Adult Obesity

Today, more than 65 percent of adults in the United States are overweight or obese. Obesity puts people at increased risk for chronic diseases such as heart disease, type 2 diabetes, high blood pressure, stroke, and some forms of cancer.

The large number of people with obesity and the serious health risks that come with it make understanding its causes and treatment crucial. This fact sheet provides basic information about obesity: What is it? How is it measured? What causes it? What are the health risks? What can you do about it?

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What is obesity? "Obesity" specifically refers to an excessive amount of body fat. "Overweight" refers to an excessive amount of body weight that includes muscle, bone, fat, and water. As a rule, women have more body fat than men. Most health care professionals agree that men with more than 25 percent body fat and women with more than 30 percent body fat are obese. These numbers should not be confused with the body mass index (BMI), however, which is more commonly used by health care professionals to determine the effect of body weight on the risk for some diseases.

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How is obesity measured? Measuring the exact amount of a person's body fat is not easy. The most accurate measures are to weigh a person underwater or in a chamber that uses air displacement to measure body volume, or to use an X-ray test called Dual Energy X-ray Absorptiometry, also known as DEXA. These methods are not practical for the average person, and are done only in research centers with special equipment.

There are simpler methods to estimate body fat. One is to measure the thickness of the layer of fat just under the skin in several parts of the body. Another involves sending a harmless amount of electricity through a person's body. Results from these methods, however, can be inaccurate if done by an inexperienced person or on someone with extreme obesity.

Because measuring a person's body fat is difficult, health care professionals often rely on other means to diagnose obesity. Weight-for-height tables, used for decades, have a range of acceptable weights for a person of a given height. One problem with these tables is that there are many versions, all with different weight ranges. Another problem is that they do not distinguish between excess fat and muscle. According to the tables, a very muscular person may be classified obese when he or she is not. The BMI is less likely to misidentify a person's appropriate weight-for-height range.

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Body Mass Index
The BMI is a tool used to assess overweight and obesity and monitor changes in body weight. Like the weight-for-height tables, BMI has its limitations because it does not measure body fat or muscle directly. It is calculated by dividing a person's weight in pounds by height in inches squared and multiplied by 703.

Two people can have the same BMI but different body fat percentages. A bodybuilder with a large muscle mass and low percentage of body fat may have the same BMI as a person who has more body fat. However, a BMI of 30 or higher usually indicates excess body fat.

The BMI table below provides a useful guideline to check your BMI. First, find your weight on the bottom of the graph. Go straight up from that point until you come to the line that matches your height. A BMI of 25 to 29.9 indicates a person is overweight. A person with a BMI of 30 or higher is considered obese. Please review your findings with your health care provider if your BMI is outside of the normal range.



* Without Shoes
**Without Clothes

Sources

George Bray, M.D., Pennington Biomedical Research Center.

National Heart, Lung, and Blood Institute’s Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report.

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Body Fat Distribution
Health care providers are concerned not only with how much fat a person has, but also where the fat is located on the body. Women typically collect fat in their hips and buttocks, giving them a "pear" shape. Men usually build up fat around their bellies, giving them more of an "apple" shape. Of course some men are pear-shaped and some women become apple-shaped, especially after menopause.

Excess abdominal fat is an important, independent risk factor for disease. Research has shown that waist circumference is directly associated with abdominal fat and can be used in the assessment of the risks associated with obesity or overweight. If you carry fat mainly around your waist, you are more likely to develop obesity-related health problems. Women with a waist measurement of more than 35 inches and men with a waist measurement of more than 40 inches may have more health risks than people with lower waist measurements because of their body fat distribution.

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What causes obesity? Obesity occurs when a person consumes more calories from food than he or she burns. Our bodies need calories to sustain life and be physically active, but to maintain weight we need to balance the energy we eat with the energy we use. When a person eats more calories than he or she burns, the energy balance is tipped toward weight gain and obesity. This imbalance between calories-in and calories-out may differ from one person to another. Genetic, environmental, and other factors may all play a part.
Genetic Factors

Obesity tends to run in families, suggesting a genetic cause. However, families also share diet and lifestyle habits that may contribute to obesity. Separating genetic from other influences on obesity is often difficult. Even so, science does show a link between obesity and heredity.

Environmental and Social Factors

Environment strongly influences obesity. Consider that most people in the United States alive today were also alive in 1980, when obesity rates were lower. Since this time, our genetic make-up has not changed, but our environment has.

Environment includes lifestyle behaviors such as what a person eats and his or her level of physical activity. Too often Americans eat out, consume large meals and high-fat foods, and put taste and convenience ahead of nutrition. Also, most people in the United States do not get enough physical activity.

Environment also includes the world around us—our access to places to walk and healthy foods, for example. Today, more people drive long distances to work instead of walking, live in neighborhoods without sidewalks, tend to eat out or get “take out” instead of cooking, or have vending machines with high-calorie, high-fat snacks at their workplace. Our environment often does not support healthy habits.

In addition, social factors including poverty and a lower level of education have been linked to obesity. One reason for this may be that high-calorie processed foods cost less and are easier to find and prepare than healthier foods, such as fresh vegetables and fruits. Other reasons may include inadequate access to safe recreation places or the cost of gym memberships, limiting opportunities for physical activity. However, the link between low socio-economic status and obesity has not been conclusively established, and recent research shows that obesity is also increasing among high-income groups.

Although you cannot change your genetic makeup, you can work on changing your eating habits, levels of physical activity, and other environmental factors. Try these ideas:

Learn to choose sensible portions of nutritious meals that are lower in fat.
Learn to recognize and control environmental cues (like inviting smells or a package of cookies on the counter) that make you want to eat when you are not hungry.
Engage in at least 30 minutes of moderate-intensity physical activity (like brisk walking) on most, preferably all, days of the week.
Take a walk instead of watching television.
Eat meals and snacks at a table, not in front of the TV.
Keep records of your food intake and physical activity.
Other Causes of Obesity

Some illnesses may lead to or are associated with weight gain or obesity. These include:

Hypothyroidism, a condition in which the thyroid gland fails to produce enough thyroid hormone. It often results in lowered metabolic rate and loss of vigor.
Cushing's syndrome, a hormonal disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol. Symptoms vary, but most people have upper body obesity, rounded face, increased fat around the neck, and thinning arms and legs.
Polycystic ovary syndrome, a condition characterized by high levels of androgens (male hormone), irregular or missed menstrual cycles, and in some cases, multiple small cysts in the ovaries. Cysts are fluid-filled sacs.
A doctor can tell whether there are underlying medical conditions that are causing weight gain or making weight loss difficult.

Lack of sleep may also contribute to obesity. Recent studies suggest that people with sleep problems may gain weight over time. On the other hand, obesity may contribute to sleep problems due to medical conditions such as sleep apnea, where a person briefly stops breathing at multiple times during the night. (Visit www.win.niddk.nih.gov/publications/health_risks.htm#sleep for more information on the relationship between sleep apnea and obesity.) You may wish to talk with your health care provider if you have difficulty sleeping.

Certain drugs such as steroids, some antidepressants, and some medications for psychiatric conditions or seizure disorders may cause weight gain. These drugs may slow the rate at which the body burns calories, stimulate appetite, or cause the body to hold on to extra water. Be sure your doctor knows all the medications you are taking (including over-the-counter medications and dietary supplements). He or she may recommend a different medication that has less effect on weight gain.



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What are the consequences of obesity? Health Risks

Obesity is more than a cosmetic problem. Many serious medical conditions have been linked to obesity, including type 2 diabetes, heart disease, high blood pressure, and stroke. Obesity is also linked to higher rates of certain types of cancer. Men who are obese are more likely than nonobese men to develop cancer of the colon, rectum, or prostate. Women who are obese are more likely than nonobese women to develop cancer of the gallbladder, uterus, cervix, or ovaries. Esophageal cancer has also been associated with obesity.

Other diseases and health problems linked to obesity include:

Gallbladder disease and gallstones.
Fatty liver disease (also called nonalcoholic steatohepatitis or NASH).
Gastroesophageal reflux, or what is sometimes called GERD. This problem occurs when the lower esophageal sphincter does not close properly and stomach contents leak back—or reflux—into the esophagus.
Osteoarthritis, a disease in which the joints deteriorate. This is possibly the result of excess weight on the joints.
Gout, another disease affecting the joints.
Pulmonary (breathing) problems, including sleep apnea, which causes a person to stop breathing for a short time during sleep.
Reproductive problems in women, including menstrual irregularities and infertility.
Health care providers generally agree that the more obese a person is, the more likely he or she is to develop health problems.

Psychological and Social Effects

Emotional suffering may be one of the most painful parts of obesity. American society emphasizes physical appearance and often equates attractiveness with slimness, especially for women. Such messages make overweight people feel unattractive.

Many people think that individuals with obesity are gluttonous, lazy, or both. This is not true. As a result, people who are obese often face prejudice or discrimination in the job market, at school, and in social situations. Feelings of rejection, shame, or depression may occur.

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Who should lose weight? Health care providers generally agree that people who have a BMI of 30 or greater can improve their health through weight loss. This is especially true for people with a BMI of 40 or greater, who are considered extremely obese.

Preventing additional weight gain is recommended if you have a BMI between 25 and 29.9, unless you have other risk factors for obesity-related diseases. Obesity experts recommend you try to lose weight if you have two or more of the following:

Family history of certain chronic diseases. If you have close relatives who have had heart disease or diabetes, you are more likely to develop these problems if you are obese.
Preexisting medical conditions. High blood pressure, high LDL cholesterol levels, low HDL cholesterol levels, high triglycerides, and high blood glucose are all warning signs of some obesity-associated diseases.
Large waist circumference. Men who have waist circumferences greater than 40 inches, and women who have waist circumferences greater than 35 inches, are at higher risk of diabetes, dyslipidemia (abnormal amounts of fat in the blood), high blood pressure, and heart disease.
Fortunately, a weight loss of 5 to 10 percent of your initial body weight can do much to improve health by lowering blood pressure and other risk factors for obesity-related diseases. In addition, research shows that a 5- to 7-percent weight loss brought about by moderate diet and exercise can delay or possibly prevent type 2 diabetes in people at high risk for the disease. In a recent study, participants who were overweight and had pre-diabetes—a condition in which a person’s blood glucose level is higher than normal, but not high enough to be classified as diabetes—were able to delay or prevent the onset of type 2 diabetes by adopting a low-fat, low-calorie diet and exercising for 30 minutes a day, 5 days a week. For more information about pre-diabetes and diabetes, visit www.diabetes.niddk.nih.gov.
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How is obesity treated?
The method of treatment depends on your level of obesity, overall health condition, and readiness to lose weight. Treatment may include a combination of diet, exercise, behavior modification, and sometimes weight-loss drugs. In some cases of extreme obesity, bariatric surgery may be recommended. (Visit
www.win.niddk.nih.gov/publications/gastric.htm for more information on bariatric surgery.)

Remember, weight control is a life-long effort, and having realistic expectations about weight loss is an important consideration. Eating a healthful diet and getting at least 30 minutes of moderate-intensity physical activity on most, preferably all, days of the week have important health benefits. Sixty minutes of physical activity a day may be required to prevent gradual weight gain in adulthood. Previously overweight and obese individuals are encouraged to get 60 to 90 minutes of exercise a day to sustain weight loss.

Although most adults do not need to see their healthcare professional before starting a moderate-intensity physical activity program, men older than 40 years and women older than 50 years who plan a vigorous program or who have either chronic disease or risk factors for chronic illnesses should speak with their health care provider before starting a physical activity program.

Metabolic Medical Center
Medical Weight Loss Programs

Body Mass Requirement Formula

A healthy diet includes a balance of the following key macronutrients:

- Good carbohydrates: whole grains, fruits and vegetables.

- Lean proteins: chicken and turkey (skinless), eggs, low-fat dairy products and small amounts of lean red meats, legumes.

- Healthy fats: salmon, Omega-3 eggs, olive oil, flaxseed oil, walnuts, almonds, avocados, hemp and flax oil.

The right balance of these foods is different for every person, but generally a ratio of 50 per cent carbohydrates, 25 per cent to 30 per cent protein and 20 to 25 per cent fat is a good target. Caloric needs are also very individual and can range from 1,200 to 2,500 calories (or more) depending on height, weight and activity level.

Remember, when you are planning your nutrition program you need to make sure you are eating enough calories. If you eat too little, your body will go into "storage" mode and actually hold on to excess fat. Aim for a goal of one to two pounds of weight loss per week and don't let your daily caloric intake go below your BMR.

HOW MUCH TO EAT

To lose a pound a week you need to burn 3,500 more calories than you consume. Below is a formula you can use to quickly calculate your approximate caloric needs:

- Step 1: Calculate your body mass requirement (BMR). This is your caloric expenditure before exercise (calories you need to simply function):

Formula for women:

BMR = 655 + (4.35 x your weight in lbs.) + (4.7 x your height in inches) - (4.7 x your age in years)

For example, a woman who is five feet, five inches tall, weighs 130 lbs and is 30 years old would calculate as follows:

BMR = 655 + (4.35 x 130) + (4.7 x 65) - (4.7 x 30) = 1,384 calories

Formula for men:
BMR = 66 + (6.23 x weight in lbs) + (12.7 x height in inches) - (6.8 x age in years)

- Step 2: Once you have your BMR, you need to then multiply this by an activity factor to determine total daily calories required.

Sedentary (no or very little exercise): 1.2

Light activity level (exercising two days per week): 1.375

Moderate activity level (exercising four days per week): 1.5

High activity level (exercising four days per week): 1.7

Higher activity level (exercising five or more days per week): 2

- If you don't want to do your own calculating, go to mayoclinic.com/health/calorie-calculator/NU00598 and simply type in your information to find out your daily calorie requirement to maintain your current weight.

To lose weight at a rate of one pound per week you need to expend 3,500 more calories than you consume per week. Using the example of the woman above, she would decrease daily calorie intake to 1,603 per day (note that this is above her BMR of 1,384) for a reduction of 2,100 calories per week and increase her activity to burn an extra 1,400 calories per week for a total weekly deficit of 3,500 calories.

Metabolic Medical Center
Medical Weight Loss Programs

Build Healthy Suroundings

If you're eager to be a positive force, there’s no shortage of people that could use some help. In 1994, 10-20% of every U.S. state’s population was considered obese. By 2001, the numbers in 30 states grew to 20% or more. According to the American Medical Association, more than 1 of every 4 adults in Alabama is obese.

Being overweight is an international problem, and it just keeps getting worse. This is bad news, but could be great for you because it gives you the chance to make a real difference. You can use what you’ve learned to make a dent in those trends. All while making an even bigger dent in your waistline.

Here are some simple strategies to follow when you’re looking to build healthy surroundings:

1. Find reasons to get people together

This is a leadership practice that can easily boost your consistency and drive. A simple idea might be to form a group of people around common goals, like a running club. Instead of putting all of your energy into your own program, try to bring others along. By holding them accountable and motivating them, you’ll get better at doing it for yourself. What groups are you a member of? What personal interest can you combine with social time?

2. Create opportunities to trade knowledge

You have a lot to teach others. You also have a lot to learn. Can you set something up where people are learning from each other on a regular basis? Maybe a weekly cooking class. Or a Workout Exchange, where people trade ideas for “Fitting in Fitness.” Or lead a discussion about why chocolate is not a food group. What are you already good at? What do you get compliments on? What do you like to talk about?

3. Focus on pushing others and you’ll end up challenging yourself

A strong example of this opened the eyes of our founder, Chris, before he started SparkPeople. While at his last job, Chris started an exercise streak. Every day on his door, he posted the number of days in a row he had done some exercise, no matter how small. He eventually posted ‘100’ then ‘200’ on his door. One day, a woman across the hall followed his example and posted a '1' on her door, starting her own streak. After seeing great changes in her appearance, she was inspired to organize fitness programs and activities for others. She made a big difference because Chris had unwittingly helped motivate her. In return, Chris was inspired and challenged to start SparkPeople.

4. Use positive peer pressure

A simple way to do this is to just live as an example. This motivates others while keeping your own standards of conduct high. The other day, several of us went to the local pizza joint for lunch. After sitting down with our collection of personal pizzas, a curious thing happened. One woman in our group started dabbing the extra grease off the top of her pizza with a napkin. She did it without fanfair or announcement. It was just a habit of hers. But then the man to her left started doing it too. Then the guy across from him. And on down the line until the whole table was dabbing away. We saw her doing something smart and healthy, and instinctively knew that we should do the same. One by one, we imitated her without too much thought – and probably picked up a new habit in the process.

Genetics and Obesity

A new research shows that an entire network of genes in the body is disrupted by overeating and this not only causes obesity, but also diabetes and heart disease.


In two related studies, scientists at Merck Research Laboratories (MRL) and their collaborators used large-scale analyses of data on DNA variations, gene expression patterns in disease-relevant tissues and clinical data to identify molecular networks underlying metabolic disorders.


The first study, involving Merck researchers and colleagues from the University of California at Los Angeles, used liver and fat tissue samples from mice to identify genetic variations associated with obesity, diabetes and atherosclerosis. Then, the authors constructed gene networks and identified core groups of genes in these networks that caused the diseases. Based on various analyses, the authors identified and experimentally validated three novel genes causally related to obesity-associated traits: Lpl, Pmpll and Lactb. All of them provide new targets for anti obesity drugs because they seem key players in the genetic network that control girth.

The second study by researchers from Merck, the Icelandic company deCODE Genetics and the National University, Iceland involved more than 1,000 people known to be susceptible to obesity and then used a powerful computer to match data on genetic makeup, gene use and obesity to identify networks of gene interactions altered in individual susceptible to obesity. A gene expression network constructed from human fat tissue contained a similar core group of genes found to be causally related to obesity in the mouse study.

“What the new methods we’ve developed deliver is the complex web (network) of interacting genes in disease relevant tissues that actually lead to disease. These studies strongly support the theory that common diseases such as obesity result from genetic and environmental disturbances in entire networks of genes rather than in a handful of genes. If diseases like obesity are the result of complex networks of genes, the accurate reconstruction of these networks will be critical to identifying the best therapeutic targets,” Dr. Eric Schadt, executive director of Genetics at Merck Research Laboratories and senior author wrote in the studies.


Dr. Schadt also said a good diet and exercise remain the best ways to prevent the onset of obesity.

"If you are not going to alter your lifestyle, we can identify what network is going to be most significantly altered. Then we can bring that network more into a state to where it looks like when you are on a normal diet."

Schadt suggests the diseases of obesity seem to originate in the immune system and the network is enriched for genes that are involved in macrophages.

"In a normal state these things are keeping you free of infection and fighting off things that want to harm your body. This network is also significantly changed when you are on a high-fat diet," he added.

The results of the studies appeared in the journal Nature.

Arena says safety board clears obesity drug trial | Industries | Healthcare | Reuters

Arena says safety board clears obesity drug trial | Industries | Healthcare | Reuters

Daily exercise improves quality of life among postmenopausal women

A new study of how exercise can increase the quality of life among postmenopausal women showed that physical training gives energy, vitality and improves emotional state.

This study is a continuation of the Dose Response to Exercise in postmenopausal Women (DREW) study, but this time it shows really great and impressive results.

The whole process looks like this: 430 women (57 year old on average) women were randomly divided into four groups, three of which did various amounts of exercise (70, 135, or 190 minutes per week), while the fourth group did no exercise.

In the end all the women in the exercise groups showed a great improvement in social functioning compared to women in the non-exercise group. Those groups with larger amounts of exercise revealed improvements in general, emotional and mental health.

Six months of exercise showed that the women improved almost 7 percent in physical function and general health, 16.6 percent in vitality, 11.5 percent in performing work or other activities, 11.6 percent in emotional health, and more than 5 percent in social functioning.

So the best advice is to start exercise training; spend at least 10 minutes to 30 minutes every day and you’ll improve the quality of life. It’s especially important for sedentary, overweight or obese women as it may improve your overall condition and help you get rid of any health or emotional limits.

The study was reported Thursday at the American Heart Association's Conference on Nutrition, Physical Activity and Metabolism, in Colorado Springs, Colo.

New AMA Weight Loss Study out

The American Medical Association just released a weight loss study. Go to www.mmcdiet.com to download the complete study.

Weight Loss More Effective Than Intensive Insulin Therapy For Type 2 Diabetics

ScienceDaily (Mar. 11, 2008) —

Weight-loss and major lifestyle changes may be more effective than intensive insulin therapy for overweight patients with poorly controlled, insulin-resistant type 2 diabetes, according to a diabetes researcher at UT Southwestern Medical Center.

The National Heart, Lung, and Blood Institute of the National Institutes of Health recently halted part of an ongoing clinical trial on diabetes and heart disease after more than 250 people died while receiving intense treatment to drive their blood glucose levels below current clinical guidelines.

The evidence is compelling that when insulin levels are high, certain tissues are overloaded with fatty molecules, which leads to insulin resistance. And yet, the high blood glucose levels of many obese patients with insulin-resistant type 2 diabetes are being treated with increasing amounts of insulin in an attempt to overpower that resistance. While high doses of insulin may lower glucose levels, it will also increase the fatty molecules and may cause organ damage.

In a commentary in the March 12 issue of The Journal of the American Medical Association, Dr. Roger Unger, professor of internal medicine, wrote about the recent findings of his own and other labs that link insulin resistance to excess accumulation of fatty molecules in liver and muscle.

Dr. Unger, who has investigated diabetes, obesity and insulin resistance for more than 50 years said intensive insulin therapy is contraindicated for obese patients with insulin-resistant type 2 diabetes because it increases the fatty acids that cause diabetes. Instead, the most rational therapy eliminates excess calories, thereby reducing the amount of insulin in the blood and the synthesis of the fatty acids stimulated by the high insulin. Giving more insulin simply increases body fat.

“Evolution was unprepared for the change in the American diet to processed fast food and drive-through lanes,” he said. “There’s no way that our genes could evolve to gird themselves against the superabundance of very, very high-calorie foods that have flooded the U.S.”

Before the discovery of insulin, starvation was the only treatment for diabetes, said Dr. Unger, who is a member of the National Academy of Sciences.

“Today there are many treatment options, including bariatric surgery, if necessary, to lower the fat content in the body before you start giving insulin,” he said. “The fat is causing insulin resistance and killing the insulin-producing beta cells in the pancreas — that is what is causing type 2 diabetes.”

Giving more insulin simply channels the glucose into fat production. There is now a spectrum of therapies that improve diabetes by correcting the insulin resistance by reducing the body fat. Insulin treatment would be indicated only if all these fail.

Dr. Unger said insulin should be given to patients with insulin deficiency, but not if the insulin levels are already very high but ineffective. “Giving more insulin to an insulin-resistant patient is akin to raising the blood pressure of a patient with high blood pressure to overcome resistance to blood flow. Instead, you would try to reduce the resistance,” he said.

In the commentary, Dr. Unger said the increase in the number of patients with insulin-resistant type 2 diabetes can be traced to the epidemic of obesity that began in the U.S. after World War II, when food preparation was moved from the family kitchen to factories and companies that produce high-fat, calorie-dense foods, leading both men and women to consume substantially more calories on a daily basis. In addition, technological advancements such as televisions, computers and automobiles reduced the number of calories burned per day.

Type 2 diabetes occurs when the body is unable to make enough of the hormone insulin to compensate for insulin resistance. The condition affects between 18 million and 20 million people in the U.S.

Factors that increase the risk of type 2 diabetes include obesity, age and lack of exercise. Over a period of years, high blood sugar damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness and kidney disease.

Dr. Unger’s research is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, the Department of Veterans Affairs, and the Juvenile Diabetes Research Foundation.

Stick with a weight loss program for at least 3 months to be effective study shows.

Johns Hopkins Health Alerts reviews the latest research on weight loss and whether or not commercial weight loss programs actually work.

New York, NY (PRWEB) March 11, 2008 -- Johns Hopkins Health Alerts has just released a review of the latest research on weight loss, which shows that the longer you stay in a commercial weight-loss program, the more likely you are to achieve weight loss, and the greater weight loss you will achieve overall.

Successful Weight Loss Approaches
Successful weight loss requires a three-pronged approach: changing your behavior, altering your diet, and increasing your physical activity.

Making The Changes And Sticking To Them
Permanent alterations in your lifelong attitudes toward diet and exercise are the keys to successful weight management. You must be motivated enough to change habits not for a few weeks or months, but for a lifetime. The importance of this cannot be underestimated. The desire to lose weight must come from within.

The Benefits Of Commercial Weight Loss Programs
Commercial weight-loss programs can be effective tools for weight loss, but you do need to stick with the program for at least three months to see benefits. That was the conclusion of a one-year study of men and women enrolled in the Jenny Craig Platinum program.

The study results
After a month, 73% of the 60,164 people who joined the program were still enrolled. The number dropped to 42% at three months and 22% at six months. Only 7% remained at one year.

For those who stuck it out, the weight loss achieved was substantially greater. Men and women who lasted a year lost 13-16% of their initial body weight, compared with only a 1% loss in those who dropped out in the first month.

The men and women who stayed in the program for at least three months lost about 8% of their baseline weight.

The Substantial Health Benefits Of Weight Loss
Any weight loss is beneficial if you are overweight, but a loss of 5-10% of body weight can lead to significant reductions in blood pressure, cholesterol levels, and other conditions associated with overweight or obesity.

But there's a good chance that the three-month dropouts gained back the lost weight by the end of the year.

Nonetheless, the longer you can stay in a commercial weight-loss program, the more weight loss you're likely to achieve.

Be Healthy

Did you know?

Being healthy and active can help give you the energy to keep up with the demands of your busy life, take better care of yourself, and be there for the people who depend on you.
If you are overweight and inactive, you are more likely to get:

type 2 diabetes (high blood sugar)

heart disease

high blood pressure

stroke

certain forms of cancer

You may improve your health if you Move More and Eat Better! This booklet gives you tips on how to get moving and eat well even when your life is busy.


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Why Move
More and
Eat Better?


Being active and making smart food choices is good for your health. But that is not the only reason to move more and eat better. You can:
Have more energy and less stress.

Feel better about yourself.

Tone your body.

Look better in your clothes.

Set a good example for your children and your friends.


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Tips on Moving More Try to do at least 30 minutes of moderate-intensity physical activity (like brisk walking) on most days of the week. It is not as hard as you may think, and you do not have to do the whole 30 minutes at one time. Try these tips to get past things that keep you from being active.

“I don’t have time for physical activity.”

You can “sneak” it into your day, a few minutes at a time. Get started by making these small changes in your daily routine:

Get off the bus or subway one stop early and walk the rest of the way (be sure the area is safe).

Take the stairs instead of the elevator (be sure the stairs are well lit).

Walk and talk with a friend at lunch.

Put more energy into housework and yard work.

“It’s too expensive.”

There are lots of ways to be physically active that are free or low-cost. You can:

Find a local school park or school track where you can walk or run.

Walk around a mall.

Work out with videos in your home—you can find workout videos at bookstores or your local library.

TIP: Most people do not need to see their health care provider before getting physically active. If you have chronic health problems such as heart disease, high blood pressure, diabetes, osteoporosis, or obesity, talk to your health care provider before starting a vigorous physical activity program. You do not need to talk to your provider before you start a less strenuous activity like walking.

Join a recreation center or fitness center at work or near your home.

Walk your dog. If you do not have a dog, pretend that you do.



“Physical activity is a chore.”

It can be fun! Try to:

Do things you enjoy, like walking, dancing, swimming, or playing sports.

Walk or take an exercise class with a friend or a group. This way, you can cheer each other on, have company, and feel safer when you are outdoors.

Be active with your kids—ride bikes, jump double-dutch, toss a softball, play tag, or do jumping jacks. Physical activity is good for them too.

Break it up into short blocks of time—taking three 10-minute walks during your day may be easier than taking one 30-minute walk.

Use your daily workouts as time-outs just for yourself.

TIP: Keep a physical activity log. Writing down your workouts in a notebook or on a calendar lets you see how many times you have been physically active in a week. You can also use your log to track your physical activity and health goals.


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Tips on
Eating
Better




It may be hard to eat healthy if you do not have time to cook or your kids want fast food. Try these tips to eat better, save time, and stretch your food budget:

Help Your Family Eat Well
Here are some ways that you and your family can eat better:

Eat breakfast every day. Try a whole-grain cereal like raisin bran with nonfat or low-fat milk, or whole-wheat toast spread with jam. Enjoy some fruit with your breakfast too.

Teach kids that healthy foods taste good. Make macaroni and cheese with nonfat milk and low-fat cheese. Try a peanut butter (spread thin) and jam or preserves sandwich instead of a burger and fries.

Choose nonfat or low-fat milk, yogurt, and cheese instead of full-fat dairy products.

Choose whole-grain foods like whole-wheat bread, oatmeal, brown rice, or whole-wheat pasta more often than refined-grain foods, like white bread, white rice, and white pasta.

Snack on fruits and vegetables. Keep a bowl of fruit on the table, bags of mini carrots in the refrigerator, and boxes of raisins in the cupboard.

Do not keep a lot of sweets like cookies, candy, or soda in the house. Too many sweets can crowd out healthier foods.



TIP: If you cannot digest lactose (the sugar found in milk), try nonfat or low-fat lactose-reduced milk. Or try nonfat or low-fat yogurt or hard cheeses like cheddar, which may be easier to digest than milk. You can also get the calcium from calcium-fortified juices, soy-based beverages, and cereals. Eating dark leafy vegetables like collard greens and kale, and canned fish with soft bones like salmon, can also help you meet your body’s calcium needs.

Save Time and Money When You Cook
You do not have to spend a lot of time in the kitchen or a lot of money to eat well.

Buy foods that are easy to prepare, like pasta and tomato sauce, rice and beans, or canned tuna packed in water.

Plan ahead and cook enough food to have leftovers. Casseroles, meat loaf, and whole cooked chicken can feed your family for several days. (Be sure to freeze or refrigerate leftovers right away to keep them safe to eat.)

Buy fresh fruits and vegetables that are in season. Buy only as much as you will use, so they will not go bad.

Buy frozen or canned vegetables (no salt added) and canned fruit packed in juice. They are just as good for you as fresh produce, and will not go bad.

Try canned beans like kidney, butter, pinto, or black beans. They are loaded with protein, cost less than meat, and make quick and easy additions to your meals.

If your local store does not have the foods you want or their prices are too high, go to another store or your local farmers’ market. Share a ride or the cost of a taxi with friends.

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Reading
Food Labels


Food labels may help you make healthy food choices.*
But they can be confusing. Here are some quick tips for reading food labels:
Check serving and calories. All the information on a food label is based on the serving size. Be careful—one serving may be much smaller than you think. If you double the servings you eat, you double the calories and nutrients, including the percent Daily Values (DVs).

Percent DV: This tells you whether a food is high or low in nutrients. Foods that have more than 20-percent DV of a nutrient are high. Foods that have 5-percent DV or less are low.

Saturated Fat: Saturated fat is not healthy for your heart. Compare labels on similar foods and try to choose foods that have a 5-percent DV or less for saturated fat. Most of the fats you eat should be polyunsaturated and monounsaturated fats. Keep total fat intake between 20 percent to 35 percent of calories.

Trans Fat: Trans fat is not healthy for your heart. When reading food labels, add together the grams of trans fat and saturated fat, and choose foods with the lowest combined amount.

Cholesterol: Too much cholesterol is not healthy for your heart. Keep your intake of saturated fat, trans fat, and cholesterol as low as possible.

Sodium (Salt): Salt contains sodium. Research shows that eating less than 2,300 milligrams of sodium (about 1 teaspoon of salt) per day may reduce the risk of high blood pressure.

TIP: Many food labels say “low-fat,” “reduced fat,” or “light.” That does not always mean the food is low in calories. Remember, fat-free does not mean calorie-free, and calories do count!

Fiber: Choose foods that are rich in fiber, such as whole grains, fruits, and vegetables.

Sugar: Try to choose foods with little or no added sugar (like low-sugar cereals).

Calcium: Choose foods that are high in calcium. Foods that are high in calcium have at least 20-percent DV.

* For more information on reading nutrition labels, visit: www.cfsan.fda.gov.

For information about the U.S. Department of Agriculture and the U.S. Department of Health and Human Services’ 2005 Dietary Guidelines for Americans, see www.healthierus.gov/dietaryguidelines.


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Eating on the Go
In real life, you cannot always cook your meals or eat at the dinner table. Here are some ways to make healthy choices when you are on the go:

Choose a salad or a grilled chicken sandwich (not fried) instead of a burger at fast-food restaurants.

If you really want a burger, make it a small one without sauce, and skip the fries—or share them with a friend.

Take healthy snacks with you to work. Try graham crackers, pretzels, baby carrots, or a small amount of raisins or nuts (but remember that nuts and raisins are high in calories).

Balance your meals throughout the day. If you have a high-fat or high-calorie breakfast or lunch, make sure you eat a low-fat dinner. If you know you will be having a higher fat dinner, make lower fat choices earlier in the day.
TIP: Fried foods, high-fat foods, and take-out foods can be part of a balanced eating plan—as long as you do not eat them every day and only eat small amounts.

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Keeping Track of Serving Sizes Many people think that bigger is better. We are so used to value-sized portions in restaurants that it is easy to eat more than our bodies need. Eating smaller portions will help you cut down on calories and fat (and might save you money, too). Here is a 1,600-calorie per day sample menu with sensible servings:*

Breakfast
1/2 cup cooked oatmeal
1 English muffin with 1 tablespoon low-fat cream cheese
1 cup low-fat milk
3/4 cup orange juice


Lunch
2 ounces baked chicken without skin (a little smaller than a deck of cards)
Lettuce, tomato, and cucumber salad with 2 teaspoons oil and vinegar dressing
1/2 cup white rice seasoned with 1/2 tablespoon tub or liquid margarine
1 small whole-wheat roll with 1 tablespoon margarine

TIP: Use margarine instead of butter. Choose a soft margarine that has no more than 2 grams of saturated fat per tablespoon and that lists “liquid vegetable oil” as the first ingredient on the ingredient list. (American Heart Association)

Dinner
3 ounces lean roast beef (about the size of a deck of cards) with 1 tablespoon beef gravy
1/2 cup turnip greens seasoned with 1/2 tablespoon margarine
1 small baked sweet potato with 1/2 tablespoon margarine
1 slice cornbread
1/4 honeydew melon

Snack
2 1/2 cups low-fat microwave popcorn
1 1/2 teaspoons margarine

TIP: Keep a food diary. Writing down what you eat, when you eat, and how you feel when you eat can help you understand your eating habits. You may be able to see ways to make your eating habits healthier. You can also use your diary to plan weekly menus, make shopping lists, and keep track of recipes you would like to try. For more information about keeping track of food portions, read the Weight-control Information Network (WIN) brochure Just Enough for You: About Food Portions.

* Adapted from National Heart, Lung, and Blood Institute (NHLBI) sample menus.


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You can do it! Set goals. Move at your own pace. Celebrate your successes. Allow for setbacks. Let your family and friends help you. And keep trying—you can do it!

Overweight Kids Lose More Weight When Parents Do Too

When families enroll in a weight-control treatment program, parent weight loss predicts child weight loss. Kids not only lose weight when parents do, they lose more when their parents lose more.

This finding is the result of analyzing body mass index (BMI) changes in parents and children participating in one of three family-based behavioral weight-control studies. One hundred forty-two obese children (defined in this study as BMI greater than 85 th percentile) aged 8 to 12 years old participated in the study, along with at least one parent who was not necessarily obese but whose BMI was above the 70 th percentile for adults. Most participating parents were mothers (81 percent) and most families (95 percent) were white.

Parents were asked to adopt healthy eating and physical activity habits, and to change their home environments.

Dietary changes were based on the Traffic Light Diet. This eating plan categorizes foods based on their nutritional value as “green,” “yellow,” or “red.” Green foods are low in fat and high in nutrients; eating green foods was encouraged. Yellow foods have between 2 and 5 grams of fat per serving and some nutritional value, and should be eaten in moderation. Red foods have 5 or more grams of fat per serving, lots of sugar, and little nutritional value. Families were encouraged to decrease the red foods they eat.

All families were provided with a physical activity program. In addition, families were encouraged to alter home environments to support healthy eating and physical activity habits. For example, families were asked to keep fewer red foods in the house and to have green foods readily available.

Parent and child BMI measures were taken at the beginning of the study period, and after 6, 12, and 24 months. After 2 years, results of BMI analysis showed that the amount of weight a parent lost predicted the amount of weight her or his child lost. Parents who lost the most weight had kids who lost the most weight.

Study authors reason that parents who are more successful at weight loss have made larger changes to eating and physical habits and created a healthier home environment. In addition, these parents may model more healthy behaviors

Tips for a Healthy New Year

Vow to treat yourself to good health this year. Eating nutritious foods and getting regular physical activity may improve your health, boost your energy level, and help you feel good about yourself. These six simple tips may help you eat better, be more physically active, and enjoy a healthier new year.

Hang up old habits. Before you plunge into making resolutions that may be too tough to keep, it may help to examine your current eating and physical activity habits. Rather than trying to overhaul your routine, start by thinking of gradual ways to tweak it. You may wish to slowly replace some of your less healthful habits like overeating or eating when not hungry with healthy ones that you enjoy. Ask yourself where, when, and why you have those unhealthy eating or physical activity habits, and think of creative replacements for them.

Eat smart. A healthy eating plan takes into account what and how much you eat and drink. Emphasize vegetables, fruits, whole grains, and lean meats and fish in your diet, and minimize foods that are high in saturated and trans fats, sugar, and sodium. Be mindful of portion sizes, too. Forget Mom’s advice to clean your plate at all times. Instead, listen to your body and eat just enough to satisfy your hunger.

Activate yourself. Regular physical activity is fun, invigorating, and important for good health. Aim for 30 minutes of moderate-intensity physical activity on most days of the week. If you cannot do it all at once, break it up into shorter segments. Nearly everyone has time for 10 minutes of activity here and there throughout the day. Select activities that you enjoy—you will be more likely to stick with it.

Look for support. Enlist friends, family, and coworkers to join you in eating well and being active. Social support is a terrific motivator. People are more likely to be physically active if they are held accountable to someone else, and if your social circles agree to make healthier selections, it may be easier for you to jump on the bandwagon. Encouragement from others often makes it easier to stay on track.

Tailor your lifestyle to the season. Take advantage of seasonal offerings to avoid falling into a rut. In the winter, stock up on produce such as sweet potatoes, rhubarb, and cranberries. Enjoy physical activities like ice skating and walking in the crisp air. When spring arrives, try produce such as strawberries and sugar snap peas, and step outdoors to garden or bike. Continue to mix up your routine throughout the year—the variety may keep you motivated.

Hatch a plan. Set goals for yourself, such as getting 30 minutes of activity a day and eating whole grains when possible, and be sure to set rewards as well. You may find it easier to meet your goals if you have a plan. This may be especially helpful when you face potential barriers like traveling or parties. By creatively planning ahead, you can keep up your healthy ways.

Subtle Cues and Dish Size Affect Portions

Subtle Cues and Dish Size Affect Portions
It is no secret that portion sizes have expanded along with Americans’ waistlines. Restaurants and super-sizing options are frequently blamed, but we are also guilty of serving ourselves too much food. A study conducted by researchers at Cornell University found that our tendency to over serve ourselves is influenced by the size of dishes and utensils.

The researchers hosted an ice cream social and invited 85 faculty, staff, and graduate students from a university nutrition department. Thus, these “study participants” could safely be assumed to be nutrition savvy. Researchers randomly gave the participants a small or large bowl and a small or large serving spoon, and everyone served themselves. The researchers weighed their ice cream as participants filled out a survey about how much they believed they served themselves.

Those who were given a larger bowl ate 31 percent more than those who received the smaller bowl. Despite this significantly larger serving size, they did not perceive that they served themselves more than other participants. Similarly, participants using the larger serving spoon gave themselves 14.5 percent more ice cream, regardless of whether they had a large or small bowl. Perhaps not surprisingly, participants who were given both a large bowl and a large spoon ate the most ice cream—56.8 percent more than people with a small bowl and spoon.

Researchers described the sizes of bowls and spoons as “consumption cues” that influence serving size. They pointed out that these cues are so subtle and common that even nutrition experts fall prey to their effect. However, they also believe that cues such as dishware size are easy to alter—simply by using smaller dishes, for instance, people can reduce unnecessary calorie consumption. Alternately, if the goal is to eat more fruits and veggies, perhaps a large plate would help.

What is type 2 diabetes?

Type 2 Diabetes


Type 2 diabetes is a disease in which blood sugar levels are above normal. High blood sugar is a major cause of coronary heart disease, kidney disease, stroke, amputation, and blindness. In 2002, diabetes was the sixth leading cause of death in the United States.

Type 2 diabetes is the most common type of diabetes in the United States. This form of diabetes is most often associated with old age, obesity, family history of diabetes, previous history of gestational diabetes, and physical inactivity. The disease is more common among certain ethnic populations.

How is type 2 diabetes linked to overweight?


More than 85 percent of people with type 2 diabetes are overweight. It is not known exactly why people who are overweight are more likely to develop this disease. It may be that being overweight causes cells to change, making them resistant to the hormone insulin. Insulin carries sugar from blood to the cells, where it is used for energy. When a person is insulin resistant, blood sugar cannot be taken up by the cells, resulting in high blood sugar. In addition, the cells that produce insulin must work extra hard to try to keep blood sugar normal. This may cause these cells to gradually fail.

What can weight loss do for type 2 diabetes?


You may lower your risk for developing type 2 diabetes by losing weight and increasing the amount of physical activity you do. If you have type 2 diabetes, losing weight and becoming more physically active can help you control your blood sugar levels and prevent or delay complications. Losing weight and exercising more may also allow you to reduce the amount of diabetes medication you take. The Diabetes Prevention Program, a large clinical study sponsored by the National Institutes of Health, found that losing just 5 to 7 percent of your body weight and doing moderate-intensity exercise for 30 minutes a day, 5 days a week, may prevent or delay the onset of type 2 diabetes. For more information about the Diabetes Prevention Program,

visit www.diabetes.niddk.nih.gov/dm/pubs/preventionprogram/index.htm.

What are the risks to my health from being overweight?

Weighing too much may increase your risk for developing many health problems. If you are overweight or obese, you may be at risk for:

* type 2 diabetes
* metabolic syndrome
* certain types of cancer
* sleep apnea
* osteoarthritis
* gallbladder disease
* fatty liver disease
* pregnancy complications

You may be able to lower your health risks by losing weight, doing regular physical activity, and eating healthfully.

What is metabolic syndrome?

What is Metabolic Syndrome?


The metabolic syndrome is a group of obesity-related risk factors for coronary heart disease and diabetes. A person has the metabolic syndrome if he or she has three or more of the following risk factors:

A large waistline. For men, this means a waist measurement of 40 inches or more. For women, it means a waist measurement of 35 inches or more [1].
High triglycerides or taking medication to treat high triglycerides. A triglyceride level of 150 mg/dL or higher is considered high [1].
Low levels of HDL (“good”) cholesterol or taking medications to treat low HDL. For men, low HDL cholesterol is below 40 mg/dL. For women, it is below 50 mg/dL [1].
High blood pressure or taking medications to treat high blood pressure. High blood pressure is 130 mm Hg or higher for systolic blood pressure (the top number) or 85 mm Hg or higher for diastolic blood pressure (the bottom number) [1].
High fasting blood glucose (sugar) or taking medications to treat high blood sugar. This means a fasting blood sugar of 100 mg/dL or higher [1].
A person with metabolic syndrome has approximately twice the risk for coronary heart disease and five times the risk for type 2 diabetes [1]. It is estimated that 27 percent of American adults have the metabolic syndrome [2].

How is it linked to overweight?


The metabolic syndrome is strongly linked to obesity, especially abdominal obesity. Other risk factors are physical inactivity, insulin resistance, genetics, and old age.

Obesity is a risk factor for the metabolic syndrome because it raises blood pressure and triglycerides, lowers good cholesterol, and contributes to insulin resistance. Excess fat around the abdomen carries even higher risks.

What can weight loss do?


It may be possible to prevent the metabolic syndrome with weight management and physical activity. For patients who already have the syndrome, losing weight and being physically active may help prevent or delay the development of diabetes, coronary heart disease, or other complications.

Individuals who are overweight or obese and who have the metabolic syndrome should aim to lose 10 percent of their body weight and do at least 30 minutes of moderate-intensity physical activity every day. Quitting smoking, eating healthfully, and taking prescription medications for conditions such as high blood pressure or low HDL cholesterol may also be recommended. You can learn more about the metabolic syndrome from the National Heart, Lung, and Blood Institute at www.nhlbi.nih.gov.

Recipes from our Bluffton Office : Metabolic Medical Center

Recipes from our Bluffton Office : Metabolic Medical Center

These are some great receipts from our Hilton Head Weight Loss Center.

Enjoy

Food for Thought : Metabolic Medical Center Journaling for Weight loss

Food for Thought : Metabolic Medical Center

Another pill promise

Thursday, March 6th 2008, 4:00 AM
Getty
Consumers may eat up the latest trendy weight loss supplement, but health experts doubt the pills' effectiveness.
"Eat all you want and still lose weight" boast the ads for Akavar 20/50, one of the most heavily advertised new weight-loss supplements on the market.
Their promise gets caught in your head, not simply because it's repeated - no, shouted - multiple times, but because, at this time of year, it sounds a lot better than going to the gym.
With New Year's workout kick winding down and months to go before bikini season, midyear sees a dramatic slump in gym activity, according to a study in the Journal of Clinical Psychology. So why don't we all just pop a pill, order a pizza and commence the fat burning? Because it's hard to believe such a miracle drug exists.
Akavar's own research chemist, Dr. Nathalie Chevreau, was happy to fill us in on a 2001 report featured in the Journal of Human Nutrition and Dietetics that stated 24 people who took Akavar lost an average of 11 pounds in 45 days, while 23 who were given a placebo lost nearly no weight at all.
In fact, she even takes it herself.
"I take one serving, which is two tablets, once in the morning to make sure I'm not too hungry for the day," says Chevreau of the pills, which cost $39.99 a bottle. "There is a slowdown of the stomach emptying into the intestine, so you have an increased sense of fullness." She attributes the process to three active herbal ingredients, yerba mate, guarana and damiana.
But that's not necessarily a good thing, say other experts.
"If it's decreasing the appetite and causing you to eat less, you're body goes into starvation mode and starts to burn lean tissue and store fat. The active ingredients are stimulants, and no one really knows what the safe doses are for any of these herbs in the long term," counters weight-loss expert and non-Akavar affiliate Dr. Dave E. David, who equates the caffeine levels in one dose to 3-1/2 cups of coffee.
"Taking more than 250mg of caffeine has been implicated in insomnia and high blood pressure," says nutritionist Thomas Von Ohlen, who works with thousands of patients to address the hundreds of different reasons for weight gain.
"The idea of one cure-all is absurd. Losing weight by taking diet pills and going to Dunkin' Donuts all day long is a biochemical impossibility," he adds. "The basic rule is, if it sounds too good to be true, it is."
Meanwhile, Akavar's ad claims: "We couldn't say it in print if it wasn't true."
Well, actually, they pretty much can, as there's no federal agency that reviews advertisements before they appear.
"They're about as bold as you can be," says lawyer Scott Shepherd of the outrageously brazen ads.
His firm, Shepherd, Finkelman, Miller & Shah, LLC, has filed a class-action lawsuit against the company, set to go to trial in 2010. "We filed our case in November 2007 based on consumer fraud claims," said Shepherd, whose firm has successfully settled a $16 million suit against Rexall Sundown Inc., for weight-loss product Cellasene and a $12 million suit against the now-defunct Dr. Phil-endorsed Shape Up! diet supplements.
Meanwhile, the Federal Trade Commission was unable to confirm whether any investigation is pending.
One thing is clear: Getting off your behind and heading to the gym is looking better and better.

New Protein Shake Recipe for March

Shake Recipes : Metabolic Medical Center

Metabolic Medical Centers : A Doctor's "Weigh" to a Healthier You.

Metabolic Medical Centers : A Doctor's "Weigh" to a Healthier You.

Interesting Article

ScienceDaily (Mar. 4, 2008) — The cannabinoid receptors best known for delivering the psychological effects of marijuana also explain the connection between chronic alcohol use and a buildup of fat in the liver, according to a report in the March issue of Cell Metabolism. Alcoholic fatty liver can progress to more serious disease, and alcoholism is a leading cause of liver disease in Western societies.

The researchers also found that mice treated with rimonabant, a drug designed to block cannabinoid receptors, become resistant to alcohol's fat-building effects in the liver. Rimonabant is now in use for weight loss in several European countries but has not received FDA approval for use in the United States.

"What makes these findings particularly interesting from our perspective is that they may have practical implications," said George Kunos of the National Institute on Alcohol Abuse and Alcoholism. "Treatment of animals with a [cannabinoid receptor] antagonist largely prevented alcohol's effect. It suggests that the development of fatty liver in those who use alcohol could be interfered with, or perhaps reversed, with such treatment."

In addition to alcoholism, obesity can also lead to the development of fatty liver disease. Scientists have shown that natural cannabinoids, so-called endocannabinoids, and CB1 cannabinoid receptors in the livers of mice are increased when animals are fed a high-fat diet. Studies have also shown that mice lacking CB1 receptors and mice treated with drugs that block these receptors are protected from obesity and fatty liver.

"Similar to high-fat diet, chronic ethanol exposure can increase endocannabinoid levels, at least in the brain," the researchers said. The apparent similarities between diet- and ethanol-induced changes in fat metabolism and endocannabinoid activity in the liver suggested that endocannabinoids might also be a culprit in ethanol-induced fatty liver.

Kunos's team now shows that mice fed a low-fat diet and ethanol show an increase in the gene encoding the CB1 receptor and in liver levels of one endocannabinoid, 2-arachidonoylglycerol (2-AG). These mice also developed fatty livers. In contrast, the livers of mice fed the ethanol diet plus rimonabant did not differ in fat content from those of mice fed a control diet. Similarly, mice lacking CB1 receptors, either throughout the body or only in the liver, gained protection from alcoholic fatty liver.

"Although alcoholic fatty liver is reversible in its early stages by cessation of drinking, this is often not feasible," the researchers concluded. "The present findings suggest that treatment with a CB1 antagonist may slow the development of fatty liver and thus prevent or delay its progression to more severe and irreversible forms of liver disease."

Drugs designed to selectively act on CB1 receptors found outside of the brain might fight fatty liver with less risk of adverse side effects, including anxiety and depression, they added. "Rimonabant has recently been introduced in Europe for the treatment of visceral obesity and the metabolic syndrome, which themselves are known risk factors for [liver disease]. Clinical trials testing the effectiveness of CB1 receptor blockers in the treatment of both alcoholic and nonalcoholic fatty liver and their more severe sequelae may be warranted."

Stay on that diet when dineing out

It's a lot easier to control what you are going to eat in a restaurant than at someone else's dinner table. At a restaurant, you pay, so you can say. But as a guest, it's different. If it's a casual meal with close friends, you can discuss what you can and can't eat - and even BYOF: bring your own food. If it's a social or business affair, it's harder but it's up to you to be proactive. Start by planning your meals the day before, the day of the function, and the day after to be a little lower in calories. Increase your exercise time the day before, the day of, and the day after. Tell your host or hostess that you're working hard to stay on a special diet and eat small portions of anything that is taboo. Then relax and enjoy the occasion - you aren't going to sink your ship with one meal! Plan Ahead:

Follow the meal and exercise strategy suggested above.

Increase your water consumption that day and during he meal, drink plenty of water.

Don't arrive at a restaurant ravenously hungry. If you eat an allowed snack or a salad before you go, you'll be able to make your choices with your mind rather than your stomach.

Look for foods that are grilled, broiled, baked, steamed, stir-fried or roasted. If fresh fish is on the menu, prepared in one of these ways, take advantage of it. You need a minimum of two
servings a week.

Avoid foods that are fried, have caloric sauces, or extra-large portions. Words to look out for are: fried, double-cut (lamb, veal and pork chops with meat on both sides of the bone), buttered, breaded (escalloped), creamed, creamy, Hollandaise, Béarnaise, Alfredo, Carbonara, Au Gratin.

Some vegetable sauces have cream or butter in them: always ask.

Look for low-fat or fat-free dressings. Order sauces and "dressings on the side." If a sauce or dressing is really flavorful, you can dip the tines of your fork into it, then pick up a piece of meat or lettuce, and you will get enough of the taste.

Pass up both the bread and the butter - unless it's whole-grain bread and olive oil instead of butter. Even then, remember to count calories.

Discretely remove any skin or fat from poultry or meat.

Consider having two Appetizers or an Appetizer and a Soup or Salad instead of an Appetizer and
a whole Entrée.

Split an Entrée between two persons, or divide your plate in half and take half home in a "doggie bag." Order the Vegetable Plate; even high-ticket restaurants have them.

Alcohol and dessert are extra calories. Sometimes a glass of wine or a fruit dessert can fit into your calorie allotment. Sometimes you need a cookie to keep you diligent about your diet.

Prioritize.

Metabolic Medical Centers
www.mmcdiet.com