Taking pills and supplements

Pills and supplements both have their uses, but only in moderation and only as long as strict guidelines are followed.

Over-the-counter (OTC) diet pills

The 1991/2 Weight Loss Practices Survey, sponsored by the US Food and Drug Administration (FDA) and the National Heart, Lung and Blood Institute, found that 5 per cent of women and 2 per cent of men trying to loseweight use diet pills. Products considered by the FDA to be OTC weight- control drugs are primarily those containing the active ingredient phenylpropanolamine (PPA), such as Dexatrim and Acutrim. PPA is available over the counter for weight control in a 75mg controlled-release-dosage form. The medicine should be used in combination with a restricted diet and exercise.

Using diet pills containing PPA will not make a big difference in the rate of weight loss, says Robert Sherman of the FDA's Office of OTC Drug Evaluation. 'Even the best studies show only about a half pound (250g) greater weight loss per week using PPA combined with diet and exercise,' he adds. Sherman cautions that the recommended dosage of these pills should not be exceeded because of the risk of possible adverse effects, such as raised blood pressure and heart palpitations.

Supplements

To rely on taking pills as a way of supplying nutrients is not ideal, for in a perfect world such nutrients should come from our food. But when you consider the quality of some of our food — fruit and vegetables grown in mineral-depleted soil, picked before they have ripened and shipped over vast distances in refrigeration, then put into long-term storage; meat full of hormones; grains stripped of most of their nutritional content — then taking a good multivitamin supplement and possibly extra vitamin C can benefit most people. And while you are trying to balance your blood-sugar levels, reduce body fat and rebuild lean muscle tissue, there are a few supplements that may help.

Key supplements

Magnesium

A fundamentally important mineral that counters insulin resistance.

It is hugely deficient in the Western diet. Consider taking 230-600mg per day, unless you have suffered kidney failure or have a high degree of AV heart block.

Quercetin

A flavonoid with powerful anti-inflammatory properties that helpsto control high insulin levels and inhibit fat production. Take 200-400mg three times a day before meals.

Omega-3 fats

If you don't eat fish, take 1,000-3,000mg of fish oil daily in capsule form. Vegetarians can use flaxseed oil or crushed flaxseeds instead of fish oil capsules. Try flaxseed oil in salad dressings (or even in smoothies) to ensure you get enough of this health-enhancing fat.

Chromium

A trace element that plays an important role in carbohydratemetabolism and regulating blood-sugar levels. It has proved useful in treating diabetes and shown to be effective in encouraging the body to lose fat, not muscle, when dieting. Take 400-600mcg of chromium picolinate or chromiumpolynicotinate a day.

L-carnitine

Used extensively by athletes to ensure maximum performance inendurance or aerobic sports. It is also useful for weight loss because it is involved in burning fat in muscle cells. Take 1,000-3,000mg per day.

DIETARY MYTH

Myth: I will get quicker results if I use diet pills.

Fact: there are no shortcuts — no magic pills. Losing weight sensibly and safely requires a multifaceted approach that includes setting reasonable weight-loss goals, changing eating habits and getting adequate exercise. Appetite suppressants (diet pills) may help some people in the short term, but they are not a substitute for adopting healthy eating habits in the long term.

Don't turn your back on calcium continue…

You may even be at greater risk if you consider the other factors that contribute to osteoporosis:

• The decline in oestrogen. Up to half of women over the age of 45 have some degree of type 1 osteoporosis (bone loss is most profound during the first decade after menopause).
• Smoking. It suppresses the activity of the osteoblasts (the bone-building cells) and also causes changes in oestrogen metabolism in women, resulting in an earlier menopause.
• Being thin and/or fine-boned.
• Excessive use of alcohol. This reduces calcium absorption and damages liver and bone cells.
• Avery high intake of protein increases the amount of calcium lost by the body. Veganism. Avoiding all animal products means avoiding some of the richest sources of calcium.
• Lack of exercise. Physical inactivity or prolonged bed rest are associated with the loss of bone density. Astronauts experience noticeable bone loss when in space, due to the effects of weightlessness.
• Excessive, long-term use of salt, in addition to being bad for your health in general, leads to increased calcium loss from your bones.
• Pregnancy and lactation. If there is insufficient calcium in your diet while you are pregnant or breasffeeding, calcium will be drawn from your bones and teeth to provide for the growth of the baby.
• Little or no exposure to the sun. Housebound people, elderly folk and office workers often don't enjoy enough sunlight to assist their skins in the manufacture of vitamin D, which is needed for the absorption of calcium from the gastro-intestinal tract.
• Unbalanced diets. Not only quick-fix slimming diets are low in nutrients. Our average, modern-day diets often lead to an insufficient intake of nutrients. Although you might be taking in sufficient calcium-rich foods (like cheese!), you might be taking in too little of the other bone-fortifying nutrients such as vitamin D, magnesium (soy, dried beans, nuts), zinc (chicken heart and liver, beef liver, lamb), copper, manganese and boron, found in a large variety of other foods.
• Genetic inheritance accounts for 80% of the variance in peak bone mass. Blacks have a higher bone mass than whites and Asians, and men have a higher bone density than women. A strong family history is a risk factor for osteoporosis - daughters of women with osteoporosis have been shown to have lower-than-expected bone density.
• Certain health conditions such as diabetes, rheumatoid arthritis, Cushing's syndrome, amenorrhoea resulting from anorexia nervosa and/or excessive exercise, gastrectomy, immobilising diseases, male hypogonadism (low testosterone levels), chronic liver disease or malabsorption.
• Consumption of large amounts of black coffee over a long period of time.
• Hyperthyroidism and over-treatment with thyroxin.
• The prolonged use of drugs such as corticosteroids (cortisone).

What is the role of calcium in theJody?

Everyone knows that calcium is required for healthy bones and teeth, but most people believe that calcium is only important in childhood. Wrong! There is a need for calcium throughout one's life in order to build and maintain calcium levels in bone.

Calcium acts as a metabolic regulator. Changes in the level of calcium within the cell result in the switching on and off of the processes of muscle contraction and nerve excitation.

Calcium is also involved as a co-factor in many enzyme processes. It is needed in cell division, the immune system and is also required in order for blood to clot.

More recently there has been some evidence to suggest that calcium has a positive role to play in maintaining a healthy blood pressure.

Clearly, calcium is an essential nutrient and a major role player in our general wellbeing; good health being an essential prerequisite for shedding weight successfully and permanently.

Dietary sources of calcium

The major foods in the diet that contain calcium, include milk, cheese, yoghurt, white bread, white flour, and green vegetables. The absorption of calcium by the body is dependent on many factors, including the form of calcium in the food. The best sources of available calcium are dairy foods. Green vegetables and whole grain cereals contain phytates that bind calcium and prevent absorption.

A balanced diet is important for the provision of calcium and other bone fortifying nutrients throughout your life.

What is the best way to treat overweight? Continue…

Tad' diets - the short-term losers

There are numerous diets on the market which appear to be successful, but in fact very often result in short-term weight reduction only. Such diets usually bring about high protein and water losses (from muscle tissue) - which do cause temporary weight loss - but also result in unnecessary decreases in basic energy expenditure. This in turn 'sets you up for failure' because maintaining your weight after initially losing the kilograms is much more difficult. Diets such as these also tend to encourage poor, unbalanced eating patterns instead of improving already harmful eating habits. By doing this, they increase the possibility that the weight problem will recur once you revert back to your original pattern.

Fluid intake should be at least 6-8 glasses per day.

• Sugar, sweets, cake, chocolate and cooldrink etc. are not allowed.
• A sedentary person is defined as somebody who engages in the following activities most of the time:
• Reading, writing, watching television, movies, sitting, sewing, playing cards, typing, office work done while sitting and standing, light housework (cooking, washing, dusting etc.), walking slowly, personal care. No participation in any form of physical exercise.
• A moderately active person is defined as somebody who engages in the following activities most of the time: heavy housework (making beds, scrubbing, mopping, sweeping, polishing, load washing, large articles, hanging out clothes), walking moderately fast to fast, climbing stairs, gardening, carpentry work. Participation in physical exercise occurs at least once a week.

The following are characteristics of unbalanced, fad, or unsound reducing diets. Any diet which:

• propagates the belief that certain foods, nutrients, or other substances have unique, previously undiscovered or magical properties to facilitate weight loss (novelty diets).
• claims that a low intake of carbohydrate accompanied by an unrestricted intake of total kilojoules (calories) from protein and/or fat will induce weight loss and that the excretion of by-products of fat metabolism (known as ketones) accounts for high weight loss in spite of a high kilojoule intake.

• claims that a certain meal pattern (which could vary from one day to the next) and/or certain combinations of foods and/or the exclusion of certain food groups are prerequisites for health and weight reduction.
• provides less than 4200 kJ (1000 cal) or less than 50% of an individual's average energy requirements per day (including very low calorie diets and total or intermittent fasting).
• promises fast weight loss (in excess of 2 kg per week or 1% of total body weight per week)
• promises that fat will melt away without increased exercise, hunger pains, or restrictions on favourite foods and with no restriction of food intake.

While diets such as these abound, it should be mentioned that good, balanced weight loss programmes are provided by some slimming clubs (such as Weigh-Less and Ideal Weight Club) and by some books, reputable magazines, pamphlets and registered dietitians.

What is the best way to treat overweight?

The answer to the above question is, first and foremost: Treat the cause as well as the symptoms!

A good starting point for any serious attempt at weight control is analysis of the factors which contribute to your particular situation - a case of identifying the enemy before you draw up a battle plan! It probably goes without saying that successful longterm weight loss is only possible if factors such as those listed below are recognised and dealt with in a determined fashion.

Choosing a weight reduction programme

Whether you intend to 'go it alone' or enlist the aid of an organisation or qualified person to help you lose weight, there are certain criteria which should be met by any weight reduction programme. Any such programme should include all the following:

• a balanced reducing diet
• a moderate amount of exercise aimed at enhancing weight loss and ensuring long-term weight maintenance
• the identification and changing of behaviour patterns which contribute to over-eating and weight gain
• recognition of (and determined efforts to resolve) any psychological problems which aggravate the problem

These are fundamentals in any serious attempt to lose weight on a longterm basis and you may need professional help to achieve your aims. Let's examine each of the above aspects in more detail:

The 'which diet?' dilemma

The last few decades have seen a boom in the diet industry, mainly because there are thousands who continue to believe that someone, somewhere is eventually going to come up with the magic formula that will solve their particular weight problem. And so every year a rash of formula diets, novelty diets, books and medications find their way into the lives of thousands of 'diet junkies' who can't resist yet another variation on an old theme. Generally speaking, the only long-term loss most of these methods incur is the money spent on them! What's more, many of these diets are basically unsound and could cause important nutritional deficiencies.

So how do you tell a good diet from a bad one?

Quite simply, a reducing diet that is worth its salt must:

• satisfy all nutrient needs except energy - in other words, it must include minimum daily amounts recommended for each of the five food groups
• supply at least 4200 kilojoules (1000 calories) per day - or no less than 50% of an individual's average energy requirements
• include a balanced eating pattern which does not alter significantly from day to day
• fit in with your individual tastes, habits and lifestyle
• be practical (in other words, it must include foods that are readily available) and socially acceptable
• promote balanced eating habits and encourage you to establish a long-term healthy eating pattern
• improve your overall health.

Diets that promise a weight loss of more than ¹/₂ to 1¹/₂ kg per week (or more than 1% of total body weight per week), or which have you feeling faint with hunger most of the time, should be avoided.

Effects of dieting on eating control

Dieting causes problems with the control of food intake. Attempting to diet results in increased calorie consumption in certain situations. Dieters feel more out of control than non- dieters, and experience chaotic eating patterns.

Dieters aim to eat less and to control their food intake. Women often attribute their perceived 'large size' to their inability to eat appropriately, believing that the reason why they are over their desired weight is because they overeat. Women look at other people's eating behaviour and believe that they eat less and at different times and understand their own behaviour in terms of loss of control. Dieting is regarded as a means to impose self- control and an external structure on their food intake. However, there is no evidence to suggest that, before dieting, women who are over their desired weight eat any differently or experience more episodes of loss of control than women who are at their desired weight. There is no evidence to suggest that larger women are more out of control than their thinner counterparts, or that women who decide to diet have experienced more overeating than those who don't.

However, there is evidence to suggest that dieting increases episodes of both perceived and actual loss of control. Imposing the dieting structure on food intake appears to have the opposite to the desired effect.

Perceived loss of control

Because of the limitations set by the diet, any food which is eaten beyond these limits is regarded as overeating and attributed to loss of control. Eating which would usually be seen as a large meal, a special occasion or a treat is regarded as overeating and indicative of lost control. The urge to eat which would usually be regarded as hunger is registered in terms of craving, and giving in to this urge is regarded as a weakness.

One woman said: 'When I start to diet I want to eat things I shouldn't eat. I want to buy fattening foods when I know I am on a diet.' She did not eat any more than before she began to diet; however, desires to eat certain foods are perceived as being a problem.

Actual loss of control

One of the main effects of dieting is that it contributes to actual loss of control over eating. Dieting causes increases in the preoccupation with food, making food more attractive, it alters responses to food, resulting in certain foods becoming 'forbidden', which triggers specific states of mind, and it causes mood changes. All these contribute to actual loss of control and result in the dieter eating more than she would have if she hadn't dieted in the first place.

One woman said that she found the diet very difficult. 'I feel depressed about dieting. I overate to start off with, felt depressed and then ate more. I felt that eating would make me happier, but I just felt guilty and wanted more to eat.' Dieting resulted in her eating more than if she had not tried to diet in the first place.

Another woman said: 'I can't cope at the moment with the feelings of deprivation that I get when I go on a diet. It wells up inside me and I panic and eat.' The diet made her feel deprived, and so even though she wasn't eating less, she then ate more to compensate.

Dieting aims to control food intake and to reduce food consumption. It aims to impose a structure on the dieter's behaviour and to result in weight loss. It doesn't appear to achieve either of these aims. The cognitive and emotional changes which occur as a response to dieting undermine attempts at eating less, and cause overeating, the very behaviour dieters are trying to avoid.

If I were thinner everything would be all right

Dieters diet to become thinner, and being thinner is seen as the way to make life better.

Thinness has many meanings beyond that of simply weighing less. On the following page is a questionnaire to identify what being thin means to you.

Circle the answer that best applies to you.

How often do you think, If I were thinner...

• I would be happier NEVER/SOMETIMES/OFTEN
• I would be more attractive NEVER/SOMETIMES/OFTEN
• I would be more popular NEVER/SOMETIMES/OFTEN
• I would be more confident NEVER/SOMETIMES/OFTEN
• I would be better at my job NEVER/SOMETIMES/OFTEN
• I would be more successful NEVER/SOMETIMES/OFTEN
• I would be more outgoing NEVER/SOMETIMES/OFTEN
• I would feel more in control NEVER/SOMETIMES/OFTEN
• I could show the world that Ihave will-power NEVER/SOMETIMES/OFTEN
• I would feel more assertive NEVER/SOMETIMES/OFTEN

Score the questions by awarding yourself one point for each 'never', two points for each 'sometimes' and three points for each 'often', then add up all your scores. The highest score possible is thirty and the lowest is ten.

The questionnaire illustrates how important being thin is, and how many other changes you expect from thinness other than simply weighing less. A high score suggests that you expect many changes.

If you diet because you feel that being thin offers a solution to many of life's problems, then it is necessary to put being thin into perspective. If you think that being thinner will change your life, then challenge these thoughts.

This is difficult because the association between thinness and a good life is intrinsic to our perception of ourselves. However, with a degree of effort and dedication it is possible to realise how ridiculous this association is.

The following exercise aims to highlight how it is possible to dissociate thinness from all the other supposedly related qualities.

Think of all the things you, would be able to achieve or feel if you could weigh less. To do this, picture yourself as you are at the moment and then as you would be if you were thinner and try and evaluate what the difference would be. Make a list of these differences, and next to each item write down all the possible reasons why this may not be the case.

Overleaf is a list of some of the possible meanings of being thinner and a reason why thinness does not have to have this meaning.

Thinness and attractiveness

We believe that if only we were thinner we would be more attractive. But how thin do we have to be before suddenly becoming attractive? Most women who diet would be considered as thin by everyone else anyway. But they still feel that being thinner would be an advantage. Dieting makes you miserable, preoccupied with food and weight, feel a failure — none of which are attractive qualities. A failed dieter can feel useless and lacking in will-power. Attractiveness is about liking yourself and presenting a likeable person to the outside world. Dieting detracts, not adds, to your attractiveness.

If you do lose weight, will this make you more attractive? What weight will this be, or will you always feel that if only you could be that bit thinner you could be more attractive? Look at the people around you. Are the thinner people more attractive? Do your thinner friends feel more attractive? Attractiveness is about using your body in a positive way and it's about feeling confident with your body. Being thinner does not create this, but your attitude to yourself does.

Thinness and success

Seeing weight loss as the way to success is self-defeating. Trying to diet undermines any feelings of success because weight loss is so difficult. Dieting is associated with feelings of failure which generalise to other areas of your life. Feeling a failure is not the way to succeed. Constant attempts at dieting can contribute to low self-esteem which can actively prevent success. Why spend so much time trying to lose weight, and feeling bad when it does not happen? Success in dieting is very difficult, so why chose weight loss as the area for success?

And if you do lose weight, will you be more successful? Or will you simply be thinner?

Thinness and happiness

We are sold the message that thinness is happiness, so we try to become thin. Whatever size we are to start with we still want to be thinner. But getting thinner is difficult, it is depressing and can be a miserable way of life. If we never achieve the goal of gettingthinner, we are constantly disappointed and annoyed with ourselves. Being disappointed and annoyed is not the way to be happy. And even if we achieve the desired weight loss, thin people are no happier than their larger counterparts because thin people still want to be thinner.

Happiness is about liking ourselves and not being constantly critical. It is about feeling positive and in control and proud of what we have to offer. Dieting is about the opposite. Trying to be thin creates a state of constant self-criticism, it is a difficult task and generates a negative view of who we are at the present while focusing on who we could be in the elusive future.

Thinness and control

We believe that 'If only I could control my weight then I would be able to control my life'. But weight naturally controls itself and is regulated around a fairly stable set point. Dieting imposes an unnatural form of control upon something which is self- regulating. Constantly trying to eat less, sometimes succeeding and sometimes overeating, undermines this control and can leave the dieter less in control than she was before she started to diet. In the short term dieting may provide a structure, but in the long term constantly trying to limit your food intake can create chaos. And feeling out of control of your eating can generalise to other areas of your life. Trying to be thin can undermine, not add to, your sense of control.

So if we realise why we diet, and can find a substitute for dieting, we can stop dieting.

Understanding Your Relationship with Food

That society discriminates against overweight people is a fact of life. It starts in school, and anyone who has been larger than his classmates can tell tales of the rejection and ridicule that come out from the mouths of thinner peers. That the prejudice is widespread in the business world, too, is well documented. And countless men and women can tell you that their weights and their dissatisfaction with their bodies keep them from getting close to other people or sometimes even enjoying sex with their spouses.

Being overweight takes a toll on your self-esteem and the way you relate to others. Self-esteem is key to your relationship with food, too. If you don't feel good about your body, you may not feel good about the food you put into it. And without a healthy relationship with food, your body image will plummet. It's a Catch-22 situation.

This section is about body image: finding out how to feel good about who you are, regardless of your body size or shape.

Just whose ideal are you anyway

According to research conducted by the Kellogg's Corporation (published by the Opinion Research Corporation), women in the United States determine their ideal body size and shape from the way models in television ads and fashion magazines look, not from the way women look in real life. Women are obsessed about their weight, fueled by a society that sets an artificial standard for beauty based on the way models look. Women also believe that how they're described by men and by each other promotes the notion of an ideal woman, whom they will never be able to match.

The Kellogg's survey found that women tend to focus on the specific body parts they don't like, not on their bodies as a whole. They may like their hair color and think that they're tall enough, but only 14 percent of the women surveyed were happy with their weights. Almost a third of the women surveyed said that a woman's ideal weight is between 110 and 125 pounds, and half said that a weight between 126 and 145 is ideal. But in reality, there is no such thing as an ideal weight, because people are genetically programmed to be different shapes and sizes.

That so many women are confused about what they should look like isn't surprising. The role models look nothing like the average woman. In fact, if you think about it, it's the fashion models who don't conform to the standards of the average adult, not the other way around. Only 1 in 40,000 women has a supermodel like body - 40,000! That ratio means that out of the entire population of Indiana, a state with more than 6 million residents, only 152 women have model-perfect bodies!

The following table compares the average American woman to the media's and society's ideals, demonstrating that when it comes to selling clothes, life doesn't imitate art. In fact, it's getting farther away from it. Marline Morn, the pinup girl of the 1950s, wore a size 14 dress - the same size that many women in the United States wear today. This isn't to say that a size 14 is healthy for all women. It depends on your height and other factors. If you're 5 feet tall and you wear a size 14, then you're probably unhealthy. But if you're 5 feet 6 inches tall, a size 14 may be okay, even though you'd still be considered on the large side by society's standards. The scary thing is that today's models, who are usually at least 5 feet 8 inches or taller, typically wear only a size 6. And between 1955 and 1998, the measurements of a Playboy centerfold dropped by 35 percent.

Female Role Models
	Average Man	Mannequin	Model
Dress size	12	6	6
Weight	152		120
Height	5'9"	6'	6'
Body measurements	37-34-40	34-25-34	34-25-34
	37 waist	30 waist	30 waist
Percent body fat	34		28
BMX (Body Mass Index)	26.1		17.2

This phenomenon isn't unique to women. Even male models and mannequins are smaller than the average American male. Table illustrates the differences.

Male Role Models
	Average Man	Mannequin	Model
Pant size	37	30	30
Suit size	42 regular	40 regular	40 regular
Weight	180		145-150
Height	5'9"	6'	6'
Body measurements	41 chest	39 chest	39 chest
	37 waist	30 waist	30 waist
Percent body fat	22		15
BMX (Body Mass Index)	26.6		205

The important point to take away from these tables is that you need to stop comparing yourself and your weight to unrealistic numbers. Even if you diet religiously, you probably won't end up with the body of a super model. Stop beating yourself up for not meeting standards that are clearly unrealistic and concentrate on the things you can do to make your body healthy. And begin to feel good about your progress, too.

One study of obese women - their average weight was about 218 pounds - conducted by Foster and others at the University of Pennsylvania did just that [see the Journal of Consulting and clinical Psychology 65(1), 1997]. The women were asked to write down their goal weights and then the weight-loss amounts that they would consider "acceptable" and "disappointing." Most women set their goals 32 percent lower than their starting points (about 72 pounds). "Acceptable" was about a 25 percent loss (55 pounds), and the women considered a weight loss of only 17 percent of their starting weights (38 pounds) to be "disappointing."

After 6 months of dieting, exercising, and behavior modification and 6 months of maintenance, the average weight loss that these women were able to maintain was only 16 percent of their defined starting weights (or 36 pounds). They hadn't even reached their "disappointing" weight_ Did they fail? No. These women can be called successful for several reasons: A weight loss of just 10 percent is enough to bring down high blood pressure, lower cholesterol and triglycerides, and improve overall health. And these women beat that goal by 6 percentage points.