Obesity is define as an abnormal increase of fat in the subcutaneous connective tissue.

This means a lot of fat cells are gathered in the tissue under skin. Eating greater amounts of food than the body can use for energy causes this deposition. In 2010, around 43 million children under five were overweight. Once considered a high-income country problem, overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings. Close to 35 million overweight children are living in developing countries and 8 million in developed countries Evidence is now emerging to suggest that the prevalence of overweight and obesity is increasing word wide at an alarming rate. Both developed and developing countries are affected. More over, as the problem appears to be increasing rapidly in children as well in adults, the true health consequences may only become perceivable in the future. NURSING PRIORITIES 1.Assist patient to identify a workable method of weight control incorporating healthful foods. 2.Promote improved self-concept, including body image, self esteem. 3.Encourage health practices to provide for weight control throughout life. DISCHARGE GOALS 1.Healthy patterns for eating and weight control identified. 2.Weight loss toward desired goal established. 3.Positive perception of self verbalized. 4.Plans developed for future weight control. 5.Plan in place to meet needs after discharge. NURSING DIAGNOSIS: Nutrition: imbalanced more than body requirements May be related to Food intake that exceeds body needs Psychosocial factors Socioeconomic status Possibly evidenced by Weight of 20% or more over optimum body weight; excess body fat by skinfold/other measurements Reported/observed dysfunctional eating patterns, intake more than body requirements Desired Outcomes Identify inappropriate behaviors and consequences associated with overeating or weight gain. Demonstrate change in eating patterns and involvement in individual exercise program. Display weight loss with optimal maintenance of health. Obesity Nursing Care Plans(NCP)-Nutrition: imbalanced more than body requirements Actions / Interventions Rationale Identifies/influences choice of some interventions. Review individual cause for obesity, e.g., organic or nonorganic. Provides the opportunity for the individual to focus on/internalize a realistic picture of the amount of food ingested and corresponding eating habits/feelings. Identifies patterns requiring change and/or a base on which to tailor the dietary program. Helps identify when patient is eating to satisfy an emotional need, rather than physiological hunger. Although there is no basis for recommending one diet over another, a good reducing diet should contain foods from all basic food groups with a

Implement/review daily food diary, e.g., caloric intake, types and amounts of food, eating habits. Discuss emotions/events associated with eating. Formulate an eating plan with the patient, using knowledge of individuals height, body build, age, gender, and

individual patterns of eating, energy, and nutrient requirements. Determine which diets and strategies have been used, results, individual frustrations/factors interfering with success.

focus on low-fat intake and adequate protein intake to prevent loss of lean muscle mass. It is helpful to keep the plan as similar to patients usual eating pattern as possible. A plan developed with and agreed to by the patient is more likely to be successful. Elimination of needed components can lead to metabolic imbalances, e.g., excessive reduction of carbohydrates can lead to fatigue, headache, instability/weakness, and metabolic acidosis (ketosis), interfering with effectiveness of weight loss program. Denying self by excluding desired/favorite foods results in a sense of deprivation and feelings of guilt/failure when individual succumbs to temptation. These feelings can sabotage weight loss. The patient who binges experiences guilt about it, which is also counterproductive because negative feelings may sabotage further weight loss efforts. Reasonable weight loss (12 lb/wk) results in more lasting effects. Excessive/rapid loss may result in fatigue and irritability and ultimately lead to failure in meeting goals for weight loss. Motivation is more easily sustained by meeting stair-step goals. Provides information about effectiveness of therapeutic regimen and visual evidence of success of patients efforts. (During hospitalization for controlled fasting, daily weighing may be required. Weekly weighing is more appropriate after discharge.) Exercise furthers weight loss by reducing appetite; increasing energy; toning muscles; and enhancing cardiac fitness, sense of well-being, and accomplishment. Commitment on the part of the patient enables the setting of more realistic goals and adherence to the plan. Signals of hunger and fullness often are not recognized, have become distorted, or are ignored.

Emphasize the importance of avoiding fad diets. Discuss need to give self permission to include desired/craved food items in dietary plan.

Be alert to binge eating and develop strategies for dealing with these episodes, e.g., substituting other actions for eating.

Identify realistic increment goals for weekly weight loss.

Weigh periodically as individually indicated, and obtain appropriate body measurements.

Determine current activity levels and plan progressive exercise program (e.g., walking) tailored to the individuals goals and choice.

Develop an appetite re-education plan with patient. Reducing tension provides a more relaxed eating atmosphere and encourages more leisurely eating patterns. This is important because a period of time is required for the appestat mechanism to know the stomach is full. Techniques that modify behavior may be helpful in avoiding diet failure.

Emphasize the importance of avoiding tension at mealtimes and not eating too quickly.

Encourage patient to eat only at a table or designated eating place and to avoid standing while eating.

Discuss restriction of salt intake and diuretic drugs if used.

Water retention may be a problem because of increased fluid intake and fat metabolism. Individual intake can be calculated by several different formulas, but weight reduction is based on the basal caloric requirement for 24 hr, depending on patients sex, age, current/desired weight, and length of time estimated to achieve desired weight. Note: Standard tables are subject to error when applied to individual situations, and circadian rhythms/lifestyle patterns need to be considered. May be used with caution/supervision at the beginning of a weight loss program to support patient during stress of behavioral/lifestyle changes. They are only effective for a few weeks and may cause problems of addition in some peopl May be necessary when hypothyroidism is present. When no deficiency is present, replacement therapy is not helpful and may actually be harmful. Note: Other hormonal treatments, such as human chorionic gonadrotropin (HCG), although widely publicized, have no documented evidence of value.

Reassess calorie requirements every 24 wk; provide additional support when plateaus occur. Provide medications as indicated: Appetite-suppressant drugs, e.g., diethylpropion (Tenuate), mazindol (Sanorex), Sibutramine (Meridia);

Hormonal therapy, e.g., thyroid (Euthroid), levothyroxine (Synthroid);

Obesity is a global problem that plagued the world today. Lifestyle changes including the propensity to consume foods high in fat is a factor contributing to obesity. The majority of obesity is due to overeating. It is considered the primary obesity. And others, caused by disease or hormonal disorders or genetic disorders that are in the secondary obesity. Efforts to streamline the body have been conducted, including the dietary, lifestyle changes, medication and surgery to reduce fat or remove some of the intestines. Food intake should always be sufficient to meet the needs of the body's metabolism and is also not excessive, causing obesity. Also, because the foods contain different proportions of protein, carbohydrate, and fat are different, then a reasonable balance must be maintained among all of these foods so that all segments of the body's metabolic system can be supplied with the materials needed. Definition of Obesity Obesity is defined as the excess accumulation of body fat, at least 25% of the average weight for age, sex, and height. Obesity is also a pathological condition with the presence of an excessive accumulation of fat than is necessary for bodily functions. Nutritional problems due to excess calories usually accompanied by excess fat and protein, fiber and micro-nutrient excess. Nutrients that would be a risk factor for the occurrence of various types of degenerative diseases such as diabetes, hypertension, coronary heart disease, rheumatism and various types of malignant disease (cancer) and other health problems that would require a very large medical expenses. Clinical Manifestations of Obesity Obesity can occur in all age groups, but usually occurs in children and adolescents in the period ahead of teens, especially girls, in addition to body weight increased rapidly, as well as more

rapid growth and development (apparently if you check the age of the bones), so that ultimately adolescents rapidly grow and mature it will have a relatively low height compared to children her own age. Body shape, appearance and expression in patients with obesity: a. Thighs look great, especially on the proximal, relatively small hands with fingers shaped tapered. b. Emotional expression disorder, nose and mouth appears to be relatively small with a double chin shaped. c. Chest and enlarged breasts, breast forms similar to the breast that had been grown in male children such circumstances lead to an unpleasant feeling. d. Abdomen, and hung bulge, similar to the form of pendulum clocks, there are sometimes white or purple strie. e. Upper arms enlarged, the enlargement of the upper arm is usually found in the biceps and triceps. In people, common symptoms of emotional distress which may be the cause or circumstances of obesity.

Nursing Care Plan for Obesity Nursing Assessment for Obesity Physical Examination 1. Activity / Rest symptoms: - Weakness, drowsiness trended - Inability / lack of desire to be active or exercise regularly - Dyspnea with work signs: - Increased heart rate / breathing with activity 2. circulation symptoms: - History of cultural factors / lifestyle affects food choices - Weight loss can / can not be accepted as a problem - Eating may relieve feelings of pleasure, such as loneliness, frustration, boredom - Prisoners of the closest people to lose weight 3. Food / fluid symptoms: - Digesting food with excess / normal - Experiment with different types of diet with little results - History repeated and decreased weight gain

signs: - Weight loss is not right with height - Endormofik body type (soft / about) - Failed to determine the input of food to reduce demand (eg, changes in lifestyle from active to not exercise, aging) 4. Pain / Comfort Symptoms: Pain / discomfort in the joints that support weight loss or spine 5. Breathing Symptoms: Dyspnea Signs: cyanosis, respiratory distress 6. Sexuality Symptoms: menstrual disorders, amenorrhea 7. Education / learning symptoms: - Problems can be either lifetime or in connection with life events - Family history of obesity - Health problems that accompany diabetes, including hypertension, gallbladder disease and cardiovascular disease, hypothyroidism

What Causes Overweight and Obesity? Lack of Energy Balance A lack of energy balance most often causes overweight and obesity. Energy balance means that your energy IN equals your energy OUT. Energy IN is the amount of energy or calories you get from food and drinks. Energy OUT is the amount of energy your body uses for things like breathing, digesting, and being physically active. To maintain a healthy weight, your energy IN and OUT don't have to balance exactly every day. It's the balance over time that helps you maintain a healthy weight.

The same amount of energy IN and energy OUT over time = weight stays the same More energy IN than energy OUT over time = weight gain More energy OUT than energy IN over time = weight loss

Overweight and obesity happen over time when you take in more calories than you use. Other Causes An Inactive Lifestyle Many Americans aren't very physically active. One reason for this is that many people spend hours in front of TVs and computers doing work, schoolwork, and leisure activities. In fact, more than 2 hours a day of regular TV viewing time has been linked to overweight and obesity. Other reasons for not being active include: relying on cars instead of walking, fewer physical demands at work or at home because of modern technology and conveniences, and lack of physical education classes in schools.

People who are inactive are more likely to gain weight because they don't burn the calories that they take in from food and drinks. An inactive lifestyle also raises your risk for coronary heart disease, high blood pressure, diabetes, colon cancer, and other health problems. Environment Our environment doesn't support healthy lifestyle habits; in fact, it encourages obesity. Some reasons include:

Lack of neighborhood sidewalks and safe places for recreation. Not having area parks, trails, sidewalks, and affordable gyms makes it hard for people to be physically active. Work schedules. People often say that they don't have time to be physically active because of long work hours and time spent commuting. Oversized food portions. Americans are exposed to huge food portions in restaurants, fast food places, gas stations, movie theaters, supermarkets, and even at home. Some of these meals and snacks can feed two or more people. Eating large portions means too much energy IN. Over time, this will cause weight gain if it isn't balanced with physical activity. Lack of access to healthy foods. Some people don't live in neighborhoods that have supermarkets that sell healthy foods, such as fresh fruits and vegetables. Or, for some people, these healthy foods are too costly. Food advertising. Americans are surrounded by ads from food companies. Often children are the targets of advertising for high-calorie, high-fat snacks and sugary drinks. The goal of these ads is to sway people to buy these high-calorie foods, and often they do.

Genes and Family History Studies of identical twins who have been raised apart show that genes have a strong influence on a person's weight. Overweight and obesity tend to run in families. Your chances of being overweight are greater if one or both of your parents are overweight or obese. Your genes also may affect the amount of fat you store in your body and where on your body you carry the extra fat. Because families also share food and physical activity habits, a link exists between genes and the environment. Children adopt the habits of their parents. A child who has overweight parents who eat highcalorie foods and are inactive will likely become overweight too. However, if the family adopts healthy food and physical activity habits, the child's chance of being overweight or obese is reduced. Health Conditions Some hormone problems may cause overweight and obesity, such as underactive thyroid (hypothyroidism), Cushing's syndrome, and polycystic ovarian syndrome (PCOS). Underactive thyroid is a condition in which the thyroid gland doesn't make enough thyroid hormone. Lack of thyroid hormone will slow down your metabolism and cause weight gain. You'll also feel tired and weak. Cushing's syndrome is a condition in which the body's adrenal glands make too much of the hormone cortisol. Cushing's syndrome also can develop if a person takes high doses of certain medicines, such as prednisone, for long periods. People who have Cushing's syndrome gain weight, have upper-body obesity, a rounded face, fat around the neck, and thin arms and legs. PCOS is a condition that affects about 510 percent of women of childbearing age. Women who have PCOS often are obese, have excess hair growth, and have reproductive problems and other health issues. These problems are caused by high levels of hormones called androgens. Medicines

Certain medicines may cause you to gain weight. These medicines include some corticosteroids, antidepressants, and seizure medicines. These medicines can slow the rate at which your body burns calories, increase your appetite, or cause your body to hold on to extra water. All of these factors can lead to weight gain. Emotional Factors Some people eat more than usual when they're bored, angry, or stressed. Over time, overeating will lead to weight gain and may cause overweight or obesity. Smoking Some people gain weight when they stop smoking. One reason is that food often tastes and smells better after quitting smoking. Another reason is because nicotine raises the rate at which your body burns calories, so you burn fewer calories when you stop smoking. However, smoking is a serious health risk, and quitting is more important than possible weight gain. Age As you get older, you tend to lose muscle, especially if you're less active. Muscle loss can slow down the rate at which your body burns calories. If you don't reduce your calorie intake as you get older, you may gain weight. Midlife weight gain in women is mainly due to aging and lifestyle, but menopause also plays a role. Many women gain about 5 pounds during menopause and have more fat around the waist than they did before. Pregnancy During pregnancy, women gain weight to support their babies growth and development. After giving birth, some women find it hard to lose the weight. This may lead to overweight or obesity, especially after a few pregnancies. Lack of Sleep Research shows that lack of sleep increases the risk of obesity. For example, one study of teenagers showed that with each hour of sleep lost, the odds of becoming obese went up. Lack of sleep increases the risk of obesity in other age groups as well. People who sleep fewer hours also seem to prefer eating foods that are higher in calories and carbohydrates, which can lead to overeating, weight gain, and obesity. Sleep helps maintain a healthy balance of the hormones that make you feel hungry (ghrelin) or full (leptin). When you don't get enough sleep, your level of ghrelin goes up and your level of leptin goes down. This makes you feel hungrier than when you're well-rested. Sleep also affects how your body reacts to insulin, the hormone that controls your blood glucose (sugar) level. Lack of sleep results in a higher than normal blood sugar level, which may increase your risk for diabetes.

1. What is known about the relationship between obesity and cancer? Obesity is associated with increased risks of the following cancer types, and possibly others as well:
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Esophagus Pancreas Colon and rectum Breast (after menopause) Endometrium (lining of the uterus)

o o o

Kidney Thyroid Gallbladder One study, using NCI Surveillance, Epidemiology, and End Results (SEER) data, estimated that in 2007 in the United States, about 34,000 new cases of cancer in men (4 percent) and 50,500 in women (7 percent) were due to obesity. The percentage of cases attributed to obesity varied widely for different cancer types but was as high as 40 percent for some cancers, particularly endometrial cancer and esophageal adenocarcinoma. A projection of the future health and economic burden of obesity in 2030 estimated that continuation of existing trends in obesity will lead to about 500,000 additional cases of cancer in the United States by 2030. This analysis also found that if every adult reduced their BMI by 1 percent, which would be equivalent to a weight loss of roughly 1 kg (or 2.2 lbs) for an adult of average weight, this would prevent the increase in the number of cancer cases and actually result in the avoidance of about 100,000 new cases of cancer. Several possible mechanisms have been suggested to explain the association of obesity with increased risk of certain cancers:

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Fat tissue produces excess amounts of estrogen, high levels of which have been associated with the risk of breast, endometrial, and some other cancers. Obese people often have increased levels of insulin and insulin-like growth factor-1 (IGF-1) in their blood (a condition known as hyperinsulinemia or insulin resistance), which may promote the development of certain tumors. Fat cells produce hormones, called adipokines, that may stimulate or inhibit cell growth. For example, leptin, which is more abundant in obese people, seems to promote cell proliferation, whereas adiponectin, which is less abundant in obese people, may have antiproliferative effects. Fat cells may also have direct and indirect effects on other tumor growth regulators, including mammalian target of rapamycin (mTOR) and AMP-activated protein kinase. Obese people often have chronic low-level, or subacute, inflammation, which has been associated with increased cancer risk. Other possible mechanisms include altered immune responses, effects on the nuclear factor kappa beta system, and oxidative stress.

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2. What is known about the relationship between obesity and breast cancer? Many studies have shown that overweight and obesity are associated with a modest increase in risk of postmenopausal breast cancer. This higher risk is seen mainly in women who have never used menopausal hormone therapy (MHT) and for tumors that express both estrogen and progesterone receptors. Overweight and obesity have, by contrast, been found to be associated with a reduced risk of premenopausal breast cancer in some studies. The relationship between obesity and breast cancer may be affected by the stage of life in which a woman gains weight and becomes obese. Epidemiologists are actively working to address this question. Weight gain during adult life, most often from about age 18 to between the ages of 50 and 60, has been consistently associated with risk of breast cancer after menopause. The increased risk of postmenopausal breast cancer is thought to be due to increased levels of estrogen in obese women. After menopause, when the ovaries stop producing hormones, fat tissue becomes the most important source of estrogen. Because obese women have more fat tissue, their estrogen levels are higher, potentially leading to more rapid growth of estrogen-responsive breast tumors. The relationship between obesity and breast cancer risk may also vary by race and ethnicity. There is limited evidence that the risk associated with overweight and obesity may be less among African American and Hispanic women than among white women.

3. What is known about the relationship between obesity and endometrial cancer? Overweight and obesity have been consistently associated with endometrial cancer, which is cancer of the lining of the uterus. Obese and overweight women have two to four times the risk of developing this disease than women of a normal weight, regardless of menopausal status. Many studies have also found that the risk of endometrial cancer increases with increasing weight gain in adulthood, particularly among women who have never used MHT. Although it has not yet been determined why obesity is a risk factor for endometrial cancer, some evidence points to a role for diabetes, possibly in combination with low levels of physical activity. High levels of estrogen produced by fat tissue are also likely to play a role. 4. What is known about the relationship between obesity and colorectal cancer? Among men, a higher BMI is strongly associated with increased risk of colorectal cancer. The distribution of body fat appears to be an important factor, with abdominal obesity, which can be measured by waist circumference, showing the strongest association with colon cancer risk. An association between BMI and waist circumference with colon cancer risk is also seen in women, but it is weaker. Use of MHT may modify the association in postmenopausal women. A number of mechanisms have been proposed to account for the association of obesity with increased colon cancer risk. One hypothesis is that high levels of insulin or insulin-related growth factors in obese people may promote colon cancer development. High BMI is also associated with rectal cancer risk, but the increase in risk is more modest. 5. What is known about the relationship between obesity and kidney cancer? Obesity has been consistently associated with renal cell cancer, which is the most common form of kidney cancer, in both men and women. The mechanisms by which obesity may increase renal cell cancer risk are not well understood. High blood pressure is a known risk factor for renal cell cancer, but the relationship between obesity and kidney cancer is independent of blood pressure status. High levels of insulin may play a role in the development of the disease. 6. What is known about the relationship between obesity and esophageal cancer? Overweight and obese people are about twice as likely as people of healthy weight to develop a type of esophageal cancer called esophageal adenocarcinoma. Most studies have observed no increased risk, or even a decline in risk, with obesity for the other major type of esophageal cancer, squamous cell cancer. The mechanisms by which obesity may increase risk of esophageal adenocarcinoma are not well understood. However, overweight and obese people are more likely than people of normal weight to have a history of gastroesophageal reflux disease or Barrett esophagus, which are associated with an increased risk of esophageal adenocarcinoma. It is possible that obesity exacerbates the esophageal inflammation that is associated with these conditions. 7. What is known about the relationship between obesity and pancreatic cancer? Many studies have reported a slight increase in risk of pancreatic cancer among overweight and obese individuals. Waist circumference may be a particularly important factor in the association of overweight and obesity with pancreatic cancer. 8. What is known about the relationship between obesity and thyroid cancer? Increasing weight has been found to be associated with an increase in the risk of thyroid cancer. It is unclear what the mechanism might be. 9. What is known about the relationship between obesity and gallbladder cancer?

The risk of gallbladder cancer increases with increasing BMI. The increase in risk may be due to the higher frequency of gallstones, a strong risk factor for gallbladder cancer, in obese individuals. 10. What is known about the relationship between obesity and other cancers? The relationship between obesity and prostate cancer has been studied extensively. The results of individual studies do not suggest a consistent association between obesity and prostate cancer. However, when the data from multiple studies are pooled, analyses show that obesity may be associated with a very slight increase in the risk of prostate cancer. In addition, several studies have found that obese men have a higher risk of aggressive prostate cancer than men of healthy weight. Generally, risk of prostate cancer has been linked to levels of certain hormones and growth factors, especially IGF-1. Some studies have shown a weak association between increasing BMI and risk of ovarian cancer, especially in premenopausal women, although other studies have not found an association. As with some other cancers, an association between ovarian cancer and obesity may reflect increased levels of estrogens. Some evidence links obesity to liver cancer and to some types of lymphoma and leukemia, but additional studies are needed to confirm these associations. 11. Does avoiding weight gain or losing weight decrease the risk of cancer? The most conclusive way to test whether avoiding weight gain or losing weight will decrease the risk of cancer is through a controlled clinical trial. A number of NIH-funded weight loss trials have demonstrated that people can lose weight and that losing weight reduces their risk of developing chronic diseases, such as diabetes, while improving their risk factors for cardiovascular disease. However, previous trials and the results of an NCI workshop have demonstrated that it would not be feasible to conduct a weight loss trial of cancer prevention. The reason is that the effect of weight loss on the prevention of other chronic diseases would be demonstratedand the trial consequently stopped so that the public could be informed of the benefitsbefore the effect on the prevention of cancer would become evident. Therefore, most data about whether losing weight or avoiding weight gain prevents cancer come mainly from cohort and case-control studies. Data from these types of studies, called observational studies, can be difficult to interpret because people who lose weight or avoid weight gain may be different in other ways from people who do not, just as obese people may differ from lean people in other ways than BMI. That is, it is possible that these other differences explain their different cancer risk. Nevertheless, many observational studies have shown that people who have a lower weight gain during adulthood have a lower risk of:
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Colon cancer Breast cancer (after menopause) Endometrial cancer A more limited number of observational studies have examined the relationship between weight loss and cancer risk, and a few have found decreased risks of breast cancer and colon cancer among people who have lost weight. However, most of these studies have not been able to evaluate whether the weight loss was intentional or related to underlying health problems. Stronger evidence comes from studies of patients who have undergone bariatric surgery to lose weight. Obese people who have bariatric surgery appear to have lower rates of obesity-related cancers than obese people who did not have bariatric surgery. It is important to note that whereas most lifestyle weight loss interventions result in weight losses of 7-10 percent of body weight, weight loss from bariatric surgery combined with lifestyle changes generally results in weight loss of 30 percent.

How to Lose Weight 1. Choose a low carb diet 2. Eat when hungry 3. Eat real food 4. Measure your progress wisely 5. Be patient 6. Women: Avoid fruit 7. Men: Avoid beer 8. Avoid artificial sweeteners 9. Review any medications 10.Stress less, sleep more 11.Eat less dairy products and nuts 12.Supplement vitamins and minerals 13.Exercise smart 1. Choose a Low Carb Diet If you want to lose weight you should start by avoiding sugar and starch (like bread). This is an old idea: For 150 years or more there have been an infinite number of weight loss diets based on eating less carbs. Whats new is that at least 17 modern scientific studies have proven that, yes, low carb is the most effective way to lose weight. Obviously its still possible to lose weight on any diet just eat less calories than you burn, right? The problem with this simplistic advice is that it ignores the elephant in the room: Hunger. Most people dont like to just eat less, i.e. being hungry forever. Thats dieting for masochists. Sooner or later a normal person gives up and eats, hence the prevalence of yo-yo dieting. The main advantage of low carb diets is that they cause you to want to eat less. Even without counting calories most overweight people eat far fewer calories on low carb. Sugar and starch may increase your hunger, avoiding it may decrease your appetite to an adequate level. If your body wants to eat a suitable number of calories you dont need to bother counting them. Thus: Calories count, but you dont need to count them. A 2012 study also showed that people on a low carb diet burned 300 more calories a day while resting! According to one of the Harvard professors behind the study this advantage would equal the number of calories typically burned in an hour of moderate-intensity physical activity. Imagine that: an entire bonus hour of exercise every day, without actually doing it. Bottom line: A low carb diet reduces your hunger and makes it easier to eat less. And it might even increase your fat burning at rest. Study after study show that low carb is the smart way to lose weight and that it improves important health markers. How to do it: LCHF for beginners Inspiration: Weight loss stories on low carb

2. Eat When Hungry Dont be hungry. The most common mistake when starting a low carb diet: Reducing carb intake while still being afraid of fat. The problem is that carbs and fat are the bodys two main energy sources. It needs at least one. Low carb AND low fat = starvation Avoiding both carbs and fat results in hunger, cravings and fatigue. Sooner or later people cant stand it and give up. The solution is to eat more natural fat until you feel satisfied. For example: Butter Full-fat cream Olive oil Meat (including the fat) Fatty fish Bacon

Eggs Coconut oil, etc. Always eat enough, so that you feel satisfied, especially in the beginning of the weight-loss process. Doing this on a low carb diet means that the fat you eat will be burned as fuel by your body, as your levels of the fat storing hormone insulin will be lowered. Youll become a fat burning machine. Youll lose excess weight without hunger. Do you still fear saturated fat? Dont. The fear of saturated fat is based on obsolete theories that have been proven incorrect by modern science. Butter is fine food. However, feel free to eat mostly unsaturated fat (e.g. olive oil, avocado, fatty fish) if you prefer. This could be called a Mediterranean low carb diet and works great too. Eating when hungry also implies something else: If youre not hungry you probably dont need to eat yet. When on a LCHF diet you can trust your feelings of hunger and satiety again. Feel free to eat the number of times per day that works best for you. Some people eat three times a day and occasionally snack in between (note that frequent snacking could mean that youd benefit from adding fat to your meals, to increase satiety). Some people only eat once or twice a day and never snack. Whatever works for you. Just eat when youre hungry.

3. Eat Real Food Another common mistake when eating a low carb diet is getting fooled by the creative marketing of special low carb products. Remember: An effective low carb diet for weight loss should be based on real food, like this: Real food is what humans have been eating for thousands or (even better) millions of years, e.g. meat, fish, vegetables, eggs, butter, olive oil, nuts etc. If you want to lose weight youd better avoid special low carb products that are full of carbs. This should be obvious but creative marketers are doing all they can to fool you (and get your money). They will tell you that you can eat cookies, pasta, ice cream, bread and plenty of chocolate on a low carb diet, as long as you buy their brand. Theyre full of it. Dont be fooled. Here are three examples of what to avoid:

1. Atkins Fairy Tale Cookies 2. Julian Bakerys High Carb Low Carb Bread 3. The Dreamfields Pasta Fraud These three companies are not unique. There are thousands of similar companies trying to trick you into buying their low carb junk food, full of starch, sugar alcohols, flour, sweeteners and strange additives. Two simple rules to avoid this junk:

Dont eat low carb versions of high carb stuff, like cookies, bars, chocolate, bread, pasta or ice cream unless you are SURE of the ingredients (perhaps by making it yourself). Avoid products with the words net carbs on them. Thats usually just a way to fool you. Focus on eating good quality, minimally processed real food. Ideally the food you buy shouldnt even have a list of ingredients (or it should be very short). 4. Measure Your Progress Wisely Tracking successful weight loss is sometimes trickier than you think. Focusing only on weight and standing on the scale every day might be misleading, cause unnecessary anxiety and undermine your motivation for no good reason. The scale is not necessarily your friend. You may want to lose fat but the scale measures muscles, bone and internal organs as well. Gaining muscle is a good thing. Thus weight or BMI are imperfect ways to measure your progress. This is especially true if youre just

coming off a long period of semi-starvation (calorie counting), as your body may want to restore lost muscles etc. Starting weight training and gaining muscle can also hide your fat loss. Losing fat and gaining muscles is great progress, but you may miss it if you only measure your weight. Thus its smart to also track the disappearance of your belly fat, by measuring your waist circumference. Heres how to do it: 1. Put the measuring tape around your middle, like in the picture above, slightly above your belly button (to be exact: at the midpoint between your lowest rib and the top of your hipbone, at your side). 2. Exhale and relax (dont suck in your stomach). 3. Make sure the measuring tape is snug, without compressing your skin. 4. Measure Compare your result to these recommendations: Measuring progress I suggest measuring your waist circumference and weight before starting and then perhaps once a week or once a month. Write the results down so that you can track your progress. If you want you can measure more areas: around the buttocks, the chest, the arms, legs, etc. Note that your weight can fluctuate up and down several pounds from day to day, depending on fluid balance and stomach contents: Dont worry about short term changes, instead follow the long-term trend. If you can, try to check other important health markers when starting out, like these: Blood pressure Blood sugar (fasting blood glucose and/or HbA1c) Cholesterol profile (including HDL, triglycerides) These markers are almost universally improved on a low carb diet, even before major weight loss. Re-checking these health markers after a few months can be great for your motivation as theyll usually show that youre not just losing weight, youre gaining health too. PS: Dont have a measuring tape at home? Try these options: Use any piece of string. Wrap the string around your waist and clip off the extra on day one. This string could magically appear to become longer and longer every week you wrap it around your waist. Comparing how an old pair of jeans fit is also a decent option.

5. Be Patient It usually takes years or decades to gain a lot of weight. Trying to lose it all as quickly as possible by starving yourself rarely works well long-term, thats just the recipe for yo-yo dieting. To succeed you need something that works long term. What to aim for Its common to lose 2-6 pounds (1-3 kg) within the first week on a strict low carb diet, and then on average about one pound (0.5 kg) per week as long as you have a lot of weight remaining to lose. This translates into about 50 pounds (25 kilos) per year. Every 5 pounds of fat loss roughly equals 1 inch lost around the waist (1 kilo = 1 cm). Young males sometimes lose weight quicker than this, perhaps twice as fast. Post-menopausal women may lose it at a slightly slower pace. People eating a very strict low carb diet may lose weight quicker, as well as those who exercise a lot (a bonus). And if you have an enormous amount of excess weight to lose you could start out much faster.

As you get closer to your ideal weight the loss slows, until you stabilize at a weight that your body feels is right. Hardly anyone gets underweight on a low carb diet as long as they eat when hungry. Examples: Weight loss stories. Obesity Surgery Options - Gastric Ballooning The intragastric balloon device is not considered a permanent weight loss procedure. The intragastric balloon is primarily used to provide initial weight loss in a severely morbidly obese patient prior to definitive surgery to make it safer. It may also be used in patients who do not qualify for definitive surgery. An inflatable balloon is placed in the stomach, under guidance and vision using a gastroscope. It is placed under sedation, and does not usually require a full anaesthetic. All balloons are temporary, and need to be removed after a period of time as long term presence in the stomach may cause severe complications such as perforation of the stomach. There are newer models on the market that can stay in place for one year, instead of the usual 6 months. . Patients are usually very uncomfortable in the first week, and about 5-10% of patients require early removal due to intolerance of the device. Most of the weight loss occurs in the first few months, then slows down in most patients. Weight loss is variable but averages about 10% of initial weight at 6 months. (BMI drops by 4-9 kg/m2.) Long term results are lacking, especially with the yearlong balloons, but broadly speaking, if initial BMI < 30, about 1/3 will maintain weight loss; 1/3 will regain weight; and 1/3 will regain and put on further weight. Severe complications are rare (< 0.1%) but patient satisfaction is not great (60% satisfied). There is no insurance coverage for an intragastric balloon in NZ, nor in Australia at this point.(2011)

How can I make healthier food choices? The U.S. Department of Health and Human Services (HHS) and Department of Agriculture (USDA) offer tips for healthy eating in Dietary Guidelines for All Americans.

Focus on fruits. Eat a variety of fruits fresh, frozen, canned, or dried rather than fruit juice for most of your fruit choices. For a 2,000-calorie diet, you will need 2 cups of fruit each day. An example of 2 cups is 1 small banana, 1 large orange, and 1/4 cup of dried apricots or peaches. Vary your veggies. Eat more:
o o o

dark green veggies, such as broccoli, kale, and other dark leafy greens orange veggies, such as carrots, sweet potatoes, pumpkin, and winter squash beans and peas, such as pinto beans, kidney beans, black beans, garbanzo beans, split peas, and lentils

Get your calcium-rich foods. Each day, drink 3 cups of low-fat or fat-free milk. Or, you can get an equivalent amount of low-fat yogurt and/or low-fat cheese each day. 1.5 ounces of cheese equals 1 cup of milk. If you don't or can't consume milk, choose lactosefree milk products and/or calcium-fortified foods and drinks. Make half your grains whole. Eat at least 3 ounces of whole-grain cereals, breads, crackers, rice, or pasta each day. One ounce is about 1 slice of bread, 1 cup of breakfast cereal, or 1/2 cup of cooked rice or pasta. Look to see that grains such as wheat, rice, oats, or corn are referred to as "whole" in the list of ingredients. Go lean with protein. Choose lean meats and poultry. Bake it, broil it, or grill it. Vary your protein choices with more fish, beans, peas, nuts, and seeds. Limit saturated fats. Get less than 10 percent of your calories from saturated fatty acids. Most fats should come from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils. When choosing and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free. Limit salt. Get less than 2,300 mg of sodium (about 1 teaspoon of salt) each day.

How can physical activity help?

The new 2008 Physical Activity Guidelines for Americans state that an active lifestyle can lower your risk of early death from a variety of causes. There is strong evidence that regular physical activity can also lower your risk of:

Heart disease Stroke High blood pressure Unhealthy cholesterol levels Type 2 diabetes Metabolic syndrome Colon cancer Breast cancer Falls Depression

Regular activity can help prevent unhealthy weight gain and also help with weight loss, when combined with lower calorie intake. If you are overweight or obese, losing weight can lower your risk for many diseases. Being overweight or obese increases your risk of heart disease, high blood pressure, stroke, type 2 diabetes, breathing problems, osteoarthritis, gallbladder disease, sleep apnea (breathing problems while sleeping), and some cancers. Regular physical activity can also improve your cardiorespiratory (heart, lungs, and blood vessels) and muscular fitness. For older adults, activity can improve mental function. Physical activity may also help:

Improve functional health for older adults Reduce waistline size Lower risk of hip fracture Lower risk of lung cancer Lower risk of endometrial cancer Maintain weight after weight loss

Increase bone density Improve sleep quality

Health benefits are gained by doing the following each week: Moderate activity During moderate-intensity activities you should notice an increase in your heart rate, but you should still be able to talk comfortably. An example of a moderate-intensity activity is walking on a level surface at a brisk pace (about 3 to 4 miles per hour). Other examples include ballroom dancing, leisurely bicycling, moderate housework, and waiting tables. Vigorous activity If your heart rate increases a lot and you are breathing so hard that it is difficult to carry on a conversation, you are probably doing vigorous-intensity activity. Examples of vigorous-intensity activities include jogging, bicycling fast or uphill, singles tennis, and pushing a hand mower.

2 hours and 30 minutes of moderate-intensity aerobic physical activity or

1 hour and 15 minutes of vigorous-intensity aerobic physical activity or

A combination of moderate and vigorous-intensity aerobic physical activity and

Muscle-strengthening activities on 2 or more days

This physical activity should be in addition to your routine activities of daily living, such as cleaning or spending a few minutes walking from the parking lot to your office. If you want to lose a substantial (more than 5 percent of body weight) amount of weight, you need a high amount of physical activity unless you also lower calorie intake. This is also the case if you are trying to keep the weight off. Many people need to do more than 300 minutes of moderate-intensity activity a week to meet weight-control goals.

How you can increase your physical activity

If you normally...

Try this instead!

Park as close as possible to the store

Park farther away

Let the dog out back

Take the dog for a walk

Take the elevator

Take the stairs

Have lunch delivered

Walk to pick up lunch

Relax while the kids play

Get involved in their activity