[Garry Egger] Quick Start Weight Loss Program for (Bookos-z1.Org)

5/26/2018 [Garry Egger] Quick Start Weight Loss Program for (Bookos-z1.Org)

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PROFESSOR TRIMSQUICK START


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PROFESSOR TRIMS PROFESSORS

Professor John Blundell PhD, C Psychol, MBPSProfessor of Bio-Psychology, Leeds University, UK and Board

Member of the International Association for theStudy 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, FRACPBoden Professor of Human Nutrition,

Sydney University and Vice President, IASSO

Professor Terry Dwyer MBBS, MPH, MD, FAFPHM

Director Menzies School of Health Sciences Hobart,and University of Tasmania

Professor Garry Egger MPH, PhD, MAPSDirector, Centre for Health Promotion and Research Sydney

Adjunct Professor of Health Sciences, Deakin University

Professor James Hill PhD

Director, Center for Human Nutrition, University of ColoradoHealth Sciences Center and Co-Founder,National Weight Control Registry

Professor Kerin ODea BSc, PhDDirector of Menzies School of Health Research, Darwin

Professor Stephan Rossner MD, PhD

Director, Obesity Research Program, Luddinge Hospital,Stockholm, Sweden and Past President of IASSO

Professor Boyd Swinburn MD, MBChB, FRACPProfessor of Population Health and Nutrition, Deakin University

Professor Klaas Westerterp PhDProfessor of Human Energetics, Head of Department of Human

Biology, Maastricht University, The Netherlands


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PROFESSOR TRIMS

QUICK STARTTHE WEIGHT-LOSS PROGRAM

for families

Dr Garry Egger MPH, PhD, MAPS

By the originator of theGutBusters 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 ortransmitted in any form or by any means, electronic or mechanical,including photocopying, recording or by any information storageand retrieval system, without prior permission in writing from thepublisher. TheAustralian Copyright Act 1968 (the Act) allows amaximum of one chapter or 10% of this book, whichever is thegreater, to be photocopied by any educational institution for itseducational purposes provided that the educational institution (orbody that administers it) has given a remuneration notice to

Copyright Agency Limited (CAL) under the Act.

Allen & Unwin83 Alexander StreetCrows Nest NSW 2065AustraliaPhone: (61 2) 8425 0100Fax: (61 2) 9906 2218Email: [email protected]

Web: www.allenandunwin.com

National Library of AustraliaCataloguing-in-Publication entry:

Egger, Garry.Quick start weight-loss program for families.ISBN 1 74114 116 8.

1. Weight loss. 2. FamilyNutrition. 3. Physical fitness.I. Title. (Series: Professor Trims medically supervised weight lossprograms).

Set in 11/12.5 pt Adobe Garamond by Midland Typesetters,Maryborough, VictoriaPrinted by Griffin Press, South Australia

10 9 8 7 6 5 4 3 2 1
http://www.allenandunwin.com/http://www.allenandunwin.com/


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CONTENTS

Introduction:

How to use Professor Trims Quick Start Weight-LossProgram for Families vii

1 Why is your family overweight? 12 Why is it so hard to lose weight? 73 Why bother anyway? 11

4 Measuring your familys risk 175 What works, what might and what doesnt 226 Changing your (micro) environment 277 The family diet 318 Moving morenot exercising! 419 Problems for individual members of the family 50

10 Other options 61

Appendix:Purchasing Professor Trims MedicallySupervised Weight-Loss Programs 66


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ABOUT THE AUTHOR

Garry Egger is Director of the Centre for HealthPromotion and Research in Sydney and AdjunctProfessor of Health Sciences at Deakin University.

He has been involved in health promotion for almost30 years and is the author of more than 25 books.


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INTRODUCTION: How touse Professor Trims QuickStart Weight-loss Program

for Families

The Professor Trims (PT) Quick Start Weight-Loss Programfor Families is an introduction not only to effective and

sustainable weight loss, but to a lifetime of weight man-agement for the whole family. You can read it by and foryourself, or as a family. You can also take part in theprogram under the supervision of your specially selectedand trained PT doctor.

Several thousand Australian doctors have now had

special training in weight management as part of aPost-Graduate Medical Certificate in Weight Controland Obesity Management from Sydney University. Thesedoctors (who you can find atwww.professortrim.com)willhelp you lose and maintain your weight through a shared-care system that provides the best information available.

PROFESSOR TRIMSTHE HISTORYProfessor Trims evolved from the GutBuster program,which started as a mens waist loss program in 1991.GutBusters became the biggest, and most successful,

mens weight-loss program in the world. It had an

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http://www.professortrim.com/http://www.professortrim.com/


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internationally acclaimed scientific advisory board andwas consistently rated by consumer groups as among the

best weight-loss programs available.GutBusters was initially designed for men. However it

soon became clear that other groups, such as women,were interested in a similar type of program, even thoughtheir issues and needs were quite different. This led to thedevelopment of the Professor Trim programs for men and

women, Becoming Gut Lessand Becoming Slimmerand, inturn, these specific Quick Start programs.

PROFESSOR TRIMS QUICK STARTWEIGHT-LOSS PROGRAMS

Some people dont find it too hard to lose weight. Its justa matter of gathering the right information about dietand exercise then putting it into practice. For thesepeople a quick start program like those in the currentseries will be enough. Others need information andadvice that is tailored to their specific needs, as well asadditional support along the way.

It is now generally recognised that getting the wholefamily involved is the best way for one or all familymembers to manage their weight effectively for life.Indeed, a family program is the only effective way to helpan overweight child manage their eating and exercisehabits. There are great advantages in treating the family asa unit, which is why we have designed this Professor TrimQuick Start program. There are, however, specific factorsthat need to be considered for individual members of thefamily, and these are covered in Chapter 9.

Mum and dad may want to continue the quick start toweight loss they will get from this program with more

intensive individual programs. For that reason, information

THE WEIGHT-LOSS PROGRAM FOR FAMILIES

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about the full Professor Trims mens and womens weight-loss programs, Becoming Gut Lessand Becoming Slimmer, is

contained in the back of this book. You can also purchasethese programs privately or directly from your ProfessorTrims doctor and work with him or her through the full12 months of the program.

To get the best effects from this Quick Start weight-lossprogram, first read the book. You can then find regular

updates on current research and information from theProfessor Trim Internet site atwww.professortrim.com. Inaddition, at the end of each chapter in this booklet youwill find an easy-to-follow summary of its contents, con-tained in a Professor Trims Prescription Pad. Use thesesummaries as your checklist for putting the program into

action.Youve taken the first important step by buying thisbookyou and your family are now on your way tobecoming leaner, healthier and happier. Good luck!

INTRODUCTION

ix

Professor Trims Prescription Pad

Read this booklet as a family. Try to put the recommendations at the end of

each chapter into action.

Check in at the Professor Trim Website(www.professortrim.com).

Check in with your Professor Trim doctor forongoing help.

For more specific programs, and how to contacta personal weight coach, see page 25.
http://www.professortrim.com/http://www.professortrim.com/http://www.professortrim.com/http://www.professortrim.com/http://www.professortrim.com/


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Chapter 1

WHY IS YOUR FAMILYOVERWEIGHT?

FAT RULES OK?When I was a boy (back in the dim and distant past),there was only one overweight kid in my school. He wasalways allowed to get away with things that we couldnt(come to think of it, thats probably why Ive spent my

life working in obesity). Fatty Foster was excused fromdoing anything active because . . . Fattys got a bit of aproblem. The problem was, though, that Fatty was alsoexcludedhe was the last to be picked for the footyteam, and so on.

Look around any primary school today and youll findthat its now the lean kids that are in the minority. Fatrules! And nationwide surveys support this observation.Up to 30 per cent of under-18s and 15 per cent of under-12s are now classified as overweight or obese.

The statistics for adults paint an even more dismalpicture. At the turn of the millennium, 2 out of every3 Australian men and 1 in 2 women were medically over-

weight. We have no comparative figures from 50 years ago,but its a fair guess that it would have been less than 1 in50for men and women! In fact, being overweight hasbeen an aberration throughout human history, limited tothe unfortunate few with a genetic pre-disposition, or thevery wealthy, who could afford to stuff themselves stupid

while their much leaner servants ran around after them.

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THE GAIN IN THE NATIONS WAISTSo how has one of the fittest nations on Earth become one

of the fattest? Despite popular belief, its not necessarily theamount of food we eat. Records show that around the turnof the twentieth century, Australians, on average, wereeating about one-third morethan we are today. Nor is it adecline in our interest in sport. Although weve alwaysbeen a sporting nation, our zeal (and prowess) in such

endeavours really hit its straps with the introduction ofcolour TV in the 1970s and reached its zenith at the 2000Sydney Olympics. Theres also a far greater proportion ofthe population bouncing around inside gyms than at anyother time in our history. Youd be excused, of course, forblaming Ronald McDonald and, of course, fast and fatty

foods doubtless have had an impact on our waistlines. Butlets be honest, its not that much worse in terms of caloriesand fat than what great-granny used to dish up to great-grandad. Taste might be a different matter, though!

The answer lies not so much in the individual, but intheir modern environment. For thousands of years of

evolution, we have sought comfortfood on the table atthe end of the day without having to expend too mucheffort to get it. Thanks to the industrial revolution of thenineteenth century and the technological revolution ofthe twentieth, this is something we have now achieved.

Technology not only entertains, it also means that we

dont have to work as hard on a day-to-day basis. Thelabour-saving wonders of the 1950s have developed tosuch an extent that now almost everything can be avail-able at the push of a button. Unfortunately, now that wehave all this surplus energy, the easiest place for ourbodies to store it is as fat cells. So its Bill Gates and

Henry Ford as much, or more, than Ronald McDonald,


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who should be blamed for the modern obesity epidemic.Computers, televisions, microwave ovens and remote

controls all should come with a health warning:Guaranteed to increase the size of your familyscollective rear end.

WHAT ABOUT GENETICS?The most common scapegoat people will blame for their

weight problem is their genes. Its in the family, they say.But if this was the case, why is the obesity epidemic only30 years old? Before that, Fatty Fosters were the excep-tions, rather than the rule. The obesity epidemic is alsotoo recent to suggest that the gene pool could havechanged, so how do we explain the family-gene excuse?

Humans have always had the genes (there are morethan one by the way) to get fat. But except in those rareFatty Foster cases, they were not enough to overcomeour environment, one in which we have had to movearound a lot to survivenot just to find food but also toavoid our enemies. Since the technological revolution,

however, we dont have to do this any more.In this new environment, just about everybody has thepotential to get fat. Those Fatty Fosters with the greatestgenetic payload (who incidentally would have survivedlonger in times of famine), get fattestin fact morbidlyobese. Those with just a few fat-gaining genes becomeoverweight. The changing influence of genes and theenvironment with increasing body weight, as measured byBody Mass Index (BMI), are shown in Figure 1.1.

You can find out your BMI by using the followingsimple formula: weight (kg) = BMI

height2

The recommended healthy BMI range for women is

1924; for men it is 2025.

WHY IS YOUR FAMILY OVERWEIGHT?

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WHO CAN WE BLAME?The bottom line is that your weight problem is probablynot your faultat least not all of it. A lot of the respon-sibility lies in the obesogenic environment in which youlive, and the genes you inherit make the most of thatenvironment. However, because genes cant be changed(yet!), your environment, as much as your lifestyle, has tobe managed and manipulated if you are to have anysuccess in reducing your, and your familys, weight.

Within families, the tendency to inherited weightproblems is clear. If both mum and dad are overweight,

and have been since childhood (which is a fairly clearindication of a genetic predisposition), there is an 80 percent chance that their children will have weightproblems. Where either mum or dad has a problem, thechances drop to 40 per cent (i.e., 2 out of 5 kids mighthave a problem). Where both mum and dad are lean,

there is only an 8 per cent chance that their kids will pick


4

20 30 40 50 60

Environment

Genes

BMI

Figure 1.1: The relative influence of genes and environ-ment at different body weights or Body Mass Indexes

(BMIs)


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up a weight problemand it will probably be more aresult of their lifestyle than genetics.

This is why this booklet is aimed at the family unit.As well as providing social support for each other, itsonly by working together that the family can change thecircumstances in which its fat intake is increased. Youmay not be able to change the macro-environment thatexists in the country or the world, but you can change

the micro-environments in your home, school and work-place, and this will go a long way towards reducing thefamilys fat load.

There are other reasons why and how the familyshould be involved in any weight loss program, and theseinclude:

Being there to support each other Changing the home environment Saving money, which can go towards a reward for

the whole familyperhaps a holiday Cutting down on medical bills Having more energy to do things together

Providing competition for each other Keeping the family together Showing up the relos at Christmas gatherings.

So while the information in this Quick Start programhas implications for each individual in the family, it shouldbe taken in by the family as a whole for the best benefits.

Keep this in mind as we go through the rest of the booklet.

WHY IS YOUR FAMILY OVERWEIGHT?

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6


Dont blame yourself for your weight. Itsprobably not your fault (at least not all of it).

Start to consider your environment as the mostfattening thing around you.

Get started on a weight-loss mission andinvolve the whole family.

Get the family to help each other out with theirweight control efforts.


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Chapter 2

WHY IS IT SO HARD TOLOSE WEIGHT?

Our environment has a lot to do with how hard we find itto lose those extra kilos (or not gain them in the firstplace). But even if their environment is ideally suited tolosing weight, some people do it easy, while others do ittough. Why is this?

In general, men will lose weight much more easilythan women. This is because female fat is designed toensure the survival of the species by providing enoughenergy for a woman to survive any famine that might hitwhile she is pregnant. Dont be surprised then if dad losesfaster than mum, and sons lose faster than daughters inthis whole family package. The differences between menand women when it comes to weight loss are summarisedon page 8.

Also, within men and women, some people loseweight more easily than others. There can be a range ofreasons for this but again, in general, those with moreupper body fat (or who are apple-shaped) will lose

weight faster than those with more lower body fat (whoare pear-shaped). Those who are genetically prone to getfat tend to carry more fat all over (more like the box thatthe apples and pears come in) and they find it harderthan others who are not genetically prone to be fat.

Even within the one family, genes can play a funny

hand, affecting one member much more than others. Little

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Bobby can be the spitting image of great-uncle Fred, orJeannie have the hips of her grandmother Marge. Thatsthe luck of the draw. It doesnt mean that nothing can be

done to help, but it does mean that some family memberswill find it harder to keep their weight stable than others.

CAUSESOR EXCUSES?Other factors can also make weight loss more difficult.

Among the most common excuses are a slow metabolism


8

A summary of sex differences in fat loss

In losing body fat, women differ from men in thatthey generally have:

a higher proportion of body fat (1535 per centof body mass compared with 1224 per cent inmales)

a greater proportion of their fat stored in thelower body, gluteal fat cells (fat stored in glutealcells is harder to shift, even with food restriction)

less lean muscle tissue, therefore a lower restingmetabolic rate and lower overall need forenergy

greater compensation of energy intake follow-ing exercise a potentially greater appetite for high energy or

energy-dense foods which can lead to yo-yodieting, or frequent ups and downs in body weight

more labile fat stores on the breast and upper

body than on the hips and lower body.


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or a thyroid problem. Both of these can be measured ifnecessary, but thyroid problems, at least, are unlikely to

be the cause, except in a very small number of people.Studies have shown that overweight people dont haveslower metabolismsin fact, they tend to be fasterbecause it takes more energy to move a heavier body mass.

Gaining and losing weight in cycles from earlyadolescence is one way to slow metabolism. For this

reason any program of weight loss you undertake, such asthis Quick Start program, has to be something you cando for life. If you expect to lose weight by putting thefamily on a diet and then going off it when youve lostthe weight, youre sadly mistaken. Youre also looking atthe wrong program, because youll be advised strongly

against such an approach.In any case, even if a slow metabolism is your problem,theres no need for you to do anything different fromwhat well be doing here. Almost everything designed tohelp you and the family lose weight will help speed upyour metabolism and keep the weight off.

GET AWAY FROM BLAMEThere are other factors that make some people loseweight more easily than others, but we dont need to gointo these here. Suffice it to say that any particular

member of the family must not be blamed for not losingweight as quickly as others on this, or any other program(unless, of course, theyre obviously not playing thegame). Everyone needs to run their own racebut withthe family offering support as a unit.

Another piece of good news is that even if you, or other

family members, dont lose weight despite following the

WHY IS IT SO HARD TO LOSE WEIGHT?

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recommendations in this program, your health will beimproved dramatically. As youll see, you can actually

prevent diseases like diabetes by being more activeregardless of whether or not you lose weight. A change indiet can also lower the risk of heart disease in the absenceofweight loss, even more so with a 510 per cent loss in bodyweight. So look at the program to follow as a healthprogram for life, not just a weight-loss program for a few

months.


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Dont expect everyone in the family to loseweight at the same rate.

Forget the idea of going on a dietit wontwork!

Work for long-term improvements in yourhealtheven if you dont lose any weight.


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Chapter 3

WHY BOTHER ANYWAY?

THE USUAL REASONS FOR WANTING

TO LOSE WEIGHTIf youre a woman, you probably want to lose weight tolook better or to fit into your favourite clothes again. Ifyour children are overweight, youre probably more con-cerned about them being picked on at school, or theirlong-term health being jeopardised. If youre a man, the

chances are you dont really care about your weight, butif youve thought about it at all, its probably becausecarrying that extra protuberance above the belt makesyou feel uncomfortable.

SOME REALREASONS TO DO SOMETHINGAll of these reasons may be valid, but theyre not reallyimportant. A much more important reason is the effectexcess body fat can have on you and your familys health.Excess weight can contribute to many physical andmental conditions, which are shown in Figure 3.1.

Excess body fat (note were talking fat, not weight)affects metabolic factors such as blood fats and bloodsugars, leading to an increased risk of diseases such asdiabetes, heart disease and stroke.

Excess weight also causes mechanical problems such assore knees, sore back, snoring and asthma. Together theseeffects are known as the M and M syndromeMetabolic

and Mechanical problems.

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* Likely to negatively affect motivation

The mechanical problems with an * in Table 3.1 are those

that are also likely to affect a third M and thats Motiv-

ation. If you suffer from breathlessness, arthritis, a bad

back, or incontinence, youre less likely to be motivated towant to do that thing that is most likely to help you reduce

weightphysical activity. This can lead to a vicious cycle in

which your weight continues to increase and the physical

problems get progressively worse. As part of this Quick Start

program, youll learn how to break into that cycle.


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Level of risk Metabolic disorders Mechanical problems

Greatly Sleep apnoea and snoring*

increased Breathlessness*

Asthma*

Social isolation/depression*

Fatigue/daytime sleepiness*

Moderately Heart attack Reflux (Heartburn)

increased Stroke Osteo-arthritis*

Gout Respiratory disease*

Psychological problems*

Slightly Some cancers Varicose veinsincreased Reproductive problems Musculo-skeletal problems*

Reduced fertility Bad back*

Polycystic ovaries Stress incontinence*

Skin complications Oedema/cellulitis

Cataracts

Table 3.1: Adverse effects of excess body weight onyour health


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NOT IF, BUT WHEREIts not necessarily ifyoure fat, but where youre fat

thats important. The fat that women store around thehips and buttocks is designed to help them survivepregnancy in times when food is scarce and is, there-fore, not dangerous to their health. The fat that men,and post-menopausal women, store around their waists,however, is much more dangerous. Its more central

location allows it to be released easily into the blood-stream, where it clogs up and raises blood sugar levels,leading ultimately to conditions such as diabetes andheart disease.

Carrying too much fat around the middle is the firstvisible sign of a problem. Raised blood sugars, or

increased blood fats (like cholesterol) are the first meta-bolic signs. If these continue untreated long enough,diabetes will be the first illness sign. Because there is agenetic factor involved in this, any incidence of diabetesanywhere in the familyeven a distant relativeshouldbe a warning to you to start being proactive about your

weight.

ARE YOUR FAMILY OBMNIs?If improving your familys health is the main reason forconsidering a family weight loss program, its worthknowing if losing weight is really necessary. Researchsince the 1950s at Harvard University has found thatthere is a small sub-group of overweight people whoseem not to suffer any health problems as a result ofbeing overweight. In fact, they are every bit as healthyas those who are not overweight. In a recent reviewpublished in the prestigious journal Metabolism, Professor

Ernest Sims from Vermont University has called these

WHY BOTHER ANYWAY?

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people OBMNIs, or Obese but Metabolically NormalIndividuals. Although they are well above the prescribed

recommended level of body fatness, these people havenormal blood pressure, blood sugars and blood fats.There is usually no family history of disease or earlydeath and Dr Sims concludes that forcing these peopleinto a weight-loss program could in fact be counter-productive, as it might cause psychological problems. If

members of your family fit into this category, gettingthem to eat properly and exercise obviously wont dothem any harm but health maintenance, rather thanweight loss, should be the issue. Discuss with your PTdoctor whether its worth putting them under pressureto lose that extra kilo.

AND SOME MORE GOOD NEWS . . .Not only is the fat women store in their hips andbuttocks not dangerous to their health, it may actually bea sign ofgoodhealth. Research carried out in Sweden has

shown that increased hip size is independently associatedwith reduced risk of heart disease. Its the fat around thewaist that is more dangerous. Despite what most fashiondesigners would have us believe, it appears that womenare designed to have ample hips.

And some more . . . type 2 diabetes, which is primarily

caused by being too fat and/or too unfit, can almost alwaysbe prevented. Even if you cant lose weight, becomingmore active can help keep this disease (which is now oneof the fastest growing diseases in the modern world) atbay, and can even help cure it after it has developed. (Formore about this see Professor Trims Quick Start program

for people with diabetes).


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EXPECTATIONSREALISTIC ANDOTHERWISEMost overweight individuals probably expect to lose upto 35 per cent of their initial body weight on any kind ofweight-loss programincluding this one. Yet years ofresearch shows us that this is an unrealistic expectation.Most people lose only 510 per cent of their initialweight but again, the good news is that this is enough.

Medical researchers have shown conclusively that a 510 per cent decrease in weight can lead to a big improve-ment in health and may prevent the onset of any of thoserestrictive diseases listed in Table 3.1.

Setting goals

Its always important to set goals in life. Its also impor-tant to make sure that these goals are realistic. Also,sometimes a goal should be to change theprocessof whatyou are doing rather than just the outcome. For example,as well as setting a long-term goal to lose say 510 kilos,a short-term process goal of walking 34 km at least

3 days a week will help you achieve a short-term target.It will also help you on your way to your possibleoutcome goals. Table 3.2 lists some short-, medium- andlong-term process and outcome goals. It also providesspace for you to write in your own goals.

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Short-term Medium-term Long-term

Process Walking 13 km Eating no more Being active every

Goals a day than 40 g of fat day as part of

a day lifestyle

Dad

Mum

Child 1Child 2

Outcome Losing 1 per cent Losing 12 kilos Reducing waist to

Goals of waist a week in a month 100 cm

Mum

DadChild 1

Child 2

Table 3.2: Setting goals


Beware of the cyclical problems of the M and Msyndrome.

Aim to lose fat, not weight and go for the fataround the waist first.

Be especially conscious of your weight if there isdiabetes in the immediate family.

If you are a woman, dont worry about having bighipsthey can be very healthy!

Set realistic expectations for weight loss510per cent is a good start.

Setprocessgoals, as well as outcomegoals and makethese short-term, medium-term and long-term.


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Chapter 4

MEASURING YOURFAMILYS RISK

TARGET FAT, NOT WEIGHTBecause itsfat, not weightthats important, and becauseits fat around the middle rather than the hips thats evenmore important, measuring the health risks of beingoverweight is relatively simple. Forget the scales. In fact

after weighing yourself and each member of your familyat the start of this program and writing the weights downin the measurement chart provided later on, hide thescales and dont use them again unless told to later in thisprogram. The measurements that we use instead arebased on fat, and fat distribution.

The most important measurement is your waist. Thereare some other measurements that are relevant for differ-ent members of the family and these should be entered inthe measurement chart (Table 4.1) in this chapter.

MEASURING UP THE FAMILY

DadMeasure around the waist at the navel and write downthe result, in centimetres, in Table 4.1. Your long-termgoal is to get below 100 cm if youre Caucasian and90 cm if youre Indian, Asian or Aboriginal. For Pacific

Islanders, the aim should be to get below 110 cm. Get on

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the scales at the start of the program and write yourweight down, then take your height and work out

your Body Mass Index (BMI) using the formula BMI =weight in kg divided by height in cm (squared).

MumFeel for your bottom rib and the top of your hip-bone onthe dominant side of your body. Then measure aroundthe waist at the mid-point between the lowest rib and the

top of the hip. Your long-term goal is to get below 90 cmaround the waist if youre Causasian and 80 cm if youreIndian, Asian or Aboriginal. If you are a Pacific Islander,100 cm should be the goal for good health. Also measurearound your bust, hips, mid-point of the thigh and hipsat a spot that you think you will remember for future

comparisons. Write down the results in Table 4.1. Writedown your weight and then put the scales away. For goodmeasure work out your BMI.

SonsMeasure around the waist as for dad. Also make a note ofyour weight and write these measures in Table 4.1. Up tothe age of 18, aim for a waist circumference of 90 cm.Measure your height and calculate your BMI. Comparethe result with the range for normal BMIs on pages 3.

DaughtersMeasure as for mum, then calculate your BMI. Dont weigh

yourself again until advised to by the program, unless youare using BIA scales to check your body fat percentage(Body Impedance Analysis (BIA) scales can be found insports stores, exercise stores and gyms, and are designed tomeasure the percentage of your weight that is body fat.).

Now that you have all the familys measurements, the

next thing is to try to forget about them. Concentrating


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1

9

Weight Waist BM(kg) starting (cm)

measurement

Dad

Son (1)

Son (2) etc.

Mum

Daughter (1)

Daughter (2) etc.

Table 4.1: Family measurement chart


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20

Overweight Obese

Age Males Females Males Females(years)

5 17.4 17.1 19.3 19.25.5 17.5 17.2 19.5 19.3

6 17.6 17.3 19.8 19.76.5 17.7 17.5 20.2 20.17 17.9 17.8 20.6 20.57.5 18.2 18.0 21.1 21.08 18.4 18.3 21.6 21.68.5 18.8 18.7 22.2 22.2

9 19.1 19.1 22.8 22.89.5 19.5 19.5 23.4 23.510 19.8 19.9 24.0 24.110.5 20.2 20.3 24.6 24.811 20.6 20.7 25.1 25.411.5 20.9 21.2 25.6 26.1

12 21.2 21.7 26.0 26.712.5 21.6 22.1 26.4 27.213 21.9 22.6 26.8 27.813.5 22.3 23.0 27.2 28.214 22.6 23.3 27.6 28.614.5 23.0 23.7 28.0 28.915 23.3 23.9 28.3 29.115.5 23.6 24.2 28.6 29.316 23.9 24.4 28.9 29.416.5 24.2 24.5 29.1 29.617 24.5 24.7 29.4 29.717.5 24.7 24.8 29.7 29.818 25 25 30 30

Table 4.2: Overweight and obese cut-offs for BMI fromages 518


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too much on the outcomeof a weight-loss program canhave an adverse effect on its progress. Instead, at least inthe early stages, try to concentrate on the processesyou

listed in Table 3.2.Although you can collect the familys measurements as a

guide to ongoing progress, Id advise against it as its tooeasy for individual family members to start becomingobsessive about these measurementsespecially younggirls. Young girls have it pretty tough if they are overweight,

so it is best not to focus on the numbers too much and justget on with the process of creating a healthy lifestyle foryour family. Concentrating on the outcome, rather than theprocess, of losing weight can lead to all kinds of problems,because any deviation, no matter how slight, from theexpected can cause disillusionment, a sense of failure and

a desire to give up. Keep the starting measurements as arecord, then move on to better things.

MEASURING YOUR FAMILYS RISK

21


Weigh yourself once at the start of thisprogram, write your weight down, work outyour BMI and then put away the scales.

Take the relevant measurements for eachmember of the family and write them down inthe family measurement chart.

Dont become obsessed with measurements.


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Chapter 5

WHAT WORKS, WHATMIGHT AND WHATDOESNT

ACTION AND RE-ACTIONTheres no shortage of weight-loss programs in the world,and just about all of them workfor a while at least!In fact, if they didnt no one would ever try them. Thereason they workfor a whileis because anything thatchanges your energy balance, that is the ratio betweenenergy you take in from the food you eat and the energyyou expend in activity and your metabolic rate, will leadto (short-term) weight loss (albeit at different rates indifferent people).

Unfortunately though, the way this energy imbalanceis created will determine how quick the loss is, and howlong it stays off. Unlike calculations made on a piece ofpaper, the human body reacts to changes in food intakeand energy expenditureif it didnt, wed lose weightcontinuously until we faded away and diedand being

dead is just not a healthy state to be in.

Reactive lossesIf you lose too much weight too quickly, the weight willcome back as soon as you stop dietingwith interest.Women are more prone than men to this cycle of regular

weight gain and loss (known in the trade as the rhythm

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method of girth control). Unfortunately these womenwill probably wind up the fattest later in life. This is

because the extra fat becomes even harder to shift sincethe body tries harder and harder to protect itself fromthose periods of starvation.

How weight loss happensDecreasing energy intake through food can happen in a

number of ways: You can decrease the total calories youtake inbut just counting these can become an obses-sion and has its own problems. Alternatively, you candecrease the carbs or carbohydrates in your diet, one ofthe current popular approaches. This will guarantee aquick weight loss (from the water stored in each gram of

carbohydrate or sugar in the body), but because sugarsfrom carbohydrates are our best source of real energy,this diet will make you pretty tired and lethargic after amonth or two. You wont feel like doing the exercise thatwill help you maintain your weight loss.

You can decrease your total calorie intake by going onone of the crazy diets that are aroundthe grapefruitdiet, the Israeli Army diet, the Fit for Life diet, etc.butyou can guarantee that you wont be able to sustain adiet like this for life. Going on a diet means coming offit at some stageso it will probably make you fatter inthe long-term.

Without labouring the point, any of these programsor diets will work because you are decreasing your totalenergy intake. But they cant be kept up for a lifetime,and thats what has to happen if youre going to lose andmaintain weight loss in your family. True, this wonthappen without you making changes. But change hasto be permanent and therefore has to be based on

learningwhat the best foods are, what the worst foods

WHAT WORKS, WHAT MIGHT AND WHAT DOESNT

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are. Well look at just what this learning involves in laterchapters.

WHAT DOESNT WORKWe can say with some conviction that what wontworkfor permanent weight loss is just about 100 per cent ofthe pills or potions you can buy over-the-counter at your

chemist or health food shop. While many have seeminglycast-iron guarantees and promise you the body of yourdreams, about the only thing theyll lighten over the longterm is your family budget.

If they do work, and remember anything can workfor a while, they work through the diet and exercise

program that goes with them, which usually cant bemaintained for life. If you need more proof, check outthe research.1

WHAT DOESWORKCarbohydrate and protein each have only 17 kJ of energyper gram. Alcohol has 30, but the body has no mecha-nism for converting alcohol to fat. Fats and oils, on theother hand, have 38 kJ per gram. So reducing the fat inyour diet will be the quickest way to arrive at an energyimbalance. Because fat can also be addictive, a decreasein fat can also make it easier to maintain a low-energyeating plan for life.

Over the past ten years research has shown that acombination of lower fat and high fibre in the diet, butwithout calorie counting or restrictive dieting, will leadto a steady but constant weight loss. Its this combinationthat well look at when we examine dietary changes in

Chapter 7.


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WHERE CAN YOU GET HELP?Unfortunately, there are surprisingly few professionals

well-versed in the modern research relating to weightloss. Dietitians should be expected to be expert in thearea, but look for those with affiliations with groups likethe Australian Society for the Study of Obesity (ASSO).By definition most dietitians will concentrate on dietand may tend to neglect the physical and psychological

components of weight loss. Exercise and fitness specialiststake the opposite approach, and still tend to adhere tothe . . . if it doesnt hurt it doesnt help philosophy. InAustralia, psychologists who specialise in weight controlare about as common as underpants with pockets. Healthfood stores are usually interested only in selling a

product. So whos left?Fortunately, Australian general practitioners have been

making a determined effort to update themselves in thisfield. Over 4000 have completed at least part of theCertificate in Weight Control Management I developedfor Sydney University. In conjunction with Professor

Trims programs, they represent perhaps the best pointof ongoing contact for you. New developments in thehealth care system mean that doctors can now work withother health professionals (such as dietitians and exercisespecialists) to help you and your family devise an effec-tive action plan for weight loss. You can check for a GP

who is qualified in weight control in your area on theProfessor Trim (PT) Website (www.professortrim.com).

PT doctors now also have access to specialist weightcoaches who have been trained under the PT program.Your PT doctor can refer you to a coach for individual orgroup help, particularly with your exercise program and

motivation.

WHAT WORKS, WHAT MIGHT AND WHAT DOESNT

25
http://www.professortrim.com/http://www.professortrim.com/http://www.professortrim.com/http://www.professortrim.com/


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If your family has a chronic and severe weight problem,it might be best to check out the specialist Metabolic

Units now operating in the big hospitals in most states.These have doctors, dietitians, psychologists and exercisepeople all there to help with this problem. A list is givenon the PT Website(www.professortrim.com).

1 Egger, G., Stanton, R. and Cameron Smith, D. (1999), The effectiveness

of popular non-prescription weight-loss supplements, Medical Journal of

Australia, 171, pp. 6048.


26

Professor Trims Prescription Pad Be careful about big, quick weight lossesthe

weight will come back even quicker. Avoid fad diets. Resign yourself to the fact that some lifestyle

changes are necessary for permanent weightloss.

Make sure any changes make your life moreenjoyable than it is now.

Avoid fantastic, magic, new, miracle pills orpotions for weight loss.

Check in with your special Professsor Trim GP,weight coach or qualified health professional forongoing help.

If your family has a chronic weight problemapproach the Metabolic Unit at a majorhospital near you for help.
http://www.professortrim.com/http://www.professortrim.com/


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Chapter 6

CHANGING YOUR(MICRO) ENVIRONMENT

As weve seen, its our modern environment that makes usfat. And while we cant do much in the immediate termabout the macro-environment of our city, country orthe world around us, we can do something about ourmicro-environmentthat around our home and, to some

extent, our neighbourhood.There are four types of environments we need to lookat: physical, policy, economic and socio-cultural. Withineach of these, there are environments relating to food andthose relating to physical activity. A quick glance at eachof these will give you an idea of what can be done to

make each more family fat loss friendly.

THE PHYSICAL ENVIRONMENTThis can be represented by the question what is available?.It includes things like the available foods in the house,

opportunities for exercise and the presence of effort-savingdevices like remote controls, cordless phones, etc. Here area few tips for making this less fat-friendly:

Keep the fatty foods in the house to a minimum(see Chapter 7).

Keep treats like chocolate out of eyesightif they

are kept in the house at all.

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If you open a bar of chocolate, turn the bar aroundso that only the unopened end can be seen.

Leave the remote control on the TV (or put itaway in a drawer) and get up and change thechannels manually.

Dont have a TV in the childrens bedrooms. Dont shop while you are hungry (youll just buy

more of the wrong types of food).

Plant a home vegetable garden.

THE POLICY ENVIRONMENTThis refers to the house rules and mainly applies to therules for children. Examples might include the following:

Dont allow treats like sweets or chocolate on anempty stomach. This only encourages cravings forsuch foods.

Make up a list of food rules, such as water insteadof soft drinks or fruit juices, and stick to it!(In general, to avoid arguments and promote ahealthy attitude to food, adults should decidewhat type of food and when and children shoulddecide if and how much.)

Dont do active things for your kids. Make themdo it themselves.

Allow only a certain amount (e.g., a maximumof 2 hours a day) of passive entertainment (e.g.,watching TV, playing video games or surfing theNet).

Have stipulated non-TV/video games times of theday, week or month.

Make pocket money contingent on completing a

certain number of active chores.


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Get a dog, with rules that it must be walked acertain number of times a week (otherwise it will

drive you crazy). Walk wherever you can: to school, the shops, or

the park. Set rules about playing outside and in the neigh-

bourhood that promote active play but keep childrensafe. Encourage participation in team sportsthis

doesnt have to be as formal as joining a club; neigh-bourhood knock-abouts are far more fun!

THE ECONOMIC ENVIRONMENTThis refers to the economic cost, or value, of certain

fatness or fat loss-creating activities within the immediateor micro environment. Some examples might be:

Make pocket money contingent on eating e.g.,3 different fruits and 4 vegetables a day.

Buy whole, rather than processed foods (theyrecheaper and less energy dense).

Learn to cook wholesome, low-fat meals from scratch. Join a sports association. Give up privileges (e.g., TV) if certain goals are

not met (e.g., eating a healthy meal). Save money by not using petrol (e.g., by parking

the car, or not having a car). Work out the savings of eating less, and of eating

more healthy food and then put this towards somefamily reward.

Run a family weight-loss competition and put themoney in a pool for the winner.

Reduce the number of meals that you eat outside

the home.

CHANGING YOUR (MICRO) ENVIRONMENT

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THE SOCIO-CULTURAL ENVIRONMENTThis refers to the attitudes, perceptions, beliefs and

values (that are often based in wider cultural, religious,social and ethnic factors). Some cultural factors (oftenfamily myths) that can influence body weight are:

The belief that fat is good. The idea that puppy fat is harmless and will

disappear when a child gets older. Gender stresses suffered in some families, which

can lead to over-eating. The belief in some cultures that pregnant women

shouldnt be active. The old-fashioned belief that an expectant mother

must eat for two and put on as much weight as

possible. The idea that the plate should always be emptied,

no matter how big the serving. Encouraging children to eat everything on their

plate and think of the starving children in thethird world.

Feasting at religious ceremonies and other culturalfestivities.

Seeing overweight parents as role models.


30


Start to see your environment, not just yourdiet or lack of gym membership, as fattening.

Check the list of things you can do to changeyour fattening micro-environment.


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Chapter 7

THE FAMILY DIET

GOOD AND BAD FOODS

What your family eats will be closely connected with howyou monitor the food environment in the household. Ifyou have the wrong foods on hand, youll eat the wrongfoods. If you shop when youre hungry, youll more thanlikely bring back the wrong foods to the kitchen larder.

So what are the right and wrong foods? A good place

to start is to suggest that you stop thinking in terms ofright or wrong. If a food is thought of as wrong, it willbecome even more desirablelike the forbidden fruit. Ifits thought of as right, you might eat too much of it. Interms of weight control, foods should be thought of on acontinuum; from those that, eaten often, will cause big

weight gains, to those that, eaten prudently, can result insteady weight loss.

But food isnt all there is to nutrition. We dont eat justbecause food is there or not there. We eat because weare hungry, or because we thinkwere hungry. So in thischapter well look at two important factors for family

weight controlhow to manage food and how tomanage hunger.

MANAGING FOODThere are four things to do more of and three things

to do less of, if you want to establish healthier eating

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patterns for your family. The four things to do more of are:

Eat more fibre. Eat more lean protein. Eat a greater variety of foods. Eat regularly.

The three things to do less of are:

Eat less food that contains too much fat and sugar.

Eat fewer foods that are energy dense. Eat less food in total.

Lets consider these separately, taking the positive first.

Increase FibreFibre is usually found in the stringy part of foods, like thebits of an orange that hold it together, or the husk on theoutside of a grain food. There are different types of fibre,but for our purpose, well consider them all together andmake a blanket assumption that the most high-fibre, lowenergy-dense foods are edible plants, such as fruits andvegetables. However some manufactured foods such as

bread, pasta and cereals have good fibre levels.By increasing your familys fibre intake, youll decrease

their fat intake and have a double impact on the familysweight problem. A simple formula for this is to eat atleast three different fruits and four different vegetables aday, and increase your intake of pasta, breads (without

fatty or sugary sauces and spreads) and cereals.

Eat a greater proportion of proteinin the dietProtein is muscle food. Its main source is the muscle ofother animals we eat, but other good low-fat sources are

beans, legumes and some other vegetables.


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Because protein is turned into muscle in our bodies,and muscle is active, protein helps to increase our meta-

bolic rateprovided we combine its intake with exercise(see Chapter 8). Protein generally does not turn to fat,because any excess is either lost as body heat or passedout through the urine or sweat. Its important that youincrease theproportionof protein in your diet, not neces-sarily the total amount. You shouldnt be eating more

food, as protein is still a significant source of food energyin small quantities. Its also important to make sure thatany increase in protein in the family diet comes fromlow-fat sources. Some examples of good, low-fat sourcesof protein are shown in Table 7.1.

Increase the variety in your dietThis may raise a few eyebrows, given that it implieseating more food. But thats not necessarily the case. The

Japanese, for example, eat a wide variety of foods, but

THE FAMILY DIET

33

Meat Seafood VegetablesKangaroo Fish (most kinds) LegumesCrocodile Prawns LentilsChicken breast Lobster

(without skin) CrabLamb (trimmed Squid/octopusof all visible fat) OystersLean porkLean beef

Table 7.1: Good low-fat sources of protein


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dont necessarily eat more in total. They do this by incor-porating small amounts of herbs, spices, vegetables and

protein in foods like sushi. Eating as wide a variety offoods as possible will guarantee your family all thevitamins, minerals and nutrients they needeven if thisfood is low in energy.

Try to get each member of the family to eat at least40 different (good) foods a week. Remember though, this

has to tie in with the other rules, which means low-fat,low energy-dense and less food. So youll be looking fora variety of fruits, vegetables and other unprocessedfoodseven herbs and spices.

Eat regularly

Again, this may sound a bit cockeyed, but eating oftendoesnt mean eating more. In fact it can mean you eatless, because your hunger is better satisfied by small,regular intakes of food. Recent research also suggeststhat eating several small meals a day, instead of oneor two large meals, will decrease cholesterol levelsin the blood. The first thing this means is that nofamily member should go without breakfast. Then, ifpossible, try to eat at least every 4 hoursbut makesure you eat something healthy, like fruit, veggies orlow-fat snacks.

Now lets look at what you should be eating less of.

FatTheres been a lot of controversy in the media recentlyabout whether you should decrease your intake of fat orcarbohydrate when you are trying to lose weight, butthere should be no controversy because the answer is cutand dried: its the total energy you take in (calories or

kilojoules) which is important, as we saw in Chapter 1.


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But because fats and oils contain 38 kilojoules per gram(remember oil is just a liquid form of fat) as opposed to

the 17 kilojoules per gram in carbohydrate and protein,its much easier to take in more calories if those caloriesare in the form of fat.

So the long and the short of it is, if you can reduce allfats in the diet (even those commonly regarded as goodfats, such as olive oil), youll go a long way to solving your

familys weight problem. Heres some simple ways youcan do this:

Dont use spreads like butter and margarine (or, ifyou must, spread them very thinly).

Take the skin off chicken beforecooking it. Dont fry food in oils.

Cut all visible fat off meat. Avoid full-fat dairy or soy products.

To take the low-fat issue further, youll need to under-stand a bit about fat. The PT program has a couple ofsimple rules you can work by:

Avoid foods with more than 10 per cent fat. How doyou know if a food is more than 10 per cent fat? Look forProfessor Trims Ultimate Food Energy Guideat any book-store (you get a copy with each full PT program, seep. 66). This handy, pocket-sized guide will tell you thenumber of grams of fat per 100 gm in a stack of differentfoods. If its more than 10 g/100 g (ie. 10 per cent) fat,avoid that food. In fact, ban it from the house.

Reduce daily fat intake. Again, your Ultimate FoodEnergy Guidewill tell you just how much fat you andyour family are eating in your diet. Check the quantity ofeach food eaten and the number of grams of fat, thencompare the totals to the recommended daily fat intakes

for each member of the family in Table 7.2.

THE FAMILY DIET

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Eat less high energy-dense foodsEnergy density is a relatively new term which refers to thenumber of calories (kilojoules) per gram of food. The

reason for this new term is that weve discovered that some-times its not just fat which blows out the total calories, buthigh quantities of sugar and/or fat. We wont go into thisin much detail in this program as its considered in moredetail in the main Professor Trim programs. Its enoughat this stage to say that energy density is calculated by

dividing the number of kilojoules in a food by the numberof grams of that food. Where this turns out to be morethan 12.5 kJ per gram of food (1 calorie = 4.2 kJ, so12.5 kJ/g = ~3 cals/g), it implies a high-energy dense foodthat should be avoided. Between 7.5 and 12.5 kJ/g ismedium and below 7.5 kJ/g is low energy-density. These

foods can be eaten in (almost) unlimited quantities.

Reduce the total energy (cals/kJs)you take inWhether we look at fat, carbohydrate or protein, at theend of the day its still the total amount of energy

(calories or kilojoules) you take in that causes a weight


36

RDFI

Dad 4060 g Mum 3050 g Son (very active) 70 g Son (not very active) 4050 g

Daughter 3040 g

Table 7.2: Recommended daily intakes (RDFIs) of fat fordifferent family members


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problem. If youve truly cut back on fatty foods and highenergy-dense foods its almost impossible to eat too much

foodalmost! Still, taking in too much food can stillbe a problem for some people. If you think this might beyou, cut back on your total food intake and eat smallerportion sizes, just to make sure.

MANAGING HUNGERTo talk about managing hunger is really grabbing thesnake at the wrong end. This is because genuine hungeris almost impossible to manage. Weve been trying to doit with drugs for years and it hasnt workedat least notvery effectively. So how could we do it by just talking

about it? The answer is that we are not interested inmanaging genuine biological hunger. What we are inter-ested in is managing learned appetite. You see, these daysfew of us eat when we are genuinely hungry. We eat whenits time to eat, when we are with friends, when we havea cup of tea, when we feel sad or need to relax, or whensome other learned stimulus tells us we should eat.

The first way to deal with this is to learn to recognisegenuinehunger rather than stimulus-driven hunger. Manyof the stimuli in our modern environment, such as fastfood take-aways, eye-catching packaging and food courts,are designed to make us eat at times in the day when wedont really need to. If we start doing this in associationwith some other normal, daily activity, the chances are thatyou will feel hungry the next time you are in that situation.For example, driving into a take-away every time you gosomewhere with the kids means that theyll expect take-aways on every trip. If you always get the kids a treat at thesupermarket to keep them quiet in the checkout queue,

the supermarket will come to symbolise treat.

THE FAMILY DIET

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This is called a conditioned response and, like ratsthat learn to press a bar for food, the only way to stop this

pattern of behaviour is to not deliver the food until therat stops pressing the bar. It may be hard at first, but therat pretty soon learns. Now Im not suggesting your kidsbe equated with furry rodents, but thinking of them thisway (as you may already do sometimes), could helpreduce their weight problemor prevent them having a

weight problem in the future.So what we often consider to be hunger is what could becalled pseudo-hunger, and someone with a big appetite ispossibly someone who has learned to eat too much. Itsimportant to differentiate between the pseudo-hunger andthe real thing, so here are some other tips to help you:

Deal with or avoid completely those situationswhere pseudo-hunger is making your family fat.

Recognise the difference between real hunger andlearned appetite.

Dont eat treats (i.e., chocolate) when you arehungryit conditions you to believe that only

treats satisfy hunger. Fill up with high-fibre, low-fat foods. Dont get hungryeat small, eat often.

SUMMARYNutrition is a complex science and not something we cango into in detail in only a few pages. But nutrition forweight management is not complicated when the sur-rounding environment is controlled. A hundred yearsago, our ancestors had much less healthy diets than wehave now, yet very few of them had a weight problem

because they lived in a different environment. Your first


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task then, if youre concerned about your familys health,is to change your immediate environment. This will help

you improve your familys nutrition and manage theirweight over the long-term. After that, successful weightmanagement boils down to volumethe total number ofcalories that is eaten over the course of the day, the weekor the year.

THE FAMILY DIET

39


Dont think of food as good or badjustbetter and best.

Eat at least three different fruits and four differ-ent vegetables a day.

Increase the proportion (NOT total amount) oflow-fat protein in the family diet.

Increase the variety of foods the family eats tomore than 40 different foods a week.

Eat small, eat often. NEVER miss breakfast; dont go for longer than

about four hours without something to eat. Dont use (or, if you must, use them very spar-

ingly and spread thinly) butter and margarine. Take the skin off the chook or the turkey

before cooking. Dont fry foods in oils. Cut all visible fat off meat. Avoid full-fat dairy or soy products. Avoid foods with more than 10 per cent fat and

always check the labels for fat in the ingredients.


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40

Eat more low energy-dense and less high

energy-dense foods. Eat smaller portion sizes. Recognise genuine hunger and teach yourself

not to respond to learned appetite.


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Chapter 8

MOVING MORENOTEXERCISING!

MOVEMENT AND WEIGHT LOSSThis is the chapter that most people will want to avoid,because they think movement = exercise and exercise =pain. In addition, youll also have heard that exercisedoesnt really work for weight loss; that you have to jog

for 32 km to lose half a kilo of fat; and that youll neverget your family more active.Well heres the good news. None of this is true. Rather

than just accepting this statement at face value, lets putthe issue into perspective. For almost all of the million-odd years of human evolution, humans had never evenheard of, let alone frequented, gyms or fitness centres.They had no Reeboks or Nikes and only ever jogged ifthey had to catch their lunch. Yet virtually everyone waslean. And if they werent lean, they were fitat least fitenough to be extra-ordinarily active. And thats the cruxof the matterto be active, you need a reasonable levelof physical fitness. But to be fit, you have to get active.

Technology and labour-saving machines have turnedFITness into FATness. Unfortunately, this is nowheremore evident than in twenty-first-century schoolchildrenand will probably explain your own childrens weightproblems. Kids dont walk to school anymore, whetherbecause of safety concerns or their parents time con-

straints. Physical education is no longer compulsory in

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most schools and playgrounds are getting smaller andsmaller. If children arent playing as much on the streets,

or going out to the park alone or in groups, the mostpopular alternative indoor activities are sitting stillwatching TV, playing computer games or watchingvideos.

So how hard isit to increase the familys activity levelsin order to reduce the aggregate body weight? Also,

should we approach individual family members needsdifferently?

FAT LOSS, NOT FITNESSThe answer to the first question is not difficult at all, but

most popular weight-loss programs have totally misun-derstood, or neglected, the issue of movement in weightloss. Blind Freddy could see that its lack of movement,not over-consumption or eating the wrong type of foodthat is the primary cause of the nations obesity epidemic.In fact, the issue of exercise for weight loss is so simple,it will probably surprise you. Basically, it boils downto movement. The more you move your body, the lesschance it has of storing unused energy as fat. It doesntmatter whether this movement is in the form of walking,crawling or bouncing along on your bottomall humanmovement burns energy, and our excess energy is stored asfat. Even more importantly, regular physical activity willhelp prevent you regaining the weight you lose. What dis-tinguishes people who successfully lose weight and keep itoff, as compared to people who lose weight initially butregain, is daily physical activity, such as walking.

Obviously, some forms of movement will be moreeffective than others, but in general we can say that its

those forms of movement that are non-weight supportive,


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i.e. where you have to carry your own body weight, thatuse up the most energy. In fact, for the average 75 kg

person, every 25 steps he or she takes will burn up roughlya calorie. It doesnt matter whether these steps are inthe form of a brisk walk, a jog, or just a walk around thehouse or office.

FAST OR SLOW . . .So the simple answer to what best burns fat ismovement and there is nothing better for burning offfat than plain old walking. True, jogging is a great formof exercise for cardiovascular fitness, and you can burnthe same amount of energy in less time. But jogging can

be painful and potentially dangerous for most overweightpeople and is therefore best avoided. Its much better toslow down and make sure that fat, rather than sugar, isthe fuel that you are burning off.

Now if we go back to those times in history weve alreadytalked about, when humans have not been overweight, themain reason for this is because they walked everywhere.They had to; to get food, to socialise, to gather fueljustto exist. There were no cars or other machines to help them.

We are never going to live in that kind of environmentagain. We have achieved everything we need for our con-tinued survival, but now we have to re-create an artificialsituation where walking (or some other form of activity)becomes part of the daily routine. A good starting pointis to begin moving around more at home, at work andat leisure; by not using machines; and by thinking ofphysical activity as an opportunity, not an inconvenience.So instead of parking the car as close as you can to theentrance at your local shopping centre, park it at the

other side of the car park and walk to the shops.

MOVING MORENOT EXERCISING!

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Planning more movementAs technology continues to progress it becomes even

harder to do enough movement to compensate for thedecreases in our activity levels caused by machines andmodern living. In fact, one study carried out by one ofmy students, comparing the difference in movementbetween nineteenth-century Australians and those today,estimates that we are now moving the equivalent of a

16-kilometre walk less per day than we were 100 yearsago. Its almost impossible to make up this kind ofdistance just by moving around more during the day,although that is important to increase energy use. Whatyou need to do is organise some form of planned activitythe whole family can enjoy.

Here are some ideas for ways in which you can encour-age the family to get active. You may only be able to acton some, but anything will be better than nothing:

Get the kids to play activelychase, tag, hide-and-seekand play with them if possible.

Use equipment like balls, frisbees, bats and bikes,

etc., where those are going to get family membersmore active.

Plan activity time ahead of time, because if its notplanned, its not likely to happen.

Buy a dog: that way youll be encouraged (by thedog if no-one else!) to get out for a daily walk.

How far do you need to walk?As part of the full PT program youll get a digitalpedometer which measures the number of steps you takeeach day. Youll also be given a table which will help youset your stepping rate so that you can achieve weight

loss at different levels. For this introductory program


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however, its enough to say that anyamount of walkingwill do you good. The optimal amount would add up to

around 4 km per day. But dont get discouragedthisdoesnt have to be completed all in one go. Accumulatedactivity is just as good for weight loss as continuousactivity. So 4 lots of 1 kilometreor even 40 lots of100 metreswill have the same effect as going out fora 4 km walk.

What if youre too big?For some people, their weight problem severely limitstheir range of movement. Lets face it, its painful to getaround when youre big. Its that vicious circle again,though, because as a result of not getting around, you

then get bigger, and the problem gets worse. We need tofind a starting point and that is in activities where thebody weight is supported. Now I know Ive said that non-weight supportive activity is best for weight loss, but toget the very big started, weight supportive activities suchas cycling, rowing or walking in wateranything wherethe weight is taken off the legsis likely to be less painfuland therefore more likely to be completed successfully.

As your program progresses and these forms of activitybecome less painful, you can then move more on to thenon-weight supportive activities like walking. This can bevery short distances to start (i.e., walking to the letter boxand back), but these can be increased gradually as yourfitness improves and your weight goes down.

Ironically, as you find your chosen activity becomingeasier your weight loss will plateau or slow down. This isbecause your body has adjusted to the increased level ofphysical activity and has become more energy-efficient.For this reason its good to have variety in your physical

activities. Walking should remain the basis of all your


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family weight loss activities, but other activities should beaddedit helps if these are things that you enjoy. Check

the activities in Table 8.1 to see which are the most effec-tive for weight loss.

* Rating is based on safety, effectiveness, fun and enjoyment

Remember, you dont have to choose only the best

weight-loss activity because all movement is beneficialand, if you enjoy doing something, youre more likely tokeep it up than something you dont enjoy.

The family goal should be to carry out the NationalPhysical Activity Guidelines as shown in the pyramidin Figure 8.1. At the bottom, it urges you to consider

movement as an opportunity not an inconvenience.


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Activity Rating Activity Rating

Walking 10 Walking in water 9

Jogging 9 Weight training 7

Cycling 6 Rowing 6

Tennis/Golf 6 Aerobics 6

Swimming 5 Squash 4

Kids Stuff 10 Family Stuff 10

swings/roundabouts picnics

ball games becoming a tourist

dancing museums/galleries

chasing games bush walks

Frisbee throwing beach walks

Totem tennis sand castle building

Shuttlecock

French cricket

Table 8.1: Rating physical activities for effectiveweight loss*


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Next up the pyramid is be active every day in as manyways as you can. This means any form of activity includ-

ing gardening, washing, even walking around the house.Once you are doing this, youll get extra benefits from thethird guideline which says put together at least 30 min-utes of moderate intensity physical activity on most days.This is where walking, and any of the other activities thatyou may have decided on in Table 8.1 can come to the

fore. At the top of the pyramid, the guideline says if youare able, also carry out some regular, vigorous physicalactivity. This is more likely to apply to the males in thehousehold and is not vital for weight loss. However, itcan carry extra health benefits and help break throughthose plateaus where weight loss no longer seems to be

happening. If you are going to exercise at a vigorous level,though, you should have a thorough medical check upbefore you start, as it could be dangerous for the unfit.


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Figure 8.1: National Physical Activity Guidelines

Ifyou are

able, also carryout some regularvigorous activity

Put together at least 30 mins of

moderate intensity physical activityon most days

Be active every day in as manyways as you can

Think of movement as an opportunitynot an inconvenience

34 days/week

Most days

Daily

Always


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NOT BEING INACTIVE CAN MEANBEING MORE ACTIVEResearch carried out in the US has shown that one of thebest ways to get younger members of the family to loseweight is to reduce the amount of time they spend beinginactive, that is, watching TV, playing on computers orplaying video games, etc. This actually works better thantrying to get them active by forcing them into some form

of sport that they may not like. On this basis then, its vitalthat you restrict passive activity time, such as TV viewing.Better still, it should be earned. You can draw up a chartwhere kids get to watch units of TV or play units of videogames (in the form of quarter- or half-hour lots) in com-pensation for completing units of NOT doing these

things. The ratio of non-active to active hours should be atleast 1:4; that is, if the kids want to watch a TV programthats an hour long, they have to have completed at leastfour hours without doing anything else passive.

The following statement taken from the NationalClinical Obesity Guidelines might help to put physical

activity for weight loss in perspective:


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1 Egger, G., Lifestyle management for obesity and weight control. Work-

shops for GPs, CHPR, Australia, 2000.

The main goal of physical activity for weightloss should be to restore the human energy oncecarried out as part of day-to-day living and nowreplaced by technology, and to change attitudes so

that movement is seen as an opportunity for weightcontrol and health advancement, rather than atroublesome inconvenience.1


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Move moreas part of your daily lifestyle. Do non-weight supportive movement (e.g.,

walking) for the most effective fat loss. Walk as much as possible instead of driving. Stand, dont sit. Consciously move your hands, feet arms and

legs by deliberate fidgeting. Catch public transport instead of taking the car. Do things for yourself and dont get others to do

them for you (unless they need to lose weighttoo).

Dont use remote controls for the stereo or the

TV. Get up and change the channels by hand. Set up a family competition to see who can be

the most active. Regularly record your daily activity levels. Get rid of the four-wheel driveor at least use

it less and walk some of the tough terrain.

Have dedicated no TV periods for the wholefamily.

Take active holidays. Allow extra time for appointments so you can

walk rather than drive. Use the stairs wherever possible and not the

elevators. Think of movementany movementas an

opportunity, not an inconvenience. Introduce some planned movement activity

into the familys day.


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Chapter 9

PROBLEMS FORINDIVIDUAL MEMBERSOF THE FAMILY

Although the general issues about weight loss we havelooked at so far apply to all members of the family, thereare some specific issues for different family members. Forexample, men and women gain and lose weight at differ-ent rates, with men generally finding it much easier thanwomen to lose weight. The main issue for most men isa lack of knowledgeof nutrition, exercise and otherhealth issues. More women, on the other hand, have theknowledge, but battle more psychological issues, includ-ing coping with the relentless media pressure to loseweight, that limit their success. Children are more likelyto find it harder to gain weight, but sometimes faceparticular difficulties in losing excess kilos.

In this chapter we look at specific factors which mayneed to be added to the general rules for each member ofthe family.

DADLack of knowledge about issues related to weight lossis generally the major stumbling block for men. Inaddition, many men arent prepared to admit that this is

the problem. They think that because they were lean

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when they were young, because of training for football orother sports, all they have to do to lose the excess weight

they are carrying now is some vigorous exercise. In factthis is not the case. Coming to terms with the key issuesin this book will help the males of the household loseweight, and hopefully maintain that loss in the longterm.

Getting Dad even to admit he has a weight problem is

a major hurdle. In general, men are less restricted by theirbody image than women. Men tend to be less concernedabout a bit of lard hanging over the belt; in fact, somemen might think of it as a positive sign of good health,whereas, in reality, even a little bit of extra weight storedaround the waist is much more dangerous than female

fat which is stored more typically around the hips andbuttocks.The cut-off waist size of 100 cm weve used here for

Caucasian men is the first indication that Dad does havea problem. If hes gone up more than about 3 trouser sizessince he was 20, this would also indicate that hes devel-oping a weight problem. Where hes no different fromthe other members of the family is in getting him toaccept that he needs to do something about his weight.

Alcohol can also be an issue for many men and, under-standably, they dont want to give it up completely. Thegood news is that they dont have to and, in fact theyshouldnt, if they want to lose weight for life. The PTprogram, like its predecessor GutBusters, is notable forits innovative approach to alcohol intake and weight loss.Alcoholper sedoes not form fat. Its only where the totalenergy intake, particularly the fat intake, is high that thefat piles on. Hence, its not a beer gut that Dad sports,but a beer + peanuts gut, or a beer + chips gut. Get rid

of the chips and peanuts and hell get rid of the gut. Just

PROBLEMS FOR INDIVIDUAL MEMBERS

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to make sure however, PT suggests that men trade offwalking one kilometre for every standard measure of

alcohol (beer, wine, nip of spirits) that is consumed in aday (up to a maximum of four glasses a day). Saving upthe weekly allowance to have 24 drinks on Friday nightis not acting in the spirit of the arrangement!

Finally, while having said that men lose weight easierthan women, it should be noted that this is not the case

for all men. Those who have a genetic predisposition tostore weight, or who have a more female or pear-shapedphysique will, like most women, find it more difficult tolose weight than those who are apple-shaped with just alittle patio above the playground.

MUMStarting with generalities again, we can say that mostwomen wont lose as much weight or as quickly as theirmale partners. This is because female fat, which is gener-ally stored around the hips, buttocks and breasts, is thereto enable women to survive the nine months of preg-nancy and thus allow the human species to carry on.

After menopause, however, women begin to store morefat on the upper body, like men. This means that they thenhave to pay even more attention to their pre-menopausalstores of lower body fat. Hormone replacement therapy(HRT) is available for women (but not yet recommendedfor men), and this can help keep down the post-menopausal fat gaindespite recent controversies about itin other respects. Many women on HRT would disagree.However, there are now several well-conducted studies toshow that most women put on weight after menopause (atan average rate of around 0.5 kg a year), but that those on

HRT put on less than those on a placebo.


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Throughout their lives, women are typically undermuch more pressure than men to maintain an unrealisti-

cally lean body shape, and this can have genuine psycho-logical consequences, particularly for those women whoare genetically predisposed not to look like an anorexicEuropean model. As a result, many women have lost andgained weight more than once, through trying a range ofdifferent crazy and unproven diet and weight-loss tech-

niques. Consequently, they now find it even harderto lose weight because their bodies have gone on strike.The body is saying to the mind, Im never going to gothrough that severe weight loss again in case theres afamine and I disappear. So it decides to hang on to whatit has even more grimly than it would otherwise.

When taken together, these factors can cause what isknown as a vicious cycle of dieting as shown in Figure 9.1.

PROBLEMS FOR INDIVIDUAL MEMBERS

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Figure 9.1: The vicious cycle of dieting

Decide torestrict food

Restrict foodintake

ThinkI'm fat and ugly

DeprivationEat for comfort

Feel guiltyAnger

Why me?

Rebel againstfood rules

Feel outof control

Gorge

Think

all or nothing

Binge


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A woman may feel unhappy about her body image anddecide to go on a diet. As a result, she feels deprived, then

angry. In this state of mind shes likely to binge, whichwill make her feel anxious and depressed. And of courseone of the best treatments for depression is . . . youguessed it . . . food! The cycle continues.

As a result of this complex psychology, many womenare what is known as overly-restrained eaters, that is, they

go for long periods on very restrictive diets or purposelytrying not to eat. But this is totally counter-productive. Assoon as they are faced by one of lifes inevitable problems,overly-restricted eaters reach for the nosebag and begin togorge. The cycle of gorging and bingeing is one of themost dangerous there is for weight gain.

Dealing with such a cycle often requires sophisticatedcounselling techniques. For our purposes here, its worthpointing out that a key factor is to reduce the guilt abouteating. If, as a woman, you can stop yourself feelingguilty about everything you eat, you willbreak into thatvicious cycle and actually eat less. Its like the forbiddenfruit: if you are allowed to have it you dont desire it asmuch. Practise seeing food, not as anything special, butsomething you need to survive.

Another critical period for women is pregnancy. Forsome women this is the time they gain weight which theythen seem to have much more trouble losing. Manywomen think that they must have undergone somephysiological change that causes them to keep thatweight on. However most of the research done to datesuggests this is not the case. The weight gains are dueprimarily to the changes in behaviour that occur withnursing babies and bringing up childrenits harder toeat balanced meals, for example, when youre concentrat-

ing on bringing up a baby.


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Some women (particularly those restrained eatersreferred to above) use pregnancy as an excuse to eat for

two. They then put on large amounts of weight whichthey think will just drop off after they give birth. But themore weight thats put on, the harder it is to get off.Really, a weight gain of around 9 kg during pregnancy isenough for most women, although most pregnancyguidelines advocate a weight gain of between 11 and

15 kg for women of average weight. A woman who isoverweight before

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