once were obese tend to have higher levels of hunger than individuals who have never been obese. It’s now thought that this might be because fat cells, once reduced in size, send messages to the brain increasing hunger in a bid to regain their former size. For this reason, losing weight—particularly for obese people—is no guarantee of slenderness from then on. A proper maintenance program, incorporating all aspects of care, needs to be adopted to prevent the bounceback effect.

No magic pill The discovery of the ob gene and its product leptin in 1994 made obesity researchers hopeful of finding a quick solution, in the form of a leptin-type drug, to overcome hunger in those prone to obesity. However, in reality, the more we find out the more complex the situation appears to be. Although administering leptin to obese strains of mice does appear to reduce their body weight drastically, measuring leptin levels in humans shows that in fact obese people have more leptin rather than less, as was expected from an understanding of the role of the substance 37.17 This implies that the problem might not be in the making of the hormone (the ‘key’), but in the receptors (the ‘locks’) on which the hormone acts. Initially, it was thought that there would be only one type of receptor, which would be in the appetite centre of the brain (the hypothalamus). But new studies have found receptors in many other organs of the body. If these are deficient in obese people, one way of making them respond to leptin might be to develop an agonist drug, or one that helps the ‘key’ fit the ‘lock’. There’s still a flurry of research activity in the area. But given the complexity revealed so far, it might not be wise to wait up for the results.

15

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Are your medications working against you? Some medicines have weight gain as a side effect.18 If this is happening to you, your doctor can arrange an alternative. Check the table below for any medications you might be using. Table 2.2 Prescribed medications that might affect fat or weight loss Androgens (Male hormones) Generic name:

Brand name:

ethyloestrenol fluroxymesterone nandrolone oxymetholone

Orabolin Halotestin Durabolin Adroyd Anapolon Winstrol Andriol Primoteston Sustanon

stanozolol testosterone

Benzodiazapines (Anti-anxiety) Generic name:

Brand name:

alprozolam chlordiazepoxide clorozepate diazepam lorazepam oxazepam flurazepam temazepam triazolam nitrazepam

Xanax Librium Tranxene Valium Ativan Serapax Dalmane Normison Halcion Mogadon

Corticosteroids (Anti-allergy; anti-inflammatory) Generic name:

Brand name:

betamethasone dexamethasone methylprednisolone prednisolone

Celestone Decadron Medrol Delta-Cortef

16

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BIOLOGY MATTERS prednisone triamcinolone cortisone (naturally occurring) hydrocortisone prednisone triamcinolone

Deltasone Aristocort Cortate Cortef Deltasone Aristocort

Cyproheptadines (Allergy relief) Generic name:

Brand name:

cyproheptadine HCl

Periactin

Antidiabetic agents Generic name:

Brand name:

Insulin

Actrapid Humulin Velosulin Promatime Ultralente

Sulfonylureas chlorpropamide glipizide tolbutamide

Diabinese Minidiab Rastinon

Phenothiazenes (Antipsychotics) Generic name:

Brand name:

chlorpromazine prochlorperazine

Largactil Stemetil

Tricyclic antidepressants Generic name:

Brand name:

amitriptyline

Endep Tryptanol Anafranil Prothiaden Tofranil

clomipramine dothiepin imipramine

17

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Oral contraceptives* Type of pill Combined

(Oestrogen content) (30 ug and under) (35 ug)

(50 ug)

Phased

(30–50 ug)

Brand name Microgynon 30 Brevinor Modicon Nordette Microgynon 50 Neogynon Orthor Novum Ovulen Biphasil Synphasic Triquilar

Hormone replacement therapy (HRT) medications* Generic name: Oestrogen conjugated oestrogens ethinyloestradiol oestradiol Progesterone levonorgestrel medroxyprogesterone norethisterone

Brand name: Premarin Estigyn Primogyn C Oestradiol implants

Microlut Microval Depo-Provera Micronor Primalut

* Some of these medications might cause fat gain in some women.

18

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Chapter 3 BEHAVIOUR MATTERS

INTRODUCTION Excess fatness, particularly in women, often has psychological causes, ranging from lack of self-esteem or self-confidence to reactions to early sexual and physical abuse. These can’t be dealt with through mere admonitions to do more of or less of something, such as eat less and exercise more. They require detailed, and usually prolonged, counselling. However, some principles established by recent research might help women overcome some of the behavioural negatives that militate against weight loss.

THERE ARE NO QUICK FIXES Putting on and taking off weight is a gradual thing. Even under the most extreme conditions there’s only so much that can be gained or lost in a set time. Changes in the body’s metabolism and other adaptive factors help to guarantee that this is the case, otherwise the human race wouldn’t have survived the feasts and famines of the past. Commercial weight-control programs seem almost to compete to see who can advertise the greatest weight loss in the shortest period of time. This approach is highly unethical and could ultimately lead to greater weight gains than losses—which, of course, would satisfy many commercial organisations because it guarantees a continual clientele. Weight losses greater than 0.5–1 kg per week, or waist losses greater than 1%, are now regarded as potentially counterproductive.19 Any suggestion that there are quick, easy fixes that can ensure these types of losses in the long term should be dismissed—they all have potential ill effects.

19

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RECOGNISE WEIGHT-LOSS GIMMICKS FOR WHAT THEY ARE The weight-control field is rife with scams, fads and gimmicks, all designed more to lighten the pocket than to reduce the waistline. There are a few basic principles used by many of these artists, and if you can recognise them you can prevent the endless cycle of gain and loss. Any or all of the following should alert you to the fact that a weight-loss product or program is probably a rip-off: • • • • • • • • •

Use of the terms ‘magic’, ‘wonder’ or ‘miracle’ in promotions Use of a ‘new’, ‘secret’ or ‘unique’ ingredient Ingredients from inaccessible places, such as the ocean floor or the Tibetan mountains Promises of dramatic weight loss in a short period of time Promises of ‘no effort’, ‘no exercise’, ‘no dieting’ Use of a white-coat-clad person in promotions Promises of unconditional, money-back guarantees if a particular weight loss is not achieved Use of testimonials from ‘cured’ patients Complicated (and usually unsupported) technical explanations of how the product works.

DON’T EXPECT BIG CHANGES OVERNIGHT The average human body contains between 30 and 50 billion fat cells. Each of these contains around 0.5 micrograms of fat, giving a total of around 15–25 kg of fat in the average person. Even with maximal effort (eating yourself stupid and lying motionless) a weight gain of more than about 1 kg per week would be difficult—after all, this represents nearly 10% of a body fat level it has often taken a lifetime to achieve. It stands to reason, then, that body fat is unlikely to decrease at a much greater rate. Of course weight losses greater than this are possible. But most of the weight lost will be water, which is quickly regained. Significant decreases in weight will also lead to adaptive changes in metabolism, which serve to slow the weight loss down and ultimately restore the body to its previous level. Research has shown that ideal body weight losses for long-term maintenance are around 0.5–1.0 kg per week.20 Losses of 1.5 kg per week or more have been shown to increase the risk of health problems such as gallstones. Such a rate of loss can also increase the risk of extra fatness at a later stage. 20

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UNDERSTANDING WHAT MAKES US FAT Read the daily press and you’ll think the world is full of plots to make us fat. But despite all the hype, there are only two mechanisms by which increases in body weight can occur.21 These are an increase in energy intake, or food, and/or a decrease in energy expenditure, which is activity level, metabolic rate and heat loss. Other factors, such as drugs, genes, age and gender, can only have an impact through either or both of these mechanisms. Within each of these influences there is of course a range of factors which can lead to weight gain (and therefore help influence weight loss), some of which are shown in Table 3.1. Table 3.1 Factors influencing energy balance Energy intake

Energy expenditure

Other factors that affect energy intake and expenditure

Too much fat Excess total energy Too high energy density Too much high Glycaemic Index (GI) foods Too little variety Excessive hunger Night eating Binge eating ‘Restrained eating’ Social/holiday eating Habitual eating Irregular eating Lack of awareness of food intake Food intake with alcohol The eye–mouth gap The ‘exception’ rule

Sedentary job Inactive transport to/from work Lack of planned activity Lack of incidental activity Lack of awareness Wrong type of activity Fatigue or laziness Fear of crime Environment/weather Injury/incapacity The foot–brain gap Childhood experiences Self-consciousness Discomfort Changes with age Family commitments Influence of holidays

Genetics Thyroid problems Medication Disease (e.g. diabetes) Slow metabolism History of crash dieting Early experiences Age and gender Fear of failure Fear of success Influence of pregnancy/ menopause Stopping smoking Some prescribed drugs Seasonal Affective Disorder (SAD)

21

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Table 3.1 tells us that while taking account of factors such as genetics, stages of life (for example, menopause, pregnancy), illness and medication, these should be considered to have a role in body–weight balance only in the way they influence either energy intake or energy expenditure.

ARE YOU GENUINELY MOTIVATED? Motivation is the key to success in any weight management program. Do this little test22 to see if you’re really ready to try to lose fat. Add up your scores and compare with the results below.

Measuring motivation

1. Compared with previous attempts, how motivated are you this time to lose fat? 1 2 Not at all motivated

3

4

5 Extremely motivated

2. How certain are you that you’ll stay committed to a fat loss program for the time it will take to reach your goal? 1 2 Not at all certain

3

4

5 Extremely certain

3. Considering all outside factors at this time in your life—the stress you might be feeling, your family obligations, etc.—to what extent can you tolerate the effort required to stick to a fat reduction plan? 1 Cannot tolerate

2

3

4

5 Can tolerate easily

4. Think honestly about how much fat you hope to lose and how quickly you hope to lose it. Figuring a weight loss of around 0.5–1.0 kg per week, how realistic is your expectation? 1 2 Not at all realistic

22

3

4

5 Completely realistic

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5. While dieting, do you fantasise about eating a lot of your favourite foods? 1 Always

2 3 4 Frequently Occasionally Rarely

5 Never

6. How confident are you that you can work regular exercise into your daily schedule, starting tomorrow? 1 2 Not at all confident

3

4

5 Extremely confident

Scores: 6–12: You’re not very serious about losing fat. You should leave it until you are. 13–24: You’re reasonably motivated, but you might need some help. 25+: Your motivation is high. You should have little trouble getting started.

BECOME AWARE OF YOUR EATING HABITS People often eat because they associate a cue (such as ads on TV) with a reward (such as getting up to get something to eat or drink). After the association between the stimulus and the response becomes automatic, the habit is entrenched, often without the individual’s being conscious of it. The first stage of breaking this cycle, says psychologist and author Hilary Tupling, is to ‘stalk the habit . . . like a hunter stalks his prey’ in order to understand it, then break the link between the cue and the reward.23 This can be done by replacing the reward with another more helpful reward (for example, doing some exercises during ad breaks), or removing the cues (turning off the TV). To apply this to your eating behaviour, first stalk your habit and identify it. Write down what it is that makes you eat more, or more often, when you eat and how you feel when you eat at those times. Second, once identified, try to break the stimulus–response connection by associating a different response with the stimulus (which could be feeling depressed, feeling angry, an ad on TV) that has led to the eating response. Becoming aware of habits is often enough to help you break them.

23

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Check your level of dietar y ‘restraint’ At first glance you might be excused for thinking that restrained eating— being careful about what you eat—would be a positive way of keeping your weight down. But scientific studies emerging on eating disorders suggest that the connection isn’t so clear cut. In the modern environment we all have to be restrained eaters to some extent. But overly restrained eaters count calories, don’t finish meals to the point of satisfying hunger, choose low-calorie food, avoid sweets and fats and are permanently cautious about their weight and eating behaviour. They’re generally female and can be identified by their level of cognitive or mental control during eating. Ironically, obese women are more likely than non-obese women to be restrained eaters. So if restrained eating means restricting food intake and if reduced food intake reduces body fat, what’s going wrong? From recent research it appears that the degree of rigidity of restrained eating is a key factor. Those who have strict control over their eating can usually perform well until they are faced with a disturbance. Stress, conflict, depression or other personal problems can easily disrupt their order and, once disrupted, total collapse can follow. According to German psychologist Dr Volker Pudel,24 who specialises in the psychology of obesity, self-imposed cognitive control only works as long as it’s not violated. Once this happens, the whole system of self-control collapses; bingeing and overeating occur as compensation, and the individual is likely to gain fat. Restrained eaters who have greater flexibility under various difficult conditions—parties, breakouts and so on—are more likely to be able to cope with these setbacks. Such flexibility means dietary glitches can be tolerated. Flexibility in any eating plan is essential for long-term fat loss. Not only will rigid control reduce the effectiveness of a weight loss program, it’s likely ultimately to result in increased weight gain.

GIVE YOURSELF PERMISSION TO EAT Social pressure to attain an unrealistic body image is immense. Many people, women in particular, have undergone years of social conditioning to attain an unrealistic body ideal, as exemplified by, in many cases, almost anorexic fashion models. As a result, they often feel guilty and depressed when they succumb to pressures to overeat, or indeed to eat anything they think might be the least bit fattening. 24

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As shown in Figure 3.1, guilt is a counterproductive emotion when it comes to weight control.25 Guilt often leads to overeating because it is eating that is established early in life as a comfort for unhappiness and anxiety—how many times were you given a food comfort when you were upset about something? . . . guilt is a counterproductive emotion when it comes to weight control. For many women for whom eating is a problem, the first stage in a proper weight management program is to develop a sensible attitude to food. Give yourself permission to eat, occasionally to overeat, to eat tempting sweet and fatty foods sometimes and to enjoy the act of eating. This can help break the guilt cycle that is often the cause of obesity problems. Figure 3.1 The vicious cycle of obesity

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’

25

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EMOTIONAL PROBLEMS BEFORE WEIGHT PROBLEMS People can become overweight and obese because of emotional disturbances such as stress, grief or bereavement.26 These states of mind can often lead to comfort eating and inactivity. Instead of trying to ‘hold onto your hat in a cyclone’, it might be better to deal with the issues separately. The primary cause of the problem (your stress) is likely to be the emotional disturbance. The best way to deal with this is through counselling, social networks or psychological assistance— before you make any concerted attempt to do anything about your body weight. Work on becoming relaxed in your life, and you’ll become relaxed about your weight.

TAKE CONTROL OF YOUR THOUGHTS As we have seen, habits can be behavioural or cognitive. Bad behavioural habits are incorrect ways of acting. Bad cognitive habits are incorrect ways of thinking. Both can lead to negative weight control outcomes: the former through actions that lead directly to incorrect eating or ways of moving; the latter through thought patterns that lead indirectly to eating for comfort, stress reduction or as a reward. Cognitive habits can lead to cyclical thinking patterns. An example might be the way you think about bingeing on a particular occasion. A rational way of thinking about this would be to realise that the behaviour is only occasional and therefore is not likely to have any lasting effect. An irrational thought process might lead someone to think she is a failure, that she must never binge. As a result, she becomes depressed. An obvious consequence of depression is seeking comfort through tasty, sweet and/or fatty foods. Thus the cycle is perpetuated. American psychologist Albert Ellis pioneered a process called rational emotive therapy, or RET, to deal with irrational thinking.27 Basically, RET involves disputing irrational beliefs and arriving at alternative consequences. According to Ellis, the most damaging consequences result from the irrational beliefs that one ‘must’, ‘should’ or ‘has to’ think in a certain way. RET is a technique designed to help combat this.

26

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The ABCD of RET According to Albert Ellis, everyone is faced with Adversity at some stage in their lives. This might be severe or trivial. Over the years we develop Beliefs to cope with adversity; these might be real or imaginary. The type of belief we have leads to Consequences, which can be negative (‘I’m not good at sport therefore I’m not good at anything’). Over time, these can build up into a sense of ‘learned helplessness’. The sequence needs to be Disputed at the belief stage. Beliefs need to be turned into learned optimism if successes such as a reduction in body fat are to occur in the long term. This is the ABCD of learned optimism: Adversity leads to a Belief, which has Consequences. Negative Beliefs need to be Disputed or Disrupted to break the chain of ‘learned helplessness’. This occurs by changing thought patterns (and thereby beliefs), which is done by Disputation, or arguing the point with yourself by reversing the three Ps of pessimism (see page 29), or Distraction of negative thoughts through thought-stopping techniques (see page 32).

DON’T TAKE YOUR WORD FOR IT ‘Diet resistant’ is a term given to people who seem never to lose weight, even as a response to reduced food intake. It’s a common phenomenon, often put down to ‘gland problems’ or ‘genetics’. Diet resisters have usually been taken at their word. They say they don’t eat much, and they do exercise. But now evidence indicates that not only overweight people but even people of normal weight tend to underestimate the amount of food they eat and overestimate the amount of exercise they do. This is called the eye–mouth gap and the foot–brain gap. This could help explain why those who believe they can’t lose weight really don’t seem able to. Working with a group of obese individuals in New York, scientists used a radioactive monitoring technique to accurately estimate the amount of energy taken in (food) and burned up (exercise) by the subjects over a twoweek period.28 All of those measured had been on a self-reported food intake of less than 1200 kcals (5040 kJ) per day for the previous six months but had failed to lose any weight. 27

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Compared with their actual energy intake and output measured radioactively, ‘diet-resistant’ overweight individuals underestimated their daily food intake by around 30% and overestimated the amount of energy they burnt up each day by almost 40%. The implications of this are that the apparently ‘diet resistant’ need to take particular care in estimating food and exercise levels. If you suspect you might fall into this group, then, if possible, use more accurate techniques of estimation. Keeping a daily dietary diary and an exercise log, or using a pedometer to measure exercise output are both non-subjective sources of confirmation to keep you on track.

BEWARE THE ‘THREE D S ’ In his book Act Thin, Stay Thin, Dr Richard Stuart29 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 people sometimes overeat and underexercise without necessarily knowing it. Denial helps us maintain a positive image of ourselves. 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’. These issues require honest scrutiny and some objective measurements (such as pedometer scores and food diaries) that can’t be denied. Distraction occurs when other things are happening. For example, it’s easier to eat too much while you’re having a drink or talking with friends. Research has shown that overweight people are more vulnerable to distractions than people of normal weight. Eating with others or having a conversation with someone while eating can be distracting enough to lead to excessive food intake without your being aware of it. Distortion refers to the way big people judge their behaviour. Studies measuring actual food intake and exercise output and comparing this data with reported food intake and exercise output have shown that overweight people underestimate food intake and overestimate exercise. This is not thought to be deliberate (because even people of normal weight do it). It’s an unrecognised distortion of the facts. These individuals are simply unaware of how much they actually eat. Self-monitoring can help you negotiate the triple threats of denial, distraction and distortion because, according to Dr 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’. 28

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LEARN OPTIMISM In the late 1960s, Dr Martin Seligman and his colleagues at the University of Pennsylvania found that rats that were given electric shocks over which they had no control actually learned to be helpless—they became timid, weak and diseased, and some even died.30 Rats that were shocked but had a chance to learn how to avoid the shock, on the other hand, actually thrived on the experience. Since the 1970s, Seligman and his students have turned to clinical psychology to try to work out how learned helplessness can be transformed into ‘learned optimism’. Seligman’s theory is founded in a branch of psychology called cognitive therapy. His findings help to explain a well-known phenomenon in weight control: why people who fail continue to fail, and what might be done about it. In humans, learned helplessness develops, according to Seligman, not because things go wrong, but because of what we think about things going wrong. Everyone suffers setbacks in life, but different people—pessimists and optimists—have different ways of looking at them. Three common characteristics of pessimists that lead them to helplessness and depression are personalisation, permanence and pervasiveness: •

•

•

Personalisation. For the pessimist, everything that happens is my fault —‘I broke the diet because I’m weak’, rather than ‘. . . it’s a totally unrealistic diet and I was seduced by advertising’. This can only be overcome by ‘externalising’, or not blaming oneself. Permanence. When something goes wrong for an optimist it’s unfortunate, but a temporary setback. A pessimist, on the other hand, convinces herself that this is something that always happens; it’s a lifetime disaster: ‘I always fail because I’ve got no self-control’. According to Seligman, by rethinking problems from permanent to temporary (‘. . . I had no self-control today’), pessimism can be overcome. Pervasiveness. This is when even the small things that go wrong suffuse the pessimist’s life (‘. . . I spilt the tea, therefore I’m a failure, therefore there’s no point in trying’). Everyone suffers small setbacks, but the optimist sees these for what they are: small, isolated problems.

The thought patterns of personalisation, permanence and pervasiveness in pessimists are maintained, according to Seligman, by ‘rumination’, or mulling over the bad things continually but not necessarily doing the same 29

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with the good things. The pessimist with learned helplessness is therefore set up for failure in weight control. It’s little wonder a pessimist bounces from diet to diet with little chance of success. Seligman’s process of cognitive therapy for reversing the cycle of learned helplessness works in four stages: 1. Recognising your thoughts at the times you feel worst. These can be in the form of short phrases or sentences such as ‘I can never lose weight. I’ve got no self-control’. 2. Learning to dispute these automatic thoughts by marshalling contrary evidence. Based on reversing the three Ps of pessimism, this involves making bad thoughts temporary, external and non-pervasive. 3. Learning to offer different explanations, called re-attributions, to dispute automatic thoughts. ‘I ate that cake today, but I felt obliged to, and I can walk it off later.’ 4. Learning how to displace depressing thoughts. This can be done using processes such as ‘thought stopping’.

GO MILD WITH YOUR ENERGY RESTRICTION A lot of research has been carried out in recent years on the weight-loss effects of very low calorie diets (diets less than 1000 kcals or 4200 kJ a day) with very big people. In general, the results have been disappointing, with subsequent weight gain often making up for the small losses that are achieved. Ironically, there’s been little research done on using mild energy restriction in individuals who are not drastically overweight. This was the basis of some research done recently in the Netherlands.31 Nutrition scientists reduced the total energy input in a small group of men by 20% after determining how much food was needed daily to keep them at a stable weight. They then compared their weight loss over a ten-week period with that of a control group of men who kept eating the amount of food required to keep their weight stable. . . . small changes in food intake are likely to be much better for fat loss than drastic changes in the long term. The reduction in food in the test group resulted in an average food intake of around 2200 kcals (9240 kJ) /day—a not insubstantial amount to keep going on. Still, the men lost an average of 7.4 kg, over 83% of which was 30

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body fat. What was perhaps more important, there was no plateauing of weight loss over the ten weeks of the study. The implications of this study are that small changes in food intake are likely to be much better in the long term for fat loss than drastic changes, even though your head might tell you otherwise.

Biological vs emotional hunger There are two main types of hunger. The first is biological, or real, hunger. The second is emotional, or socially and psychologically influenced, appetite. Recognising this distinction is important because it can help you to stop overeating. Biological hunger: 1. 2. 3. 4.

is genuinely physiological doesn’t go away if you wait (say 15 minutes) before eating increases with time cannot be staved off by distractions.

In contrast, emotional hunger: 1. 2. 3. 4.

is psychological rather than physiological is likely to go away or decrease in intensity if you wait doesn’t increase with time can be staved off by distractions.

In modern societies, we are more likely to have difficulty controlling emotional hunger or appetite, than satisfying physiological hunger. The implications of appetite for overeating are significant.32

REALISTIC WEIGHT LOSS EXPECTATIONS A common belief among people aiming to lose weight is that any amount can be lost down to an imagined ‘ideal’, if they try hard enough. Obese people typically claim they would like to lose an average of 35% of their existing body weight. However, of all the weight loss techniques available (diet, exercise, behaviour therapy, drugs, surgery, etc.), only surgery has consistently been shown to result in this amount of weight loss in the long term. Even then, surgery needs to be combined with other lifestyle changes. Losses of 5–10% are typical with other weight-loss programs, and most modern ‘diets’ result in weight being regained quickly. Psychologists therefore now warn that creating unrealistic expectations of weight loss can be counterproductive. When people fail to reach their goal they become 31

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disillusioned and regain the weight—with interest. It then becomes even more difficult to lose weight on subsequent occasions. Some good news is that research now shows clearly that even a 5–10% weight loss can lead to big health improvements.33 Changing your expectations might be the first step in any good weight-loss program.

THOUGHT-STOPPING TECHNIQUES The art of thought stopping is now used widely by psychologists to help people leave negative thinking patterns. Some thought-stopping techniques to help weight-watchers are: 1. Slamming the palm of your hand against a fixed object, such as a wall, and saying to yourself ‘Stop!’, before thinking about something else. 2. Imagining a large roadside stop sign in your mind. Concentrate on the details of this every time a negative thought enters your head (such as in the middle of the night). 3. Examining very closely a small object you pick up in your hand. Note the curves, material, irregularities and any other details of the object. 4. Wearing a rubber band around your wrist, which you snap every time a negative thought occurs, then changing the thought to a less permanent, pervasive or personal one. 5. Using worry beads or something similar that you can carry in your hand or pocket. Concentrate on the feel of each individual object instead of thinking negative thoughts.

EXTEND YOUR WEEK TILL FRIDAY NIGHT Market research surveys have shown that people eat less fat and sugar, drink less alcohol, eat breakfast more often and generally behave in a way that is more conducive to their health earlier in the week. There is a slight dip in their resolve by about Wednesday (as any restaurant or nightclub owner will tell you), and then a steady decline culminating in the Friday night binge. Saturday is usually a write-off, and the whole cycle begins again on Sunday night. By extending the week till Friday night, the inevitable lapses in behaviour that occur on the weekend can be traded off.34 This way some indulgences can be enjoyed without the usual guilt. 32

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SAUNAS SHOULD LEAVE YOU COLD In the past, heat treatments such as saunas and steam baths have often been used as weight-loss techniques. But losses effected this way are purely in the form of water through sweating, and this is quickly replaced on rehydration. A principal aim of the body is homeostasis, or the maintenance of a median physiological condition. Core body temperature is maintained at around 37.5oC, and the body will work hard to maintain this temperature in the presence of external cooling or heating. However, much less effort is required to cool the body than to heat it. In fact, in the presence of excess heat there is a tendency for the metabolism to slow down, to conserve energy and maintain body temperature. When it is cold, on the other hand, the body is stimulated to use a good deal of energy to raise body temperature. Heat treatments like sauna baths might be relaxing, but they have no long-term effect on body weight. Therefore, you could say that the ideal treatment for fat loss would not be heat treatments such as saunas and steam baths, but rather cold treatments such as ice-packs or refrigerated rooms. Unfortunately (or fortunately), there’s little chance of these therapies selling in the average fitness centre. Heat treatments are much more pleasant and can have relaxation and other psychological benefits, but they have no long-term effect on weight loss.35

DON’T GET TOO COMFORTABLE AFTER A MEAL The thought of a tasty roast followed by a port by the fireplace is enough to get even the hardiest of dieters salivating. But while the roast and port might be permissible—even for the weight conscious—a post-prandial (after-dinner) warming by the fire might add more to those calories gained during the meal than you realise. We can conclude this from a clever piece of research carried out recently in Sweden.36 Researchers tested heat loss following a meal in obese and nonobese people, some of the latter being kept warm by blankets and plastic coverings around the waist. . . . a post-prandial warming by the fire might add more to those calories gained during the meal than you realise. 33

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Reducing heat loss after food intake by non-obese people by heatwrapping their stomachs resulted in heat retention similar to that observed in the obese. Non-obese subjects who were not heat-wrapped lost more heat and therefore burned more energy than both the obese and the non-obese who had been heat-wrapped. It’s hypothesised that the reduced heat loss effect of food in obese people could be due to their extra ‘padding’, or warmth, around the middle. The implications here are that overwarming after a meal could be disadvantageous. The post-prandial port in front of the fire should perhaps be avoided.

WATCH WHAT YOU OVEREAT Low-fat and low-energy foods are now relatively easy to come by. But US research shows that these foods might have an unexpected effect on total food intake.37 Studying women who were given a pre-load of food (that is, the equivalent of a first course), scientists found that the amount of food eaten later in the meal depended on whether the pre-load was labelled high fat or low fat—irrespective of whether or not the label was accurate. Those eating what they thought was a low-fat pre-load tended to eat more at the main meal than those who thought they were eating a high-fat pre-load or had no information at all about the fat content of the pre-load. Unexpectedly, there was no difference in the amount of food eaten after the pre-load between women labelled ‘restrained’ and those labelled ‘nonrestrained’ eaters. The indications are that messages about the content of food can influence the amount ingested—at least in some women. So watch out that you don’t consume more at a meal just because you believe it to be low fat. Even if it is, when you overeat because of this, the benefits will be lost.

TEST YOUR ASSUMPTIONS Food is not only important for its energy density. The taste, or even predicted taste, of a food can encourage overeating. Therefore, whether or not a person thinks a food is likely to be filling might be important in determining just how much she eats. Psychologists at Leeds University in the UK recently put this notion to the test.38 A number of people were asked to rate how tasty and filling they considered a number of different types of foods, particularly snack foods. They were then given these to eat, and their food intake for the 34

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rest of the day was monitored to see if their ratings of how filling a food was conformed to the ability of the food to satisfy their hunger. . . . whether or not a person thinks a food is likely to be filling might be important in determining just how much she or he eats. High-sugar and high-fat snack foods (chocolate and pastries and such) were generally thought to be very filling. Nonetheless, they led to a total daily energy consumption almost double that of other foods lower in sugar and fat. This suggests that some overeating might occur because of how the food is perceived. When it comes to tasty food, not all is as it might seem.

QUITTING SMOKING AND WEIGHT GAIN Researchers in California have studied the weight gains of ex-smokers in a large sample of identical and non-identical twins from the biggest twins register in the world for the period 1917 to 1927.39 They followed the progress of over 2000 who had quit smoking and compared the weight gains of these individuals with those of matched twins who were ex-smokers or non-smokers. . . . contrary to popular belief, almost as many smokers either lose weight or remain stable as those who gain weight after quitting smoking. Quitters were divided into three categories: 1. those who gained 11.3 kg or more over the sixteen years since quitting (super-gainers), 2. those who gained more than 2.3 kg but less than 11.3 kg (gainers), 3. those with no weight change (weight stable), and 4. those who actually lost weight (weight losers). The percentages in each group, compared with continuing smokers and non-smokers, were: Weight group 1. 2. 3. 4.

Super-gainers Gainers Weight stable Weight losers

Quitters

Non-smokers

Continuing smokers

13% 39% 33% 15%

4% 30% 45% 21%

6% 29% 42% 23%

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Of particular interest is the fact that, contrary to popular belief, almost as many smokers (48%) either lose weight or remain stable after quitting smoking as those who gain weight (52%). Also, there were only around 17% more quitters than continuing smokers or non-smokers who gained weight in that time, suggesting the problem is not confined to smokers. Interestingly enough, comparisons between identical and non-identical twins showed a greater correlation in weight loss after quitting among identical twins. This suggests a genetic factor might also be important in determining whether or not weight gain occurs after quitting smoking.

Learn to lose before you tr y to quit Although it’s not inevitable that you’ll put on weight if you quit smoking, there is a good chance this will happen. There are three possible reasons for this: 1. Nicotine works to keep your metabolic rate high and therefore your weight low. 2. Smoking gives you something to do with your hands other than eat. 3. The taste of food improves after quitting and so you’re likely to eat more. Because smoking is dangerous, however, and because it results in a relocation of fat to the more dangerous fat deposits around the viscera or internal organs, quitting should be regarded as more important than weight loss. Swedish researchers have found that obese smokers find it easier to both quit and lose weight if they try to do both at the same time.40 Learning weight control then helps to prevent the weight gain which can occur with quitting. However, in behavioural terms, it is often hard to do two things at the same time. Therefore, learning rational weight-loss techniques and putting them in practice before you try to quit can often make it easier to quit when the time comes, because you’re likely to feel healthier and better disposed to quit.

DON’T START IF YOU DON’T FEEL UP TO IT Research findings from the Obesity Unit at the Royal Prince Alfred Hospital in Sydney have shown that women who score low on a measure of ‘stages of change’ and on one of ‘self-efficacy’ are most likely to ‘fall off the wagon’ when it comes to maintaining weight loss.41 ‘Stages of change’ is a theory of behaviour change that predicts the phases people go through in any behavioural change. There are five stages: 36

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1. 2. 3. 4. 5.

Pre-contemplation Contemplation Decision Action Maintenance.

Women who haven’t reached at least the decision stage and who also have low self-efficacy or confidence about their chances of success on any program tend to have a much greater rate of failure than those who are committed and really believe they can do it. The moral? Don’t try until you’re committed and you’re sure you can do it.

USE THE BEST BEHAVIOURAL TECHNIQUES Modern psychological practice has identified the best techniques for longterm weight loss. According to Professor John Foreyt from Baylor College, Texas, evidence from all the behavioural research currently available suggests that most success in weight-control programs will come from taking the following eight steps:42 1. Changing negative feelings, particularly depression and anxiety. 2. Focusing on overcoming the pressure of social situations, such as travelling and entertaining. 3. Self-monitoring your behaviour to see what triggers overeating. 4. Increasing your internal motivation. 5. Building a network of social support. 6. Carrying out regular physical activity. 7. Setting goals at very gradual increments, rather than large, sudden changes. 8. Setting realistic goals.

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Chapter 4 ENVIRONMENT MATTERS

INTRODUCTION The recent focus on molecular research in the obesity field has taken our attention away from the real causes of obesity. It’s undoubtedly true that there are genes that make getting fat easy and losing weight difficult for some people. But if genetics were the only cause of the problem, why hasn’t a large proportion of the human race been as fat as it is now for thousands of years? The answer, of course, lies in the interaction between genetics and the environment. Changes in the gene pool don’t occur in a short time span: in one, two or even ten generations. They take hundreds and in some cases thousands of years to happen. If we accept this truth, we also have to accept that the genes for obesity have been around for a long time. Therefore, we need to look at our environment to see how it’s changed to make the genetic causes of the problem more manifest. You don’t need to be Einstein to see how this has happened. In western industrialised countries, high-energy dense, or fatty, foods have become abundantly available through modern techniques of food manufacturing and marketing. On the other hand, machines and technology have made daily physical exertion almost a thing of the past. Put the two together, and you have a ripe mix for a human gene to create the excess body fat that was so important for survival throughout evolution when there weren’t machines and fast food! Before you can set out to fix or change anything, you have to know what you can change.The tips in this chapter concern changing your environment to help you lose weight. I hope they will also show you that much of the guilt you might be experiencing about how you’re coping with your diet is unwarranted.

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WEIGHT MANAGEMENT IS NOT EASY Modern medicine has solved all sorts of problems: infections; genetic disorders, environmental diseases. So why can’t it cure the fastest growing problem in western societies—obesity? According to Spanish obesity expert Professor Xavier Formiguera, there are four main reasons:43 1. Obesity has a multifactorial origin. There’s no single cause of obesity. For some people wrong eating is the problem, for others it’s too little movement, and for others still there’s a psychological component. Dealing with multiple causes requires multiple solutions and these are rarely available. 2. The nature of the disorder means it must be treated for life. ‘Weight’ loss is easy. Long-term fat loss is hard. To maintain fat loss over an extended period is hardest of all, and requires a lifetime’s commitment to a treatment that is often not acceptable. So for anything to work, it must be sustainable for a lifetime. 3. The treatment is more painful than the disease. Being obese or overweight, for most people, is painless. They’ve lived with it for many years, and have suffered little more than its psychological disadvantages. The potential treatment, on the other hand, is restrictive: reduced capacity to eat, drink and be merry! Unlike infections and other diseases, who wouldn’t prefer the disease to the cure? 4. There are as many treatments for obesity as there are causes. If they can’t deal with the problem alone, individuals who carry excess flab might need help from a range of disciplines: medical, psychological, psychiatric, as well as physical exercise. The diversity of the problem points to a diversity of treatments, which currently don’t seem to exist—at least not in one place. A fifth reason we could add to this list is our modern environment. Human beings have always had the propensity to get fat, but their environment throughout history has acted against this. Now our modern industrialised environment provides ready access to high energy-dense foods with little need to expend energy to get at them. If we are to maintain a stable body weight in modern society, our environment needs to be controlled.

CONTROL YOUR MICRO-ENVIRONMENT The environment in which we live can be broken down into a number of different categories. In the first place, there’s the division between macro- and 39

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micro-environments. Second, there’s the distinction between the physical and the socio-cultural environment. These classifications and some examples of each are shown in Figure 4.1. The macro-environment represents the global or national environment in which we live and the influences—such as technology, advertising and social factors—at work in this sphere. It’s generally difficult for any one individual to significantly change this domain. The micro-environment, on the other hand, represents our immediate environment, such as the physical environment of our homes and neighbourhoods and our immediate social and workplace networks.44 Changes in the micro-environment are vital to the maintenance of reduced body weight. Some simple approaches would be to ban fatty foods from the house, not to keep or use effort-saving devices, such as a second car, and to enlist family and peer support for any weight-control efforts. Control of the micro-environment, particularly in our modern, energyreduced society, can be a vital part of any fat-loss program. Figure 4.1 Environments that affect body weight management Physical

Macro

Micro

Socio-cultural

• • • •

Food supply Technology Fast food outlets Transport

• • • •

Social attitudes Cultural factors School PE Cultural attitudes

• • • •

Food at home Effort savers Eating environs Second car

• • • •

Peer pressure Work pressure Partner support Family support

DO A HOME AUDIT Changing your home environment can reduce your prospects for fat gain. Table 4.1 is a checklist you can use for modifying your home microenvironment. 40

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Table 4.1 A home audit checklist Check your household for: • high-fat foods (foods with more than 10% fat) stored in the house • accessibility of fatty snack foods and other ‘treats’ • oversized meals presented at meal times • low-fat alternative products, such as milk • excessive use of fats or oils in cooking • low-fat cooking methods and appliances (such as microwave ovens, grillers) • easy access to fresh fruit • excessive use of effort-saving devices (including TV remote; cordless telephones, leaf blowers, electronic kitchenware) • availability of bikes or exercise equipment • limiting eating places within the house.

WATCH THE TRAPPINGS OF CIVILISATION It’s been thought for some time that industrialisation helps to make populations fat. Now University of Melbourne researchers have proved this by measuring body mass index (BMI) scores in six villages in Papua New Guinea.45 The villages were graded for ‘modernity’, based on the use of technology and effort-saving devices such as cars, TVs and airconditioners. Villages were also graded on the modernity of their housing, employment and education. They found that as modernity indices increased, so did obesity, as measured by the BMI. Physical activity showed corresponding decreases, as might be expected. Having all the mod cons at your disposal might make life easier, but if they’re all used all the time they can also make you much fatter.

COMPENSATE FOR EFFORT-SAVING TECHNOLOGY You might have noticed that lifestyles are not quite as they were thousands, hundreds or even tens of years ago. The main difference is technology, and in general these advances have been positive. However, all technology has only two functions: 1. time saving, or 2. time wasting. In the latter case, the technology also usually results in effort reduction. As a consequence, the technological revolution has resulted in a significant decrease in the physical 41

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activity required to live from day to day. If activity burns energy, and energy means ‘fat’, how much of the modern obesity epidemic is due to modern technology? This question was answered by work carried out by a Dutch student working in Sydney on the GutBuster men’s ‘waist loss’ program in 2001. She got actors working at Old Sydney Town (a theme park north of Sydney replicating the life of settlers around 1850) to live for a week as they would have then.46 They had no access to computers, cars, telephones or any of the trappings of modern living. Their movement levels were measured by a special motion-sensitive device called a Tracmor, and then compared with those of a group of office workers in modern-day Sydney. The difference between the groups was calculated in terms of equivalent distance walked, and this was found to be around 16 km per day. This equates to about 1000 kcals (4200 kJ) of energy per day. Even with a reduction in food intake of 950 kcals (3990 kJ) a day from 1850 to today, this would translate to around an extra half a kilogram of fat being stored every 70 days. To counteract even some of this effect requires a deliberate and systematic effort.

USE YOUR LOCAL CORNER STORE Technology has brought marvellous changes to society, among them the shopping mall. A mall in your neighbourhood means you can do all your business with one stop. And if you’re lucky enough to win the contest for the closest car park to the exit, you might not have to move your legs much at all! Dr Billi Corti, of the University of Western Australia, wrote her doctoral thesis on the effects of the environment on physical activity levels in the community.47 Dr Corti found that having a corner store, rather than a supermarket or shopping mall, in your neighbourhood means you have a six times greater chance of achieving the levels of physical activity recommended for health by the National Heart Foundation. Just having a corner store nearby means that you are more likely to take a quick walk to collect the thing you inevitably forgot at the supermarket—if you have got the option, the corner store might mean you’ll live longer, although perhaps poorer.

WATCH OUT FOR THE FATTENING EFFECTS OF TELEVISION According to Dr Bill Dietz, a paediatric obesity specialist from the Boston Floating Hospital, television makes kids fat. Over 35% of American 42

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children now watch more than five hours of TV per day, and Australian surveys have turned up similar results. Is it just coincidental that around 35% of children are now also overweight or obese?48 Television has a number of effects on children that actually bring about an increase in fatness. Dietz suggests not. Television, he says, has a number of effects on children that actually bring about an increase in fatness. In the first place, it decreases the amount of physical activity they might otherwise carry out. The same applies to adults. There’s also evidence that TV viewing might actually decrease the metabolic rate and lead to a greater than usual storage of body fat. Why this is so is not known. But it appears to be more than just the decrease in exercise that accompanies increased viewing. Second, watching television can lead to an increase in food intake. This happens because of the convenience of eating while viewing and the resultant increase in the amount of snacking that goes on. It’s also more likely that what’s eaten will be high-fat snacks rather than healthy low-fat foods. In addition, there’s the influence of food advertising on TV, which is likely to intensify all the other effects.

BEWARE FAD DIETS The Oxford Dictionary defines a ‘fad’ as a peculiar notion or a craze. This best sums up fad diets. There are many that have come and gone over time. There are others that are reincarnations of the old ones with a couple of new gimmicks or, in some cases, just a new cover on the book. Some fad diets incorporate a strategy that has some potential merit, such as chewing your food 100 times before swallowing. Of course this will slow down eating, which is always a good idea, but the idea of keeping this up for any length of time is ridiculous. Perhaps the most important evaluation of any diet is whether or not it is possible to maintain it for life. Only an individual plan arrived at with some trial and error will achieve this.49

PLAN AHEAD TO DEAL WITH SOCIAL EATING Both rats and people eat more when they’re in a group than when they’re alone. There’s much we don’t know about what scientists call the ‘cohabitation 43

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effect’. But recognising social effects on individual food intake is the first step towards devising a plan to deal with them.50 If you’re aware that social eating, either with friends or at your in-laws, is likely to encourage either overeating or eating the wrong types of foods, there are steps you can take to control this: • • • • •

Ask for smaller serves. Don’t always feel you have to finish what is on your plate. Ask for more vegetables and less fat. Have an alternative to dessert, such as tea or coffee. Most of all, be prepared.

CAPITALISE ON MODERN FOOD TECHNOLOGY The increase in the range and quality of lower-fat foods on the market is testament to our now being a fat-conscious society. But the effectiveness of these foods for fat loss is a hot topic of scientific debate. A 1994 study carried out in the US caused some ripples when it showed that people eating low-fat foods over an extended time tended to compensate by simply eating more.51 A similar study carried out in the Netherlands recently showed no such effect. When given free access to full-fat foods over a six-month period, a group of over 100 people actually ate more fat and more total energy than a similar group given access to only low-fat versions of the products. The decrease in fat in the diet in the low-fat group was around 7%. There was no increase in fat taken in from other products the subjects were able to purchase from normal suppliers. An almost identical trend in fat reduction (an 8% drop) was found in another study over a six-week period of increasing carbohydrate and protein intake. In this case, however, subjects did compensate for fat reduction by taking more energy from other sources. The researchers cautioned that an increase in energy from carbohydrate and protein might limit long-term reductions in energy intake. The interesting finding was that although subjects didn’t reduce their energy intake by decreasing total food intake, they did lose just over 1 kg in the first four weeks and remained stable for the remaining two weeks. Eating reduced-fat foods as part of a low-fat diet appears to have the desired effect of reducing total fat consumption and, at least in the shortterm, will increase fat loss. For long-term success, it might be wise to make sure you’re not overcompensating and even consider reducing high-fat food 44

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(energy from other sources) or replacing it with food naturally low in fat, such as fruits and vegetables.

GO FOR ‘DIET’ SOFT DRINKS Each year, the average Australian guzzles about 80 litres of soft drink. Given that some people don’t drink any, there are others who must be making up for this shortfall in copious quantities. If you have a soft spot for ‘softies’, consider a diet version of the real thing. There are considerable energy savings to be made with these low-calorie beverages. One 375 ml can of regular soft drink contains about ten teaspoons of sugar. In one that is artificially sweetened, this figure drops down to only a small pinch of sugar.52 Despite some reports in the popular media, artificial sweeteners in moderate amounts have not been found to have any longterm ill effects. Diet drinks have sugar substitutes that have zero, or negligible calories. If you don’t like the taste of diet soft drinks, be prepared to try a few different types. Some, such as diet Coke, can be made a bit more like real Coke simply by adding a slice of lemon. Even better, just go for some ‘Adam’s Ale’! Not only is water refreshing, it’s also calorie free. The other recommendation here is to take note of what you’re eating with the drink. Very often sugar is not in itself the main problem. It’s quite likely for it to be taken with a quantity of fat (such as fried chicken), in which case the sugar is used as energy and the fat is stored in reserves, such as the waist or buttocks.

SUBSTITUTE PERSON POWER FOR HORSEPOWER Improvements in technology have been both a boon and a bane to modern society. Using remote controls for televisions, garage doors and communications might make life more efficient, but it also makes it more sedentary. This decline in energy use translates directly into a decrease in fat burned and an increase in body fat. The Old Sydney Town study reported previously showed that the average person 150 years ago was doing the equivalent of a 16 km walk per day more than the average person at the beginning of the new millennium—all through the auspices of modern machinery! This means that we need to eat roughly 1000 kcals (4200 kJ) a day less than our forebears if we don’t want to gain weight. 45

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. . . the average person 150 years ago was doing the equivalent of a 16 km walk per day more than the average person at the beginning of the new millennium. Because technology is not likely to disappear overnight, the only solution to this is for us to change the physical environment so that people are encouraged once more to engage in those incidental activities that were once needed for day-to-day survival. We can do this quite simply by using person power instead of horsepower, for example taking the stairs instead of the lift, parking the car and walking. By increasing our incidental activity, we’ll reduce the need for planned or institutionalised exercise.53

A TREADMILL FOR HOME With the call of convenience and fears of diminished safety on the streets, the market for home exercise machines is booming. Home devices have always sold well, but in the past they’ve mainly been weight-lifting machines and spurious ‘flab fighting’ devices. Now that we know more about the benefits of aerobic exercise, demand has shifted to more aerobic machines. These allow for continual use of the large muscle groups over an extended period. New versions include treadmills, stationary bicycles, stair climbers, rowing machines and alpine crosscountry skiers. All claim superior benefits. But which one has the evidence to prove it? Researchers at the Medical College of Wisconsin have recently conducted the first scientific test of this using six different machines with subjects at different experience levels at different time periods.54 The machines analysed were: 1. an ‘Airdyne’ cycling machine with air-resistance wheel spokes; 2. a standard cycle ergometer; 3. a simulated cross-country skier; 4. a rowing ergometer; 5. a stair climber; and 6. a treadmill for walking and running. A treadmill results in up to 40% more energy being used at a set level of exertion than an exercise cycle . . . All tests on the machines were standardised for level of effort using a measure known as the ‘perceived rate of exertion’ (PRE). This allows a subjective rating of effort on a scale of 1 to 20. The rating used in the current tests was a PRE of between 11 (fairly light) and 15 (hard). The actual energy use (per minute) was then estimated using standard physiological measures. 46

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The researchers scored treadmills as the most energy-effective machines. A treadmill results in up to 40% more energy being used at a set level of psychological exertion than an exercise cycle, which used the least energy. However, the researchers did note the effectiveness of all the machines tested in achieving a heart-rate range goal. For greatest economy of time, however, the treadmill leads the pack.

EXERCISE WITH A PARTNER/FRIEND The problem with any form of planned exercise in a weight-management program is adherence. Psychologists have shown that a number of factors can increase adherence.55 Exercising with a friend or partner is one of these. Exercising with a partner not only increases your likely adherence to a program, it provides you with valuable feedback and support about your progress. A standing arrangement to exercise with a partner makes it more difficult to renege when conditions are less than ideal. A possible danger, however, is becoming so dependent on that partner that the program breaks down if the partner is not available. So although the buddy system is recommended to aid motivation, you should also try to develop your own level of motivation.

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Chapter 5 NUTRITION NEWS

INTRODUCTION You’d be excused for thinking that food is food, and that once you know about what makes you fat, that’s all there is to know. But it’s not quite as easy as that. New research shows that’s it not all black and white when it comes to types of foods and how they act in nutrition. Foods once thought to be fattening are now considered essential ingredients in the fat management recipe. The starchy carbohydrates—potatoes, pasta and rice—aren’t fattening. If anything, they fill you up and prevent you from going after the ‘greasies’. The burden of restrictive dieting and constant hunger is therefore no longer the price you have to pay for success in weight management. Discovering that results can be achieved by eating differently, not less, might be a welcome surprise—but this book is all about surprises! We start with a look at what not to do.

WHAT NOT TO DO Don’t get fazed by the low-fat/ low-carbohydrate diet argument The argument about whether lowering fat or carbohydrate is best for weight loss has tended to distract us from the main issue: regardless of whether fat or carbohydrate—or any other nutrient—is reduced, weight loss will result if the effect is to reduce total energy balance.56 There are advantages and disadvantages to reducing total energy through the various means. Reducing fat, for example, leads to a greater decrease in energy because fat has 9 kcals (38 kJ) per gram, compared with the 4 of carbohydrate or protein. Reducing carbohydrate, on the other hand, means that many of the tasty, fatty foods available in our modern environment have to be avoided. However, the end result is the same given a similar reduction in total energy. 48

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It’s also possible for individuals to respond differently to different forms of energy restriction. For a number of reasons, fat might be easier to reduce for some people than carbohydrate—or the other way around. Because of the range of possible health risks (say cholesterol versus triglyceride) of various eating plans, we might need to opt for a form of dietary reduction that suits our individual risk make-up. Whichever way you look at it, there’s no such thing as a free lunch. All energy has to go somewhere, and all of it affects the speed at which you lose weight and your ability to keep it off. What works best for you might be a matter of choice. The information provided here might help you make that choice.

Don’t fast Contrary to popular opinion, fasting doesn’t ‘cleanse the system’ or eliminate ‘fat-producing toxins’. Unfortunately, what it does do is eliminate vital minerals and other elements. During World War II, Dr Ancel Keys conducted a series of fasting experiments on a group of wartime conscientious objectors (research that wouldn’t be allowed today).57 The men were put on a semi-starvation diet (1570 kcals/6560 kJ), which provided less than half the normal amount of nutrients, and were required to lose 19% to 28% of their body weight. If a man wasn’t on target to lose this amount, his food was cut further. Vigorous exercise was also part of the regimen. As the study progressed, the men experienced the following: Physically • • • • • •

a 50% drop in the ability to carry out work decreased body temperature, feeling cold all the time weakness and tiredness giddiness and fainting on rising muscle cramps, eye aches, ulcers, sores and loss of hair a fall in basal metabolic rate of almost 40%.

Psychologically • • •

apathy, irritability, moodiness and depression impaired judgement and decreased libido an increase in psychosis and violence. 49

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They also became preoccupied with food (who could blame them!) and experienced intense cravings. To deal with this, some of the subjects actually took up smoking. After they were returned to their normal food intake, some continued to have psychological disturbances and, to make up for the period of deprivation, they compensated by eating up to 200% of what they were eating before the study began. As a result, they gained fat rapidly, and ended up fatter than they were before their ordeal. From this you can see why starvation, or even short-term fasting, isn’t the answer. Fasting doesn’t reduce weight in the long term. It might even increase it!

Don’t diet The word ‘diet’ has become synonymous with a structured reduction in food intake. Most ‘diets’ involve either a strict regime dictating what may be eaten each day or rigid control over the types and quantities of food eaten.58 There are a number of reasons why this doesn’t work for weight loss: 1. ‘Going on a diet’ necessarily means ‘coming off it’ again at some stage, and that all you have lost will eventually be regained (probably with interest). Permanent weight loss requires permanent changes. Basically, when it comes to weight control, if it’s not something you can do for a lifetime, it won’t work. 2. Food (energy) restriction (particularly with no increase in exercise) leads to a slowing of the body’s metabolic rate, which can be such that it counteracts any loss of body mass and then some. For example, a 10% loss in body mass from dieting can lead to a 20% reduction in metabolic rate. As metabolic rate accounts for about 70% of our total daily energy use, any reduction can lead to an increased ability to conserve energy (store fat). Even with sustained dieting, this would mean at the least a levelling out or plateauing of fat loss. But since most people can’t stay on a diet—they tend to go back to eating more—the reduced rate of energy consumption inevitably leads to an increase in body weight. 3. Much of the weight lost on a diet (again without exercise) is lean body mass (mainly muscle). This can be as much as 25% in an average-sized person. (In a lean person it can be even higher because they have less fat to lose.) However, muscle is a prime locus of energy use, so muscle loss will slow metabolism, and therefore weight loss. When weight is regained after eating resumes, less of the amount regained 50

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will be muscle. The consequence then of a short-term ‘diet’ is increased weight—and proportionally more fat than might have been the case with gradual weight gain. . . . it’s true that dieting can make you fat. Avoid diets like you’d avoid the plague. 4. Diets are too hard. Where food is tempting and abundant—as it is today—‘dieting’ constitutes masochism. Besides, the hungrier you let yourself get, the greater the likelihood of your giving in and ending up bingeing. 5. Diets are the first casualty of stress. Those among us who are ‘restrained’ eaters are most likely to drop their bundle when faced with stress, grief or depression, which happen to us all from time to time. Because food is often a source of comfort, stress can induce us to overeat, leaving us in a worse state than we were in to begin with. 6. Diets are often not nutritionally balanced. Every commercial diet plan has its ‘gimmick’. Many of these, such as the low-carbohydrate, lowfat, fruit juice and other special ‘wonder food’ diets, can lead to deficiencies in some of the major nutrients required by the body. Some well-known diets have even been legally challenged because of these potential risks. For all of these reasons it’s true that dieting can make you fat. Avoid diets as you’d avoid the plague!

Don’t eat less than 1200 kcals (5040 kJ) a day Resting metabolic rate (RMR), or the rate at which your body burns energy at rest, can be estimated by formulas that work with gender and weight59: Table 5.1 Estimating resting metabolic rate (RMR) Males: Females:

RMR = 716 + (15 x weight (in kg)) RMR = 716 + (12 x weight (in kg))

51

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Corrections for age need to be made in the following way: Age 30–35 yrs 36–49 yrs 50–69 yrs 70 + years

Decrease by 5% 10% 15% 20%

Using these formulas, we can see that a 25-year-old female weighing 50 kg would have an RMR of 1316. This means that around 1300 kcals (5460 kJ) of food would be required to maintain such a person’s energy balance (with no gain or loss of weight). Depending on the activity level of the person, the energy requirement can vary by up to 2.4 times the RMR. So a relatively active woman weighing 50 kg might require a daily food intake of RMR
2.0 = 2632 kcals (11 054 kJ) just to maintain her weight! Less than this would bring about a loss in body weight. Dropping her food intake too far below this level without strict supervision could cause her body to adjust radically to the change using the mechanisms discussed in point 2 above. This means that in the long term fat gain rather than fat loss might be the outcome. A daily input of around 1200 kcals (5040 kJ) can be regarded as the lower level for safe, effective, long-term fat loss (with the exception of some medically supervised very low-energy diets).

Avoid cafeteria-style foods The ‘cafeteria diet’ is a term used to describe snack foods that are high in fats and sugars—characteristic of modern western cultures. Research with Puma Indians in the US, which involved allowing them free access to vending machines that dispensed a variety of familiar palatable foods, has shown that cafeteria eating can increase energy intake by over 50%.60 Around 40% of the extra intake is in the form of fat, and 48% of it is carbohydrate. Measures of the rate at which nutrients are oxidised—or burned up as energy—showed that extra carbohydrate intake results in extra carbohydrate being oxidised. However, extra fat intake had no such effect; extra fat was stored as extra body fat. The cafeteria diet not only results in more being eaten, but in more fat being stored.

Don’t go too long without eating Hunger does not promote rational food choice. All good intentions fly out the window when hunger calls. The usual interval for this in human beings 52

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is around every four hours, so a basic rule is not to go for longer than about four hours without something (healthy) to eat.61 One way of personally assessing the level of hunger, with a view to decreasing unnecessary eating, is to rate hunger on a scale such as that shown in Table 5.2. Avoid going to either extreme on your scale—be it going without food (ravenous) or eating too much food (beyond ‘full’— feeling ill). A quick self-assessment should identify the causes of hunger pangs. Is it a genuine need for food or just a passing whim? . . . don’t go for longer than about four hours without something (healthy) to eat. Table 5.2 Subjective hunger scale 8. 7. 6. 5. 4. 3. 2. 1.

Beyond ‘full’—feeling ill Very ‘full’ Slightly ‘full’ Feeling satisfied No hunger Slightly hungry Hungry Ravenous

Don’t drop dietar y fat too quickly Reducing dietary fat is an essential anti-obesity strategy. But how far can you cut back on fat before the body gets wise and starts compensating? Researchers at the University of Leeds have gone part of the way to answering this question.62 The Leeds scientists previously found that reducing fat from 40% to 30% of daily energy intake elicited no physiological or behavioural responses: the body didn’t seem to miss the fat at all. With this confirmed, they conducted a further experiment to examine the effects of a more severe reduction in fat intake. In a covert feeding study, subjects participated in two two-day test sessions. On day one of the first test, subjects ate meals containing 32% energy in the form of fat (a moderate reduction from the British average of 38%). On day one of the second test, subjects ate meals containing only 20% of energy in the form of fat. On day two of both tests, subjects were allowed to eat freely and food intake was monitored. To ensure that subjects 53

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were unaware of any manipulation and to eliminate sensory influences, a fat substitute was used to produce the fat reductions. In this experiment a 74% compensation in energy intake occurred the day after using the fat substitute. This group was also tested on their hunger ratings. On the day of the fat substitution, subjects were more hungry in the afternoon, and the next morning they were still hungry. The sudden drop in fat intake to well below habitual intake appeared to stimulate a ‘biobehavioural response’ to eat more. The implications of this are that while people might be able to take fat reductions from 40% to 30% of food energy in their stride, more drastic reductions in dietary fat, where these are coincident with a drop in energy intake, might thwart dietary adherence. This experiment also shows that heavy use of fat substitutes might not be very effective if it triggers a hunger response. Whether or not a gradual decrease in fat over a number of weeks can lessen the compensatory response of the body remains to be tested. In the meantime, though, don’t reduce the fat in your diet too drastically or all in one go.

Avoid a low-fat overload You’re doing the right thing by choosing foods with less fat. But is it helping you to reduce overall fat and energy intake? Some low- or no-fat yoghurts, ice creams and cakes still contain a considerable amount of sugar. There’s also the possibility of eating more so-called ‘bad’ foods because you’ve been ‘good’ earlier in the day. Remember, a low-fat label isn’t a licence to overeat—this trend was, until recently, supported only by anecdotal evidence. To analyse this phenomenon, two researchers at Pennsylvania State University conducted a study on whether information on the fat content of foods influenced subsequent food and overall energy intake.63 Fortyeight non-dieting women each were given 350 g of one of three different raspberry yoghurts without labels. They were: low-fat, low-calorie (3 g fat/ 161 kcals/ 676 kJ); low-fat, high-calorie (2 g fat/357 kcals/1499 kJ); and high-fat, high-calorie (26 g fat/357 kcals/1499 kJ). The subjects didn’t know which yoghurt they were given to eat before lunch, unless a label was attached. Lunch was buffet style, eaten 30 minutes after they ate the yoghurt. Not surprisingly, the women who ate the yoghurt labelled ‘low-fat, highcalorie’ consumed more energy at lunch than did those who ate yoghurt labelled ‘high-fat, high-calorie’. The effect was even noticed at dinner that evening—even though each yoghurt contained the same actual amount of 54

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energy. This suggests a need for greater awareness of how we go about balancing the reduced-fat foods we eat.

WHAT TO DO Change things in order For some people, their diet is the main cause of their excess weight; for others it’s a lack of activity. Where diet is the problem, this boils down to too much total energy (calories/kilojoules), but this can come from different sources. If changes in food intake are to be made, it’s best to make them in a hierarchy such as that described in Figure 5.1. Figure 5.1 A hierarchy of nutritional recommendations for weight loss

Decrease fat

&

Increase fibre

Increase the proportion of protein

Step 2:

Decrease energy density

Step 3: Decrease portion size If this doesn’t work:

Step 4:

Reduce alcohol and

Step 5:

Measure calories in food and reduce total energy intake (by, say, 500 kcals/2100 kJ a day)

Increase variety of foods eaten

Step 1:

55

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So, your approach to changing your diet will follow these steps: 1. Start with decreasing fat and increasing fibre. Protein intake (provided it’s low fat) should be maintained or kept relatively high (20–25% of total nutrients). 2. If this doesn’t work, look at portion size. 3. Decrease energy density (see below). 4. If you still don’t get results, you might need to look at reducing alcohol and total energy (kcal/kJ) intake. 5. Keep eating a variety of foods to guarantee proper nutrient intake and good health. Let’s look at some tips for following these recommendations.

DECREASE ENERGY DENSITY Choose foods with low to medium energy density Energy density (ED) is a new concept now being used to explain why certain diets can lead to weight loss or gain.64 ED is thought to explain the benefits of dietary patterns such as the Mediterranean diet. In the past this has been thought to be due to olive oil. But even with this oil, the diet is low in energy per gram of food because it is high in low energy-dense foods. ED is the amount of energy (calories or kilojoules) in a food per gram of that food. Energy density explains why some foods can be low in fat but still high in total energy, and so still fattening—largely because of their excess sugar. Breakfast food manufacturers, for example, have capitalised on the increased avoidance of fat by many consumers by adding loads of sugar to maintain a sweet taste. Recommended levels of ED are yet to be confirmed, but research to date suggests the following cut-offs and recommendations for weight control: Table 5.3 Suggested energy density cut-offs LOW ED MEDIUM ED HIGH ED

56

= <1.8 kcals (7.5 kJ)/g Eat mostly these foods = 1.8 kcals (7.5 kJ)–3 kcals (12.5 kJ) Eat these foods moderately = >3 kcals (12.5 kJ) Eat these foods sparingly or not at all

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Energy density for a wide range of foods is given in Professor Trim’s Ultimate Energy Guide. A sample list of foods with percentage fat and ED are shown in Table 5.4. Table 5.4 Fat and energy density levels of a sample list of foods Food Breakfast biscuit, wholewheat, bran Popcorn, air-popped, no added fat Cornflakes Rice cake, natural, brown Biscuit, savoury crispbread, puffed and toasted Bread, melba toast Cereal (mixed grain, sugar >35%, fortified) Fudge, not chocolate, plain Pretzels, regular Biscuit, fruit, polyunsaturated, wholemeal Bread stick, hard Muesli, toasted Mousse, low-fat, chocolate, artificially sweetened Rice cake with corn and sesame Turkish delight, chocolate-coated Confectionary, carob-coated, sugar

Fat g/100 7.6 4.2 0.5 3.4 3.8 4.9 4.2 4.2 7.2 9.9 3.8 9.8 5.0 2.5 9.8 9.9

ED kcals/g (kJ/g) 3.5 (14.9) 3.5 (14.8) 3.7 (15.6) 3.7 (15.6) 3.8 (16.1) 3.8 (16.0) 3.8 (16.1) 3.8 (16.1) 3.8 (15.8) 3.9 (15.9) 3.9 (16.3) 3.9 (16.2) 3.9 (15.0) 3.9 (15.0) 4.0 (16.6) 4.2 (17.5)

DECREASE TOTAL ENERGY How much food do you really need? The first stage of estimating how much food you need is measuring your resting metabolic rate (RMR). This is done through detailed and complicated laboratory analyses, or it can be estimated using formulas such as those for males and females set out in Table 5.1 (at page 51). Even a 50 kg woman requires around 1300 kcals (5460 kJ)per day to balance metabolism in the resting state. Special calculations are needed to estimate the extra requirements for physical activity carried out throughout the day. Table 5.5 shows the energy required at different levels of exertion by multiplying metabolic rate by Physical Activity Level or PAL. 57

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Table 5.5 Energy intake required at various activity levels Chair- or bed-bound RMR x 1.2 Seated with no option of moving and little exercise RMR x 1.4–1.5 Seated at work, needing to move around but little strenuous exercise RMR x 1.6–1.7 Standing work (e.g. housework, shop assistant) RMR x 1.8–1.9 Strenuous work or highly active leisure RMR x 2.0–2.4

To lose weight, a standard approach is to decrease food needed for maintenance (RMR + PAL) by around 500 kcals (2100 kJ) a day. This should lead to a weight loss of 0.5 kg a week (at least for the first few weeks).65

Choose low glycaemic index (GI) foods Although energy density can affect the total amount of energy we consume, food that is absorbed slowly can work to reduce the total amount of energy consumed. The Glycaemic Index (GI) is a relatively new concept in nutrition, used to explain the rate of absorption of various foods.66 Because of their more complex structure, starches are digested more slowly than sugars. So it’s been thought that these would be particularly beneficial in managing a disease such as diabetes, and for weight loss. But recently it’s been shown that digestion and metabolism are not so simple. Some carbohydrates are not broken down just according to their ‘simple’ or ‘complex’ nature. Another measure has been developed to explain this. The Glycaemic Index (GI) is a method of classifying the glycaemic (or blood sugar) response to carbohydrate-rich foods. Put another way, it’s a measure of how quickly carbohydrate reaches the bloodstream. Foods can be tested and rated out of 100 according to their GI measure. Foods closer to 100 are more quickly digested, so in general it’s best to consume foods with a lower GI rating. Not all sweet, sugary foods will be absorbed quickly and therefore have a high GI. It’s far more complex than that, and depends on a number of characteristics of the food consumed. For example: •

58

Glucose (GI = 100) has a higher GI than fructose (GI = 20). So temperate fruits (apples, pears, oranges), which have a high fructose content, have a lower GI than tropical fruits (watermelon, rockmelon, mangoes).

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•

•

•

•

The ratio of two types of starches (amylose:amylopectin) in a food can affect its GI. Amylopectin is more easily digested than amylose. Therefore foods such as legumes, with their high amylose: amylopectin ratio, have a lower GI than rice, which has a higher amylopectin content. Processing can increase the GI of a food. Wholemeal bread, where the grains have been ground down and incorporated into the dough, is more quickly digested (and therefore has a higher GI) than a whole grain bread, where the grains are still intact. Soluble fibre (such as gums in fruits) can decrease the rate of absorption of glucose and thus decrease GI. Fibre supplements have not been found to have the same effect because the fibre is not contained within food and so doesn’t slow absorption. Large amounts of fat can slow down digestion. While this results in a low GI for foods that contain both carbohydrate and fat (such as ice-cream), the fat content should be the primary consideration when making food selections.

Low GI foods are scored below 55, intermediate from 55 to 70 and high, above 70. You can combine a high and low GI food to produce an intermediate GI meal. The use of low GI foods can be a useful addition to a reduced-fat, high-fibre eating plan. Table 5.6 Glycaemic Index of selected foods (foods with a lower GI are likely to be better for effective weight control, assuming fat is also controlled) Bread Bagel Crumpet Mixed grain bread (av) White bread (av)

72 69 45 70

Croissant Fruit loaf (white) Rye bread Wholemeal (av)

67 47 50 77

Breakfast Cereals Kellogg’s All BranTM Kellogg’s CornflakesTM Kellogg’s SustainTM Muesli – untoasted

30 77 68 56

Sanitarium Weet-BixTM Kellogg’s NutrigrainTM Kellogg’s Mini WheatsTM Porridge

75 66 58 42

Grains/Pasta Buckwheat

54

Noodles – instant

47 59

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83 58 76

Pasta – egg fettuccine – ravioli (meat) – spaghetti

32 39 41

Biscuits/Cakes Puffed crispbread Water cracker Shredded wheatmeal Apple muffin

81 78 62 44

Ryvita Arrowroot Shortbread Sponge cake

69 69 64 46

Vegetables Carrots Potato – baked – new – pontiac

49 85 62 56

Parsnip Sweet potato Peas (green) Sweet corn

97 54 48 55

Legumes Baked beans Butter beans Kidney beans

48 31 27

Broad beans Chick peas Soya beans

79 33 18

Fruit Banana Grapefruit Mango

53 25 55

Cherries Grapes Orange

22 43 43

Snacks Corn chips Popcorn

72 55

Peanuts Potato crisps

14 54

Dairy Foods Milk – whole – skim

27 32

Yoghurt flavoured, low-fat Ice-cream

33 61

DECREASE FAT Exclude, modify, substitute or replace It’s up to you! There’s an infinite combination of foods to make up an eating plan for successful weight control. To help categorise the available options, Dr Allan Kristal and his colleagues in Seattle have come up with a fourfactor method of reducing fat in the diet.67 They suggest: 60

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1. Exclude, or eliminate, certain foods or food preparation techniques: • • • •

don’t put butter or margarine on toast avoid sausages or luncheon meats eat salads without mayonnaise or dressing avoid fried foods.

2. Modify, or alter, foods so that they are lower in fat: • • • •

trim fat off meat grill rather than frying skim fat off soups drain fat off cooked mince.

3. Substitute, by using reduced-fat or low-fat varieties of regular foods: • • • •

choose reduced-fat cheeses have skim milk instead of full-cream milk use lean mince eat reduced-fat ice-cream.

4. Replace foods, or change to new foods or ingredients: • • • •

use lemon juice instead of salad dressing eat yoghurt instead of ice cream have fruit rather than a piece of cake baste meats with vegetable stock instead of oil.

Break the fat addiction Research done at the Monell Chemical Senses Centre in Philadelphia has shown that cutting back on fat can reduce the pleasure derived from eating fatty foods.68 Scientists experimented with three groups of people: one eating a normal, generally high-fat diet, a second on a fat-restricted diet, and a third on low-fat substitutes for fatty foods within a normal diet. . . . cutting back on fat can reduce the pleasure of fatty foods. The groups were tested on their pleasure ratings in response to a range of foods for twelve weeks while they were on the diet and again for twelve weeks after it was finished. At the end of the initial period, the researchers found a decrease in ‘hedonic’ ratings, or the degree of appeal of fatty foods in the two groups with restricted fat intake. They also noticed a decrease in 61

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overall energy intake, and a decrease in body weight in these groups, compared with the normal diet group. At the end of the post-test period (twelve weeks later) the intake of fats and expressed satisfaction derived from eating fatty foods was still low in the lowfat diet group, but not in the group using low-fat replacement foods. The implications of this study are that while fats might be addictive and might help increase total calorie intake in the diet, restricting their use can break their addictiveness. So don’t think that you can trick your body or mind by substituting low-fat equivalents for fatty foods. While this tactic certainly does make for a healthier diet and is a better way to go than eating the ‘real’ thing, you’ll find that cutting down on the food type is the only way to stop an addiction to it.

Give toddlers their due Reduced-fat eating is now recommended for adults and adolescents. However, it’s important to remember that you can’t simply apply what’s good for one group to another—diets low in fat can compromise the growth of important nerve tissue in younger children. Speaking at the Sixth European Conference on Obesity in Copenhagen in 1995, Dr Michelle Rolland-Cachera, from L’Hopital St Lazare in Paris, claimed there could be a drop in growth potential for young children on limited-fat diets.69 Infants require a high level of fat for their energy needs, as well as for the myelination, or ‘coating’, of nerve fibres. Breast milk caters for this well, as it has a fat content of around 50%. . . . a low fat intake should be avoided in the early childhood years to guarantee optimal growth. A high fat intake is not always a bad thing, according to Dr RollandCachera. In fact, a low fat intake should be avoided in the early childhood years in order to guarantee optimal growth.

Don’t cut out all fats Some fats are very healthy! Unfortunately, the message to reduce fat can be read as ‘. . . all fats are bad’. This is certainly not the case. Your body needs a minimum amount of fat for essential fatty acids, which make nerve cells and hormones and help transport and absorb fat-soluble vitamins A, D, E and K. Scientists are accumulating evidence to suggest that some fats are in fact beneficial for combating problems such as heart disease and some cancers. The latest in the fish oils saga is a good example. A Seattle study of people with heart disease has shown that people who eat 62

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fish at least once a week have about half the risk of a heart attack of those who don’t eat fish at all.70 If this is so, it is likely to be explained by the fact that fish oils seem to make the blood less clottable and sticky. They might also make the heart muscle more stable and less prone to the type of abnormal rhythm that can lead to cardiac arrest. The Seattle study is one of many indicating benefits from regularly eating fish rich in omega-3 polyunsaturated fats. A practical recommendation for health is to aim for at least two fish meals a week. Oils or spreads made from olive oil or canola oil also get the thumbs up from health authorities. If you use added fat, these are the oils of choice. While olive oil is over three-quarters mono-unsaturated fatty acids, canola oil has a significant omega-3 content. A recent entrant to the market, ‘Sunola’ oil, has the highest mono-unsaturated fat content, at 85%. The effects of different oils on health might be varied. The effects on body weight, however, are likely to be more consistent (with the possible exception of fish oils), because all fats and oils have the equivalent of 9 kcals (38 kJ) per gram.

Cut out butter and margarine Spreads such as butter and margarine have become popular more for social reasons and as a matter of convention than anything else. Some cultures don’t bother with spreads at all. As a result, they don’t take in the high amounts of fat that come with regular spreads on bread and toast.71 A reasonable serving of butter or margarine on a slice of bread is the equivalent of around 5 g. As about 80% of this is fat (in butter and margarine—it’s just the type of fat that is different), you’re adding about 4 g of fat or 36 kcals (151 kJ) of energy to every piece of bread you eat. Just say you take in around 8 to10 slices per day (including sandwiches), this amounts to 32–40 g of fat, or 288–360 kcals (1210–1512 kJ) of energy— or about 10% of your daily energy intake! Toast is probably even more of a worry, because spreads sink into warm toast. With butter in particular, this usually means that you have to use more to give you that ‘lacquered’ effect. You could wind up with the equivalent of about half a kilo of fat every ten days—just from the spreads under your Vegemite or marmalade! Going off or at least reducing spreads, whether butter or margarine, is a good way of eliminating fat without too much hardship.

Develop a lifestyle eating plan Fat in food is high in energy (9 kcals/38 kJ per gram versus 4 kcals/17 kJ per gram for carbohydrate or protein). And fat is stored in the body with greater efficiency. Fat also tends to increase rather than decrease the appetite and the total amount of food that is eaten at a sitting. So reducing fat in the 63

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diet is now accepted as being perhaps the single most effective measure for controlling obesity. But whether this can be done without a strictly planned, low-fat diet regimen is open to question. In contrast with volitional eating, diet plans that involve people being told what foods to eat in minimal amounts have traditionally been the order of the day. But research from the Agricultural University in Denmark72 suggests this should stop. Scientists were investigating a food program in which a group of men and women were told where the fats were in the foods they were eating and then asked to keep these foods to a minimum. Those on this program were compared with a group of controls on a standard modern diet after eleven weeks and it was found that those on the program actually lost more weight, even though they consumed no fewer total calories! This weight loss was also quite clearly from fat rather than muscle stores, suggesting a greater long-term maintenance of fat loss since a reduction of fat is less likely to lower metabolic rates. Those with the highest levels of fat at the beginning of the program also achieved the greatest fat losses, again a move in the right direction. In assessing their results, the Danish researchers pointed out the inadequacies of weight-reducing ‘diets’. They suggested that by reducing the fat in their diet, people can avoid obsessive calorie counting but still lose weight, and in a healthy manner. . . . by reducing the fat in their diet, people can avoid obsessive calorie counting but still lose weight, and in a healthy manner.

Find out where fat hides When something looks and feels fatty, chances are it is. But today there’s a huge selection of processed foods that have varying appearances and textures. Studies suggest that identifying fat content in foods is difficult. For example, consumer research carried out recently by the Australian Dairy Corporation compared the actual fat content of various foods with consumers’ knowledge of that fat content. Interestingly, levels of fat in food were estimated by consumers to be higher than they actually were for a range of fatty foods such as chips (52% perceived, compared with 32% actual), meat pie (45% to 14%) and sausages (47% to 17%), but less high for some other food products, such as popcorn (consumers thought 5%, compared to an actual content of 20%). Another study revealed that people commonly misclassify many foods.73 In this study, men and women were again asked to estimate the fat content of various foods. They dramatically underestimated the fat content for some 64

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foods, while for others they went the other way. Foods commonly misclassified as being higher in fat than they are included potato, pasta, baked beans and beer. Foods perceived to be lower in fat than they are included chicken with the skin, sardines, cheese and peanuts. Almost 70% of subjects thought that margarine was lower in fat than butter. These findings underpin the importance of recognising the fat content of foods.

Check your figures Selecting foods for fat content should become easier as more food manufacturers put nutrition information panels on their products. From a dietary fat perspective, the most important number is the amount of fat per 100 g. The lower the better. And for those who need a guideline, try choosing foods with less than 10 g fat per 100 g of food.74 Table 5.7 compares nutrition information for two foods; potato crisps and oven-baked pretzels. There’s a big difference in fat content, and it’s obvious the pretzel would be the better choice for a savoury snack. Table 5.7 Sample nutrition information panel Nutrition Information

Size of pack Serving size Energy Protein Fat Carbohydrate Total Sugars Dietary fibre Sodium Potassium Cholesterol

Food 1 Crisps 100 g 50 g

Food 2 Pretzels 100 g 30 g

545 kcals (2290 kJ) 6.1 g 37.1 g

386 kcals (1620 kJ) 10 g 3g

51.0 g 0.4 g 5.6 g

81.1 g 4.0 g 0g

1600 mg 965 mg 0 mg

670 mg 1230 mg 0 mg

This arbitrary cut-off point of 10 g/100 g needs to be flexible, especially in the case of cheese, where the many reduced-fat varieties still have around 24 g fat per 100 g. It’s also important to check that the serving size quoted on the 65

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pack is realistic. For example, a 200 ml tub of regular yoghurt has about 8 g of fat which, when added to the daily fat intake, can be quite significant.

Decode ingredient lists Where ingredient quantities are not given, manufacturers are required by law to state on labels the ingredients, listed in decreasing order by volume. To overcome listing fats high on the ingredient list, some manufacturers show these as individual fats, which are less by volume. A general principle is to avoid foods where fats constitute any of the first three ingredients. Fats can go under many names. A list of the common ones is given below.

Common names for fats on food labels Lard, animal fat, animal shortening, coconut oil, palm oil, vegetable oil, butterfat, whole milk solids, copha, tallow, chocolate, chocolate chips, shortening, margarine, cocoa butter.

Watch out for fat–sugar combinations Fats in foods are more of a worry for weight gain than sugars. But a combination of the two might be cause for even greater concern. There are a couple of reasons for this. First, the fat–sugar combination makes it easier to get the food into your mouth. A study of 1700 women found that the main risk from sugar in the diet is that it’s used to make high-fat products such as cakes, biscuits and chocolate more palatable.75 The research showed that most sugar eaten by these women was not as added sugar but ‘hidden’ in processed foods. The sweet, fatty foods they ate tended to be at the expense of fruit and vegetables. Once inside the body this ‘bliss-point’ mixture might facilitate greater fat storage. Studies have recently been done on fat disappearance rates, or the rate at which fats in foods are used up in the body as energy. These show that after eating fatty foods, such as ice-cream with sugar (such as a caramel topping), blood fats in the form of triglycerides are slower to disappear from the bloodstream than after eating either ice-cream alone or sugar alone. This suggests that the body is likely to store fat more readily if it is accompanied by sugars. Other research has shown a similar effect with a fat–alcohol combination. The intervals that should be left between eating these kinds of foods, however, is unknown. So while, as a discerning waist watcher, you should look out for fat, you should probably be even more wary of combining it with either alcohol or sugar. 66

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High-fat foods during the day Rather than having to watch fat intake all day long, there might be key times to be more conscious of what you eat. Research at the National Institute of Health in Maryland in the US shows that fat intake varies during the course of a day.76 Examining food diaries of a large sample of women, researchers found that most have a very controlled fat intake early in the day. Even those women who have high daily fat intake apparently eat less of it at the morning meal and in snacks, and more of it than lower fat eaters at lunch and dinner. This implies that a ‘low-fat’ breakfast can easily be achieved, but restricting fat intake at later meals can be more of a challenge. Focusing on the fat content of lunch or dinner might be a more productive strategy, and one that could have significant (and sustainable) effects for some people.

Fat substitutes In 1990, 10% of food products were labelled either low fat, or no fat, obviously capitalising on market demand. But because fat is tasty, the prize awaits whoever develops the best no-fat, fatty-tasting substitute. Basically, there are three types of fat substitutes currently available: 1. Protein-based fat substitutes. These are usually made from milk and/or egg white proteins, sugar, pectin and citric acid (for example, Simplesse). They have the disadvantage of being heat sensitive and therefore unsuitable for use in cooking. 2. Carbohydrate-based fat substitutes. These can be in either digestible or indigestible form, and are usually made from starches. They feel like oil in the mouth because of their ability to form heat-stable gels. However, as with protein-based products, they can’t be used for frying. 3. Fat-based fat substitutes. These are modified-fat alternatives and, although they still provide calories, they can be effective in small amounts. They’re mostly used in soft confectionery and can reduce the calorie content of baked and filled dairy products, but probably won’t satisfy the fat craving. The surge in fat substitutes has given rise to concern about their safety. With standard food ingredients, testing is subject to a rigid set of experimental criteria where 100 times the normal quantity is fed to animals over an extended period. But unlike most food additives, which are consumed only in small quantities, fat substitutes could replace a substantial proportion of the diet for some people. Safety is therefore difficult to guarantee from animal research.77 67

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There does appear to be potential in the diet for low-fat substitutes, but for now the jury is still out. In the meantime, it might be advisable to use low-fat substitutes with caution and ‘watch this space’.

If you like chips, make them low fat Potato chips are one of the most tempting morsels on any careful food eater’s list. But they’re also disastrous in terms of fat and energy content. There are ways, however, of lowering the fat content and keeping the taste.78 Here are some of them: •

•

•

•

•

68

Use frozen, not thawed chips. Potato chips that are pre-cut and frozen form an instant crust when dropped in oil, thus minimising water loss and fat absorption. Thawed chips release more water into the surrounding oil and lower the oil temperature, therefore requiring more cooking and more absorption of fat. Cook at the right temperature. The best temperature for cooking lower fat chips is between 180°C and 185°C. Cooking chips at a lower temperature prevents the formation on the chip surface of the crust that prevents excessive fat absorption. Estimates suggest that 40% more fat is absorbed when the temperature is 10% lower than the recommended cooking temperature. Cooking at excessively high temperatures can change the nature of the oil and make it less healthy. Use poly- or mono-unsaturated oils. The fat content of chips is affected by the type of oil in which they are cooked. Stable oils with a high level of mono-unsaturated fats, such as Sunola oil (from sunflower seeds), are known to be relatively stable and longlasting. Other apparently healthy choices, such as cottonseed oil and soybean-based oils, are less stable and more susceptible to undesirable changes at the recommended cooking temperatures. Maintain the quality of the oil. Older oil/fat is characterised by a darkness in colour and a tendency to smoke. Older oils inhibit the formation of the crust on chips that reduces fat absorption. Oils should be discarded regularly and not overused, as continual heating can change the oil to include more ‘trans’ fatty acids, which are as unhealthy as saturated fats. Use the right type of chip. Absorption of fat during cooking is affected by the surface area of the chip. Because of its greater surface area, a crinkle-cut chip is likely to absorb more fat and therefore have a higher fat content than a plain chip. Bigger chips also have less surface area to total volume than small, thin chips.

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INCREASE FIBRE Fill up on fibre Fibre is the part of carbohydrate that resists breakdown by enzymes in the intestine. Most fibre passes through to the large bowel, ready for excretion in the faeces. You can therefore eat fibre without absorbing any energy from it. The benefits of eating foods that contain fibre have a lot to do with energy density. (This term refers to the number of calories in a given weight of food. See pages 56–7 for further details on ED.) Many foods that are naturally high in fibre have low energy density. In contrast, many fast foods laden with fat and little or no fibre have high energy density. If you were to eat two meals, both with the same amount of energy, the high-fat meal would be much smaller and consumed a lot faster. A recent review of effects of energy density on obesity concluded that ‘a low-fat, low energy dense diet results in a spontaneous fall in energy intake while maintaining feelings of satiety’.79 This means that you can eat less fat and less energy and still avoid the ‘. . . perpetual hunger that often accompanies active periods of food restriction’. As with most modifications to your diet, moderation is important. While too little fibre can cause constipation, too much, especially in the form of wheat bran, can decrease the absorption of iron and zinc, which are important minerals. It can also make you a little unpleasant to be around—if you get my drift! Around 30–40 g of fibre a day is what you should be aiming for.

Put (resistant) starch back on the menu Once thought to be a primary cause of obesity, starchy foods are now thought to have the opposite effect. But not all starches are the same, says Professor Alison Stephens, an expert in carbohydrate metabolism from the University of Satkatchewan in Canada.80 ‘The re-emergence of starchy foods (or non-fibre-complex carbohydrates) and their influence in health is making the interest in fibre a little old fashioned’, says Stephens. Recently, attention has turned to a form of starch in foods called ‘resistant’ starch because it is not easily digested in the intestine. Raw potato and green bananas are the best (although somewhat unpalatable) examples of this, and research comparing digestion of these has shown that not only do they add fewer calories to the diet, they also appear to cause an increase in fat use instead of glucose use by the body. Researchers from the prestigious Centre for Food Research in Denmark suggest resistant starches might have an effect on fat burning similar to 69

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abstaining from eating, because they are not digested quickly and burned as energy, so fat is used instead. These starches could also have major benefits for diabetics and people who suffer from other metabolic disorders. The recently introduced high-fibre white breads are a good source of resistant starch. There’ll be more on these foods in future research.

Eat more fruit and vegetables For years, health authorities have been encouraging us to eat more fruit and vegetables. The CSIRO Division of Human Nutrition in Adelaide, for example, recommends at least three serves of fruit and four serves of vegetables each day for health and weight control.81 Vegetables have the lowest energy density of all the food groups. The average carrot provides only 24 kcals (101 kJ), with 3 g of fibre and no fat. Fruit contains a little more energy from natural sugars, mostly fructose. Contrary to what some people believe, bananas have very little fat (less than one-fifth of a gram). The odd fruit out is the avocado. Munching on several avocados a day will add significantly to fat intake (about 40 g per avocado), even though it contains healthy, mono-unsaturated fat. In contrast, using avocado as a sandwich spread instead of margarine is a good way to cut back on fat. If this is not enough, the increasing volume of scientific evidence linking fruit and vegetable consumption with reduced risk of various cancers is another plus for eating extra fruit and vegetables.

Eat the fruit rather than drink the juice If you’ve been drinking a glass of fruit juice at breakfast for longer than you can remember, you’re probably a bit concerned after reading this heading. Well, don’t be. But do take into consideration some of the waist-wise advantages of whole fruit over juice. Since it takes around 0.5 kg of fruit to make a cup of fruit juice, the sugar (and therefore energy) value of the juice becomes highly concentrated, and very easy to consume. On the other hand, it’s quite filling to eat the whole fruit from which it came.82 . . . don’t drink anything you can eat whole (with the possible exception of (low-fat) cow’s milk! As we’ve said, dietary fats are always the first thing to cut back on in a weight control plan. After this, it’s a good idea to check for excessive sugar. If you’re drinking a litre of orange juice a day, the sugar can add up and might need to be considered. For that reason, a good principle is ‘don’t drink anything you can eat whole (with the possible exception of cow’s milk!)’. 70

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If you can’t live without your juice in the morning, at least make sure you expend some energy—juice it by hand!

Make breakfast a priority Physiologically speaking, it’s easy to see why eating carbohydrate shortly after rising is a good way to go (literally, too!). Blood glucose levels fall overnight, and without an early ‘recharge’ they can drop further as the day wears on. People who miss breakfast have the potential to get very hungry, very quickly. This intense feeling of hunger can compromise wise food choices and lead to overconsumption of fatty foods. High-fibre breakfast cereals have been found to delay the onset of hunger for longer than cereals with lower fibre contents. Getting more fibre from breakfast cereals has also been associated with choosing better sources of fibre during the day. Add to this the findings that breakfast eaters have lower fat intake, smoke less and get more vitamin C, and you can appreciate why having breakfast is an integral part of a healthy lifestyle and weight control program.83

Eat foods that bring satiety, not satiation Satiation is the feeling of fullness at a meal; satiety is satisfaction some time later. Fatty foods provide a low level of ‘satiation’, but a high level of ‘satiety’.84 This means that you can eat more during a meal without feeling full (have you noticed that it’s always possible to slip in some extra chocolate or a fatty dessert after a meal?). Satiety is generally greater some time after a meal of fatty foods, but this doesn’t prevent us eating more than we need to at the time. High-carbohydrate and fibre-rich foods, on the other hand, provide high levels of satiation, as well as relatively high satiety. This means that less is likely to be eaten at the meal, because you’re more likely to feel full. So a meal high in carbohydrate and fibre is likely to result in less hunger, as well as less energy being taken in, than a meal high in fat.

Choose foods that fill you up Foods are generally rated on their nutrient value—fat, carbohydrate and protein—with those trying to lose weight often advised to cut back on fats or carbohydrates. However, a new food index has now been developed that suggests that this approach might not be best in practice. Dr Susannah Holt, from the CSIRO Human Nutrition Unit, developed the measure, called a ‘satiety index’, at Sydney University.85 It’s expected to play a significant role in future weight loss and diabetes control programs. As part of her research, Dr Holt fed a number of different foods to a group of people, then rated how satisfied they felt, or their 71

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level of ‘satiety’, every 15 minutes over a two-hour period. She then compared how much each ate after this period when allowed free access to food. Dr Holt compared the ‘satiety’ ratings of each food to bread, which was given a satiety index (SI) score of 100. The foods found to be highest on the SI score were not those that are most craved. In fact, foods high in fat (which also have the highest energy value) often had the lowest SI, meaning they’re not really filling even though they might be very tasty. The likely outcome? You feel like more. One of the highest SI scores given so far is that for boiled potatoes (average SI = 323). Other carbohydrates, such as porridge, fruit, pasta and even jellybeans, also rated high (see Table 5.8). Croissants, which are high in fat, have the lowest SI so far (SI = 47), possibly explaining why that rich, Sunday morning breakfast leaves you hungry for more. In contrast the protein, fibre and water content of a food tends to make it more filling. Sugar doesn’t seem to pose as much of a problem as fat, suggesting that satisfying a craving with sweets might be better than doing so with fats. Table 5.8 The satiety level of different foods

Bread Potatoes Porridge Oranges Apples Brown pasta Steak HoneysmacksTM Jellybeans

Low-fat foods

Potato chips Peanuts Mars BarTM Donuts Cake Croissant

High-fat foods

0

50

100

150

200

250

Satiety Index Score (%)

72

300

350

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KEEP PROTEIN RELATIVELY HIGH Keep protein levels high A decrease in food intake has consistently been shown to slow down metabolism by between 10% and 20%, and a big drop can even occur in the first 24 hours of an energy-restricted diet. This is likely to have a considerable effect on your total energy expenditure, and therefore on your weight loss. This dramatic drop in metabolic rate is a normal physiological response to sudden changes in body mass; it is designed to protect you against starvation. Now, research carried out at the Rowett Research Institute in Scotland suggests that maintaining protein intake while decreasing total energy intake might maintain muscle mass and thus protect metabolic rate.86 Studying a small group of men and women in a metabolic chamber, where energy expenditure can be accurately assessed, the researchers examined changes in metabolic rate after a seven-day diet using high-protein, then normal-protein and high-fat and finally high-carbohydrate diets. Each person was tested on each of the diets over a seven-day period, with a seven-day ‘wash out’ between. All of the diets fed a total of 1000 kcals (4200 kJ) multiplied by 1.4 times the metabolic rate of the individual. The high-protein diet contained 36% protein, compared with 15% protein in the other diets. The remaining 64% was divided equally between carbohydrate and fat. The high-carbohydrate diet had 53% carbohydrate and the high-fat diet had 53% fat. Although the diets were too short (seven days) to arrive at any noticeable differences in body weight, there were big differences in metabolic rate. On high protein, there was no decrease in metabolic rate, whereas there was a 3.5% decrease in metabolic rate on the high-carbohydrate mix and a 5% decrease on the high-fat diet. This amounted to an energy difference between the high-protein and the other diets of around 45 kcals (189 kJ) a day. The reason for energy output maintenance with high protein would appear to be the smaller proportion of lean body mass (muscle) lost with the diet; this helps to maintain a high metabolism. A total of 45 kcals (189 kJ) a day might not seem much, but it could be significant over time because it could counteract further declines in metabolic rate. Apparently, in any energy restriction, particularly low fat for fat loss, protein levels should be kept high. Good sources of high protein, low-fat energy, such as seafood, beans and lentils, might be useful for this purpose. 73

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DECREASE PORTION SIZE Watch your por tion size Far too many people think that if they cut back on fat in their diet they can eat as much as they like. Of course this denies the second law of thermodynamics, which says that ‘energy is neither gained nor lost, it just changes form’. Portion size is important.87 You might not have noticed, but fast food takeaways have larger average portion sizes these days. Instead of getting a standard serve, you get a kingsize serve, because that’s a better way of marketing than dropping the price. You’ll also be asked if ‘you’d like fries with that’ to add to the total amount you’ll eat. Cutting back on portion size is the next thing you’ll have to look at if cutting back on fat and increasing fibre hasn’t worked. Try to keep your plate down to a reasonable size, and don’t go for extras.

Beware of compensator y overeating The human body is exceedingly cunning in its attempts to retain body fat, even in the presence of increased energy expenditure. Because fat is a valuable energy source that can help you survive in times of food scarcity, the body tries hard to preserve the fat it has. In essence, it’s saying to you ‘I’m alright at this weight, thank you. At least I’m alive, and I’ve got some spare energy just in case I need it. And I’m going to fight hard to keep it.’ . . . female humans, like female rats, tend to overeat after exercise to compensate for the energy burned up, whereas male humans, more like male rats, tend simply to decrease their body weight. One of the mechanisms by which this occurs is energy compensation. In active people, food intake tends to increase to compensate for the energy used up during exercise. Athletes, for example, eat up to four times what non-active people eat. However, they usually burn this off during exercise. Non-athletes might be a little less well regulated and might even balance their energy output with extra food input, thus maintaining a higher than wanted level of body fat. The problem is worse in females. Swedish researchers in the 1980s found that female humans, like female rats, tend to overeat after exercise to compensate for the energy burned up, whereas male humans, more like male 74

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rats, tend simply to decrease their body weight. More recently, these findings have been repeated with human subjects in research carried out at Leeds University in the UK.88 You might need to pay special attention to overeating when you introduce an exercise regime into your weight management program. However, it’s not clear whether such efforts can overcome the biological drive to eat to maintain body fat, particularly in the case of women whose body fat reserves are required for reproduction.

DECREASE ALCOHOL Trade of f drinks Restrictive diets don’t work because of the risk of rebound bingeing. Giving up alcohol can have a similar effect: if abstaining results in a psychological battle to stay off it, this can be counterproductive. You have to feel comfortable that any change you make is manageable. When asked about adopting healthy habits, most people clearly indicate that they want as little disruption of their lifestyle as possible.89 Rather than becoming non-drinkers, they’d prefer to do extra physical activity to burn off the energy from drinks. This makes sense, and allows a drink to be enjoyed even more when it’s deserved. How much is too much? The World Health Organisation has classified drinking levels: consuming less than two standard drinks a day might pose no health risk; daily consumption of more than two drinks for women and four for men can be potentially hazardous.

Beware the post-alcohol binge! Although it’s not well documented in scientific literature, there’s abundant anecdotal evidence to suggest that the craving for fats and sweets is increased after a night of alcohol consumption. The reasons for this are not clear; nor is it possible to say at this stage whether or not it can be controlled. However, an awareness of the problem might just help to reduce its effects by helping you alter your post-alcohol eating patterns, if necessary.90 It’s now well known that fats in foods are the real bugbear. Sweets, without fats, don’t seem to have the same potential for body fat storage. Therefore, post-alcohol cravings might be satisfied with sweet but low-fat foods, such as jellybeans, jubes, meringue or dried fruits such as dates or prunes. 75

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There’s no guarantee this will work. But it is worth a try to help you though these danger periods. Table 5.9 What is a standard drink? A standard drink is that amount of an alcoholic beverage that contains 10 grams of alcohol: 375 ml can of ‘low alcohol’ beer 285 ml glass of regular beer 100 ml glass of wine 60 ml glass of fortified wine 30 ml nip of spirits

Alcohol by itself isn’t fattening Contrary to popular opinion, beer doesn’t give men their bellies. Alcohol per se doesn’t make you fat. It’s what you have with the alcohol that does this. This evidence comes from a number of quarters: in the first place, there’s good epidemiological data to show an inverse association between body weight and alcohol consumption in many countries.91 This is particularly so with females. . . . there’s no such thing as a ‘ beer belly’. Alcohol per se doesn’t make you fat. It’s what you have with the alcohol that does this. Second, alcohol is regarded as a toxin, and as such is thought to be metabolised by the body for energy, lost as heat or used as a fuel of first priority. Research has shown that alcohol, like carbohydrate, seems to take precedence in the energy system before fats. Finally, research substituting alcohol energy for other nutrients (such as carbohydrates or fats) has generally shown a smaller increase in body weight over time, which supports the notion that alcohol is generally used up as energy rather than stored as fat. However, if alcohol is combined with fatty foods, it will be used as energy while the fats will be stored in the fat cells. So it’s probably not the alcohol that causes weight gains: it’s the chips, peanuts and other fatty foods in the diet. If you cut out the fats, you will be more likely to lose those extra kilograms—even without cutting out the alcohol. 76

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INCREASE VARIETY Eat a wide variety of foods If you eat from only a small variety of fatty foods every day, it’s easy to get fat. This was observed in a comparison of eating habits between lean and obese people in Nevada. The obese people ate from fewer food types than the lean people, and ones that were generally higher in fat. In a previous study, low scores on an index of food variety were found to be associated with almost all the established cardiovascular risk factors such as cholesterol, high blood pressure and high blood sugars. A chronic intake of fat is the best way to keep or increase fat on the body. To combat this, even without focusing directly on dietary fat, simply increasing your selection of foods is a wise move. The first of most government dietary guidelines usually states that we should ‘. . . enjoy a wide variety of nutritious foods’. These include breads, cereals (breakfast cereals, pasta, rice), vegetables, legumes, meats, chicken, fish, eggs, nuts, milk, cheese and yoghurt.

Go for something unfamiliar Diet-induced thermogenesis is the term given to energy used up (and given off as heat) following the digestion of food. This is known to account for a significant proportion of daily energy use (around 15–20%). Hence, any increase in thermogenesis can be beneficial for fat loss. One way of increasing thermogenesis was hinted at in European research on thermogenesis in a group of women fed familiar and unfamiliar foods.92 Diet-induced thermogenesis during the first serving of a meal consisting of unfamiliar food was found to be significantly higher than when familiar foods were eaten. Familiarity, in metabolic terms, it seems, might breed content. Try some unfamiliar foods to make your body work harder.

Add a little spice to your food The idea that spicy foods might entail some benefits in fat loss was first put to the test by scientists in 1985. In an experiment using a variety of different spicy foods, it was found that metabolic rate was increased with the addition of spices to food, resulting in an increase in energy use over a 24-hour period. Naturally, this generated a lot of interest in the weight-control industry. But for many years, the results couldn’t be replicated. Research carried out at the University of Tasmania in the early 1990s, however, might put the 77

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idea squarely back on the waist watchers’ table. Dr Eric Colquhoun and his colleagues found that:93 • •

different foods have different levels of the spicy ingredients associated with metabolic increases there has to be a prolonged use of the right type of spice in order to derive any metabolic benefits.

According to Dr Colquhoun, one ingredient in spices such as peppers and chillies could be responsible for most of the fat-burning effect. The ingredient is called ‘capsaicin’. The Tasmanian group found that if capsaicin was injected into the blood in a rat’s hind limb, oxygen consumption was increased to the large muscles, meaning an increase in energy being used and, ultimately, therefore a decrease in body fat. However, the Tasmanian researchers also found that the amount of capsaicin ranged from around 47% in Tabasco sauce to around 5% in other types of chilli sauces. Therefore it’s difficult to make a general claim about the benefits of spices without knowing their natural constituents. Colquhoun’s group also found that oxygen consumption in rat tissue didn’t increase for some days after the introduction of spicy foods into the bloodstream, but when it was introduced, it led to a gradual increase in metabolism. This research has reignited the issue of spicy foods and weight control. A metabolic boost should be seen as a possible bonus, and spicy flavours can improve the taste of low-fat food. If you find you’re complaining of dietary blandness, spice up your meals with some of the ‘hot stuff ’.

Make the most of caf feine It’s well known that caffeine, as in coffee, can have a stimulatory effect on many people. Many studies have now shown that this translates into thermogenesis: it can help raise the metabolic rate. Some studies show an increase in metabolism of 7–22% in lean people, according to the amount of coffee consumed. There’s also evidence that caffeine increases fat burning and helps ‘spare’ carbohydrate to be used as a fuel. For this reason it’s consumed by endurance athletes in long-distance events. Therefore moderate coffee consumption (3 to 4 cups daily) has been promoted as an aid for those wanting to lose extra body fat. Research from Switzerland suggests, however, that the effect of caffeine might not be as great in those who most need to reduce fat.94 When measuring the metabolic rate of lean and obese people in a metabolic chamber 78

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over 24 hours, researchers found that the effects of caffeine were blunted in people regarded as obese. Although there was still some effect, it tended to diminish as the level of body fat rose. The researchers suggest that for various physiological reasons, obesity decreases the body’s ability to metabolise caffeine, resulting in a less significant effect for the obese. There might still be a small effect, though, and this can at least justify not cutting caffeine out of your eating plan.

Graze, don’t gorge If you eat a given type and amount of food in a day, does it really matter how or when you actually eat it? It appears that it does. A ‘grazing’ pattern of eating with smaller meals eaten more often might in fact be better than a gorging pattern with only one to two large meals and little else each day. Eating more frequently might help minimise hunger levels during the day and therefore help you to consume less total energy. Researchers at Laval University in Canada studied the effect on metabolism of food consumed in one large meal (653 kcal or 2743 kJ) compared with four small meals (163 kcal or 685 kJ each) at 40-minute intervals.95 There was a larger overall increase in metabolic rate after eating with the four smaller meals than with the single large meal. Fat utilisation for body fuel was also greater with the four-meal pattern. Eating more often can also help minimise hunger levels during the day, and therefore help you to eat less overall. If you’ve just had breakfast and you plan to eat nothing until dinner time, you might not get there before the ‘bear in your belly’ gets the better of you. For these reasons as well, it’s better to ‘graze’ rather than ‘gorge’.

Eat for health and weight control The motivation for many people to eat better is to lose weight. But efforts to do so by cutting back on fat, for example, aren’t entirely without hazard, as was revealed in a 1990 study of the dietary habits of over 3000 Australians.96 Researchers separated the group into high- and low-fat consumers. Those on the lower fat intakes achieved this by restricting meats and dairy products, and this resulted in a reduced intake of vitamins A and B12 and the mineral zinc. The poor reputation of meats and dairy foods with slimmers means that they’re often seen as fatty and are cut back unnecessarily or eliminated from the diet altogether. This is a dangerous trend, which has sparked health 79

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campaigns to inform consumers about the benefits of leaner varieties of meats (lean beef, trim lamb and pork) and lower fat milks and cheeses. The Australian researchers concluded that ‘. . . for optimal effect, nutrition messages about specific nutrients should not be given in isolation but in the context of a general “healthy eating” message’. This makes perfect sense. If you’ve developed a fat phobia, try to regain a more healthy perspective.

OTHER MEASURES Don’t bother with food combining The notion of combining or, more correctly, not combining certain foods has a long history. First proposed in the 1920s by a medical graduate, the typical claim is that the human body doesn’t possess enough of the enzymes required to digest both protein and carbohydrate at the same time. Eating these together would therefore overload the system. If this biochemical claim were true (and it isn’t) it would be an advantage for fat loss, as some food would remain undigested and pass through the body without the energy being absorbed. But the human body is perfectly capable of dealing with any nutrients, be they protein, carbohydrate, fat or alcohol, all at the same time. If it wasn’t, human beings wouldn’t have evolved as far as they have. If you are tempted to succumb to this argument, remember that the body has enzymes specifically for each nutrient. The enzyme pepsin works on protein, while a whole team of sugar enzymes go to work on carbohydrate. Diets that promote an enzymatic benefit from separating nutrients or foods are clearly misguided.97

Avoid the dangers of fad diets In case we don’t already know it, a survey of 19 popular diets from women’s magazines reported in the Australian Journal of Nutrition and Dietetics has found that none conforms to both the national guidelines for nutritional health and the recommended dietary targets.98 The survey also showed that: • • •

80

most popular diets contain an appropriate amount of energy from fat, but about half provide too little energy from carbohydrate recommended fibre intake is too low in about one-third of commercial diets iron intake was less than 70% of the recommended daily intake in up to half the diets

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•

nearly half the diets included no cereals, vegetables or dairy foods on some days, often limiting intake to fruit only.

When determining the suitability of a proposed diet, you need to consider its overall health benefits—not just whether or not you will lose weight. The 19 diets surveyed might have helped women lose weight, but this is most likely to be short term, and to have this as a priority at the expense of your general health is sheer stupidity.

Get smar t with ar tificial sweeteners The advent of artificial sweeteners was supposed to be a boon to those watching their waistline. But claims in the popular media that these might increase appetite and therefore food consumption have led some consumers to question their usefulness for reducing energy intake. To investigate these claims, Dr Adam Drewnowski, a renowned expert in the field from the University of Michigan, has reviewed all the research in the area.99 He concludes ‘. . . there is no evidence that the addition of an intense sweetener to a plain stimulus promotes appetite or results in increased food consumption during some later meal’. Drewnowski’s analysis is an eye-opener about how misinformation in the health area is spread. Most claims that intense sweeteners promote hunger and increase food consumption have been based largely on two pieces of published research. The first, a letter to the Lancet, claimed that the use of aspartame (a commonly used sweetener) increased the motivation to eat. The second report, from a reputable laboratory in the UK, claimed to show an increase in food consumption later in the day after sweetener use. Although this was widely reported, subsequent research failed to replicate the results. Drewnowski’s conclusion, based on a careful review of all this research, is that hunger is more affected by the type and volume of food eaten than by the sweetness or energy density of the food. Sweeteners do not appear to influence appetite or food consumption. There’s also the question of whether sweeteners actually help fat loss. Using artificially sweetened foods does appear to be more effective for this than sweetening products with sugar. But, again, few long-term studies have compared ‘sweetened’ foods in an eating plan with non-sweetened alternatives. One such study, reported in the journal Appetite in 1988 did show that people using sweeteners experienced better long-term maintenance of weight loss.

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Outsmar t the cravings The way to a man’s heart, it’s said, is through his stomach. But if you’re thinking of doing it with chocolate, think again. A good hunk of steak might do the trick better. Research on food cravings is now beginning to uncover why a man feels he must have a steak, when all a woman wants is chocolate. Cravings, for people eating normally, it seems, are not based on nutritional needs, but are probably hormonal or psychological in origin. How else can we explain that young, pre-menopausal women crave fat, sugar and carbohydrates, whereas post-menopausal women, whose female hormonal status has changed, have cravings more akin to a man’s? According to Dr Harvey Weingarten, of McMaster University in Canada, 97% of young women he sampled in a large study on food cravings claim to have unexplained midnight urges for particular foods. This occurred in only 67% of men. These findings are discussed in a book called Why Women Need Chocolate, by dietitian Debra Waterhouse.100 She claims that men crave meat because they need protein for muscle. Although studies have yet to prove this idea, there is sound evidence to support the notion that the food cravings of men and women are different. Dr Andrew Drewnowski, an expert in taste preferences, has shown that many foods high on the female preference list are a mixture of fat and sugar. He suggests, ‘Although food cravings undoubtedly exist, the nutrientspecific term “carbohydrate craving” may be a misnomer, indicating sensory preferences for foods that are sweet, rich in fat, or both’. Overwhelmingly, sweet cravings should be satisfied by something sweet, but not fatty. Having jelly babies instead of chocolate might not always work, but when you’re done eating jelly babies, you haven’t eaten any fat. Savoury cravings might need to be satisfied by that ‘meaty’ flavour—just make sure it’s lean.

Learn label lingo The 2002 supermarket contains thousands of foods with an assortment of nutritional claims. This can leave even the keenest shopper bewildered. A Choice Magazine survey of 408 shoppers in New South Wales, for example, found that many people were not aware of what common nutritional claims actually meant. Here’s a summary of what the survey revealed:101 ‘Reduced’, ‘lower’, ‘less’: More than 50% regarded it as an absolute term (e.g. reduced-fat cheese has the same fat content as reduced-fat yogurt). People confused these terms with ‘low fat’. 82

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‘Light’ and ‘lite’: Over half thought yoghurts labelled ‘light’ or ‘lite’ had a lower or low-fat content—and they were right. But 33% believed oils so labelled were low or lower in fat. ‘% fat-free’: Some thought that a 97% fat-free frozen dessert was completely fat-free. Others thought that a 90% fat-free mayonnaise was low in fat (but not at 10% fat). Almost half surveyed thought that 80% fat-free mince was lower in fat than lean mince—incorrect. ‘Fights cholesterol’ and ‘cholesterol free’: Almost one-third thought that the ‘fight cholesterol’ claim on a margarine meant lower or low food cholesterol, and they were correct. However, one in ten thought the margarine was low in fat or fat free. ‘No added sugar’: About half thought products labelled ‘no added sugar’ contained little or no sugar. But these claims are often found on products fairly high in natural sugars, such as fruit juice and jam. In response, Food Standards Australia & New Zealand (FSANZ) has produced a Food Standards code which was due to be released at the time of writing. For definitions of labels on foods and their meaning check www.foodstandards.gov.au.

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INTRODUCTION Ask anybody how to lose weight and they’ll invariably answer: diet and exercise. We’ve seen in the previous chapters that the typical diet can be downright counterproductive. It might interest you to know that the usual approach to exercise is probably wrong too. The standard idea about exercise is that you keep going until it hurts: the ‘no pain, no gain’ philosophy. Yet physiological research shows that this is not only incorrect; it might also be dangerous. Anyone carrying excess poundage is also likely to be a little unfit. Doing vigorous exercise when you’re unfit can put extra pressure on your cardiovascular system and even bring on a heart attack. What is more important, high-intensity exercise doesn’t burn fat; it uses that other main energy source from carbohydrate—glucose. In someone who’s not very fit, ‘high intensity’ is not very high. So any form of activity that’s painful—or even somewhat uncomfortable—is not likely to use up excess body fat optimally in a fat person, even though it might do so in someone who is very fit. This means that exercise doesn’t have to be, and indeed shouldn’t be, very vigorous for fat loss. In fact, the most that’s needed from you is to move. Because of advances in technology and effort-saving devices in modern society, nobody does much of this any more. And it’s this ‘incidental’ movement that can add to the energy burned up in the course of a normal day. There are a number of simple ways you can accomplish this.

ACTIVITY LEVELS UP = WEIGHT DOWN? For some people, weight loss is difficult, even if they adopt the correct lifestyle changes. Expectations are often high. In fact, surveys have shown 84

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that overweight individuals expect to lose an average of 35% of their body mass on a weight-loss program, whereas a 5–10% loss is a more common average and a more realistic goal. Epidemiological studies have shown, however, that losses of 5–10% are enough to lead to significant improvements in metabolic health, including lowered blood pressure, lowered blood sugars and altered blood fats.102 Improvements in metabolic health result particularly from changes in physical activity levels, although improvements in diet will also help achieve them. Exercise, helping, as it does, to reduce blood sugars by using them up in the muscles, leads to an improvement in insulin resistance— and poor insulin resistance is the underlying cause of many metabolic health problems. Therefore, health gains, as much as weight loss, should be seen as the goal of any weight-loss program. Health gains, as much as weight loss, should be seen as the goal of any weight-loss program.

DON’T GET STRESSED ABOUT GETTING ‘FIT’ Exercise has connotations of good health. But the increased prevalence of obesity in recent years has concentrated attention more on whether reductions in body fat, rather than exercise per se, might be a better goal for the average person. What is more, as we age there’s a natural tendency to get fatter. Is it important to fight this, or should we simply carry out some light activity daily? Research carried out with middle-aged and older men at the University of Maryland compared the benefits of aerobic exercise and weight loss in reducing risk of heart disease.103 Men aged 61 and older were given either a regular exercise program on cycles and treadmills three times a week or instruction on how to cut down food intake. Results were compared with a control group, who maintained their weight over the nine months of the program. Surprisingly, while those in the weightloss group lost about 10% of their body weight, they didn’t increase their fitness levels. Still, there was an improvement in blood pressure, blood fats and blood sugars. For those in the exercise only group, there was an improvement in fitness, no loss in weight and also relatively little change in risk factors. The researchers concluded that, at least in middle-aged men, weight loss is more important than fitness when it comes to the overall health of the body. It’s reasonable to assume that this particular finding would also apply 85

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to women. So, don’t assume that exercise alone will help you lose weight and gain health—it won’t.

INCREASE YOUR ‘INCIDENTAL’ ACTIVITY Captain Cook didn’t need an aerobics instructor on board the Endeavour. And neither would we if we had to do what our forebears did just to stay alive: chop the wood, catch kangaroos, wash the clothes by hand, and so forth. Not having to do any of this has meant decreased energy use in modern times, estimated at around 1000 kcals (4200 kJ) a day (see Chapter 4), or the equivalent of 1 kg of fat every seven days! Captain Cook didn’t need an aerobics instructor on board the Endeavour. And neither would we if we had to do what our forebears did just to stay alive. How do you catch a kangaroo today? You can’t (unless you want animal rights lobbyists on your doorstep). But you can walk instead of driving the car, take the stairs instead of escalators, not use technology where person power can do the job, or simply stand when you could sit. All of this ‘incidental’ movement—and much more—can help burn the fat that’s not being burned at the moment because of the use of machines. Think incidental activity, and you will need to worry less about exercise.

JUST MOVE MORE . . . DAILY Recommendations for improving physical fitness over the past two decades have involved carrying out intensive activity for 20–30 minutes on three to four days of the week. Until recently, this was also the prescription given for losing fat, on the understanding that exercise for fitness is no different from exercise for slimness. More recently, it’s been found that the only type of effort really needed to reduce fat is movement.104 Regular movement, either through walking, running, cycling, rowing or playing games, is required on as many days of the week as possible—preferably seven days. Fortunately, this movement doesn’t need to be as vigorous as the type of activity needed for improvements in aerobic fitness. 86

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IF YOU’RE TOO BIG TO MOVE COMFORTABLY— FIDGET! For some people, large movements, such as carrying one’s own body weight, are painful or difficult to execute. This might be because of the excess weight they are carrying, or as a result of injury. In these cases, the energy used up by fidgeting can far exceed that used up by simply sitting. Researchers in the US, for example, have shown that fidgeting can add to the energy costs of your resting metabolic rate or those of just sitting or standing,105 as shown in Table 6.1. Table 6.1 Extra energy costs of fidgeting Energy costs (kcals [kJ] per hour) Resting Metabolic Rate Extra energy costs (add to 60 kcals/h) Sitting motionless Fidgeting while seated Standing motionless Fidgeting while standing

60

3 + 5 kcals (13 + 21 kJ/hr) hr 40 + 21 kcals (168 + 88 kJ/hr) hr 10 + 7 kcals (42 + 29 kJ/hr) hr 70 + 29 kcals (294 + 122 kJ/hr) hr

BEWARE THE M AND M (AND M) SYNDROME It’s well known that being overweight can cause metabolic (ill-health) problems. What is less well known is that being overweight can also cause mechanical problems, such as a sore back, knees, hips or ankles, asthma or difficulty in breathing, tiredness and even incontinence. These problems can in turn affect motivation (the third ‘M’),106 which results in a drop in physical activity and a cyclical problem with obesity, as shown in Figure 6.1. In many cases, reducing the weight reduces the resultant mechanical problems. This is best done through a sensible eating and exercise program. So persisting with an activity program or finding exercises that are less ‘painful’, such as walking in water, riding a bicycle or other weightsupporting activities, is perhaps the best approach. If pain or discomfort persists, consult a doctor, podiatrist or exercise specialist. 87

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Figure 6.1 A cycle of weight problems Increased body weight

Inactivity

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Joint problems

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Respiratory problems

DON’T SIT WHILE YOU CAN STAND The decline in incidental activity in modern western life has significantly reduced our daily energy expenditure. While a return to pre-industrial revolution times is unlikely, adding certain activities to your daily living can help compensate for the decline in overall energy expenditure.107 For example: • • • • • • • • • • 88

don’t sit when you can stand don’t drive or ride when you can walk don’t use remote controls for TVs, stereos, garage doors, etc. do it yourself, don’t ask someone else (the kids) to do it for you mow the lawn and wash the dishes by hand carry your bags, don’t use a trolley walk up stairs, don’t use the lift park some distance from your destination and walk walk, don’t drive, locally hang out the laundry; don’t use a clothes drier (unless it’s raining).

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ADD MORE ACTIVITY TO YOUR LIFESTYLE In line with recent research, which shows clearly that total, accumulated activity is more important for weight loss than intense, continuous activity, several studies demonstrate that this is best achieved by building activity into one’s lifestyle. Dr Steven Blair and his colleagues from the Cooper Aerobics Institute in Dallas, Texas108 have found that if individuals are asked to carry out a set amount of planned exercise during the day, they tend to do less incidental activity for the rest of the day. This is particularly so with increasing age. Building activity into one’s lifestyle by becoming more active throughout the whole day is likely to be more effective for long-term weight loss.

DO SMALL, REGULAR BOUTS OF PHYSICAL ACTIVITY Work with athletes has led scientists to believe that exercise needs to be carried out in a single session for the most benefit. And while this might be true for anyone wanting to increase their fitness levels, it’s now thought that it is not necessary for reducing fatness. Frequent short bouts of movement appear to be a better recommendation for long-term weight loss than fewer, more extended bouts. Research with obese women carried out at the University of Pittsburgh compared the effects on subjects walking for four bouts of 10 minutes a day over three months with those on others walking for one session of 40 minutes a day at the same intensity.109 The results showed that because the group carrying out the short bursts complied much more readily with the program, they tended to lose as much or more body weight over the test period. Perhaps unexpectedly, they also had a slightly better improvement in cardiovascular fitness. The results are almost certainly explainable by the fact that it’s easier for big people to comply with a program of shorter exercise sessions. Frequent short bouts of movement therefore appear to be a better recommendation for long-term weight loss than fewer, more extended bouts.

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VOLUME OF EXERCISE, NOT INTENSITY When it comes to exercise or physical activity: Volume = Frequency
Intensity
Duration We now know that it is total volume of activity that is most relevant for weight loss. This can be increased by increasing any of the components: frequency, intensity or duration. However, in someone who is overweight and unfit, high-intensity exercise can be dangerous. Therefore, increases in frequency and/or duration are usually the preferred options.110

IF YOU’RE AEROBICALLY FIT . . . Aerobic capacity is the ability of the heart and lungs to carry oxygen to working muscles. 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. Hence it becomes possible for someone who is fit (but perhaps still overweight) to reduce the duration and frequency of activity and achieve economies of time by increasing exercise intensity.111 Do take care, though, not to reduce your activity levels for the rest of the day as a result of fatigue from vigorous activity, thereby counteracting the benefits of the shorter, but more intense activity.

DON’T EXPECT SHORT BOUTS OF ACTIVITY TO KEEP YOU SLIM One of the main causes of the modern obesity epidemic is the lower ‘ambient’ level of activity required in the modern environment. Studies reported elsewhere in this book (see Chapter 4) have shown that over the last century or so our activity levels have probably decreased by up to 1000 kcals (4200 kJ) per day. This shortfall is unlikely to be made up by increases in activity through short exercise sessions, particularly where these are compensated for by decreases in total daily activity. Large and permanent losses in body weight can only come from a significant commitment to being more active every day, probably for up to 80 minutes or so (although not necessarily continuously). 90

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A 2002 consensus statement on exercise and weight control from a World Health Organisation meeting in Bangkok112 supports this by suggesting that: The current physical activity guideline for adults of 30 minutes of moderate intensity activity daily, preferably all days of the week, is of importance for limiting health risks for a number of chronic diseases including coronary heart disease and diabetes. However for preventing weight gain or regain this guideline is likely to be insufficient for many individuals in the current environment. There is compelling evidence that prevention of weight regain in formerly obese individuals requires 60 to 90 minutes of moderate intensity activity or lesser amounts of vigorous intensity activity. Although definitive data are lacking, it seems likely that moderate intensity activity of approximately 45 to 60 minutes per day, or 1.7 PAL (Physical Activity Level), is required to prevent the transition to overweight or obesity. For children, even more activity time is recommended. A good approach for many individuals to obtain the recommended level of physical activity is to reduce sedentary behavior by incorporating more incidental and leisure-time activity into the daily routine. Political action is imperative to effect physical and social environmental changes to enable and encourage physical activity. Settings in which these environmental changes can be implemented include the urban and transportation infrastructure, schools, and workplaces.

DON’T OVERESTIMATE THE ROLE OF FITNESS EXERCISE The scientific evidence supporting the need for exercise in weight loss— particularly in very big people—is surprisingly equivocal. This could be because the net value of exercise has been overestimated, say US exercise specialists Glen and Arlene Blix.113 Most estimates of the value of exercise are based on the amount of energy burned up during the exercise. Jogging a mile (1.6 km), for example, will burn around 95 kcals or 400 kJ. If 1 kg of fat is the equivalent of 7619 kcals or 32 000 kJ, this means an extra mile a day would burn up 1 kg of fat in about five weeks. But as the Blixes point out, this ignores the fact that if someone isn’t jogging, they’re doing something else. Even lying in bed requires energy. Therefore it’s the net energy used during exercise that should be considered, rather than the gross expenditure. If the alternative to jogging was walking 91

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around the house, about 48 kcals or 200 kJ might be burned in the same period. So it would now take closer to 7.5 weeks to burn the extra kilogram of fat, which is a much less rosy proposition. In addition to this, the amount of energy used up during exercise decreases with the amount of weight lost. Theoretically, then, any loss in weight from exercise will tend to slow down the rate of weight loss that occurs from a similar amount of exercise in the future. In fact, the Blixes calculate that even if you walked 1000 miles (1600 km), you’d only lose 3.53 lbs (1.6 kg) of fat, rather than the 33 lbs (15 kg) predicted by other equations! While none of this discounts the value of regular exercise for fat loss, it does rather scotch the idea that a 30-minute aerobics class three times a week is the answer to your weight-control problems. Regular, daily, planned and incidental exercise needs to be built into our lifestyle for long-term weight control.

GO FOR DISTANCE, NOT SPEED A legacy of the fitness tradition is that effort is important. The faster and harder an exercise is carried out, the greater the improvement in fitness. But as we’ve said, reducing fatness is different from increasing fitness. Body fat responds to total energy use. In a relatively fat, unfit person, intensive activity can result in blood sugars, rather than fats, being used as the fuel source. Setting a distance rather than a speed is therefore likely to be more productive for fat loss, in contrast with fitness.115 Walking a daily distance of 3–4 km is generally accepted as appropriate for most people. This can be carried out at a leisurely pace, or even done in three to four bouts of 1 kilometre. The main thing is to make sure that it’s done. An equivalent distance for cycling is around 15–20 km. You’ll need to work out your own equivalents for other activities such as rowing or skiing.

LONG AND SLOW DOES THE JOB You might have always wanted to run a marathon but been turned off by all the heavy training involved. You might be prepared to give your ‘eye teeth’ to be fit and healthy, but can’t stand the thought of getting out of breath. The good news is that all these things might be possible—without going to extremes—as has been shown with novice marathon runners at the 92

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University of Northern Iowa.116 A total of 28 healthy males and 41 healthy females were trained (at the same intensity) either over four days a week or six days a week for 15 weeks before completing a marathon. Surprisingly, those who were trained for only four days a week were able to complete the event as quickly as those who trained six days a week. They also lost as much body fat and recorded similar other improvements in markers of fitness, suggesting that, at least in novices, a high level of intense training is not necessary. This training was, moreover, only moderate in intensity (60–75% of maximum), suggesting that benefits in terms of fat loss and fitness can be gained at a lower intensity than is often recommended.

ONLY DO PLANNED EXERCISE THAT YOU ENJOY It’s important for weight control that you be able to maintain any planned exercise program for a lifetime.117 By definition, you are only likely to exercise if it’s enjoyable. And while you perhaps cannot expect to enjoy it from Day 1, you should know after a number of sessions whether or not you are likely to continue with a particular form of exercise. As movement, and not any specific type of exercise, is the key to longterm success, a regular, planned exercise program should include the activities you enjoy.

ENJOY VARIETY IN EXERCISE To succeed in losing weight, you must carry out planned exercise over your lifetime. One of the main impediments to doing so for many people is the boredom, or staleness, that can set in. Try several different types: walking, cycling, rowing, weight training. This can help you make up your mind about what you prefer. You can vary your activity from day to day to derive maximum enjoyment.118 Varying the exercise routine—type, duration, location, time of day—not only increases your prospects of enjoyment, but enhances your prospects of fat burning through change. Changing the routine prevents the body adapting to one particular form of activity and becoming too efficient at performing it. If this occurs, less energy, and therefore less fat, is used up carrying out the activity. While specificity (or carrying out the same activity regularly) is vital for athletes who are competing in a specific event, it’s not necessary for 93

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fat loss. The main concern for the latter goal is regular use of energy— any energy used in any way!

KEEPING WEIGHT OFF ONCE YOU’VE LOST IT Exercise is more important in weight maintenance than in the early stages of weight loss. Research has shown that in the long term, a lifestyle program with exercise built into it is much more likely to be effective.119 It helps burn energy (if done the right way). But it might even help change eating patterns. Men, in particular, have been shown to eat more carbohydrate and less fat as a result of a regular, planned exercise program. Relapse is also less common in women who have exercise as part of a regular maintenance routine. . . . in the long term, a lifestyle program with exercise built into it is much more likely to be effective. If you are a big person, the changes that are likely to have the greatest impact early in a fat-loss program are changes in food type (such as a decrease in fat) combined with increases in incidental activity. Building in more planned activity into an ongoing program will help stop you relapsing into old habits and regaining weight.

WEIGHT TRAINING—FOR THE NOT SO FAT There’s controversy in the scientific literature about the use of weight training in fat loss. In theory, doing weights can help you maintain lean body (muscle) mass and therefore a good metabolic rate, even while your body is losing fat. This would also assist with further decreasing body fat.120 If you are obese or very overweight you might find that you are more concerned about your total body size than your muscle-to-fat ratio. You might also find it embarrassing and uncomfortable to lift weights. Therefore, your time is probably more efficiently spent doing more aerobic-type activity, such as walking. For someone who doesn’t have a lot of fat to lose, however, weight training can help maintain muscle, which might otherwise be lost through food restriction. The most effective form of weight training for this purpose is circuit training, or the use of relatively light weights and high repetitions (15–20 reps). 94

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ONE FOR THE VERY FIT Some extra-active people have difficulty losing that extra kilo of fat they have gained despite their high energy output. Why is this? And what can be done? The question has been partially answered by a study from the University of Limberg in the Netherlands121 that looked at the metabolism of fat in athletes who have overtrained and who are given a fat as well as a carbohydrate supplement. The researchers found that depleting the body’s carbohydrate stores—the opposite of carbohydrate loading used by marathon runners—might decrease body fat, depending on the individual’s nutrient state at the time. The scientists reduced the glucose stores of one group of men by making them cycle for two-minute bursts over 90 minutes the night before a test run of cycling at 50% of their maximum effort for 90 minutes. On another occasion, the group was fed a high-carbohydrate diet the night before the test, with no exercise to reduce the fuel source. Fat use during exercise was highest for those who were carbohydrate depleted. The theory behind this is that fat will be used more as an energy source if there is scant carbohydrate (and thus sugar) in the system. While the theory appears to have worked in practice in the Dutch research, the potential dangers of this approach preclude its use, except under strict supervision and possibly only as a last resort for elite athletes.

DON’T EXERCISE TO THE POINT OF BREATHLESSNESS The body uses two main sources of energy or fuel. The first of these, glucose or blood sugars, comes from the carbohydrates in food. The second, fat, comes mainly from fat in the fat cells of the body, which themselves come from fat in food. Glucose is the main type of fuel used by the body for vigorous intensive activity; fat is used more in long-duration, low–moderate intensity activity. Therefore, as one’s activity changes from a sprint to a leisurely stroll, the body shifts from burning its limited supplies of glucose to burning its large supplies of fat. Some fitness experts argue that because more total energy is used up at a high intensity, more fat will still be burned, even though the proportion of fat used as a fuel decreases. However, while this might well be true for fit people, it’s much less likely to be true for fat people, who are usually less fit and therefore burn less fat than fit people even at a higher level of exercise intensity. 95

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The general principle therefore is that low–moderate intensity activity is best for optimal fat loss in most fat and unfit people.122 If your activity is intense enough to make you breathe very heavily or leave you short of breath, it’s likely to be using up less fat as an energy source.

DON’T DRESS TOO WARMLY WHEN YOU EXERCISE For some time now, scientists have claimed that heat treatments for fat loss (in contrast with weight loss) don’t work. If anything, they might increase weight by decreasing metabolic rate. In fact, it might be cold conditions that burn fat best. Research by Canadian scientists on soldiers in the Arctic has shown that even with a large increase in food intake, body fat is kept down by cold temperatures.123 The simple explanation for this is that the body uses up energy in the cold to maintain body heat. You might think that the difference between a cold and a hot day is insignificant. But research carried out at New England University in New South Wales has shown that a temperature difference as small as 5oC can lead to an average 10% increase in the body’s metabolic rate in people wearing light clothes. This can amount to the equivalent of a large glass of beer in a day, or around about 5 kg of fat loss in a year. So how realistic is the use of cold for fat loss? While nobody is recommending freezers instead of sauna baths in gymnasiums for weight loss (yet), there are indications that they would actually work better. In the meantime, some tips for the waist watcher are: • • • • • •

avoid overheating by not overdressing in winter avoid overheated buildings or vehicles wear clothes that allow the body to ‘breathe’, such as cotton, rather than synthetics avoid heat treatments such as saunas and steam baths exercise during the cooler hours of the day (e.g. early mornings) avoid overheating at night under a doona that’s too warm.

DIGITAL PEDOMETERS Advances in digital pedometers have made these a useful tool in any weight loss or exercise program for giving an indication of the amount of energy used up in the course of a day.124 Some new pedometers not only measure 96

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distance covered—they even estimate calories consumed. One version can even sense and measure forms of movement that don’t involve ambulation, such as rowing or cycling. A problem that remains with some pedometers is varying stride length, such as occurs in walking up and down hills or between warming up and more extended jogging. But this can be overcome by using different stride lengths, which can easily be put into the device according to the terrain, type of stride, and so forth. Because they can be worn all day, the new pedometers give you a good indication of day-to-day variations in your activity. If you’re over or under your daily average, you can compensate by doing other activities or cutting back on high-energy foods.

WHEN YOU START TO LOSE Your body adapts to stressors you place on it. Exercise is a form of physical stressor, and physiological adaptation occurs in response to any form of constant regular exercise.125 This means that although you might continue to get health benefits and maintain a set body weight by carrying out a certain amount of exercise, you might no longer continue to lose weight or, more importantly, fat. . . . making the body less efficient is going to use more energy. Ironically, making the body less efficient will induce it to use more energy. So increasing the frequency, intensity, time or type of your exercise is likely to be less beneficial if your body has become efficient at it.

SWIMMING NOT THE BEST ACTIVITY FOR WEIGHT LOSS Swimming is usually one of the first exercises recommended for unfitness or fatness. But while swimming might be fine (if done properly) for fitness and general all-round wellbeing, it’s not an effective exercise for weight control compared with other weight-bearing activities.126 There are a number of reasons for this: 1. Since your body weight is supported in water, less overall energy is generally required to move at a set level of intensity in water. 97

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2. Because fat floats, the fatter you are, the less energy you need to stay afloat and move in water. 3. The rate of energy expenditure in water is totally dependent on the efficiency of the swimmer. A very poor swimmer will burn more fat than a very good one. 4. Maintenance of core body temperature is much easier during and after swimming than during and after land-based activities. Therefore no energy is required to return the body to its core temperature. 5. A lower centre of gravity and a greater proportion of body fat in females helps them float better and therefore use less energy than men in the water. Hence, swimming is an even less effective exercise for fat loss in women than it’s likely to be in men. . . . swimming might be fine for fitness and general all-round wellbeing, but it’s not an effective exercise for weight control. All of the above doesn’t deny the benefits of swimming, and particularly the more vigorous forms of aquarobics. However, relative to other weightbearing exercises such as walking, swimming’s principal benefits will be fitness gains for high-intensity activity rather than fat loss. If you are very big, and find weight-supporting activities difficult, swimming and other aquatic activity, including walking in water, can be a good, less painful introduction to an activity program. But remember, you will need to carry out some other activity eventually to really work on your weight loss.

AIM FOR THE PSYCHOLOGICAL REWARDS OF EXERCISE For someone who’s out of condition, any level of exercise can be uncomfortable. However, with increased fitness, exercise can become its own reward.127 And while fitness is not necessarily the goal of an exercise program for weight loss, fitness will result from even mild, regular exercise. There are three stages between unfitness and fitness: Stage 1. The discomfort stage is marked by easily getting out of breath, tiring quickly and not looking forward to any form of effort. It might last for days, weeks or even months. The type of motivation required to get through this stage is extrinsic, external to the individual. 98

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Stage 2. The physical stage is marked by feelings of wellbeing after finishing exercising. The rewards are physical and tend to become more intrinsic as well as extrinsic. This means that the exercise in itself begins to produce a level of enjoyment leading to satisfaction. Stage 3. The psychological stage: For many people, a third stage of fitness is marked by the psychological feelings that come with a high level of fitness. This is characterised by an enjoyment of the activity while it’s being carried out. The rewards are totally intrinsic and the exercise becomes enjoyable in itself. Once you reach this stage, it becomes much easier to maintain a lifetime exercise routine, which, in turn, will help you maintain a low body weight.

AIM FOR A FEELING, NOT AN EFFECT Exercise is a vital part of any weight management program. But it shouldn’t be seen as a panacea. Some reasons for the relatively modest effects of exercise on fat loss have been outlined above. The benefits of exercise can, however, be wide ranging and include feelings of wellbeing, better sleeping patterns, increased alertness and increased ability to function during the day.128 Developing these benefits should be a primary goal of any exercise program. Loss of body fat can occur as a consequence of this, but it should not be seen as the sole function of an exercise routine.

DO SOME MODERATE EXERCISE BEFORE BREAKFAST Although time of day has not generally been considered important for influencing fat burning in exercise, some recent research has begun to question this. One study carried out at the University of Lausanne in Switzerland compared the amount of fat burned up as energy exercising before breakfast with that burned up exercising after breakfast.129 The researchers found that approximately 40% more fat is used up when exercise is done before eating, and after an overnight fast (see Figure 6.2). They explained this as being due to the low levels of blood sugar available as a result of the 8–10-hour fast overnight. The body therefore calls on more fat to power the system. . . . approximately 40% more fat is used up when exercise is done before eating, after an overnight fast. 99

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Of course this effect can be neutralised to some extent by eating immediately after the exercise, since fat is used for some time afterwards to continue to supply the muscles with energy. The Swiss research found not eating for about 45 minutes after exercise was enough to solve this problem. Figure 6.2 The percentage of fat and carbohydrate (CHO) used as energy during exercise before and after breakfast.

Meal

Exercise

Exercise

Meal CHO Fat

% of energy use

CHANGE DIET BEFORE EXERCISE—FOR THE VERY FAT When you gain weight, you put on lean body tissue (muscle) as well as fat. This extra muscle is necessary to carry around the extra weight. Similarly, when you lose weight, much of this (around 25%) is muscle and other lean body tissue. For a very big person this might not be such a disadvantage because it’s often a loss in total body mass that is important—at least initially. One possible disadvantage is the reduction in metabolic rate that can occur with food restriction alone. For many very big people, however, exercise can be quite uncomfortable, even painful. Therefore it becomes a tradeoff in the early stages between the possible drop in metabolic rate and the discomfort of exercise, which might compromise such a person’s adherence to the program.130 100

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Changing your eating patterns is the priority in the early stages, until sufficient body mass has been lost to make planned exercise, such as walking, more tolerable. You can maintain your metabolism in the early stages simply by increasing the amount of incidental activity you do during the day.

DON’T CUT FOOD INTAKE WITHOUT EXERCISING—FOR THE NOT SO FAT Although we’ve recommended that diets should not be used, overall food restriction is sometimes called for, particularly dietary fat restriction in a fat-loss program. Restriction of food energy, however, leads to a relatively indiscriminate loss of body tissue. It’s estimated that up to 25% of the weight losses in an obese person can come from muscle, and the remaining 75% from fat. In a person who is not excessively overfat, the losses in muscle can be even higher, up to 50% muscle. Because muscle is more metabolically active than fat, muscle loss of this magnitude can lead to a reduction in metabolic rate, which, in turn, can make it easier to store fat at a later stage. For the slightly overweight, this can be a major disadvantage, because they can end up being fatter than when they started.131 This dilemma worsens the greater the energy restriction. More muscle will be lost on an 800 kcal/3360 kJ per day diet, for example, than on a 1200 kcal/5040 kJ per day diet. Aerobic exercise can help maintain body muscle even while fat is being lost. Because muscle is being worked during aerobic exercise, the body becomes discriminating enough not to ‘cannibalise’ this as an energy source. Metabolism therefore remains high and fat loss (although not necessarily weight loss) can be maintained. Therefore, for the overweight (in contrast with the obese), diets or food restriction should never be undertaken without a regular exercise program. . . . for the overweight (in contrast with the obese), diets or food restriction should never be undertaken without a regular exercise program.

USE PHYSICAL ACTIVITY TO BANISH TEMPTATION It’s well known that one of the major stimulants to obesity is stress in its various forms. While acute stress generally leads to a decrease in eating, 101

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chronic stress—in the form of grief, anger, distress or depression—can lead to an abandonment of inhibitions against overeating and drinking and a reduction in physical activity. In the long term, this can lead to an altered energy balance and an increase in body fat. The traditional responses to stress throughout evolution have been fight or flight, both of which involve a significant response of physical exertion or exercise. Physical activity such as walking can—if carried out as an alternative response to stress or the temptation to overeat—not only produce a distraction effect, it can also help reduce the physiological effects of the stress by relieving muscle tension. In this way, the stimulus–response connection between stress and overeating can be broken.132

COOL DOWN SLOWLY AFTER EXERCISE During any form of physical activity the body’s rate of energy use is increased. If this is carried out over an extended period at a low–moderate intensity, fat will be liberated from the fat cells to help fuel the extra energy needs. Research on the role of fat metabolism during and after exercise shows that fats released from the fat cells remain in the bloodstream for some time, to be either ‘oxidised’ in the muscles or returned to the fat cells if not utilised.133 Cooling down quickly, by showering, for example, reduces the effort required by the body and therefore the amount of excess energy burned. A gradual cool-down, on the other hand, helps maximise the exercise effort. It also decreases the risk of muscular injury that could result from not allowing circulating blood to re-supply tired muscles.

WAIT A WHILE BEFORE EATING AFTER EXERCISE A general recommendation for athletes is to replace the energy used during exercise immediately afterwards by eating carbohydrate-rich foods. But while this is necessary to replace energy for fitness, it could be counterproductive when exercise is being used to reduce body fat.134 . . . more fat is used as a result of an exercise session if food is not ingested for 30–45 minutes after exercise. After exercise, circulating blood fats continue to be used as energy in the muscles to fuel the extra energy requirements of increased metabolism. If food 102

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is eaten immediately after exercise, and particularly if this is high in carbohydrate, which is quickly converted to blood glucose, this will be used as the preferred source of energy. Circulating fats will then be less likely to be metabolised and hence will be replaced, or re-esterified in fat cells. More fat is likely to be used as a result of an exercise session if food is not ingested for 30–45 minutes afterwards. This also allows time for a gradual cool-down.

TRADE OFF WALKING FOR INDULGENCES If a weight-management program is strict and inflexible, it’s likely to be abandoned at the first small transgression. For this reason, any program, to be sustainable for a lifetime, has to allow for occasional indulgences.135 There’s a psychological process involved in accepting this philosophy. If you allow yourself some transgressions, it becomes easier to accept them without feelings of failure. However, there’s also a physiological process at work here that you can capitalise on. Indulgences usually involve too much energy input, or kilojoules. You can compensate for this by increasing your energy output, or exercise. The approximate energy value of a standard alcoholic drink is around 100 kcals (420 kJ). In an average-sized person, about this amount of energy is required to walk one kilometre. Hence, trading off each drink with an extra kilometre of walking will help overcome any negative effects of the indulgence, and make life livable. Other common indulgences that can be traded off by doing some extra walking or other exercise are chocolate, weekend breakfasts, business lunches, festive season overimbibing and dinner at your in-laws’.

FORGET MOST CALLISTHENIC-TYPE EXERCISES Most ‘fitness’ books and articles in popular magazines on fitness invariably have a section on callisthenic-type exercises, which use the body as its own form of resistance. These, we’re told, will lead to increased fitness, muscular strength and even, if you’re lucky, the body you’ve always desired.136 The main function of exercise in a weight-management program is to burn energy, preferably fat. Because of their limited duration and specific muscle orientation, callisthenic exercises have little fat-burning value compared with extended-duration aerobic activities such as walking or cycling. It’s a bit like the difference between the petrol used up by taking your car for a long drive compared with that used up revving it up a few times on the spot. Callisthenic exercises might be good for toning up 103

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muscles. But concentrate on getting rid of the fat so you can see your muscles before you even think about trying to tone them up!

FORGET THE SIT-UPS: GO FOR A WALK Because women usually store fat around the abdomen and because sit-ups work the abdominal muscles, it’s often assumed that the best cure for this kind of problem is thousands of sit-ups. Fat is metabolised through long, continuous, general aerobic activity, whereas sit-ups work a specific muscle group. Because underlying muscle is toned up through sit-ups, sit-ups—in the absence of a general aerobic program—will only serve to give you a tight, fat belly instead of a loose, fat belly. The fat is likely to remain.

IGNORE EXERCISES FOR ‘SPOT REDUCTION’ Many people think that to reduce fat on a certain part of the body all you need to do is exercise that part of the body. If this were true, gum-chewers would have skinny faces! Fat is stored in fat cells all over the body. It is taken from these cells as a fuel source for muscles in an order determined by gender, genetics and a range of other factors. As a general rule, it first comes off the last place it went on. So if you’ve become sturdier around the middle recently, the first place fat will come off—even in response to an exercise that doesn’t use the abdominal muscles, such as walking—will be the waist. Specific exercises for the gluteal muscles, often promoted as reducing fat on women’s buttocks, might even have be counterproductive. Lower body fat in women is known to be resistant to the normal stimuli that cause a breakdown of fat, probably because of the need for this fat as an energy reserve in pregnancy. Exercises for the gluteals might then increase the size of the gluteal muscles but not result in any fat loss, at least not from this part of the body.137

IF WALKING IS A PROBLEM As stated from time to time in this book, walking is one of the best forms of exercise around for weight control.138 However, because it’s a weightbearing exercise (meaning the body’s own weight is carried), walking might not be suitable for some people, such as those with lower limb injuries. In these cases, a weight-supporting exercise such as cycling, swimming, aquarobics or rowing can be substituted for walking. 104

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This might appear to be contradictory advice, since we eliminated swimming elsewhere as an efficient fat-loss exercise. But where other forms of weight-bearing activity are unsuitable, this could be your best option. Aquarobics, or exercises in water, is an even better option, as it involves using large amounts of energy with little discomfort. Other weightsupporting exercise options are cycling, rowing, canoeing or paddling.

NOW, PUT IT ALL TOGETHER As we’ve seen, exercise for fat loss can be quite different from exercise for fitness. We’ve looked at the importance of incidental plus planned exercise. We’ve also looked at different types of exercise. But just so it stays clear, we’ve displayed the recommendations for exercise for fat loss in a pyramid, modelled after some work on exercise for health. Check the pyramid and see whether what you’re doing—or, more important, what you plan to do— is right for you. Figure 6.3 shows the National Physical Activity Guidelines for Australians, developed for the National Health and Medical Research Council in 1999. Figure 6.3 National Physical Activity Guidelines

If you are able, also carry out some regular vigorous activity

3–4 days/week

Put together at least 30 mins of moderate-intensity physical activity on most days Be active every day in as many ways as you can Think of movement as an opportunity not an inconvenience

Most days

Daily

Always

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Chapter 7 MAINTAINING YOUR LOSSES

INTRODUCTION Anyone can lose weight. Losing fat is a more difficult proposition. Even so, it’s not so hard to lose fat if you know a little bit about food and exercise, and apply a few principles such as those outlined in this book. But keeping it off—well that’s a different story. The reported long-term success rate for most weight-control programs is understood to be somewhere between 5% and 20%. That is, only 5–20% of those attempting to lose weight are successful at keeping it off for up to two years (in scientific terms, any measurement period shorter than two years is not to be taken seriously). The problem is that the human body was designed to gain and lose fat as conditions dictate. This is important from an evolutionary perspective because gains in fat in the good times mean a greater chance of survival in the bad. If losses happened easily, we humans wouldn’t have survived the lean times throughout history to get us to today’s situation of plenty. Unfortunately (at least in this day and age), it’s much easier to gain than to lose. To resist fat losses, the body adapts by reducing the rate of energy it burns at rest (the metabolic rate) and during activity, and increasing hunger levels. Where food is freely available (such as in today’s ‘supermarket’ society), these changes in body function can be just a little too hard to resist. So back go those precious kilos that you’ve fought so hard to lose—unless . . . unless by understanding the principles of the body’s adaptation you can turn them to your own advantage. Some important techniques are outlined in this chapter.

LEARNING THE TECHNIQUES FOR MAINTAINING WEIGHT LOSS According to Dr Tom Wadden, a psychologist from the University of Pennsylvania, the clues to successfully maintaining fat loss come from 106

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studying the habits of those who are successful in the long term.139 This kind of observation would suggest that: • • • •

although diet might be important when it comes to losing weight, those who develop a lifetime pattern of exercise do better at keeping that weight off maintenance is more successful in women who take long, regular (although not necessarily vigorous) exercise, such as walking people who regularly eat just one fatty food have no increased risk of regaining weight, but those who eat two or more are following a recipe for relapse individuals who keep weight off most successfully: ■ ■ ■ ■

•

don’t count calories, but develop a personal eating plan exercise regularly monitor their weight closely monitor their food intake

the best kind of maintenance comes from setting realistic goals; in some severely obese people, there might be biological limits to significant reductions in weight—being satisfied with achieving more modest goals can help.

In other research, it’s been shown that the best long-term maintainers are those who also have a well-developed means of dealing with stress. This prevents any relapse into overeating or underexercising in times of psychological upheaval.

COMING BACK FROM OBESITY IS HARDER According to Danish scientists, people who have lost large amounts of weight have more trouble keeping it off than lean people do staying lean. This might, to some extent, be because there are differences in the rate at which formerly fat people and lean people burn food as energy after a meal.140 If a meal is high in fat, people who were once obese tend to store this more readily in their body’s fat cells and rely more on blood sugars from carbohydrates as an energy source. . . . people who have lost large amounts of weight have more trouble keeping this off than lean people do staying lean. 107

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The body has a limited ability to store blood sugars from carbohydrates (it holds only about 450 g or 2100 kcals/8820 kJ in total), so the greater carbohydrate usage in formerly fat people leads to a depletion of these blood sugars. Low blood sugar signals hunger to the brain, and this increases the likelihood of food intake as a result. This means that someone who has previously been obese but who has lost a lot of weight needs to take even greater care than usual with fat in their diet. Losing fat, it seems, is only the beginning. Keeping it off is the main game.

ACCEPT GRADUAL WEIGHT LOSSES Fluctuations in body weight are accompanied by physiological adaptations designed to restore the body’s status quo. In particular, a sudden decrease in body mass will lead to a slowing of metabolic rate and an increase in appetite. Decreases of over 1.5 kg per week have been shown to be associated with an increased risk of gallstones and a range of other possible health problems. You can expect large, sudden changes to result in significant adaptations, which might ultimately be counterproductive for long-term fat loss. Gradual losses, on the other hand, give the body time to adjust to changes with less of a negative impact. Medical research has shown that health risks are associated with large, sudden weight losses.141 Decreases of over 1.5 kg per week have been shown to be associated with increased risk of gallstones and a range of other health problems. Hence, a recommended safe rate of loss is between 0.5 and 1 kg per week. If a waist measurement is set as the goal (as it should be, particularly for men), about a 1% loss per week is recommended on programs such as GutBusters.

SETTING SHORT-TERM AND LONG-TERM GOALS Most people have set themselves a long-term goal when they take on a weight control program. But working towards a long-term goal only can be self-defeating, because achieving it is such a remote prospect and progress 108

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can be interrupted by plateaus along the way. It’s advisable therefore to have long-term outcome goals and short-term process goals, which can be used as milestones along the way.142 Goals could take a week, a month or a year to achieve, but they should all be clearly defined. Process goals are just as important as outcome goals because they tell you you are on track to achieve the outcome. Achieving outcome goals might be delayed because of plateauing (see below), but if the intervening process goals are reached, there is at least some reinforcement to continue. Process goals include: 1. 2. 3. 4. 5. 6. 7.

cutting fat back to 40 g a day walking six days a week walking a set distance each day reducing total food intake not eating a particular fatty food increasing daily energy expenditure cutting back on margarine or butter.

Table 7.1 Process measures in obesity management Energy intake • Daily intake of certain foods increased (say 3 fruits, 4 vegetables) • Reduced intake of high energy dense foods • Breakfast eaten daily • Daily fat intake kept below 30 g • Only foods with <10% fat eaten • Fibre intake increased (to >30 g/day) • Regular healthy snack foods eaten • Frequent daily fluid intake (not including alcohol!)

Energy expenditure • Daily steps taken/distance walked • Minimum days of exercise classes • Improvements in time taken to exercise, (say walk 1 km in less time) • Increasing distance covered (walking, swimming) • Minimum days/week for planned exercise • Not using effort-saving devices • Carrying out ‘incidental’ activities • Car usage decreased • More gardening • More outdoor activity

DOING IT FOR LIFE Long-term weight loss means making changes that are sustainable. It’s not feasible to expect to stay on a diet for life.143 This is why diets don’t seem to work. One cannot, for example, expect a middle-aged man to stop drinking 109

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alcohol and stay off it for the rest of his life. More to the point, once these sacrifices are abandoned, the likelihood of the whole program being abandoned increases. It’s not feasible to expect to stay on a diet for life. This is why the failure of diets can be confidently predicted. Any changes introduced to reduce body fat and maintain long-term weight loss must be changes that can be sustained for life. And while some changes might take a while to adjust to (for example, it can take from two weeks to six months to get used to eating low-fat meals), most will improve your sense of wellbeing and make you want to keep them up. The moral is ‘. . . if you can’t imagine yourself doing it for life, do something else’.

AS LONG AS YOU’RE NOT GAINING, YOU’RE WINNING Any loss of weight is accompanied by adjustments within your body, which make further losses more difficult. In a sense, the body fights losing its equilibrium level of body fat—the level to which it has become accustomed.144 It does this in three main ways: 1. A decrease in metabolic rate. As about 70% of the body’s daily energy expenditure is accounted for by metabolic rate, even a small change in this rate can have a large impact on body fat stores. Research shows that adjustments to metabolic rate actually counteract decreases in body mass, i.e. a 10% loss in weight might lead to a 20% reduction in metabolic rate, thus tending to slow, and perhaps even reverse, any decline in weight. 2. Changes in body composition. Not all the weight that is lost in a typical weight loss program comes from fat. In fact, the average overweight person loses about 25% of their weight from muscle. Because muscle is more metabolically active than fat, this means a decline in the overall rate of energy use, which in turn slows down the fat loss process. 3. Increases in hunger and appetite. Reductions in body weight are usually balanced centrally (in the brain) by increases in appetite, which reduce the long-term effectiveness of the fight against fat loss. In many cases these increases in appetite are so subtle that they’re not noticed. But the outcome, in terms of energy intake, is certainly recognised by the body. 110

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Natural decreases in body weight don’t happen in a linear fashion, but in a series of plateaus, as shown in the graph below. The length of the plateau and the size of the drop-off plateaus probably depends on the length of time the body spends at the level concerned. The main thing is to recognise that being on a plateau means you’re winning! Only when you start gaining weight again do you start losing the battle. Figure 7.1 Actual and expected trends in weight loss

Actual fat loss

Fat loss

Expected fat loss Goal

Time

GETTING OFF PLATEAUS Plateaus occur largely as a result of the body adapting to a different energy balance, either in the form of reduced energy input or increased energy output. Theoretically, at least, you might be able to get off a fat-loss plateau by reducing your body’s ability to adapt.145 You would do this by changing something. In relation to exercise, this could be: 1. Intensity—increase the speed at which you do your exercise. 2. Duration—exercise for longer periods, if possible. 3. Frequency—exercise more regularly (for example, by adding ‘incidental’ exercise during the day). 4. Type—vary the exercise you do, combine walking with cycling, swimming, aerobics—anything you like doing. 111

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On the other side of the energy equation—food intake—you can help get off plateaus by: 1. Decreasing calorie intake—but only where this is still high. 2. Increasing calorie intake—by re-feeding where the calorie intake has been too low (under 1000 kcals/4200 kJ per day) and has been at that level for long periods. 3. Further decreasing fat intake—to reduce the appetite as well as calories. 4. Changing the food type—eating foods that the body is not familiar with or that you haven’t had for a long time (but that are still low in fat).

SMALLER DROPS AND LONGER PLATEAUS The body adjusts physiologically to changes in body mass by changing metabolism, hunger and the rate at which energy is burned for a given amount of exercise. If being overweight or obese has been a persistent problem, these physiological adjustments become more unyielding. It’s as if the body is saying to itself: ‘I’m fine at this weight—at least I’m alive— so I’ll fight to stay here’. Fat losses are therefore likely to be smaller and plateaus, during which no weight is lost, are likely to be longer, depending on how long you were overweight or obese: this is shown in the graph below. Anecdotally, we would have to say that this is not always the case. But if you’ve been fat for a long time, you can’t expect to get skinny overnight. Figure 7.2: Fat loss in the long-term and short-term overweight Long-term obese

Fat loss

Short-term overweight

Goal

Time 112

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PERSISTENCE IS THE KEY The longer you’ve carried extra weight, the harder your body is likely to fight to keep it. And while plateauing is an inevitable part of any weight loss program, it’s likely to be even more intractable for those of you who have been obese for a long time. In some cases the body can resist a weight change for months—even in the presence of significant changes in energy balance.146 Where this is the case, you might notice other metabolic improvements: you might feel fitter, be sleeping better, even feel a little lighter, although you might actually be heavier (because of an increase in the ratio of muscle to fat owing to exercise). However, the body can’t resist forever. Ultimately, it will have to adjust to the fact that the new energy balance is now the status quo. This will only happen if you persist. If you’re confident that you’ve made the proper changes (and you’re not kidding yourself about the amount of food you’re eating or exercise you’re doing), persistence will eventually pay off. It might not happen overnight, but it will happen.

REDEFINING SUCCESS Short-term losses in weight shouldn’t be thought of as the only measure of success in a weight control program. Short-term, rapid weight loss is usually short-lived; only success over a two-year period or more is to be regarded seriously. What is more important, it has now been shown that improvements in health and risk of disease can occur on a weight-control program without any apparent loss in weight. These improvements are usually accompanied by feelings of wellbeing, improvements in self-esteem and even some changes in body composition (as seen in fat loss but muscle gain). Success therefore needs to be redefined to include less obvious things (well, less obvious than fewer kilos registering on the scales), and these are: • • • • • • • •

decreases in medication improved quality of life and feelings of wellbeing increased physical activity reduced fat intake better digestion better sleeping patterns more energy during the day less tiredness. 113

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If you take these as signals of success, you will be less fixated on actual weight loss. This can often have the paradoxical effect of leading to greater weight loss in the long term.147

MANAGING STRESS AND DEPRESSION Long-term, chronic stress (and/or depression) affect body fat levels because they can:148 •

•

•

•

•

•

Encourage nervous overeating. In some people stress diminishes the appetite, but others are driven to pig out to the max. It’s not simply a matter of nervous hands. Food provides a kind of comfort—it feels good when all about you might seem bad. Increase alcohol consumption. Alcohol is a great way to ‘blot out’ the effects of stress. After a few drinks you can live out whatever fantasies you have about solving your problems. The trouble is, it doesn’t last. Alcohol is a short-term solution for stress. Immobilise. Feeling that you don’t want to move is a symptom of severe or chronic stress. Not moving means not burning up energy. Not burning up energy means getting fat. Animals that are put in unremitting stressful situations from which they can’t escape actually give up and become totally immobilised. Psychologists call this syndrome ‘learned helplessness’. A similar thing can happen to humans. Decrease sense of self-control. Loss of control over one’s life is one of the main symptoms (and causes) of stress. If this flows through to other facets of life, control over waist loss and health practices will also be lost. Increase mobilisation of fatty acids. One of the (apparent) benefits of stress is that it causes fats from fat stores to be mobilised to be used as energy. However, if there’s no accompanying movement or exercise to use up this fat, it will remain in the bloodstream and can tend to clog arteries and cause heart problems. This is one of the main illeffects of stress. Decrease self-esteem. For many individuals, an increase in stress leads to a reduction in self-esteem, which flows through to affect all other facets of life. Including fat control.

Coping with stress is an important element of long-term weight management. So stress management is often an indirect way of facilitating longterm weight loss. 114

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FESTIVE FLUCTUATIONS One of the biggest dangers for anyone on a weight-reduction program is the festive season. Temptations abound—parties, dinners, drinks—and there is much time for working it off physically. The typical advance is retreat. You know you’re not going to win at this time so you might as well fatten up and enjoy it. The trouble is, there will be a payback time—and bills always seem to come around sooner than cheques! If your adult body weight is more than around 8–10 kg than your body weight at age 20 . . . , it might be time to start to do something about it. A more realistic approach would be the ‘passive pause’. Don’t worry about not continuing to lose. As long as you’re not gaining, you’re ahead. You can always get back on the wagon when things die down. And it’s not nearly as hard to climb back on the wagon if you haven’t fallen hard on your head. English obesity expert Dr John Garrow has shown that small gains and losses in body weight during the course of a lifetime have no apparent illeffects on health.149 If your adult body weight is more than around 8–10 kg than your body weight at age 20, on the other hand, it might be time to start doing something about it.

DON’T WEIGHT CYCLE Researchers at The University of California (Los Angeles) claim that although being fat is unhealthy, constantly yoyoing from fat to thin (weight cycling) has even greater health risks. ‘Most studies done on weight variability show that the greater the number and magnitude of weight changes, the greater the risk,’ says Dr Judith Stern, head of Nutrition at UCLA’s Davis campus. A possible reason for this is that in the weight-loss phase, muscle is lost as well as fat. When weight is regained, it’s regained just in the form of fat, and this can be in the dangerous intra-abdominal area. Research from the University of Minnesota indicates that the bigger the weight gain from age 20 to adulthood, the greater the risk of suffering or dying from a weight-related disease: diabetes, heart disease, stroke, cancer, and so forth. ‘Weight gains of 20 lb (9 kg) increase the risk dramatically,’ 115

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says Dr Robert Jeffries.150 Although it’s probably not so bad and even natural to put on some fat in later life, too much can be too much of a burden. Stability, it seems, is the name of the game. And preferably stability at your weight around age 20. Health problems of too-rapid weight loss: • gall bladder disease • altered sleep patterns • anaemia • constipation • irregular menstruation • eating disorders.

DON’T WEIGH, MEASURE There has long been controversy about the best measure of body fat to use in a weight-loss program. Weight doesn’t necessarily reflect fat (although it’s often a good indication). However, more accurate measures of body fat are usually too complicated or too expensive. Attempts to arrive at a better measure of body fat than weight are often sidetracked into complicated and expensive measures and techniques. But researchers at the University of Glasgow have shown that a simple measure around the waist is as good as most other complicated measures.151 The researchers, in the University’s Department of Human Nutrition, compared waist to hip ratio measurements and body mass index (weight divided by height squared) to get cut-off points for recommendations for the general public. . . . bathroom scales are not only unnessary, they are downright undesirable. Measuring around the waist, midway between the iliac crest (top of the hip bone) and the lower rib, they found that: 116

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• •

men with a waist circumference of more than 102 cm and women measuring more than 88 cm around the waist have an increased health risk and should reduce their body fat men with a waist circumference of 94 to 102 cm and women with one between 80 and 88 cm should be cautioned not to get any fatter if they want to stay healthy.

The easy-to-remember figures of 100 cm for men and 90 cm for women are regarded as functional cut-off points—irrespective of height—that indicate a threshold level for health risk. Waist measurements can also be used (particularly in men) as a good indication of progress in a fat-loss program, and weight may be used as a back-up measure to see if fat losses occur without losses at the waist level.

BMI NOT THE BE ALL AND END ALL The most frequently used simple measure of fatness has been body mass index (BMI), a measure of weight (in kg) ÷ height2 (in metres) BMI scores of between 19 and 25 are regarded as ‘normal’. BMI has tended to provide a reasonable indication of levels of body fatness in given populations. However, the use of weight in the equation makes BMI much less valid as a measure for individuals, or as a measure of change in body fat. Athletic men, in particular, are discriminated against because of high muscle mass, which also tends to be heavy. Body stature (musculature) can influence BMI measures in some females.

THE EFFECTS OF CRITICAL STAGES During certain stages in life it’s easy for things (like maintaining a steady body weight) to go wrong. Being forewarned is being forearmed, so awareness of the following critical periods might be crucial.152 Marriage Getting married, or its equivalent, is often a time when both partners tend to gain fat and lose fitness. Research carried out at Sydney University shows that this is particularly so for young men, possibly owing to a lower level of physical activity through involvement in organised sport and increased regular food intake. 117

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Retirement from sport A high food intake is necessary to fuel the increased energy levels required for sport, and eating at this rate becomes a habit. Retirement from sporting activity is often sudden, with a drastic decrease in energy output and often, through habit, no corresponding reduction of energy intake, leading to increases, or rebounds, in fatness. Changing jobs Changes in the work environment can disrupt your downward body fat momentum. It’s not clear why this should be so, but common sense would suggest that changes in attitude and perhaps the desire to impress could have an impact. Middle age Decreases in metabolic rate, which occur at about 2% per decade from the age of 20, start to have a significant impact at around 40 to 50 years of age. Couple this with the stresses of mid-life, life changes at menopause and other problems that occur around this time and you’ve got a ready-made ‘fat rebound’. Be prepared for it. Grief and bereavement Bereavement is a period of chronic stress where fat control becomes less important than surviving. Exercise decreases and eating, particularly of comfort foods, increases. Depending on the circumstances, this can last for anything from a couple of months to a couple of years. Dealing with your loss is your priority at this time, but try at least to stay on a plateau. Divorce or separation Like bereavement, divorce or separation has the potential for considerable psychological disruption. Again, your primary concern is to deal with the psychological difficulties associated with this kind of radical change rather than to try to keep losing weight to schedule. Try not to put it on, and get through the problem. Periods of prolonged stress When you are stressed you won’t be as restricted by the usual barriers to selfindulgence. In some cases, particularly of acute stress, food intake is actually reduced and fat can be lost. In chronic, but non-life-threatening stress, the opposite can occur, as can an increase in drinking as a coping mechanism. Learn to recognise upcoming stress periods and to deal with them so that 118

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they don’t interfere with your weight losses. After all, getting fat again will only increase your stress levels! After quitting smoking It’s well known that smokers who quit will gain an average of around 3.5 kg of body weight over 12 months. This is due largely to the loss of nicotine, which elevates the basal metabolic rate, and to the reduced food intake associated with smoking (possibly because smoking gives you something to do with your hands). Still, it’s more healthy to be a fat non-smoker than a lean smoker. The fattening effects do pass after you have quit for a while. As a result of some prescribed medications There are a number of medications, including those prescribed for anxiety, depression, schizophrenia and tissue repair (such as cortisol), that can increase body fat. Check with your doctor if you suspect this and ask for an alternative drug if it’s available (see list on pages 16–18). During festive occasions For most people, festive periods—Christmas, Easter, birthdays, reunions and other cultural, religious and personal celebrations—are a time when enjoyment overrules austerity. And besides, life is for living. The main rule is to make sure you don’t go up again—even if there are no losses!

EATING LESS AND MOVING MORE WITH AGE Energy expenditure declines naturally with age, largely as a result of decreases in muscle mass of around 1 kg per decade. Metabolic rate consequently declines at a rate of about 2% per decade, which means that if you eat and drink and exercise in the same way as you did when you were young, you’re guaranteed to put on extra poundage naturally.153 The natural slowdown in energy use and growth requirements means that just to keep your weight stable as you get older would require either taking in less food and/or carrying out a little more exercise as the years advance. This suggests that you need to pay more attention to maintaining energy output or modifying energy input with age to ensure that your body fat doesn’t balloon. The natural slowdown in energy use and growth requirements 119

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means that just to keep your weight stable as you get older would require taking in less food and/or carrying out a little more exercise as the years advance. As it’s usually not so easy to compete with your younger self on the exercise front, this generally means being more careful about your food intake. There is some good news in all of this. Research on animals, as well as humans, shows that those who eat less tend to live longer and remain healthier (but don’t go taking this to extremes!). But isn’t it a cruel stroke of fate that things don’t get easier just when you feel they ought to?

REDUCE YOUR EFFICIENCY As explained above, maintaining weight loss beyond a certain point is not only unlikely, it’s downright unhealthy. Your body adapts to stop you disappearing. And the way it does this is by becoming more efficient at doing what it does with the means at its disposal. Walking 3–4 km a day at the start of a program might be a bit of a shock to the system for most people. But after even a week or two, those muscles involved in walking spring back to life and do it quite easily. For example, where it took around 100 kcals (420 kJ) to walk 1 km in 12 minutes at the start, now it might only take 80 kcals (376kJ). In addition, because you’ve lost a couple of kilos of fat, your body doesn’t have to work as hard to keep you alive (your metabolic rate). Both these facts mean you’ve become more efficient, and you’re using less energy—and less fat—in the process. Strangely enough, you need to become less efficient again to burn more energy. Walking on your hands would do it, but that’s not always feasible (or advisable). But certainly changing the type, duration or intensity of your exercise is. Even changing the path you normally take for a walk, or the time of day you do it, might help. The same applies to the type of food you eat. It takes energy to digest food (more to digest carbohydrate than fat), and any change in eating patterns can increase total energy (and fat) loss. You need to become a less efficient eater if you want to get off a fat-loss plateau. You can do this by trying some different foods—fruits and vegetables in season, for example, or something you rarely eat, like Mongolian or Tyrolean fare. Even try a different drink; gin and tonic instead of a beer, perhaps. If you’ve hit a fat loss plateau, or are about to, becoming less efficient could be just what the fat doctor ordered—even if it’s not what the productivity consultant desires.

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IF YOU HAVEN’T MUCH TO LOSE The weight you lose consists inevitably of muscle and fat. The proportion of muscle to fat you lose when dieting decreases with your body’s increase in fat to muscle ratio. The amount of muscle lost also depends on the method used to lose weight—if muscle is used, such as through physical activity, it’s less likely to be metabolised for fuel than if the mode of weight loss caused by food restriction alone.154 Food restriction alone becomes more counterproductive to fat loss the less body fat there is to lose—a point that is often lost on many dieting young women trying for that anorexic model look. Muscle loss, in turn, can be counterproductive in a fat-loss program because it results in a decrease in metabolic rate and therefore the potential for a greater increase in body fat at a later stage. A relatively lean person with only a small amount of fat to lose would lose a greater proportion of muscle than fat on a food restriction program than a person with more fat to lose. Food restriction by itself is more counterproductive to fat loss the less body fat there is to lose. The best way for people who aren’t too overweight to lose weight is to increase their activity level.

BEWARE THE CHANGE OF SEASONS Seasonal affective disorder (SAD) is a phenomenon found in a small group of weight-sensitive people.155 The disorder is characterised by large gains in weight in the winter, often accompanied by losses instigated by purging and severe food restriction in summer. SAD is usually more common in countries with large extremes between the seasons. It’s thought to have a physiological cause, and to be brought on by lack of daylight, possibly affecting a chemical called melatonin which is involved in skin tanning and body bio-rhythms (melatonin has recently been prescribed for the prevention of jet lag in long-distance travellers). Research is now also examining the effects of artificial light on reducing SAD. Although it’s a reasonably rare phenomenon, a minor form of SAD might occur in some people who tend to overeat and underexercise in the winter months. Awareness of the effects of the change in seasons could help overcome this, but we can’t guarantee it. If you think you suffer from this, light treatment from a special therapist might help. 121

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MAKE SURE YOUR ‘ARTHRITIS’ IS REAL Big people tend to be afflicted by more knee problems than lean people. This is often diagnosed as arthritis—which gives the patient an excuse for not carrying out weight-bearing exercise, such as walking, which is most likely to help decrease weight. Without exercise, increased weight gain becomes more likely. This makes things worse for the knees, and so the vicious cycle continues. British researchers have deduced that much of what is considered to be arthritis in big patients is simply the mechanical pressure of carrying excessive body weight.156 To test this, they compared a sample of 525 men due to be listed for surgical treatment of the knee with 525 other men matched for age and consulting the same doctor. The researchers found that the risk of knee problems increased with increasing body weight. Men who were below normal body weight, as measured by a body mass index (BMI) of <20, had 10% of the risk of developing knee problems of the men of normal weight. As body mass increased, the risk of knee problems increased dramatically. For men with a BMI of >36, the risk of knee problems increased 18-fold compared with men with a normal BMI level of 19–25. This led the researchers to calculate that if overweight people could decrease their body weight by just 5 kg, 24% of surgical cases of knee osteoarthritis could be avoided. Of even greater concern in this study was the fact that individuals with a history of knee injury as well as being obese had 78 times the risk of knee problems requiring surgery! The verdict clearly is that many knee problems are not really arthritis, and that the best way to avoid the knife is to reduce the weight.

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Chapter 8 THE GOOD, THE BAD AND THE UGLY

INTRODUCTION Everyone who’s overweight wants a magic pill. They’d like to take it at night, so they can wake up in the morning and be slim, trim and terrific. Unfortunately, it’s not as easy as that. Extra fat, like extra money, takes a long time to accumulate. But unlike extra money, it also takes a long time to get rid of. There are lots of shady dealers out there who’ll try to convince you that if you spend your extra money with them, they’ll spend your extra fat at the same rate. New products and programs for weight loss pop up faster than pimples. Most will disappear as quickly, but in the meantime their backers will have quietly pocketed your extra wallet fat and moved on to the next fad. Of course, not all new products and programs are bad. The move to low-fat foods, the development of new exercise machines and controlled behaviour modification programs, for example, can all have benefits (although none should be seen as ‘magic’). We’ve grouped a range of these under the heading ‘The good’ in the pages that follow. On the other hand, there are products that either counteract any effort you might make to keep your body weight down or are likely to be neutral in effect. I’ve considered some of these under the heading ‘The bad’. This doesn’t mean you have to avoid them completely, just use them in moderation and arm yourself with the facts about them. Finally, there’s what we call ‘The ugly’. These are products with no acceptable scientific backing, sold with the sole purpose of making their marketers fat on the proceeds. Pick your way through ‘the good’, try to find your way around ‘the bad’ and don’t let yourself be fooled by ‘the ugly’. Perhaps I should add that I haven’t been paid or given any other form of consideration for assessing any of these products/programs. 123

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THE GOOD Low-fat Fruitfuls hit the spot Fruit biscuits might be expected to be just that—fruit-full. And so they would be if it wasn’t for the pastry used for the biscuit part. Unfortunately, wheat flour contains some oils and oil has to be added to the flour to make a workable dough. However, food technologists at Arnotts biscuits have devised a fermentation process that optimises the activity of the yeast and lactobacilli, which make up the microflora of a fermenting dough. By combining this with a yeast mix at the mixing stage, only a minimum of fat or vegetable oil needs to be added. This has formed the basis of a new fruit biscuit from Arnotts called Fruitfuls, which meets all the requirements for a low-fat (3% fat) tasty snack. The fruit in the biscuit is also specially prepared with a unique process developed in New Zealand. It protects the biscuit from spoiling and increases the intensity of the taste. A word of warning, though. If lowering the fat in your diet has not been enough for you, you might need to view biscuits such as Fruitfuls in a different light as they are high in energy density (see Chapter 5), with sugars making up for the decreased fat.

Undressing salad dressings Usually made from an oil base, salad dressings normally represent an energydense way of topping an otherwise low-energy salad. Some manufacturers are now giving us the option of vinegar-based dressings that taste quite similar to the real thing. Both Kraft Free and Kraft Light have absolutely no fat, as does the range of Praise No Oil salad dressings. Kraft also provides <1% fat versions of the traditional Thousand Island dressing. Salad Magic have a range of nooil dressings in the traditional styles we know and enjoy with less than 1% fat, thus increasing the options for those who can’t yet bear to undress salads.

The Cybex sit-up device Now this one might well work! Machines for reducing fat on the stomach seem to come and go with no real impact (see The Bad to follow). Now that the public is generally better informed, though, we are becoming more aware that fat is not reduced by spot reduction on the abdomen. On the other hand, muscle tone and strength can be improved by trunk flexion (such as with sit-ups). The new Cybex ab machine is a unique design, which isolates sit-up movements to the abdomen and provides a comprehensive abdominal workout. The facts about fat loss and isolation 124

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exercise notwithstanding, this device does appear to actually work the abdomen and improve abdominal musculature.

The Flexi-tester This is another abdominal exercise machine with promise. The Flexi-tester is one in a very long line of abdominal muscle developing products, most of which have dropped off the scene. But this one, like the Cybex sit-up device, might be different. Based on tension produced by rubber bands, the device involves flexing the trunk against the resistance of a padded bar held against the upper ribs and stabilised between the legs. Sitting up against the device, or raising the legs to the trunk, guarantees the use of the abdominal muscles—if the exercise is carried out properly. It should be noted, however, that machines such as this and the Cybex product in no way guarantee fat loss from the trunk, although they might improve abdominal muscle strength and tone. Fat is still only lost from the trunk region, as elsewhere, through aerobic activity. There are also some potential problems if lower-back exercises aren’t done in association with using the device, to balance trunk strength.

Codliver oil no old wives’ tale Oils are oils. Or so it’s been thought. In fact, all of them—mono, poly and saturated—are thought to have the same calorific value and therefore the same ability to make you fat. But some very recent scientific research suggests that there might just be something different in the oils that come from fish and most other types of seafood. Whether it’s the type of fish, the amount you eat or other nutrients in fish that aid fat loss is not certain. But it seems that a good seafood diet (sans frying, batter or added oils) can help break through those fat-loss plateaus. Even the much-maligned prawn might be due for a rebirth, not to mention lobster (if you can afford it). Instead of granny’s codliver oil, though, you might get more out of eating the whole cod. Tastes better too.

Thigh chafing protection It’s one thing to try to be healthy by walking daily. It’s another to cop blisters between your legs for doing so. Chafing thighs are a problem not often considered by the lean and healthy when they proselytise about exercise for the not so lean. But it’s a reality. Fortunately, technology has an answer: lycra bike pants! Worn on their own, or underneath more comfortable attire, lycra pants reduce the effects of flesh rubbing on flesh, making walking far more tolerable. 125

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Cholesterol-lowering margarines New margarines made from concentrated polyunsaturated plant oils have now been found to help lower cholesterol in some people by up to 10%. If cholesterol is an issue, these products might be useful as substitutes for other margarines. However, as cholesterol is influenced by body weight (particularly fatness) and the cholesterol-lowering margarines still add 9 kcals (38 kJ) per gram to the diet, it would seem prudent not to recommend them to someone trying to lose weight. Weight loss should be the primary objective, then cholesterol-lowering margarines can help add the beneficial effects of lipids, or fats.

The low-fat ice-cream war If you love ice-cream but not its long-term effects on your waistline, changes in ice-cream technology could leave your mouth watering. New processes of reducing milk fats have led to a range of tasty new products on the market, with names as tempting as Too Good To Be True. New labelling laws allow ice-creams with a fat content between 3% (Peters) and 7% (Streets Blue Ribbon, Oak) to be sold as ice-cream. In most cases fat content has been dropped drastically (look for products with less than 10% fat, not 10% less fat!), with definite health advantages. For the waist watcher, though, sugar content and portion size can also be problems. An increased sugar content can add to energy density, which can be a problem for someone for whom fat reduction is not enough. It’s also hard to stop at one small serve. If these things are not a problem though, go ahead . . . make your day!

Alcohol accompaniments Choosing the right kind of ‘nibblies’ to have with alcohol is an important decision for waist-watching women. Among those now available on the market: 1. Parker’s Pretzels: A low-fat (but reasonably high-salt) nibbly that provides taste, but not a lot of nutritional goodness. Also tends towards high energy density. 2. Low-fat cracker-style biscuits: These include Ryvita and some Vita Weat products. Look for brands with less than 10 g of fat per 100 g. 3. Rice crackers: Again, these might be high in salt, but because they’re not cooked in oil they’re low in fat. Watch for energy density, or the number of calories/kilojoules per gram of food. 4. Low-fat popcorn: Home-popped corn (not smothered with butter) and 126

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some new varieties soon to come on the market are low in fat. Some even have added spices. But beware of the commercially popped variety and those that have been hot buttered. 5. Low-fat cheeses: Most cheeses sold as ‘low fat’ are merely lower in fat than they could be. Check that total fat content is less than 10%. Two reasonably tasty examples are Bega Supa Light and Devondale 7 (block, not sandwich slices). Remember, total energy could be important for those who enjoy a drink, so if other reductions in the diet have not helped, you might need to have that drink without the nibblies.

Rinsing meat patties to reduce fat . . . For those with a taste for hamburgers and a cholesterol or calorie phobia, here’s a new way of cooking to reduce both. In a study carried out at the University of Iowa, scientists compared cooked ground beef crumbles with 10%, 20% and 30% fat after they had been panfried, panbroiled or microwaved. After cooking, half the crumbles were rinsed in warm water. Surprisingly, the effects of cooking method were insignificant. Initial fat levels had the greatest effect on fat level after cooking. Rinsing with warm water significantly reduced fat and increased the moisture content of cooked ground beef crumbles. However, rinsing did not cause substantial losses in either protein, iron, zinc or vitamin B12. This technique could therefore be effective not only for those watching their waists, but also for those on low-fat, low-cholesterol diets.

Make the ‘Lean Link’ If you’re not up to rinsing your beef patties, but are still fond of hamburgers, Woolworths has come up with an alternative as part of their ‘Lean Links’ low-fat range. ‘Lean Links’ hamburger patties, made from reduced-fat beef, contain around 7–8 g of fat per patty (compared with around 30 g for the average shop-bought hamburger). Patties are frozen in packs in groups of four and each patty takes 4–5 minutes to thaw and grill—an added bonus for the time-strapped. The only problem, it would seem, could be the temptation to eat more than a few because of the reduced fat and calorie content. Remember that these are ‘low-fat’, not ‘no-fat’ products.

Lite’N’Easy does it If low-fat individual products are still not enough, the answer might be to go for low-fat whole meals and to have these delivered to your door, prepared and ready to heat. This is the thinking behind Lite’N’Easy, an 127

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Australian company that produces low-fat, tasty, ready-to-heat meals in quantities sufficient for one week’s supply. Meals are delivered to your door for as many days or weeks as you wish, with the average cost of a week’s meals around what it would cost someone to feed themselves. The meals are not meant to eliminate thinking on the part of dieters, but rather to provide examples of the types of healthy food that can help reduce fat intake.

The benefits of yoga The practice of yoga is known often to aid in weight loss. Yet exercise scientists claim that the amount of effort required in yoga is not enough for the person doing yoga to equal the weight loss benefits of exercise. But yoga can reduce the stress that causes the overeating that results in obesity. Also, Indian researchers have found that yoga increases the body’s metabolic rate by up to 20%, and it might be this that produces the long-term effects on weight loss. One explanation for this improvement in metabolism could be the forced expiration of air that’s practised in some forms of yoga.

Thin fish fingers Fried fish fillets are usually a no-no for waist watchers. But food technologists at Bird’s Eye have managed to reduce the fat and salt content of Lite’N’Healthy fish fillets by eliminating the parcooking approach, resulting in the fillets having to be cooked only once—at home—and therefore not absorbing as much oil. With a healthier mix of cooking oils from monounsaturated canola oil instead of saturated animal fats in the mixture, the product now contains less fat and has a healthier mixture of fats.

Lamb on the ‘trim’ ‘Trim Lamb’ is the Australian Meat and Livestock Corporation’s latest campaign to cater to the consumer mood for food that is low in fat, low in calories and convenient. It’s designed to promote new low-fat, boneless cuts of lamb. ‘Trim Lamb’ is lower in fat and therefore calories, and should be a preferred choice of those who like meat but want to lose weight. This product could compete with other low-fat meats and chicken in cholesterol management.

New cheeses on the whey Like much of what’s nice, cheese is fattening and a source of cholesterol. With other dairy products, such as milk, cream and yoghurt, it’s relatively simple to reduce the fat content. This is more difficult to do with cheese. Early methods produced a bland-tasting product. 128

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Now, food technologists have come up with a tasty cheese containing 7–10% fat (compared with 35% in traditional cheeses), which is suitable for weight and cholesterol watchers. New brands available are Bega Supa Light and Devon 7 (currently available only from delicatessens). More are expected in the future.

Popcorn or potato crisps? The battle for the low-fat nibbly is on. Among the contenders: popcorn and potato crisps. But the fight is decidedly unequal. Figures produced by the University of California (Berkeley) Wellness Letter suggest that you would have to eat nearly 400 g of plain, unbuttered popcorn to take in the calories you would from 25 g of potato crisps (about 15 crisps). By substituting one cup of plain, unbuttered popcorn for a 25 g bag of potato crisps you save around 130 calories and 10 g of fat.

The low-fat DIY potato crisper Perhaps the most satisfying snack to combine with a drink is potato crisps. But these are usually extremely high in fat (around 38%) because of the large surface area that soaks up the oil in which they’re cooked. If you can get rid of the oil, the fat content is reduced and the fat consequences are eliminated. Enter the no-fat, do-it-yourself microwave potato chip-maker. Available from mail order supplies for the blinding fee of $9.95, the chip-maker is a simple microwaveable plastic device into which chips are sliced from any type of potato and stood upright. The microwaving technique allows the water to be reduced from the potato while it is being cooked, without the need for heating with oil.

Drugs—far between, but a few Since the last edition of GutBuster, in 1997, at least two of the drugs recommended as a possible adjunct to a lifestyle change for weight loss have been taken off the market. This illustrates the difficulties inherent in producing effective weight-loss medications. To date, none that has been used has started life specifically as a weight-loss drug. Usually they are intended to treat something else (such as depression or heart disease), and it later becomes noticeable that weight loss is a side effect. Then the marketing machine kicks in to capitalise on the medication’s unexpected but very lucrative properties. Today Xenical (orlistat) is one of the few weight-loss drugs left standing, and this might be because its main effect is through its side effects. Xenical 129

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absorbs dietary fat in the gastrointestinal tract and passes this directly through the system, allowing it to be excreted in the stools. Approximately 30% of all fat is disposed of in this way when Xenical is taken before a meal. It therefore acts as a behaviour-modification drug, teaching the patient to abstain from eating that kind of food because of the uncomfortable side effects. Prudent use of Xenical can help increase weight loss by 3–4 kg in suitable candidates. Reductil (sibutramine) is now also available as an appetite suppressant and this can add modest weight losses to a weight loss program. Although drug companies are still scrambling to find the pot of gold at the end of the weight-loss rainbow, there are few simple and effective medications, without side effects, on the horizon.

Anti-depressants and menopausal weight gain Despite the potentially negative side effects of some anti-depressants, some also have benefits that are now starting to be recognised. Prozac and Zoloft, for example, have been shown to assist in weight loss. The reason for this is not quite clear, but it might be due to the reduction of stress-related eating. Anti-depressants might act to reduce binge eating. Why some anti-depressants have this effect and others do not might be explained by the compound effects of treatments. A recent study in Italy has shown that obese menopausal women given Prozac and a dietary program for weight loss fared better than a second group who were given just the dietary program. On examination, it emerged that the weight loss experienced by the larger group might have been caused by the reduction in metabolic rate. Weight loss usually causes a drop in metabolism, which then acts to prevent further weight loss. This is a physiological adjustment designed to ensure survival in times of famine. The anti-depressant appears to counteract this drop in metabolic rate. If food intake is also reduced in individuals who tend to eat more when depressed, the drug could have a doubly positive effect. Anti-depressant manufacturers will no doubt be keen to verify this finding.

Ver y low energy diets Very low energy diets, it seems, might work under the right conditions. These diets are administered mainly in the form of balanced fluid intakes, such as flavoured shakes. They work to control food intake while providing the right mix of nutrients, and can therefore be useful for rapid weight loss. However, the physiological adaptation that kicks in after a severe energy 130

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restriction such as this can cause a bounce-back effect in body weight unless a strictly supervised re-feeding schedule is observed after the low-energy intake period. Individuals using these diets also have to be highly motivated and well supported while they are using them. Products such as Modifast are available as Schedule 3 medications from a chemist (i.e. they are not on the shelf, but do not require a doctor’s prescription). These should not, however, be used without professional assistance, such as through a Professor Trimauthorised general practitioner.

Surger y—ef fective, but expensive Obesity surgery has come of age in recent years with the development of a technique known as laproscopic (lap) banding. This involves day surgery during which a small band is placed around the top of the tube leading into the stomach. A silicon sack attached to the band and inserted permanently under the skin can then be used to expand or contract the size of the band, thus reducing or increasing the amount of food that can be eaten. Lap banding has been found to have a good success rate over five years after the procedure is performed, with an average of 35% weight loss. Because the procedure does entail some risk, however, it is recommended only for the very obese who have had no success on other programs and for whom obesity is life-threatening. Strict supervision is also required, and patients must be taught and motivated to change their lifestyle drastically before undergoing the operation. The downside is the expense (usually not refundable under medical benefits) and the long waiting list for the procedure. Surgeons skilled in the technique are known to authorised Professor Trim doctors and their details are available on the Professor Trim website (www.professortrim.com).

THE BAD Chipping away at crisps Potato crisp manufacturers have tried to jump on the health bandwagon through the introduction of ‘light’ and ‘lightly salted’ varieties of their product. Some of these, such as the Kettle Chip, were criticised by nutritionists for using saturated fats, such as palm oils, which are thought to increase cholesterol levels in the bloodstream. But manufacturers have been quick to counter this criticism with claims such as ‘No cholesterol’ and ‘No tropical oils used’. The debate seems to have strayed away from the issue of energy intake. However, if you consider that a standard snack-sized bag 131

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of potato crisps contains around 700 kcals (2940 kJ) and 38 g of fat, energy intake would seem to be far more of an issue than the type of fat used.

Some thin attempts to hide fat crisps Crisps represent one of the fattier ways of treating potatoes. With growing public awareness of this, crisp manufacturers are trying all kinds of tricks to disguise the facts. The latest techniques include: •

•

using a name that implies low fat without this ever being so. This is the method behind Thins, also promoted as ‘cholesterol free’, but with 31.4% fat, and Smith’s Lites, which are actually only lightly salted, but have a fat content of 33.5%. using a healthy-sounding crisp base. Vege chips not only strike the healthy note of a vegetable ingredient (although potato is also a vegetable), they are promoted as having ‘all natural ingredients’ and being ‘cholesterol free’. They still have over 20% fat. Soya King multigrain crisps, which play on the healthful qualities of soy beans, have 27.4% fat.

Peanut butter—of f the list Peanuts, of most types, are high in oil. Peanut butter spreads range between 30% and 60% fat. Even if this is spread lightly on bread or toast, it can amount to 5–6 g. At least half of this could be put on the fat scorecard for the day. Using it on top of butter, which many people do, adds another 3–4 g of fat. Probably more important is the more-ishness of peanut butter as a food; it’s similar to the craving for one more handful of nuts when these are eaten on their own. While by no means a junk food, peanut butter is not the spread for those wishing to avoid the ‘spread’.

Farmed seafood—is it the same? With the ocean’s resources being taxed to the limit, there is a natural move towards farming seafood. Prawns, trout, even the fast-moving tuna are now being kept in ocean pens in some parts of southern Australia. But does this compromise the quality of the seafood? Or, do fish and prawns, like cattle and chicken that are confined, change the type and amount of fat they have and therefore the health benefits for those higher up the food chain . . . namely us? This question is being examined seriously by marine food scientists throughout the world. So far there are no definite answers, although it is apparent that fat types and levels are dependent on the type of food eaten 132

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and the amount of energy expended by an animal. In one study carried out on rainbow trout in the UK, both fatty composition and immune system products differed in fish fed a more ‘natural’ organic diet compared with those fed a sunflower oil compound. It’s not yet clear what effect this would have on the human constitution. In the meantime, it’s known that ocean-bred or ‘wild’ seafood does have health and possibly even fat-loss benefits. The type of fatty acids in fish (called EPA, for eicosapentaenoic acid) has been shown to decrease cholesterol levels. Studies are now being done to assess EPA’s effects on body weight maintenance in humans; the suggestion seems to be that it might not be just the amount but also the type of fat that matters for the waist watcher. Aquaculture is undoubtedly the way of the future. It remains to be seen if this brings any of the negative effects on health and fatness that have come from other forms of farming.

Don’t let them eat cake? What is it that turns a svelte body into an extra-voluptuous one? Too much cake, biscuits and chocolates, you might well think. After all, it’s these that stand out on any list of no-noes. However, researchers at Leeds University’s Biopsychology Group, who’ve made a specialty of studying human tastes, food preferences and fat patterns, don’t think this is the answer. From analysing food intake patterns of groups of overweight and lean people, they’ve found that the former do indeed eat more foods that are higher in fat, but overweight people assign more blame to meat, fried potatoes, nuts, butter, eggs and cheese. People who are overweight also eat fewer carbohydrate-rich foods such as fruit, vegetables, breakfast cereal, skimmed milk, rice and pasta. In this context, then, the occasional chocolate treat (if you can stop at one) perhaps shouldn’t rate so highly on the guilt index—that is, if the worst offenders are taken care of.

‘Natural’ fruit juices The term ‘natural’ is often used as a marketing tool—as if manufacturers are doing us a favour by allowing food to remain in its normal state. Yet ‘natural’ doesn’t always imply ‘better’, particularly when it comes to high-energy foods. This is true of fruit juices. Most are plenty sweet enough, but because they’re high in concentrated natural sugars (with most fibre removed), they’re also high in energy. Their value in other vitamins and minerals doesn’t compensate for their weight-gaining effects—‘natural’ or not. 133

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Are fruit juicers necessar y? Fruit juicing appliances have become a modern marketing tool, promoted for their ‘health’ benefits since fruit juices are high in vitamins and minerals. But are they really necessary? Most juicers work by extracting high-fibre pulp from fluid. This is the first point at which value is lost. Fibre is an important part of the diet, and one of the major reasons for recommendations of increased fruit and vegetable intake. Some juicers liquefy the entire fruit or vegetable, retaining some of the fibre. But this results in a thick mushy juice that requires diluting with water before drinking. When the mix is diluted, the concentration of vitamins is altered, thus reducing the value per volume of fluid. So, while whole fruit is a wholesome, low-fat food and therefore recommended, the same cannot be said of products of the fruit juicer.

The down side of fruit juice Because it takes around 0.5 kg of fruit to make a cup of fruit juice, the sugar (and therefore energy) value of the juice is highly concentrated. Moreover, it’s very easy to drink a glass of fruit juice, but it would be quite filling to eat the whole fruit it came from. Fruit juice therefore is quite fattening, relative to the quantity of whole fruit from which it’s made. Because it promotes obesity, fruit juice can also increase blood triglyceride levels, thereby increasing disease risks in susceptible people. For this reason the overweight should be particularly cautious about high intakes of fruit juice, just as the underweight should be cautious about the risks of becoming overweight. The rise in blood sugars caused by drinking fruit juice can also be a disadvantage for those with diabetes, or with undetected diabetic tendencies. Blood sugar increases after eating fruit are not very different from those after drinking the same amount of regular soft drink. In contrast, whole fruit causes a less rapid rise in blood sugar than fruit juice. For those with a weight problem, fruit juice should be avoided in favour of the whole fruit. Fruit juice has no extraordinary health benefits, although in healthy individual of normal weight it can provide an important source of energy and nutrients.

JUICE MYTHS •

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Fresh juice is more nutritious than processed juice. False. As long as processed juices are handled properly, they retain all their value.

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• • •

•

Juice is as good as the whole fruit. False. Fruit contains more than just juice (in particular, fibre), which adds to its value. Juice is not fattening. False. Because juice represents concentrated sugar (without the benefit of fibre), it can be as fattening as the sugar in normal soft drink. Commercially produced juicers are better than hand squeezing. False.They might make the job easier, but because most juicers eliminate fibre, the juice they produce is probably less healthy than the hand-squeezed variety. Juice is better than milk for infants. False. Although some juice might be desirable, a high level of energy intake from fruit juice can mean infants miss out on other vital nutrients.

What about vegetable juices? Because vegetables are generally lower in sugars than fruit, most vegetable juices are lower in total energy than fruit juices. Homemade vegetable juices contain roughly the same calories as the vegetable itself and can generally be consumed quite liberally without undue weight gain.

Butter, margarine or . . . ? The butter vs margarine squabble has been around for years. And it’s not likely to be resolved in the near future because new findings and arguments are continually being presented by both camps. Butter is more ‘natural’, margarine is lower in saturated fat; butter is more stable, margarine can be produced from healthy mono-unsaturated oils . . . On a health basis, the solution is unclear. In terms of weight control, however, there’s little dispute: both butter and margarine are high in fats and oils. They all contain 9 kcals/38 kJ per gram—irrespective of type—and so have a similar effect on gains in body fat. Spreading only a teaspoonful of either will yield around 35 kcals/147 kJ; hence the rush by food technologists to come up with a lower-fat or no-fat alternative spread. Until they do, the answer for the serious waist watcher seems to be eat neither or spread either as thinly as possible.

Lite chocolate? Climbing on the ‘lite’ bandwagon, one major chocolate manufacturer has produced a ‘lite’ chocolate by substituting artificial sweetener for the more calorie-dense ‘natural’ sugars that make up a significant component of the calories in chocolate. 135

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And while this does indeed reduce the energy content and make this product lower in calories than the sugared version, the main energy problem remains. Chocolate contains significant amounts of saturated fat. Fat is more energy dense than sugar (9 kcals/38 kJ per gram compared with 4.5 kcals/19 kJ per gram) and is potentially more ‘atherogenic’ (causing blocking of the arteries through build-up of fats such as cholesterol). ‘Lite’ chocolate might indeed therefore be liter than non-lite chocolate. But it’s still hardly a ‘diet food’, as the name would imply to many.

Soft drink woes Lack of exercise and eating too much are always blamed as the main causes of being overweight. But an often unrecognised contributor to the fat stakes is soft drinks. Retail World magazine published a survey in the 1990s showing that three of the ten biggest-selling items in supermarkets are soft drinks: Coca Cola topping that list by a wide margin. Despite our increasing interest in health, ‘diet’ drinks still lag well behind. As seen in Table 8.2, soft drinks rate very high in terms of calories per standard serve. Soft drink manufacturers worldwide are becoming increasingly sensitive to their role in promoting obesity. With some people now never drinking any other type of fluid, the industry has cause for concern about its image. The rush is on for alternative low-calorie sweeteners that taste better than the available variety. This is also likely to prove a highly profitable industry in the future. Meanwhile, those with a weight problem might be better advised to break the soft drink habit than to go on low-calorie binges. Table 8.2 Energy content of various drinks Beverage Low-alcohol beer Regular beer Stout Table wine Fortified wine 1 nip spirits

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Serving size 285 ml middy/(10oz glass) 285 ml middy/(10 oz glass) 285 ml middy/(10 oz glass) 125 ml (4 oz glass) 60 ml 30 ml with nothing added, except water or soda)

Kcals/kJ 70/294 105/441 160/672 85/357 80/336 60/252

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THE GOOD, THE BAD AND THE UGLY Orange juice Cola (sugared) Orange flavoured soft drink

250 ml 370 ml 370 ml

90/378 160/672 200/840

Vegarine or Buttermite? Vegemite is a great Australian food. As the ads tell us, it’s chock-full of vitamins (B in particular), low in fat and designed to make us happy, energetic and, by implication, healthy. Nothing wrong with this. In fact, nothing wrong with the product per se. But like all goody goodies, Vegemite is tainted by the company it keeps. As you’ve no doubt noticed, it’s difficult to eat Vegemite on bread or toast without some kind of spread, usually butter or margarine—even if you are Australian! Of course, spreads are among the foods highest in fat and therefore most fattening on the market—up to 80% fats or oils for both butter and margarine. Unfortunately, Vegemite screams out for a fatty partner, so much so that it has now been added to some cheese products. In truth then, it might have been better to mix in the butter or margarine in the first place and call it ‘Vegarine’ or ‘Buttermite’. Unless you can learn to live with it without a spread (or with very little) it might not help you attain your ideal waistline. Then you’d be an unhappy big Vegemite instead of a happy little one.

Is there fat after liposuction? The effects of liposuction (removing fat cells from body parts with suction) or a lipectomy (cutting off fat cells) have never been fully documented. It’s thought that regrowth of fat cells might occur naturally. Now it has been proposed, based on work with animals, that surgical removal of fat might cause abnormalities in blood fats, such as triglyceride and cholesterol. There’s also an indication that this might be one time when fat cells can regenerate, making the whole process of negligible long-term value.

Dark glasses, seaweed and other gimmicks The list of gimmicks that have been promoted over time as aiding in weight loss is almost too long (and often too ridiculous) to contemplate. But some you can cross off your list immediately are: • •

dark glasses that make food look less appealing seaweed 137

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• • • • •

weight-loss soap acupressure ear pins vibrating belts vibrating roller machines the (fill in the blank) diet.

There are basic principles that will help you recognise weight-control myths. The first principle to apply is: If you don’t work, it doesn’t work. (Meaning, if no energy is used no energy is lost.) The second, related to nutrition, says: Any food that reduces total energy input can decrease weight—temporarily. (Though more important is whether or not it will do so permanently.) Both are qualified by the third principle, which states: If you can’t imagine doing this for the rest of your life, it won’t work.

THE UGLY Fat-burning tablets to burn Fat metabolisers or ‘mobilisers’ are touted in health food stores and gymnasiums as the latest in fat-reducing agents. These make a range of promises such as ‘converts fat to fuel’ and ‘improves muscle definition’. However, a review by respected National Heart Foundation nutritionist Glen Cardwell pours cold water on any fat-burning fire.157 Products currently being promoted have as common ingredients carnitine, inositol and choline, and sometimes various vitamins, lecithin and herbs. They are generally aimed at the sports market, but sales through pharmacies are often to those desperate to try anything. According to Cardwell, there is no scientific backing for any of the claims made by any of these products. Even if they did ‘mobilise’ fat, he points out, fat must still be burned up through exercise . . . ‘it doesn’t evaporate from the body’.

Skin patches for weight loss We’ve been there before: special ‘magic’ ingredients that melt away fat by the hour. This time, though, the technique is different. All you have to do is attach a skin patch to the body (like wearing a bandaid) and you can ‘dissolve your fat cells by the hour’. Selling under the name of MEDEX DIET PATCH or Slender PATCH (obviously two different agents) the diet patches have the ring of déjà vu. The ‘magic ingredient’ is a substance called focus vesiculosis, which (surprise, 138

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surprise) comes from North Sea seaweeds (which just happen to be inaccessible to the average person). The seaweed trick has been tried many times before, but the advent of the slowly absorbed medical patch (like the nicotine patch for smokers) has given a whole new impetus to the product. Interestingly enough, despite claims that all the best medical journals have raved about it, I can’t find any such reports on the substance in reputable medical journals or any research reported at recent international obesity conferences. What’s more, recent reports suggest that weight loss greater than 1.5 kg/week could be a health risk, yet diet patch sellers claim a loss of 2 kg/week ‘even if you are a big eater’. Avoid getting stuck on this one!

One more way of getting ‘clipped’? Ear clips are yet another of the myriad miracle cures currently doing the rounds. These claim to provide ‘acupuncture without needles’, otherwise known as acupressure. Different products are available, all needing to be worn on the ear before and after meals. Through a complex process (generally half explained in Chinese medical terms and half in English terms) this is supposed to reduce the appetite and ‘tell the brain that the stomach is full’. The claims made about ear clips have been comprehensively trounced by the US Federal Trade Commission. In particular, there is no evidence that they reduce hunger, cause weight or fat loss or control food intake. More tellingly, a controlled study of acupressure and its effects on weight loss many years ago showed absolutely no effect in weight-loss terms. In addition, there is no guarantee that the available products really do perform acupressure. You’re likely to lose just as much weight through wearing ordinary earrings.

Brindleberr y, your time is up What do you do with a ‘fat-burning’ product when the explanation proffered for its effects is proved to be completely unfounded? Brindleberry, a ‘natural’ fat-loss product, is an example. Brindleberry products are marketed in health food shops as preventing the conversion of carbohydrate to fat through the mystical-sounding chemical ATP, citrate amylase. A number of scientific studies, as well as general scientific opinion, indicate that the conversion of carbohydrate to fat—de novo lipogenesis is the technical term— does not even occur under normal physiological circumstances in humans. Only fat in foods is readily stored as fat in the body. Brindleberry sellers do have a reserve ace up their sleeves, though. Their product, they say, also 139

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reduces hunger. It’s always good to have an unrelated explanation in case of the unexpected!

The ‘slim’ is in the shor ts, not you Having (almost) given up on fad treatments to bring about weight loss, some marketers are now turning to ways to at least hide what you’ve got. ‘Waist away’ is an ‘instant waist trimmer’, sold through mail-order catalogues, that acts like a belly corset to pull the waist in. It has only a cosmetic effect, and the marketers are smart enough to say so. On the other hand, Slim Fit, which are tight long-length shorts for women, claim to have a direct effect on fat. Advertising suggests that the product ‘uses heat and micromassage to promote the removal of waste and draws superfluous fat and water molecules from the skin’s surface’—a physiological impossibility that must have been missed by advertising regulators. Wallet size is about the only the thing that will slim down here.

Watch your dollars tick away Yet another ‘no effort’, ‘no push-up’ device, the digital tummy trimmer is a clever device that requires you to expand your stomach muscles against the pressure of a tight belt. The type of exercise required is isometric, or a contraction of muscles without movement. And while isometric actions have been shown to improve strength under certain conditions, it is false to claim (especially at the muscle length at which it is carried out), as the marketers of this product do, that it will ‘firm and flatten’ your tummy.

Tummy trimmers or wallet lighteners? Despite countless warnings, they still keep coming: no-effort exercise machines to reduce stomach size. Sold with the promise of ‘a flat stomach without sit-ups or exercise’, they come in all shapes and sizes, the latest being a pressurised vibration system, advertised as: ‘so easy to use, with absolutely no exercise’. As with most of these claims, this flouts all known laws of exercise physiology. Although some methods might help tighten stomach muscles in certain circumstances (although not when there is no effort involved), these products do little for any overlying fat. This is only reduced by ‘burning energy’, such as through aerobic exercise. You therefore could hardly expect to get a ‘flat stomach’ from any of these approaches. Yet since Consumer Affairs departments seem reluctant to act against the promotion of such devices without specific complaints, your only protection will be in applying the principle of ‘caveat emptor’ or 140

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buyer beware—in the case of all those who come bearing magical ‘noeffort’ goods.

Don’t come the magic prawn with me! Promoters of weight-loss gimmicks have certainly learned one thing in recent times: you need to sell the greatest possible amount of an unproven product quickly. And to sell lots of product quickly, you needs lots of distributors with a multi-level marketing format. The latest players in the market have a slightly different version of an old standby. Chitosan is a fibre supplement made from the shells of molluscs. It’s sold in tablet form, to be taken as a supplement with meals. The claim is that it ‘attracts’ fats in the digestive tract and prevents them being absorbed. In the first place, there is no convincing evidence that this happens, or that it can happen with supplement tablets such as these. Second, if it does prevent the absorption of fats, it would prevent the absorption of ‘good’ fats (Omega 3s and 6s and linoleic acid) as well as bad fats, and that of fat-soluble vitamins such as vitamin E and beta carotene. Beta carotene and some other products of the fat-soluble vitamin A are thought to be vital anti-cancer agents, so malabsorption of any or all of these substances could be dangerous. Other themes of the Chitosan story that echo standard weight-loss marketing gimmicks are: •

•

•

•

Claims of extensive scientific research supporting the product. On closer inspection, this comes mostly from obscure foreign-language journals. The only English publications cited do not directly research the product or the supplements advocated. Announcements of a ‘new’, ‘magic’ or ‘amazing’ discovery. The product, a form of fibre, is a variation on a theme. It just so happens that it can’t be easily grown in your backyard or bought at the corner store in the form of mollusc shells. False claims based on minimal research information. The fact that one rat study has shown a decrease in cholesterol with Chitosan does not prove that it reduces fat in the diet. Many other mono- and polyunsaturated oils reduce cholesterol, but this only happens after they are absorbed into the bloodstream. Aggressive marketing by unknowing distributors. With a multi-level marketing operation the product can be sold by anyone greedy enough to want a share of the action, without any knowledge of the potential dangers of the product. 141

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•

The implication that there is no need to otherwise control food intake. Any supplement taken in the absence of a balanced eating plan poses potential health risks, independent of any possible long-term risks posed by the supplement itself.

Chitosan is not the first or the last weight-control gimmick of its kind. The unscrupulous way in which it is promoted, however, makes it categorisable in the ‘ugly’ group.

Body wraps They claim that it’s been used for centuries: the wrapping of the body in bandages and using ‘secret’ oils to increase the metabolism and ‘instantly’ lose fat. The fact that this is not physiologically feasible or possible doesn’t seem to matter. Centres selling the treatment appear to be doing a roaring trade. So what can be wrong with it? In fact, you might as well wrap the therapist in dollar bills. Wrapping causes sweating, and sweat, being water, is heavy. After any length of time in a wrap, sweat, plus compression of the body cells, will give the impression of a loss of body weight and size. Of course this is only temporary. If the treatment does happen to work in the longer term, it is simply because of the low-energy diet and exercise program prescribed with it. If the ‘magic’ oil in the treatment worked as it is reputed to, it could only do so by penetrating the skin and causing a change in the body’s metabolism. If this actually happened, the treatment would have to be scheduled under the Prescribed Drugs Act. Either way, the so-called ‘proof ’ is nonexistent. There is no respected scientific verification of this ridiculous charlatan treatment. Anybody believing it should be wrapped up for life.

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APPENDIX Joining Professor Trim’s Becoming Slimmer (by prescription) Medically Supervised Weight Loss Program Becoming Slimmer is the book for Professor Trim’s Becoming Slimmer by Prescription program for women. The program is carried out on a sharedcare basis with accredited general practitioners around Australia. It can be ordered independently by free calling Professor Trim’s at 1800 100 550, but is available at a discount through contributing GPs, who also have access to qualified PT weight coaches for personal training and advice, a very low energy diet program and specialist obesity surgeons. Accredited GPs are listed by geographical area on the Professor Trim website at www.professortrim.com. The full Professor Trim Becoming Slimmer 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 on all aspects of weight loss 6 accompanying workbooks to help you carry out weekly activities a PT tape measure an Omron PT pedometer access to the PT Internet site, with regular newsletters, updates and services and real-time feedback on your progress the unique PT ‘stressometer’.

Exactly how you will work through a Becoming Slimmer program with your doctor is outlined below. Listed are the variety of options available to your doctor and your PT advisers if weight loss is slow and needs extra attention.

143

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BECOMING SLIMMER START Purchase a ‘Professor Trim’s Weight Loss Program’ through your doctor (or direct)

YEAR • Follow the at-home program in your pack • Use your Internet access and toll-free help line for feedback and advice • Visit your doctor at suggested intervals

Longterm weight loss

Add a ‘Personal Weight Coach’, if desired

To find out more about the full PT Becoming Slimmer medically supervised program, visit the website at www.professortrim.com or order directly by free calling 1800 100 550.

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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 on the subject by Garry Egger Egger, G. 2003 Becoming Gut Less: Weight Loss for Men, Allen & Unwin, Sydney Egger, G. and Thorburn, A. 2002 National Clinical Guidelines for Weight Loss and Obesity, National Health & 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 & Medical Research Council, 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 Sweets, Allen & Unwin, Sydney Egger, G., and Champion, N. 1998 The Fitness Leader’s Handbook, 4th edition, Kangaroo Press, Sydney Egger, G. and Stanton, R. 1988 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

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NOTES

1 World Health Organisation. 1999. Preventing and Managing the Global Epidemic of Obesity, Geneva. 2 Thirlby, R. C. and Randall J. 2002. ‘A genetic “Obesity Risk Index” for patients with morbid obesity’, Obesity Surgery 12(1): 25–9. 3 Sims, E. A. 2001. ‘Are there people who are obese but metabolically healthy?’, Metabolism 50(12):1499–1504. 4 Berman, D.M. and others 2001. ‘Racial disparities in metabolism, central obesity, and sex hormone-binding globulin in postmenopausal women’, Journal of Clinical Endocrinology 86(1): 93–103. 5 Lissner, L. and others 2001. ‘Larger hip circumference independently predicts health and longevity in a Swedish female cohort’, Obesity Research 9(10): 644–6. 6 Rossner, S. and Ohlin, A. 1995. ‘Pregnancy as a risk factor for obesity: lessons from the Stockholm Weight Development Study’, Obesity Research 3: 276S–278S. 7 Sweeny, A. T. and Brown, F. M. 2001. ‘Gestational diabetes mellitus’, Clinical and Laboratory Medicine 21(1):173–92. 8 Arroyo, P. and others 1995. ‘Parity and the prevalence of overweight’, International Journal of Obstetrics and Gynaecology 48(3): 269–72. 9 Hammer, R. L., Babcock, G. and Fisher, A. G. 1996. ‘Low-fat diet and exercise in obese lactating women’, Breastfeeding Review 4(1): 29–34. 10 Reubinoff, B. E. and others 1995. ‘Effects of low-dose oestrogen oral contraceptives on weight, body composition, and fat distribution in young women’, Fertility and Sterility 63(3): 516–21. 11 Haffner, S. M., Katz, M. S. and Dunn, J. F. 1991. ‘Increased upper 146

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12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

body and overall adiposity is associated with decreased sex hormone binding globulin in postmenopausal women’, International Journal of Obesity 15: 471–8. Perrone, G. and others 1999. ‘Evaluation of the body composition and fat distribution in long-term users of Hormone Replacement Therapy’, Gynaecology and Obstetrical Investigations 48(1): 52–5. Gleim, G. W. 1993. ‘Exercise is not an effective weight loss modality in women’, Journal of the American College of Nutrition 12(4): 363–7. Treuth, M. S. and others 1995. ‘Energy expenditure and substrate utilisation in older women after strength training: 24–h calorimeter results’, Journal of Applied Physiology 78(6): 2140–6. Malina, R. M. 1996. ‘Regional body composition: age, sex and ethnic variation’, in Roche, A. F., Heymsfield, S. B. and Lohman, T. G. Human Body Composition, Human Kinetics, Champaigne, Ill. Prentice, A. M., Goldberg, G. R., Jebb, S. A., Black, A. E. and Murgatroyd, P. R. 1991. ‘Adaptations to slimming’, Proceedings of the Nutrition Society 50: 441–58. Zhang, Y. and others 1995. ‘Positional cloning of the mouse obese gene and its human analogue’, Nature 11294: 372–5. Egger, G. and Swinburn, B. 1996. The Fat Loss Handbook: A Guide for Professionals, Allen & Unwin, Sydney. Formiguera, X. 1995. ‘Health professional approach to weight control’, in Cottrell, R. (ed.) Weight Control: The Current Perspective, Chapman & Hall, London. Rossner, S. 1995. ‘Realistic expectations of obesity treatment’, in Cottrell R. (ed.) Weight Control. Chapman & Hall, London. Egger, G. and Binns, A. 2001. The Experts’ Weight Loss Guide, Allen & Unwin, Sydney. Egger, G. and Stanton, R. 1993. GutBuster Waist Loss Guide, Allen & Unwin, Sydney. Tupling, H. 1989. A Weight off Your Mind, Bantam, Sydney. Pudel, V. 1995. ‘Psychological aspects of obesity’, in Cottrell, R. (ed.) Weight Control, Chapman & Hall, London. Wysoker, E. 1994. ‘Women’s experiences losing weight and gaining the lost weight back’, International Journal of Obesity 18 (Suppl 2): 80. Ibid. Ellis, A. 1988. How to Stubbornly Refuse to Make Yourself Miserable About Anything, Yes Anything, Sun Books, Melbourne. Lightman, S. W. and others 1992. ‘Discrepancy between self-reported and actual calorie intake and exercise in obese subjects’, New England 147

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Journal of Medicine 327(27): 1893–8. 29 Stuart, R. 1985. Act Thin, Stay Thin, Penman, New York. 30 Seligman, M. 1992. Learned Optimism, Random House, Sydney. 31 Velthuis-te Wierik, E. J. M., Westerterp, K. R. and Van Den Berg, H. 1995. ‘Impact of a moderately energy restricted diet on energy metabolism and body composition in non-obese men’, International Journal of Obesity 19: 318–24. 32 Blundell, J. 1995. ‘Food intake and appetite control: from energy intake to dietary patterns’, International Journal of Obesity 19(2): 1001–2. 33 Wadden, T. A. and Sarwer, D. B. 1999. ‘Behavioral treatment of obesity: new approaches to an old disorder’, in Goldstein, D. et al. (eds) The Management of Eating Disorders, Humana Press, Totowa, New Jersey. 34 Egger, G. and Stanton, R. 1993. GutBuster Waist Loss Guide, Allen & Unwin, Sydney. 35 Wilmore, J. H. and Costill, D. L. 1994. Physiology of Sport and Exercise. Human Kinetics, Champaigne, Ill. 36 Brundin, T., Thorne, A. and Wahren, J. 1992. ‘Heat leakage across the abdominal wall and meal induced thermogenesis in normal weight and obese subjects’, Metabolism 41(1): 49–55. 37 Shide, D. J. and Rolls, B. J. 1995. ‘Information about the fat content of preloads influences energy intake in healthy women’, Journal of the American Dietetic Association 95(9): 993–8. 38 Green, S. M. and Blundell, J. 1995. ‘Comparison of the perceived fillingness and actual intake of snack foods’, International Journal of Obesity 19(2): 28. 39 Swan, G. E. and Carmelli, D. 1995. ‘Characteristics associated with excessive weight gain after smoking cessation in men’, American Journal of Public Health 85(1): 73–7. 40 Danielsson, T., Rossner, S. and Westlin, A. 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 519: 490–4. 41 Richman, R. M. and others 1996. ‘Weight loss intentions and obesity management’, Paper presented to the Australian Society for the Study of Obesity, Annual Conference, Sydney. 42 Foreyt, J. 1996. ‘Behavioural management of weight control’, National Heart Foundation Symposium, Wrestling with Obesity, Sydney. 43 Formiguera, X. 1995. ‘Health professional approach to weight control’, in Cottrell, R. (ed.) Weight Control: The Current Perspective, Chapman & Hall, London. 44 Egger, G. and Swinburn, B. 1996. ‘An ecological paradigm for under148

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45 46 47 48 49 50 51 52 53 54 55

56 57 58 59 60

standing the obesity pandemic’, National Health and Medical Council Report on the Prevention of Obesity, Australian Government Publishing Service, Canberra. Hodges, A. M. 1995. ‘Modernity and obesity in coastal and highland Papua New Guinea’, International Journal of Obesity 19: 154–61. Egger, G., Vogels, N. and Westerterp, K. 2001. ‘Estimating historical changes in physical activity’, Medical Journal of Australia 175 (11/12): 635–6. Corti, B. 1997. Unpublished doctoral thesis. University of Western Australia, School of Community Health. Dietz, W. 1995. ‘The origins and consequences of childhood obesity’, Paper presented to the Australian Society for the Study of Obesity, 3rd Annual Meeting, Melbourne, September. Stanton, R. 1989. The Diet Dilemma, Allen & Unwin, Sydney. Brownell, K. and Wadden, T. 1986. ‘Behavior therapy for obesity: modern approaches and better results’, in Brownell, K. and Foreyt, J. P. (eds) Handbook of Eating Disorders, Basic Books, New York. Gatenby, S. J. and others 1995. ‘Nutritional implications of reduced-fat food use by free-living consumers’, Appetite 25: 241–52. Drewnowski, A. 1995. ‘Intense sweeteners and the control of appetite’, Nutrition Review 53(1): 1–7. James, W. P. T. 1995. ‘A public health approach to the problem of obesity’, International Journal of Obesity 19 (Suppl 3): S37–S45. Zeni, A. I., Hoffman, M. D. and Clifford, P. S. 1996. ‘Energy expenditure with indoor exercise machines’, Journal of the American Medical Association 275(18): 1424–7. Grilo, C. M., Brownell, K. D. and Stunkard, A. J. 1993. ‘The metabolic and psychological importance of exercise in weight control’, in Stunkard, A. J. and Wadden, T. A. (eds) Obesity: Theory and Therapy, 2nd edition, Raven Press, New York. Astrup, A. 2002. ‘Editorial: Dietary fat is a major player in obesity— but not the only one’, Obesity Review 3(2): 57–8. Keys, A. and others 1950. The Biology of Human Starvation, School of Public Health, University of Minnesota Press, Minneapolis. Cardwell, G. 2002 Diet Addiction, Wellness Australia, Perth, WA. Shetty, P. S. and others 1996. ‘Energy requirements of adults: An update on basal metabolic rates (BMRs) and physical activity levels (PALs)’, European Journal of Clinical Nutrition 50 (Suppl 1): S11–S23. Larson, D. E., Rising, R., Ferraro, R. T. and Ravussin, E. 1995. ‘Spontaneous overfeeding with a “cafeteria diet” in men: effects on 149

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61 62 63 64 65 66 67

68 69 70

71 72 73 74 75 76

150

24-hour energy expenditure and substrate oxidation’, International Journal of Obesity 19: 331–7. St Joer, E. R. and others 1995. ‘How eating patterns may relate to obesity’, International Journal of Obesity 2: 28. Cotton, J. R. and others 1996. ‘Replacement of dietary fat with sucrose polyester: effects on energy intake and appetite control in nonobese males’, American Journal of Clinical Nutrition 63: 891–6. Shied, D. J. and Rolls, B. 1995. ‘Information about the fat content of preloads influences energy intake in healthy women’, Journal of the American Dietetic Association 95: 993–8. Rolls, B. 2000. ‘The role of energy density in the overconsumption of fat’, Journal of Nutrition 130 (Suppl 2): S268–S271. Movahedi, A. 1999. ‘Simple formula for calculating basal energy expenditure’, Nutrition Research 19: 989–95. Foster-Powell, K., Brand-Miller, J. and Colagiuri, S. 1998. The GI Factor and Losing Weight, Hodder & Stoughton, Sydney. Kristal, A. R. and others 1990. ‘Patterns of dietary behaviour associated with selecting diets low in fat: Reliability and validity of a behavioural approach to dietary assessment’, Journal of the American Dietetic Association 16(35): 214–20. Matters, R. D. 1993. ‘Fat preference and adherence to a reduced-fat diet’, American Journal of Clinical Nutrition 57: 373–81. Rolland-Cachera, M. F., Deheeger, M. and Bellisle, F. 1995. ‘Early nutrition and later outcomes’, International Journal of Obesity 19(2): 11. Siscovick, D. S. and others 1995. ‘Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest’, Journal of the American Medical Association 274: 1363–7. Stanton, R. 1991. The Diet Dilemma, Allen & Unwin, Sydney. Raben, A. and others 1995. ‘Spontaneous weight loss during 11 weeks’ ad libitum intake of a low fat/high fibre diet in young, normal weight subjects’, International Journal of Obesity 19: 916–23. Mela, D. J. 1993. ‘Consumer estimates of the energy from fat in common foods’, European Journal of Clinical Nutrition 47: 735–40. Egger, G. and Stanton, R. 1993. GutBuster Waist Loss Guide, Allen & Unwin, Sydney. Emmett, P. M. and Heaton, K. W. 1995. ‘Is extrinsic sugar a vehicle for dietary fat?’, The Lancet 345: 1537–40. Ballard-Barbash, R. and others 1994. ‘Variability in percent energy from fat throughout the day: Implications for application of total diet

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goals’, Journal of Nutrition Education 26(6): 278–83. 77 Gershoff, S. N. 1995. ‘Nutrition evaluation of dietary fat substitutes’, Nutrition Reviews 53(11): 305–13. 78 New South Wales Health Department, 1996. ‘Tips on Chips’ report, Sydney. 79 Poppit, S. D. 1995. ‘Energy density of diets and obesity’, International Journal of Obesity 19 (Suppl 5): S20–S26. 80 Stephens, A. 1995. ‘More carbohydrates. Better health’, Paper presented to the International Life Sciences Conference on Carbohydrates and Health, Sydney, June. 81 Baghurst, K. and others 1992. ‘The development of a simple dietary assessment and education tool’, Journal of Nutrition Education 24: 165–72. 82 Ludwig, D. S. 2000. ‘Dietary glycaemic index and obesity’, Journal of Nutrition, 130 (2S Suppl): S280–S283. 83 Turconi, G. and others 1993. ‘High-calorie fibre-rich breakfast: its effect on satiety’, Journal of Human Nutrition & Dietetics 6: 245–52. 84 Blundell, J. E. and Gillett, A. 2001. ‘Control of food intake in the obese’, Obesity Research 9 (Suppl 5): S263–270. 85 Holt, S. H. A. and others 1995. ‘A satiety index of common foods’, European Journal of Clinical Nutrition 49: 675–90. 86 Whitehead, J. M., McNeill, G. and Smith, J. S. 1996. ‘The effect of protein intake on 24 hr energy expenditure during energy restriction’, International Journal of Obesity 20: 727–32. 87 Prentice, A. M. 2001. ‘Overeating: the health risks’, Obesity Research, 9 (Suppl 5): S234–S238. 88 Ibid. 89 Egger, G. and Mowbray, G. A. 1993. ‘Qualitative analysis of obesity and at-risk overweight in working men’, Australian Journal of Nutrition and Dietetics 50(1): 10–14. 90 Lieber, C. 1991. ‘Perspective: do alcohol calories count?’, American Journal of Clinicial Nutrition 54: 49–55. 91 Egger, G. and Stanton, R. 1993. GutBuster Waist Loss Guide, Allen & Unwin, Sydney. 92 Westerterp, K. 1992. ‘Diet induced thermogenesis and cumulative food intake curves as a function of familiarity with food and dietary restraint in humans’, Physiology and Behaviour 5113: 457–65. 93 Colquhoun, E. O. 1993. ‘Possible new pharmacological approaches to the management of obesity’, Paper presented at the Second Scientific Meeting of the Australian Society for the Study of Obesity, Melbourne, July. 94 Bracco, D. and others. 1995 ‘Effects of caffeine on energy metabolism, 151

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95 96 97 98 99 100 101 102 103 104

105 106 107 108 109 152

heart rate, and methylxanthine metabolism in lean and obese women’, American Journal of Physiology 269: E671–E678. LeBlanc, J. and others 1993. ‘Components of post-prandial thermogenesis in relation to meal frequency in humans’, Canadian Journal of Physiology and Pharmacology, 71(12): 879–83. Miller, M. R. and Kose, B. 1996. ‘What are Western Australians eating? The Perth dietary surveys’, Paper presented at the Nutrition WA Conference, March. Stanton, R. 1994. ‘Dietary extremism and eating disorders in athletes’, in Burke, L. and Deakin, V. (eds) Clinical Sports Nutrition, McGrawHill, Sydney. Radimer, K. L. 1995. ‘Assessment of magazine weight reduction diets for consistency with dietary guidelines and targets’, Australian Journal of Nutrition and Dietetics 52(1): 16–23. Drewnowski, A. 1995. ‘Intense sweeteners and the control of appetite’, Nutrition Reviews 53(1): 1–7. Waterhouse, D. 1995. Why Women Like Chocolate, Vermillion Press, New York. Editorial 1995.‘Food label claims: what do they mean?’, Choice Magazine, February. Wadden, T. 1999. ‘Behavioral treatment of the overweight patient’, Ballier’s Clinical Endocrinology and Metabolism 13: 93–107. Katzel, L. I. and others 1995. ‘Effects of weight loss vs aerobic exercise training on risk factors for coronary disease in healthy, obese, middle-aged and older men’, Journal of the American Medical Association 274(24): 1915. Dunn, A. L. and others. 1999. ‘Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial’, Journal of the American Medical Association 281(4): 327–34. Levine, J. and others. 2001. ‘Measurement of the components of nonexercise activity thermogenesis’, American Journal of Physiology 281(4): E670–5. Egger, G. and Binns, A. 2001. The Experts’ Weight Loss Guide, Allen & Unwin, Sydney. Prentice, A. and Jebb, S. 1995. ‘Obesity in the UK: sloth or gluttony?’, British Journal of Medicine 311: 437–9. Blair, S. N., Kohl, H. W. and Gordon, N. F. 1992. ‘Physical activity and health: a lifestyle approach’, Medicine, Exercise and Nutrition in Health 1: 54–7. Jakicic, J. M., Wing, R. R., Butler, B. A. and Robertson, R. J. 1995.

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110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125

‘Prescribing exercise in multiple short bouts versus one continuous bout: effects on adherence, cardiorespiratory fitness, and weight loss in overweight women’, International Journal of Obesity 19: 893–901. Oja, P. 2001. ‘Dose response between total volume of physical activity and health and fitness’, Medicine and Science in Sports and Exercise 33 (6 Suppl 2): S428–S437. Votruba, S. B., Horvitz, M. A. and Schoeller, D. A. 2000. ‘The role of exercise in the treatment of obesity’, Nutrition 16(3): 179–88. World Health Organisation Consensus Statement on Physical Activity and Health, Bangkok, 2002. Blix, G. G. and Blix, A. G. 1995. ‘The role of exercise in weight loss’, Behavioral Medicine 21: 31–9. Egger, G. 1991. ‘Prescribing exercise’, Modern Medicine 34(7): 106–17. Ready, A. E. and others 1996. ‘Influence of walking volume on health benefits in women post-menopause’, Medicine and Science in Sports and Exercise 28(9): 1097–105. Dolgener, F. A., Kolkhorst, F. W. and Whitsett, D. A. 1994. ‘Long slow distance training in novice marathoners’, Research Quarterly for Exercise and Sport 65(4): 339–46. Egger, G. 1988. The Art of Sensible Exercise, Davi-Ell Press, Sydney. Egger, G., Champion, N. and Bolton, A. 1999. The Fitness Leader’s Handbook, 4th edition, Kangaroo Press, Sydney. Klem, M. L. and others 2000. ‘Does weight loss maintenance become easier over time?’, Obesity Research 8(6): 438–44. Donnelly, J. E. and others 1993. ‘Muscle hypertrophy with large-scale weight loss and resistance training’, American Journal of Clinical Nutrition 58: 561–65. Jeukendrup, A. E. and others 1996. ‘Effect of endogenous carbohydrate availability on oral medium-chain triglyceride oxidation during prolonged exercise’, Journal of Applied Physiology 80(3): 949–54. Egger, G. and Swinburn, B. 1996. The Fat Loss Leader’s Handbook, Allen & Unwin, Sydney. Shephard, R. 1992. ‘Fat metabolism, exercise, and the cold’, Canadian Journal of Sports Sciences 17(2): 83–90. Tudor-Locke, C. E. and Myers, A. M. 2001. ‘Challenges and opportunities for measuring physical activity in sedentary adults’, Sports Medicine 31(2): 91–100. Foster, G. D. and others 1995. ‘The energy costs of walking before and after significant weight loss’, Medicine and Science in Sports and Exercise 27(6): 888–94. 153

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126 Wilmore, J. and Costill, D. 1994. Physiology of Sport and Exercise, Human Kinetics, Champaigne, Ill. 127 Egger, G. 1984. The Sport Drug, Allen & Unwin, Sydney. 128 Salmon, P. 2001. ‘Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory’, Clinical Psychology Review 21(1): 64–9. 129 Schneiter, P. and others 1995. ‘Effect of physical exercise on glycogen turnover and net substrate utilisation according to the nutritional state’, American Journal of Physiology 269: E1031–E1036. 130 Garrow, J. S. 1995. ‘Exercise in the treatment of obesity—a marginal contribution’, International Journal of Obesity 19 (Suppl 4): S126–S129. 131 Garrow, J. S. and Summerbell, C. D. 1995. ‘Meta-analysis: effect of exercise, with or without dieting, on the body composition of overweight subjects’, European Journal of Clinical Nutrition 49: 1–10. 132 Grilo, C. M., Brownell, K. D. and Stunkard, A. J. 1993. ‘The metabolic and psychological importance of exercise in weight control’, in Stunkard, A. J. and Wadden, T. A. (eds) Obesity: Theory and Therapy, 2nd edition, Raven Press, New York. 133 Wolfe, R. W., Klein, S., Carraro, F. and Weber, J.-M. 1990. ‘Role of triglyceride-fatty acid cycle in controlling fat metabolism in humans during and after exercise’, American Journal of Physiology 258: E382–E389. 134 Schneiter, P. and others. 1995 ‘Effect of physical exercise on glycogen turnover and net substrate utilisation according to the nutritional state’, American Journal of Physiology 269: E1031–E1036. 135 Egger, G. and Stanton, R. 1993. GutBuster Waist Loss Guide, Allen & Unwin, Sydney. 136 Egger, G., Champion, N. and Bolton, A. 1999. The Fitness Leader’s Handbook, 4th edition, Kangaroo Press, Sydney. 137 Wilmore, J. H. and Costill, D. L. 1996. Sports Physiology, Human Kinetics, Champaigne, Ill. 138 Grilo, C. M. 1994. ‘Physical activity and obesity’, Biomedicine and Pharmacotherapy 48: 127–36. 139 Wadden, T. 1994. ‘Obesity prevention following the treatment of obesity: behavioural and psychological factors’, Paper presented to the 7th International Conference on Obesity, Toronto, Canada. 140 Raben, A. and others 1994. ‘Evidence for an abnormal post-prandial response to a high fat meal in women predisposed to obesity’, American Journal of Physiology 267: E549–E559. 141 Weisner, R. L., Wilson, L. J. and Lee, J. 1995. ‘Medically safe rates of 154

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weight loss for the treatment of obesity: a guideline based on risk of gallstone formation’, American Medical Journal 98(2): 115–17. 142 Hunt, P. and Hillsdon, M. 1996. Changing Eating and Exercise Behaviour, Blackwell Science, London. 143 Egger, G. and Stanton, R. 1995. GutBuster 2: The High Energy Guide, Allen & Unwin, Sydney. 144 Prentice, A. M., Goldberg, G. R., Jebb, S. A., Black, A. E. and Murgatroyd, P. R. 1991. ‘Adaptations to slimming’, Proceedings of the Nutrition Society 50: 441–58. 145 Egger, G. and Binns, A. 2001. The Experts’ Weight Loss Guide, Allen & Unwin, Sydney. 146 Robison, J. I. and others 1995. ‘Redefining success in obesity intervention: the new paradigm’, Journal of the American Dietetic Association 95(4): 422–3. 147 Wadden, T. 1999. ‘Behavioral treatment of the overweight patient’, Ballier’s Clinical Endocrinology and Metabolism 13: 93–107. 148 Burns, D. 1992. Feeling Good: The New Mood Therapy, Penguin, New York. 149 Garrow, J. 1995. ‘Penalties of shifting weight’, British Journal of Medicine 311: 1653–4. 150 Jeffries, R. 1994. ‘The truth about weight cycling’, Paper presented to the Australian Society for the Study of Obesity (ASSO) annual meeting, Brisbane, October. 151 Lean, M. E. J., Han, T. S. and Morrison, C. E. 1995. ‘Waist circumference as a measure for indicating need for weight management’, British Medical Journal 311: 158–61. 152 Egger, G. and Swinburn, B. 1996. The Fat Loss Leader’s Handbook, Allen & Unwin, Sydney. 153 Klausen, B., Toubro, S. and Astrup, A. 1995. ‘Effect of age and gender on 24 hr energy expenditure measured in respiratory chambers’, International Journal of Obesity 19(2): 84. 154 Prentice, A. and others 1991. ‘Physiological responses to slimming’, Proceedings of the Nutrition Society 50: 441–58. 155 Levitan, R. D., Kaplan, A. S. and Rockert, W. 1996. ‘Characterisation of the seasonal bulimic patient’, International Journal of Eating Disorders 19(2): 187–92. 156 Korner, J. and Eberle, M. A. 2001. ‘An update on the science and therapy of obesity and its relationship to osteoarthritis’, Current Rheumatology Reports 3(2): 101–6. 157 Cardwell, G. 1998. Diet Addiction, Wellness Australia, Perth, WA 155

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INDEX

adrenal glands, 13 age weight and, 5–7, 14, 21, 119–20 alcohol fat and, 66 food intake with, 21, 75–6 increasing, 114 low-fat accompaniments, 126–7 post-alcohol binge, 75–6 reducing, 56, 75–6 standard drinks, 76 as toxin, 76 weight and, 76 WHO drinking levels, 75 allergy medication, 17 ambient level of activity, 90 American College of Nutrition, 12 amylopectin, 59 amylose, 59 anaemia, 116 androgens, 16 anti-allergy medication, 16 anti-anxiety medication, 16 anti-depressants, 17, 130 anti-inflammatory medication, 16 antipsychotic medication, 17 appetite, 2, 31 fat and, 63 increased, 110 aquarobics, 104, 105 arthritis, 122 artificial sweeteners, 81 hunger and, 81 athletes fat metabolism in, 95 avocado, 70

behavioural characteristics, 2, 19–37 behavioural modification programs, 123 techniques, 37 benzodiazapines see anti-anxiety medication bereavement, 118 bikes availability, 41 binge eating, 3, 21, 130 biological hunger, 31 biology impact on weight, 5–18 biorhythms, 121 birth weight of baby weight gain of mother and, 10 Blix, Glen and Arlene, 91–2 body composition changes in, 110 body fat age and, 14 distribution of, 13 body mass index (BMI), 41, 116, 117 body size fitness and, 13 gender differences, 13 body weight model, old, 2 body wraps, 142 body’s adaption to weight loss, 106 bounce-back effect, 15, 131 breakfast, importance of, 71 breast milk fat levels, 62 breastfeeding, 9, 11 brindleberry, 139–40 buddy system for exercise, 47 butter, 135 cutting out, 63, 109 157

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BECOMING SLIMMER cafeteria-style foods, 52 caffeine fat-burning effect of, 78–9 obesity and, 79 cake, 133 callisthenic exercises, 103–4 calories, ix calorie counting, 2 canoeing, 105 capsaicin, 78 car impact of second, 40 carbohydrates, 44, 48–9 cravings for, 82 metabolism of, 69 reducing, 48 cardiovascular system pressure of exercise on, 84, 85 Cardwell, Glenn, 138 career changes, 118 cereals high-fibre, 71 cheese low fat, 127, 128–9 Chitosan, 141–2 chocolate, 133, 135–6 codliver oil, 125 see also fish oil cohabitation effect, 43–4 Colquhoun, Dr Eric, 78 compensatory overeating, 74–5 constipation, 116 contraception, 5 low-dose, 11 oral, 18 see also oestrogen, progesterone cooling down after exercise, 102 corner store impact on weight, 42 Corti, Dr Bill, 42 corticosteroids see anti-allergy medication, anti-inflammatory medication counselling, 19, 26 cracker biscuits, 126–7 crash diets, 21 cravings see food cravings crime, fear of, 21 CSIRO Human Nutrition Unit, 71–2 Cybex sit-up device, 124–5 cyclical thinking patterns, 26 158

cycling, 104, 105 cyproheptadines see allergy medication day of week impact on eating, 32 denial, 28 and eating, 28 and exercise, 28 depression, 26 effect on weight, 33 managing, 114 diabetes activity and, 91 medication for, 17 diet resistance, 27–8 shakes, 131 dietary diary, 28 dietary reporting errors in, 13 gender differences, 13 diet-induced thermogenesis, 77 diets, 2 crash, 21 fad, 42, 80–1 failure of, 50–1 low-energy, 130 nutrition and, 51 stress and, 51 Dietz, Dr Bill, 42–3 dishwashing, 88 disputation, 27 distortion, 28 actual versus reported food intake, 28 distraction, 27 eating and, 28 divorce, impact of, 118 Drewnowski, Dr Adam, 81 drink body fat and, 6 drugs, 129–30 dynamic adjustments of body, 2 ear clips, 139 eating disorders, 116 eating habits becoming aware of, 23–4 changing, 3, 4 ecological paradigm for weight control, 3 Ellis, Albert, 26–7

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INDEX emotional hunger, 31 problems, 26 energy balance, 2 compensation, 74–5 consumption, 48, 49 levels, 113 reduction, 56 requirements, 57–8 restriction, 30–1 energy density (ED) cut-offs, 56 decreasing, 56–7 effect on obesity, 69 energy-dense foods, 39 fibre and, 69 levels, 57 environment changing, 38–40 controlling micro-environment, 39–40 home audits, 40–1 impact on weight, 38–47 macro-environment, 40 essential fatty acids, 62–3, 114 European Congress on Obesity, 11th, 9 exception rule, 21 exclusion of foods, 61 exercise availability of equipment, 41 aerobic, 85, 90, 94, 101 before breakfast, 99–100 circuit training, 94 cooling down after, 102 duration, 2 eating after, 102–3 energy use during, 91–2 with friend, 47 high-intensity, 84 home, 46–7 increased, 2, 82–105 institutional, 46 intensity, 2, 96 limitations of, 12–13 log, 28 machines, 123 as major factor in weight loss maintenance, 13 mechanical problems, 87, 122 motivation, 87

obese people and, 100 planned, 46, 93 psychological rewards of, 98–9 psychological stages of, 98 regular, 92 role in maintaining weight loss, 94 slower and sustained, 13 as stress relief, 101–2 type needed for fat loss, 1 variety, 93–4 volume versus intensity, 90 see also movement eye–mouth gap, 21, 27 fad diets, 43, 80–1 family commitments, 21 support, 40 fast food, 40 fasting, 49–50 experiments, 49 physical effects, 49 psychological effects, 49–50 fat beneficial, 62–3 breaking addiction to, 61–2 content of foods, 64–5 in cooking, 41 decreasing, 48, 60–8, 109 digestion rate and, 59 hidden, 64–5 methods for reducing in diet, 60–1 stores, 5 varying intake during day, 67 fat cells differences between genders, 13 fat loss long-term, 39, 106–23 rate of reduction, 53–4 see also weight loss fat metabolisers see fat-burning tablets fat substitutes, 67–8 carbohydrate-based, 67 fat-based, 67 protein-based, 67 safety concerns, 67–8 fat–alcohol combination, 66 fat-burning tablets, 138 fatigue, 21 fatness 159

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BECOMING SLIMMER causes of, 21–2 fat-soluble vitamins, 62 fat–sugar combinations, 66 festive eating, 115, 119 fibre content, 72 increasing, 69–72 role in weight loss, 56 fidgeting, 87 fish fillets low-fat, 128 fish oils, 62–3, 125 fitness, and body size, 13 gender differences, 13 flexibility in eating plans, 24 Flexi-tester, 125 food amount, 2 body fat and, 6 combining, 80 cravings, 82 type, 2 food intake monitoring for long-term weight loss, 107 Food Standards Australia & New Zealand Food Standards Code, 83 food variety increasing, 77 foot–brain gap, 21, 27 Foreyt, Professor John, 37 Formiguera, Professor Xavier, 39 Friday night binge, 32 friends exercise with, 47 fructose digestion rate, 58 fruit availability, 41 cancer and, 70 consumption, 70–1 juice, 70–1, 133–5 whole, 70 Fruitfuls, 124 gallbladder disease, 116 Garrow, Dr John, 115 gender 160

weight and, 5, 8–13, 21 genetic characteristics environment and, 38 limitations, 7–8 weight and, 2, 5, 6, 7–8, 21 Gestational Diabetes Mellitus, 10 Gleim, Dr Gilbert, 12 glucose burning of, 95 digestion rate, 58 exercise and, 84 Glycaemic Index (GI) food, 21, 58–60 processing, 59 goal-setting, 37 grazing, 79 grief, 118 guilt, 25 GutBuster men’s weight loss program, viii, 42 habits see eating habits habitual eating, 21 health eating for, 79–80 heart disease, 85 activity and, 91 HRT and, 12 heat treatments, 33, 96 see also saunas hidden fats, 64–5 hidden sugar, 66 high-fat foods, 41 hips fat storage on, 8–9 size as health predictor, 9 see also waist:hip ratio holiday eating, 21 Holt, Dr Susannah, 71–2 home audits, 40–1 home exercise machines, 46–7 homeostasis, 33 hormone replacement therapy (HRT), 12, 18 heart disease and, 12 hunger, 52–3 caused by restrictive dieting, 3 excessive, 21 increased, 110 hypothalamus, 15

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INDEX ice-cream low-fat, 126 immobility, 114 inactivity impact of, 21 incidental activity, 46, 84, 86, 89, 91 role in maintaining weight loss, 94 infants fat levels and, 62 ingredients see nutrition information institutional exercise see exercise, institutional insulin, 17 internal motivation, 37 irregular eating, 21 Jeffries, Dr Robert, 116 Karolinska Institute Obesity Unit, 9 Keys, Dr Ancel, 49 kilojoules, ix Krystal, Dr Allan, 60 labels see nutrition information labour-saving devices effect on weight, 38, 40, 41–2 lap banding, 131 lawnmowing, 88 laziness, 21 lean body mass loss of, 50 Lean Links, 127 learned helplessness, 29–30 learned optimism, 27, 29–30 leptin, 15 life stages, critical, 117–19 lifestyle eating plan developing, 63–4 liposuction, 137 Lite’N’Easy meals, 127–8 low-energy diets, 130 low-fat cooking methods, 41 low-fat food, 34, 44–5, 123 availability, 41 importance of, 44–5 overeating and, 34, 54–5 machines effect on weight, 38

maintaining weight loss, 106–23 dealing with stress, 107 exercise and, 107 goals, 108–9 monitoring food intake, 107 monitoring weight, 107 after obesity, 107–8 persistence, 113 success, 113 techniques for, 106–7 margarine, 135 cholesterol-lowering, 126 cutting out, 63, 109 marriage, 117 measurement as weight loss indicator, 116–17 meat cravings for, 82 low fat products, 127 medication weight gain and, 16–18, 21, 119 Mediterranean diet, 56 melatonin, 121 menopause fat distribution and, 11–12 menstruation irregular, 116 metabolic health, 85 metabolic rate age and, 13 body fat and, 6 decreases in, 2, 50, 110, 130 diets and, 50 slow, 21 television and, 43 mid-life crisis, 118 modification of foods, 61 molecular research into obesity, 38 motivation for weight loss, 22–3 movement body fat and, 6 distance versus speed, 92 increased, 3, 4, 37, 84–105 for obese people, 87 regular daily, 86 short bouts of, 89 see also exercise, incidental activity muscle loss, 50 muscle mass, exercise and, 14 161

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BECOMING SLIMMER national guidelines for nutritional health, 80 National Health and Medical Research Council, 105 National Heart Foundation recommended physical activity levels, 42 National Physical Activity Guidelines for Australians, 105 negative feelings changing, 37 nervous overeating, 113 night eating, 21 nutrition, 48–83 nutrition information decoding, 66, 82–3 on packaging, 65 ob gene, 15 obesity controlling by reducing fat, 64 cycle, 25 genetic predisposition to, 2, 5, 6, 7–8 maintaining weight loss following, 107–8 modernity and, 41 research, 1 statistics, 1 in western societies, 1, 41 oestrogen, 11, 18 oil canola, 63 in cooking, 41 olive, 63 Sunola, 63 omega-3 polyunsaturated fats, 63 overeating after exercise, 74–5 partner support, 40 passive pause, 115 peanut butter, 132 pedometers, 28, 96–7 peer pressure, 40 permanence, 29 permission to eat, 24–5 person power, 45–6, 86 see also exercise, incidental activity, movement personalisation, 29 162

pervasiveness, 29 phenothiazenes see antipsychotic medication physical abuse weight gain as response to, 19 Physical Activity Level (PAL), 57–8 physical activity see movement, exercise planned exercise see exercise, planned plateauing of fat loss, 50, 110–12, 120 getting off plateaus, 111–12 longer, 112 popcorn, 126, 129 portion size, 41 decreasing, 74–5 potato chips, 68 decreasing fat in, 68 potato crisps, 129, 131–2 pregnancy, 5, 13 age and, 10 appropriate weight gains during, 9–10 multiple, 10–11 pretzels, 126 processed foods GI of, 59 progesterone, 18 protein, 44 consumption, 73 maintaining intake, 73 metabolism and, 73 role in weight loss, 56 signalling role of, 5 psychological causes of excessive fatness, 19 psychological help, 26 psychology of obesity, 24 Pudel, Dr Volker, 24 quality of life, 113 racial differences fat loss and, 8 fat storage and, 8 rational emotive therapy (RET), 26–7 recommended dietary targets, 80 reduced-fat food, 44 see also low-fat food reducing efficiency, 120 Reductil, 130 replacement of foods, 61 resting metabolic rate (RMR), 51–2, 57

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INDEX restrained eating, 21, 24 rice crackers, 126 Rolland-Cachera, Dr Michelle, 62 rowing, 104, 105 rumination, 29 salad dressings, 124 satiation, 71 satiety, 71 index, 71–2 levels, 72 saunas, 33, 96 seafood, 132–3 Seasonal Affective Disorder (SAD), 21, 121–2 seaweed, 138, 139 sedentary job impact of, 21 self-confidence, 19, 37 self-consciousness, 21 self-control, 114 self-efficacy, 37 self-esteem, 19, 114 self-monitoring, 28, 37 Seligman, Dr Martin, 29–30 separation, 118 sex steroids gender differences, 13 sexual abuse weight gain as response to, 19 sit-ups, 104 skin patches, 138–9 sleeping patterns, 113, 116 smoking cessation and weight gain, 21, 35–6, 119 snack foods, 41 avoiding, 52 low-fat, 126–7 social conditioning, 24 pressure, 24 support, 37 social eating, 21, 43–4 controlling, 44 soft drinks, 136–7 diet, 45, 136–7 energy content, 136 spice metabolic rate and, 77–8 sport

organised, 117 retirement from, 118 see also exercise spot reduction, 104 stages of change, 36–7 stairs, 88 standing, 88 starch digestion rate, 58, 59 resistant, 69–70 Stephens, Professor Alison, 69 Stern, Dr Judith, 115 stimulus–response connection, 24, 102 stress body fat and, 6 managing, 114, 118–19 Stuart, Dr Richard, 28 substitution of foods, 61 success in weight loss redefining, 113–14 sugars digestion rate, 58 see also glucose, fructose surgery, 31 sweating, 33 sweets cravings for, 82 swimming, 97–8, 104 Swinburn, Professor Boyd, viii taste overeating and, 34–5 technology effect on weight, 38, 39, 41–2 television advertising of snack foods, 43 effects on children, 43 impact on weight, 42–3 remote control, 88 thigh chafing, protection against, 125 thought-stopping techniques, 32 thoughts impact of, 26 thyroid problems, 21 tiredness, 113 toddlers fat levels and, 62 Tracmor device, 42 treadmills 163

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BECOMING SLIMMER home, 46–7 tricyclic antidepressants see antidepressants triglycerides, 66 Trim for Life, viii Trim Lamb, 128 tummy trimmers, 140–1 vege chips, 132 Vegemite, 137 vegetables cancer and, 70 consumption, 70 energy density, 70 juices, 135 volitional eating, 64 Wadden, Dr Tom, 106 waist size as health predictor, 9, 117 waist:hip ratio (WHR), 8, 9, 116–17 walking, 46, 86, 88, 103, 104 daily, 109 problems with, 104–5 trading off for indulgences, 103 warmth weight gain and, 33–4, 96 water content of food, 72 weather, 21 weight control programs commercial, 19 success rate, 106 weight cycling, 115 weight gain statistics, 1 in western societies, 1

164

weight loss drugs, 129–30 weight loss expectations, 31–2, 84–5 excessive, 19 gradual, 20, 53–4, 108 long-term outcome goals, 108–9 machines, 123 maintaining see maintaining weight loss most effective rate, 19, 51–2 nutritional recommendations, 55–6 scams and gimmicks, 1, 20, 43, 123, 137–8, 140 short-term process goals, 108–9 smaller, 121 steps for, 55–6 success rate, 106 weight problems cycle, 87–8 weight training, 94 older women and, 14 weight-supporting activities, 87, 94, 104 Weingarten, Dr Harvey, 82 wellbeing, 113 work pressure, 40 World Health Organisation drinking levels, 75 obesity management program, vii worry beads, 32 Xenical, 129–30 yoga, 128 yoyo dieting, 115 Zoloft, 130