Diaphragm

The diaphragm, which was developed in the 19th century, is one of the oldest methods of preventing pregnancy. It is a latex dome which is inserted into a woman's vagina prior to sexual intercourse. Silicon diaphragms are also available for women who are allergic to latex.

The dome is placed so that it covers the woman's cervix, and thus creates a barrier which prevents sperm from entering the uterus. A flexible spring, found in the rim of the diaphragm, prevents the dome from moving out of place during intercourse.

The device must be fitted by a health professional, to ensure the correct size diaphragm is selected, however once a diaphragm has been fitted, a woman can easily insert and remove the diaphragm before and after sexual intercourse. Diaphragms are typically used in conjunction with spermicides to increase their effectiveness.

The diaphragm prevents pregnancy by blocking the cervical opening (the entrance to the uterus). It therefore prevents sperm from entering the uterus. If a woman is fertile, (if she has a viable egg in her uterus) sperm must enter the uterus to fertilise the egg. The egg cannot be fertilised once it has been expelled into the vagina. Thus, by preventing sperm from entering the uterus, the diaphragm also prevents sperm coming into contact with and fertilising an egg.

Most women can safely use a diaphragm. However, some women may need to delay diaphragm use, and use a different method until they can safely use a diaphragm. These women include:

Those who have experienced a second trimester miscarriage or abortion should wait for at least six weeks before having a diaphragm fitted;Those who have recently given birth should wait until at least six weeks after childbirth to have a diaphragm fitted;Those with uterine abnormalities, including uterine prolapse. These women should discuss other contraceptive methods which might be more suitable with their healthcare provider so that they can choose another method;Those with latex allergies should not use a latex diaphragm. A silicon diaphragm may be appropriate, or the woman's healthcare provider will be able to give advice about other contraceptive methods.

In addition, a diaphragm should not be used by the following women

Women with a history of toxic shock syndrome - as diaphragms increase the risk of this condition. Women who have previously experienced toxic shock syndrome should discuss other, more appropriate contraceptive methods with their healthcare provider. They should also not use a cervical cap);Women who have a high risk of HIV - as a diaphragm is typically and most effectively used in conjunction with spermicide, and commonly available spermicides increase the risk of HIV infection, diaphragm use may increase a woman's HIV risk. Women who are at risk of HIV infection, for example those who have sex with partners whose HIV status is unknown, should use condoms if possible, as these reduce the risk of HIV infection and other sexually transmitted infections. (For some women find it is difficult to use condoms, for example if their partners refuse, there are pregnancy prevention methods which they can use without their partner's knowledge including hormonal contraceptive injections or implants, or a diaphragm. However, these methods do not protect against STIs.)

The Sex in Australia survey, a national study of sexual experiences and behaviours of Australians, reported that 0.9% of Australian women used a diaphragm.

When used correctly and in conjunction with spermicide during every act of sexual intercourse, the diaphragm prevents pregnancy in 94% of cases. However, most women do not use the diaphragm correctly every time they have sex, and as typically used, its effectiveness is much lower, around 84%.

It is very important for a diaphragm user to know how to use the device correctly. The health practitioner who fits the diaphragm will explain to the woman how a diaphragm is used, when they do the fitting.

Your health practitioner may recommend that new users begin by using their diaphragm in conjunction with another method. This is not because diaphragms do not work when they are first fitted, but rather to allow the woman to get used to inserting and removing the device correctly.

Diaphragm users should also be aware that:

For effective use, a diaphragm must be used prior to every act of intercourse;When a diaphragm is correctly inserted, the woman should not be able to feel it, even during intercourse;That diaphragms are most effective when used in conjunction with spermicides;That diaphragms have some side effects, the most common of which are urinary tract infections and vaginal discharges (see below).

Diaphragms must be fitted by a health professional. To select a diaphragm of the correct size, the health provider will conduct a pelvic examination. The health provider will first assess the woman's uterine cavity for any conditions which may make the diaphragm an unsuitable contraceptive method for the woman. The practitioner will then insert their index and middle finger into the woman's vagina to determine the required diaphragm size. A diaphragm will then be selected and inserted into the woman's vagina by the health practitioner, so that it covers the cervix. The practitioner will then check that the device fits correctly.

Women using diaphragms should be aware that a new diaphragm must be fitted after childbirth or a second trimester abortion. A new diaphragm should also be fitted if the woman experiences weight gain of >5kg. Women who do not need to have a new diaphragm refitted should replace their device every two years.

The diaphragm must be inserted prior to each act of intercourse. The health practitioner who fits the device will explain to women who are new users of the diaphragm, how to use the device. They may also give the women additional information about her genital organs, which will assist her to correctly insert the device. For example the health practitioner may show women the position of the cervix and pubic bone, using a diagram or model.

To correctly insert a diaphragm a woman should:

Begin by washing her hands;Check the diaphragm for cracks by holding it up to the light;Insert spermicide into the dome and around the rim of the diaphragm. It is important to always check the expiry date of spermicides before using them;Press the rims of the diaphragm together and insert the device deep into the vagina. The woman should choose a comfortable position for insertion, for example lying down;Insert her finger into her vagina and feel to check that the diaphragm is in the correct position, that it is covering the cervix. The cervix feels similar to the tip of the nose, and can be felt through the diaphragm;Remove and reinsert the diaphragm if she can feel it inside her vagina when she moves;If the woman has sexual intercourse several times, she should not remove and reinsert the diaphragm between sex acts. Rather the diaphragm should be left in place and additional spermicide added each time.

It is very important that the diaphragm is left in place for at least six hours following intercourse, but not for more than 24 hours. Leaving the diaphragm in place for more than 24 hours may result in unpleasant odour or vaginal discharge, and in rare cases, toxic shock syndrome. Once at least six hours has elapsed since the last sexual intercourse, a woman should remove the diaphragm according to the following procedure:

Before commencing, the woman should wash her hands;She should then insert a finger into her vagina until she feels the rim of the diaphragm;She should gently slide the finger under the rim and pull the diaphragm down and out. Care should be taken to ensure the diaphragm does not tear or break;Finally, she should wash the diaphragm using mild soap and water. The diaphragm should then be dried and stored in a cool dry place.

Benefits of the diaphragm include:

Use of a diaphragm is controlled by the woman and can be used without the knowledge or consent of her male partner;A diaphragm is effective even if it is inserted up to six hours before intercourse and thus can be inserted in advance to avoid disrupting sexual activity;Using a diaphragm may enable a woman to become more familiar with her genital organs, for example she will learn where her cervix is, and become more comfortable inserting her fingers into her vagina;The diaphragm is a relatively low cost contraceptive method, which does not require frequent visits to a medical practitioner.

Diaphragm use is commonly associated with urinary tract infections. This means that between 1-10% of users experience this side effects.

Candidiasis and bacterial vaginosis are uncommon side effects of diaphragm use, that is, they are side effects experienced by between 0.1%-1% of women who use the device. When the diaphragm is used in conjunction with a spermicide, these side effects are more likely.

Very rare cases of toxic shock syndrome have been reported in diaphragm users. Less that 0.01% of users experience this side effect.

Limitations of the diaphragm include:

The diaphragm must be inserted prior to every act of intercourse;The contraceptive protection of a diaphragm is much less effective than other methods (e.g. hormonal methods are typically >99% effective);To insert a diaphragm a woman must be comfortable with inserting her finger/s into her vagina. Women who have cultural or other objections to touching their genitals cannot use the method;Diaphragms do not provide adequate protection against sexually transmitted infections (STI). Women who have sexual partners of unknown STI status, should use male or female condoms if this is possible. Condoms offer high levels of protection against both pregnancy and STI.

For more information on different types of contraception, female anatomy and related health issues, see Contraception.

Association of Reproductive Health Professionals. Non-hormonal contraceptive methods- a quick reference guide for clinicians. 2007. [cited 2009, October 30] Available from: www.arhp.org/guide World Health Organisation. Family Planning: A global handbook for providers. 2007. [cited 2009, June 20] Available from:  www.who.int/entity/reproductivehealth/publications/family_planning/en/ Amy, J. Tripathi, V. Contraception for women: an evidence based review. BMJ. 2009. 339:563-8.Farmer, L. Everett, S. Nonhormonal contraception. Obstetric, gynaecological and reproductive medicine. 2007.18(2):33-8.Richters, J. Grulich, A.E. de Visser, R.O. et al. Sex in Australia: Contraceptive Practices in a representative sample of women. Aust NZ J Pub Health. 2003;27:210-6.

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Cachexia

Cachexia means "poor condition" in Greek. Cachexia has been defined as a syndrome characterised by progressive loss of lean tissue and body fat. Losses are often in excess to that explained by the associated anorexia. Cachexia occurs with various diseases, especially those that are chronic and debilitating. Diseases commonly associated with cachexia are cancer, AIDS, congestive heart failure, COPD and chronic inflammatory rheumatological diseases (e.g. rheumatoid arthritis, systemic lupus erythematosus (SLE), scleroderma, polymyositis, etc).

Weight loss in cancer cachexia is different to weight loss in simple starvation , due to accelerated loss of muscle compared with fat tissue, presence of proinflammatory cytokines and prolonged acute phase protein response that contributes to increased resting energy expenditure and weight loss. Patients with cancer cachexia experience anorexia, early satiety, weakness, sarcopenia, fatigue, anaemia and severe weight loss.

There are no definitive methods for diagnosis of cancer cachexia. Clinical signs of anorexia and weight loss =5% in 6 months would be expected but clinical judgement is required.

Treatment of cachexia should be directed towards:

Treatment of underlying disease Controlling the symptoms of cachexia

Controlling the symptoms of cachexia

Several treatment options have been outlined to treat cachexia. The principle is to improve the nutrition of the patients and to suppress the inflammatory response that is eating up the body's energy. These include:

Feeding the patient with high calorie food Drugs to stimulate the appetite Drugs to stimulate the body to build up more muscle mass

It has been proposed that eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid, may reduce the production of proinflammatory cytokines and thus may improve energy and protein intake, performance status and quality of life in cancer patients with cachexia. This may be taken as fish oil capsules or commercial nutrition supplements. However, the results of studies into the effects of EPA have been inconsistent. Your dietitian can provide more information about the dietary management of cancer cachexia.

Article kindly reviewed by:

The DAA WA Oncology Interest Group
and
Food4Health (Helen Baker Dietitian-APD)

Kotler D. Review: Cachexia. Ann Intern Med. 2000;133:622-634.Dietitians Association of Australia. 2005. Evidence Based Practice Guidelines for Nutritional Management of Cancer Cachexia.

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Clinical Trials

Click here to watch a video on drug trialling.

A clinical trial is a scientifically constructed investigation of a treatment (e.g. medication) that involves patient volunteers. Some clinical trials involve a mixture of healthy people and patients in the study group. Clinical trials are the final stage of medication (drug) research in the treatment of many diseases. They may also be conducted on new procedures (e.g. imaging scans). Clinical trials test new approaches to preventing disease, new techniques of screening for early detection of diseases (e.g. cancers), new tests to diagnose known diseases, new treatments (e.g. drugs), genetic studies, and also new approaches to managing end-of-life care for terminally ill patients. For many patients, clinical trials are an important step in accessing newly discovered therapies before they become generally available. It is important to be well informed about the risks and benefits of any treatment before starting.

Click here to watch a video on the importance of clinical trials.

Click here to watch a video on gastrointestinal cancers and clinical research.

Clinical trials are used throughout medicine to improve treatments available to patients. Scientists use laboratory and animal studies to help them to understand diseases and develop new treatment ideas. But for a new drug to be used routinely in people, the effect of new or different treatments on patients and healthy persons must be known. Clinical trials are also needed to determine the correct dose of a new medication, to determine whether the drug will treat the disease effectively in humans, the safety of a new drug alone and in combination with other therapies, and to determine whether a new treatment is better than standard treatment. Clinical trials are one requirement for a new drug to become licensed by the Therapeutic Goods Administration (TGA) in Australia. Without registration, a treatment cannot be provided under the Medicare health scheme.

Clinical trials allow access to new medications and treatments before they would otherwise be widely available. If the drug is effective, those enrolled in trials will be among the first to benefit. Being a participant in a clinical trial also improves the understanding and knowledge of many conditions, and has the potential to benefit future suffers of your disease. When you are an enrolled participant in a clinical trial, your health care is provided by a leading physician in that field (e.g. a consultant or an experienced, senior registrar). This allows close monitoring of any side effects of the treatment, limits any potential problems, and allows early recognition of problems. It also ensures that you receive the best available care and monitoring while you are involved. There is some evidence that suggests cancer patients who are involved in clinical trials have a better outcome than those who are not.

A clinical trial will involve new medications or treatments for which not all the side effects and risks are known. The doctors may not be able to predict all the side effects that may occur. Sometimes the effectiveness of a new treatment will not be fully known until there are clinical trials. For this reason, new drugs may not always work, or they may be less effective than the current standard treatment. Patients must also consider that this treatment may work for some people, but not necessarily for them. Research also continues to determine why some treatments work in some people and not in others.

There are a number of stages of development that occur before a medication is trialled in humans (clinical trial). Early steps in drug development occur in a laboratory where individual cells can be examined under a microscope and the effects of the medication can be monitored. If a medication is thought to have the desired effects, it may then be tested on animals. If there are little or no adverse effects and the medication is shown to be effective, then drug companies can apply for testing in humans. Human testing is the final stage in the drug's development. A drug will only reached this stage if it has shown promising results in laboratory and animal studies, and there are no known serious side effects for humans.

Clinical trials in humans are divided into 4 phases.
Phase I trials: The first part of development. The aim of this trial is to determine if the treatment is safe, what the expected side effects are, and to determine a dose for the treatment. These are usually only conducted with a small number of healthy volunteers. The trials usually last a few weeks to months.

Phase II trials: The aim of these trials is to establish how well a treatment works. These trials are usually conducted with a small number of supervised patients. Specialists in the field of the disease will monitor the patients and review their progress regularly.

Phase III trials: These trials involve a larger number of patients. Their aim is to show whether or not a new treatment is better than the current standard treatment. The trial involves 2 groups: one group of patients will get the standard treatment, and the other group will get the newer treatment. It is usual for the patient and the doctor not to know which of these treatments the patient is receiving. Because the trials involve a larger number of patients, this study also gives a better understanding of the potential side effects of the new treatment.

Phase IV trials: Continued research undertaken after the treatment is marketed and introduced as part of standard therapy. The aim of these trials is long-term surveillance of the treatment. Many thousands of patients are usually enrolled in phase IV trials.

United States National Institute of Health Services (cited December 9th 2007) Understanding Clinical Trials [Available online: http://www.clinicaltrials.gov/ct2/info/understand] (last updated 20th September 2007) Medicines Australia (cited November 31st, 2007) Clinical Trials [Available online: http://www.medicinesaustralia.com.au] Department of Health and Aging; Therapeutic Goods Administration (cited 9th December 2007) The Australian Clinical Trial Handbook [Available online: http://www.tga.gov.au/ct/cthandbook.pdf] National Cancer Institute (cited 9th December 2007) Clinical Trials: What is a clinical trial? [Available online: http://www.cancer.gov/clinicaltrials/learning/what-is-a-clinical-trial] (last updated 24th March 2006) Mills N, Donovan J, Smith M, Jacoby A, Neal D, Hamdy F. Perceptions of equipoise are crucial to trial participation: a qualitative study of men in the ProtecT study. Controlled Clinical Trials 2003; 24(3): 272-82. Freedman B. Equipoise and the ethics of clinical research. New England Journal of Medicine 1987; 317(3): 141-5. Styker J, Wray R, Emmons K, Winer E, Demetri G. Understanding the decisions of cancer clinical trial participants to enter research studies: factors associated with informed consent, patient satisfaction and decisional regret. Patient Education and Counselling 2006; 63(1-2): 104-9. National Cancer Institute (cited 9th December 2007) Clinical Trials: A guide to understanding informed consent [Available online: http://www.cancer.gov/clinicaltrials/learning/what-is-a-clinical-trial] (last updated 23rd December 2003) Strevel E, Newman C, Pond G, MacLean M, Siu L. The impact of an educational DVD on cancer patients considering participation in a phase I clinical trial. Supportive Care in Cancer 2007; 15(7): 829-40. Wray R, Stryker J, Winer E, Demetri G, Emmons K. Do cancer patients fully understand clinical trial participation? A pilot study to assess informed consent and patient expectations. Journal of Cancer Education 2007; 22(1): 21-4.

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An Introduction to Obesity Treatments

Obesity is a chronic health problem that has become a worldwide epidemic. Recent estimates suggest that over 70% of Australian males and fover 50% of Australian females are overweight or obese. Furthermore, rates of obesity are increasing at alarming rates due to increasingly sedentary lifestyles combined with easy access to cheap, tasty high fat foods. Rates of obesity in Australia have doubled in the last two decades to make Australia one of the fattest developed nations in the world! Of particular concern are the rising rates of obesity in children. Now almost a quarter of Australian children are considered overweight or obese.

Obesity is a serious medical condition and can lead to considerable health consequences including heart disease, diabetes, high blood pressure, high cholesterol, obstructive sleep apnoea and arthritis. Therefore it is very important that you seek appropriate treatment.

Obesity is essentially a disorder of your metabolism and is caused by an imbalance between energy intake and energy expenditure over a long period of time. In other words, you are consuming more calories or energy than you are burning through exercise and daily activities.  Treatment of obesity therefore aims to restore this energy balance.

There are numerous different treatment options available which are described briefly below. Further information can be obtained by following the links to each of the treatments. In addition you can view the following video which provides an overview of the different management options.

Traditional methods for weight loss include reducing calorie intake, increasing physical activity, and behaviour therapy. However, increasing levels of obesity and associated medical conditions has heightened interest in both pharmacological (drug) and surgical treatments for weight loss. In most cases you will be treated with a combination of therapies. The aim of therapy is to try to restore your normal weight and reduce co-morbidities without causing significant side effects or morbidity. In general, the greater the degree of weight loss achieved, the greater health benefits gained. However, even small amounts of weight loss (of 5-10% of body weight) can significantly improve your health. Therefore you should set realistic goals and be satisfied with even small amounts of weight loss.

Lifestyle modification remains the mainstay of treatment for obesity and is an essential component of all forms of weight loss programs. Lifetime changes in eating and exercise behaviour may be the only treatment that produces long term and sustained reductions in weight. Lifestyle changes can include the following components:

Dietary changes

Overall the aim of diet therapies are to reduce caloric intake. There are countless different types of commercial diets available and it is important that you find one that is suited to you and safe. Diets can be broadly categorised into reduced energy, low energy or very low energy diets based on how much they restrict your daily caloric intake. If you are severely obese and have obvious weight related medical conditions, your doctor may suggest a more restrictive very low energy diet for a short period of time. Very low energy diets can produce rapid and marked weight loss by limiting your daily intake with set meal plans, pre-prepared meals or meal replacements. However, following cessation of the program much of this weight will be regained so it is important you try to adhere to other lifestyle changes in the long term. You may also need other treatments such as drugs and behavioural therapy to help you maintain the weight loss. For this reason less restrictive diets are sometimes preferred as you have more freedom and must learn how to select and prepare healthy meal options. The long-term outcomes of the different diets are therefore quite similar.

Meal replacement programs

Recently meal replacement programs have been developed that replace normal meals with prepared meal plans or meal supplements (such as vitamin- and mineral-fortified shakes, soups and bars). These diets operate on the principles of a low calorie diet and induce a mild state of ketosis to produce weight loss. These diets limit your carbohydrate intake so your body switches to other forms of energy, in particular the fat stores in your body. Burning your fat stores eventually leads to weight loss. (Please refer to our metabolism write up for further information). These diets are specially formulated so that they provide a safe level of carbohydrates and continue to supply essential vitamins and minerals.

Physical activity

Increased physical activity is often used in conjunction with diets to increase energy expenditure. Using exercise alone for weight loss is however often unsuccessful. You can try to increase your physical activity by walking places rather than driving and climbing the stairs rather than using the escalator or lift. You should aim to engage in 30 minutes of moderate intensity exercise (such as brisk walking) at least 3-5 days per week. You should try to do activities you enjoy as this will increase the likelihood you will adhere to them in the future. If you are very obese and have difficulty exercising you could try swimming, cycling or walking in water until your fitness level improves. You may be referred to a physiotherapist or exercise physiologists to help you devise an appropriate exercise program.

Behavioural therapy

Behaviour modification methods (such as Cognitive Behavioural Therapy (CBT)) can help improve treatment compliance and improve long-term weight loss. These treatments analyse your behaviours and habits that contribute to poor eating and lack of physical activity. You are encouraged to take responsibility for your weight loss and lifestyle changes. However, these methods however can be very time consuming and expensive.

Lifestyle changes are extremely challenging and you must be highly motivated to achieve success. Most patients will achieve weight loss by the above methods but long-term maintenance of weight loss remains an issue. Approximately 90% of people will regain their weight lost in supervised programs in the next few years. Lifestyle changes however remain the most hopeful treatments for long-term weight loss if you adhere to them correctly. If you are only mildly overweight (i.e. a body mass index (BMI) less than 30), lifestyle treatments alone are often sufficient to achieve weight loss. If however you are obese (BMI greater than 30) lifestyle treatments may be insufficient to achieve satisfactory weight loss and additional treatments such as pharmacotherapy may be necessary to maintain weight loss.

Several weight loss drugs have been marketed to date which work by either suppressing the appetite (e.g. Sibutramine - Reductil) or reducing absorption of fats (e.g. Orlistat - Xenical). These drugs should always be prescribed by a medical professional. These agents can cause weight loss of up to 10% of body weight. However, following cessation of treatment much of this weight will be regained. In addition many of these drugs can have nasty side effects (such as diarrhoea) and are still being investigated in clinical trials. Some older drugs such as fenfluramine have been withdrawn form the market due to bad side effects on the heart.

In order for medications to really work, they need to be combined with lifestyle modifications such as a low fat diet and regular exercise. Medications for weight loss should only be taken for short periods (up to 3 months) and always be used with caution as they have the potential for abuse. At present they are only indicated if you are morbidly obese, have significant co-morbidities or if you have failed other lifestyle treatments.

Surgical treatments tend to be considered if you are morbidly obese (defined as a BMI greater than 40). You must however consider the operative risks associated with each of the procedures. In most cases however, the benefits to your mental and physical health and appearance will outweigh the risks of surgery. If you are markedly obese with co-morbidities, surgery is considered the only available treatment that can reliably produce significant and sustained weight loss. Surgical procedures may help you lose up to 30-40kg of excess weight; however this is only achieved if you adhere to the required lifestyle changes.

A variety of surgical procedures have been used which can be broadly classified into restrictive and mal-absorptive procedures. The former includes procedures such as the old fashioned gastroplasty and laparoscopic gastric banding. The latter is the most common procedure performed in Australia because it is safe and reversible. By means of a silicone band around the stomach, gastric banding physically limits the amount of food that can be consumed before you become full. Mal-absorptive procedures (such as gastric bypass) typically involve bypassing a segment of small intestine to reduce the absorption of calories and hence lead to weight loss. Both methods produce similar long term results in terms of weight loss with patients losing approximately 50-70% of their excess weight. However, bypass operations may be more risky and can interfere with absorption of essential vitamins and minerals.

Whilst surgery is becoming increasingly common for the treatment of obesity, diet, exercise and long-term lifestyle changes remain the cornerstone of treatment. Surgery should only be considered if you are morbidly obese with significant weight related health problems. Successful treatment of obesity therefore requires an integrated and multidisciplinary approach with input from a variety of health professionals including dieticians, physicians, physiotherapists, surgeons and psychologists/psychiatrists.

In order to achieve long term weight loss you are required to make lifetime changes in your eating and exercise behaviours. In the future, the government may also be able to help treat the obesity epidemic by altering the environment we live in. Strategies and public health campaigns to produce an environment that supports healthy eating and physical activity throughout the community are needed.

For more information on obesity, health and social issues, and methods of weight loss, as well as some useful tools, see Obesity and Weight Loss. About overweight and obesity [online]. Canberra, ACT: Australian Government Department of Health and Ageing; 2005 [cited 9 August 2007]. Available from: URL linkThe Obesity Society: Fast facts [online]. University of Sydney, NSW: Australasian Society for the Study of Obesity; 2005 [cited 9 August 2007]. Available from: URL linkFlier J, Maratos-Flier E. Chapter 242: Obesity. In: Braunwald E, Fauci AS, Kasper DL, et al (eds). Harrison's Principles of Internal Medicine (16th edition). New York: McGraw-Hill Publishing; 2006. [Book]Hamdorf J. Obesity Management [video]. Osborne Park, WA: Virtual Medical Centre; 2007 [cited 9 August 2007]. Available from: URL link Kumar P, Clark M (eds). Clinical Medicine (5th edition). Edinburgh: WB Saunders Company; 2002. [Book]Clinical practice guidelines for the management of overweight and obesity in adults [online]. Canberra, ACT: Australian Government Department of Health and Ageing; 18 September 2003 [cited 9 August 2007]. Available from: URL linkProietto J, Baur L. Management of obesity. Med J Aust. 2004;180(9):474-80. [Abstract | Full text]Wilding J. Science, medicine, and the future: Obesity treatment, BMJ. 1997;315(7114):997-1000. [Abstract | Full text]

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CoaguChek

The CoaguChek monitor is a hand-held device that is used to measure the international normalised ratio (INR) in individuals taking warfarin. 

The INR is a laboratory measurement used to determine the effects of oral anticoagulants (warfarin) on the clotting system. Warfarin (e.g. Coumadin, Marevan) is an anticoagulant – a substance that inhibits blood clot formation – that you can take orally in tablet form. It works by reducing the ability of several clotting factors (components in the blood responsible for forming blood clots) to form a blood clot.

It is important to monitor the INR regularly to ensure a correct dose of warfarin. Frequent monitoring helps to balance the risk of excessive bleeding (when the INR is too high) against the risk of thrombosis or clotting (when the INR is too low).

The CoaguChek is a portable device which allows an individual to measure their own INR at frequent intervals.

The CoaguChek device comes packaged as a kit, including:

CoaguChek device;Four alkali-manganese AAA batteries or a power supply unit;Lancing device and lancet;Carry case;User manual.

Consumable materials used in testing are purchased separately:

CoaguCheck test strips;Code chip which corresponds to and provides specific information about each set of test strips, including calibration data and expiry dates. 

If you are using the CoaguChek for your own personal use, it is important that you do not have any limitations that would prevent you from using the device suitably.

Some limitations include:

Physical limitations (such as arthritis or amputations involving the hands) that prevent proper use of the device;Cognitive limitations that prevent proper use of the device or interpretation of the results;Problems attending training sessions; andFailing training assessments.

Suitable individuals should attend a structured educational program to receive training in areas of:

Self-testing: How to use the device, how to record and interpret or report results, and how often to self-test;Instructions to prevent complications: Information on your target INR (the range of INR values that are best suited to you to maximise benefits and minimise side effects), and what to do if you have a result outside of this range; andAffect of diet and medications: The INR can vary with changes in diet, some illnesses and many medications, it is therefore important that you inform your health professional that you are taking warfarin and perhaps monitor your INR more regularly following changes in medication and/or diet.

Calibrating the device

When the device is used for the first time, you must set the correct date and time to ensure the device provides correct measurements. If the batteries are removed or replaced, you should check that the date and time is correct when the batteries are inserted. The date and time should be reset if necessary. Instructions for setting the date and time are included in the device user manual.

Using CoaguChek to test blood samples

In general, the following steps should be followed:

Familarise yourself with the device and operating instructions.Prepareyour materials CoaguChek meter;CoaguChek test strips;Code chip: Contained within each box of test strips and unique to those test strips. The code chip holds information on the expiration date and lot number of the test strips; andCoaguChek lancing device: For finger pricking to obtain the blood sample. Ensure that a new lancet is inserted into the device for each use.Turn the device on using the on/off switch. Alternatively, insert a test strip and the device will automatically turn itself on. The device will automatically check its display properties, by displaying a range of symbols on the screen.Wash your hands in warm soapy water. The hands and fingertip should be dried thoroughly.Remove the test strip from the container and insert it into the test strip guide on the device in the direction of the arrows on the strip. Close the container immediately with the stopper. You must use the test strip within 10 minutes of removing it from the container.Confirm that the code chip number displayed on the device matches the number on the test strip container. If the numbers are identical, press the M button to confirm this. While you do this, the machine will take approximately 30 seconds to warm up, during which time an hourglass will be displayed on the screen. When the device is warmed up, a blood drop will appear on screen. You must apply a drop of blood to the test strip within 120 seconds in order for the test to work properly.Collect a blood sample from the side of your fingertip using the CoaguChek lancing device and the tips to improve blood supply below. Apply the first drop of blood which appears to the test strip.Apply the blood sample to the target area on the test strip within 15 seconds of sticking the fingertip. You should hold the blood drop to the testing strip until a beep is heard and/or the flashing blood drop symbol disappears.Await the result, which should appear in approximately one minute. When blood is applied to the test strip, it mixes with various ingredients contained within the test strip. Once the meter determines that the applied blood has clotted, the time to clot is used to calculate the INR. An hourglass will be displayed on the screen while the device is determining the result. Do not disturb the device or apply more blood to the test strip during this time.Record the result: CoaguChek automatically records up to 100 of the most recent measurements, and these measurements can be accessed at any time by pressing the M button on the device. Some people may also record the results separately in a log book.Occasionally the result will be displayed with a small C underneath it. This often indicates contamination of the blood sample (e.g. from water on hands). In these cases, you need to perform the test again. If the C appears again, contact your doctor;Pack away: Dispose of the test strip and lancing device with other household waste, turn the meter off and, if dirty, wipe clean with an approved cleaner.

Introduced in the 1990s, portable devices allow individuals to measure their INR at home with a single drop of whole blood. Individuals who self-test have the option of:

Self-monitoring: In which they test their INR at home and then phone a clinic for the appropriate dose adjustment; orSelf-managing: In which they test their INR at home and adjust their oral anticoagulant dose according to a pre-determined dose INR schedule.

Self-testing has the advantage of improved convenience, greater treatment adherence, increased monitoring frequency and a reduction in the side effects associated with oral anticoagulation.

For some people, self-testing is not applicable as they may encounter difficulties such as physical limitations, problems attending training sessions/education, failing training assessments and problems with the device. You should discuss this option and your suitability with your doctor, who can advise you further.

If you do not feel comfortable or are unsuitable for self-monitoring or management, some doctors' surgeries own a CoaguChek and have a nurse trained in the area who can determine your INR.  Otherwise, your INR can still be measured at the pathology laboratory.

In order to maintain a safe and reliable system for measuring the INR:

The meter should be operated at room temperature (15–32 oC);The meter should be operated at a relative humidity of < 85%;The meter should be operated at an altitude no higher than 4,300 metres;The meter should be kept level when testing;If storing the meter for a period of time, store it in the carry case provided; andThe meter should not be used near a strong magnetic field.

In order to maintain a safe and reliable system for measuring the INR, you should avoid:

Operating the device in conditions outside of those listed above;Removing or inserting a code chip whilst the meter is performing a measurement;Using a code chip from a box of test strips other than the one in use. To prevent this from happening, change the code chip each time you begin using a new set of test strips and discard the old chip;Using wet hands to open a container of test strips or wetting the code chip;Touching test strips with wet hands;Touching and/or removing the test strip while the device is performing a test;Delaying application of the blood onto the test strip by more than 15 seconds after the finger has been cut with the lancing device;Adding more blood once the test has begun; andTouching buttons on the device while the device is testing.

Some models such as the CoaguChek XS have advanced features, including:

Touch screen;Infrared interface;Option to change the unit of measurement (%Q, secs, INR);Option to disable/enable the beeping; andAbility to set a therapeutic range.

Results are automatically stored within the device. Up to 100 results are stored. Where more than 100 tests have been performed, the oldest result is deleted to make room for the new value. Results stored in the memory can also be downloaded to another device.

Results are stored even when there are no batteries in the device. However, if the device is without batteries for longer than one minute, the time and date settings may require resetting.

A few simple measures can be taken to increase blood flow to the finger before finger prick testing, including:

Warm the hand and fingers: This can be done by holding your hand under your armpit, using a hand warmer or washing the hands with warm water;Lower the hand below the waist; andMassage the finger from its base towards the tip. Do not squeeze or press the finger.

More detailed information can be read in the user manual of the device. The user manual provides information relating to:

Inserting and/or changing batteries;Setting the date and time;Inserting a new code chip;Testing a blood sample;Preparing for a test;Out of range values;Optional testing methods;Memory;Cleaning and disinfecting;Advanced features;The meter's display;Error messages;Product specifications;Support/services;Symbols; andWarranty.

If you have any concerns or issues, discuss them with your doctor.

CoaguChek® XS User's Manual. Castle Hill, NSW: Roche Diagnostics; 2011.Garcia-Alamino JM, Ward AM, Alonso-Coello P, et al. Self-monitoring and self-management of oral anticoagulation. Cochrane Database Syst Rev. 2010;(4):CD003839. [Abstract | Full text]Shephard M, Shephard A, Watkinson L, et al. Design, implementation and results of the quality control program for the Australian government's point of care testing in general practice trial. Ann Clin Biochem. 2009;46(Pt 5):413-9. [Abstract]Coaguchek® XS Plus Operator's Manual. Castle Hill, NSW: Roche Diagnostics; 2011.

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Treating Chronic Non-Cancer Pain

Chronic pain can be a difficult medical problem for both doctors and patients. Often, there is no one diagnosis that can account for the pain, and the treatment is often complicated, long term, and sometimes unsatisfactory. This page will deal with chronic non-cancer pain, and is broken into sections detailing:

Chronic pain is defined as pain that is present for more than three months, or for four weeks longer than would be expected as part of a normal recovery. The management of chronic pain can be difficult for both patients and doctors because it is often difficult to find an exact cause that can be treated leading to frustration from both groups.

While you may think that all pain is the same, the anatomy and physiology of pain is actually very complex and there are two major groups of pain that feel quite different. The pain we are most familiar with is called 'nociceptive' or 'somatic' pain, and is due to activation of pain receptors due to real or perceived injury. This is usually quite localised, constant or worse with movement, and of an aching or throbbing quality.

The other type of pain is called 'neuropathic' pain and is due to damage to the nerves that sense pain, or even the part of the brain that deals with pain. It often follows an injury, but not always, and feels different to somatic pain. Neuropathic pain typically occurs in certain patterns and is often described as being a 'burning' pain, or even like electric shocks are being sent to the area. This can be accompanied by changes in the sensation of the area supplied by the nerve.

Before a doctor can treat someone for chronic pain, it is important that they ask a few questions so that they can work out the best course of treatment. Some of the things they may try to find out are:

That pain is the primary problemWhat 'type' of pain is it, how bad is it, and what are the symptoms of the pain?What is causing the pain?How is the pain impacting your life?Is there anything else that is making the pain worse?

After this assessment has been made, then the doctor might set some 'goals' for your treatment, that you should feel are significant but achievable. These will depend on just how bad your pain is. For example, in some cases being able to sleep through the night or walk to the shops may be the 'goals' as these will greatly improve the quality of life of the person with chronic pain. Your GP may also decide to send you to another health professional to help out with your treatment and there are numerous different people who can help with the care of someone with chronic pain. Rheumatologists (joint doctors), physiotherapists, occupational therapists and specialised pain doctors can sometimes be a great help in dealing with chronic pain.

Once a full assessment has been made, then the first step is to try and make some changes to your lifestyle that are easy to do, will also improve other aspects of your health, and can greatly reduce pain:

Weight Reduction: Reducing weight can greatly reduce the pressures exerted on joints, and thus lessen the pain that is associated with movement.Exercise: an exercise program should be included in the treatment plan of all people suffering from chronic pain. Obviously, the plan must be individualised taking into account what each individual is capable of.Cognitive-Behavioural Therapy: CBT can be a great asset in the treatment of chronic pain, improving their feeling of well-being, reducing pain scores and allowing for an improved quality of life.Mindfulness and other relaxation therapies can also be of some benefit, helping to focus patient's minds on things other than their pain and thus allowing an improved quality of life.Paracetamol: Paracetamol is a good first choice in the treatment of chronic pain, as it is very safe and also very effective for the relief of mild to moderate pain.Non-steroidal anti-Inflammatory agents: NSAIDs can be highly effective in the treatment of chronic pain, especially if there is an inflammatory character. While there is a risk of adverse effects when used for a long period of time, most notably bleeding from a stomach ulcer, this can be reduced with the use of other 'selective' NSAIDs (e.g. Celebrex) that cause less of this problem.Opiods: If the chronic pain persists, or is increasing, then in addition to the non-opioid agents, an opioid regimen with a medication such as codeine, oxycodone or tramadol should be started. If these agents are also ineffective at relieving the chronic pain and it is of a moderate to severe severity, then agents such as systemic morphine, hydromorphone, fentanyl (e.g. Durogesic) or methadone can be used.Tricyclic antidepressants: TCAs such as amitryptyline (Endep) have been shown to be useful in treating neuropathic chronic pain. While people are unsure as to how they actually work, it does more than just improve depression as the pain relief requires a much lower dose, and starts long before it helps with depression. They are also sometimes used to increase the effectiveness of opioid agents like those described above. Anticonvulsants and antiarrhythmics: these are usually used for conditions like epilepsy, but have also been shown to reduce neuropathic pain. Pregabalin (Lyrica), gabapentin and carbamazepine are all used for their membrane stabilizing properties and have been shown to be effective in neuropathic pain. Gabapentin is less likely to be effective when there is no objective finding of nerve injury. Lignocaine Patches: Lignocaine 5% patches have been shown to be effective in the treatment of neuropathic pain, presumably due to their membrane stabilising actions.

Beyond the medications mentioned above, there are also more invasive options available for those suffering from chronic pain:

Corticosteroid Injections: given into the site of the pain, especially joints, can be very useful, and give rapid and reasonably long-term relief for those suffering chronic pain.Nerve Blocks: this involves the injection of an anaesthetic agent directly into the site of the pain, into the nerve supplying the painful area, or centrally into the spinal cord. Catheters can be inserted into the epidural or subarachnoid spaces, providing excellent pain relief.Neurostimulation: This involves the placement of electrodes around areas of the nervous system that are responsible for the painful stimulus. These electrodes can be placed in the spinal cord, on a peripheral nerve, or even into the brain.Spinal Cord Stimulation: Like neurostimulation, this involves the strategic placement of electrodes into the spinal cord, which artificially stimulate the nerves to the painful area. This usually involves the placement of a spinal cord stimulation device which come in various forms.Brunton, S. Approach to assessment and diagnosis of chronic pain. The Journal of Family Practice, 2004; 53(10 supp): S3-S10.Colvin L, Forbes K, Fallon M. Difficult Pain. BMJ, 2006; 332:1081-1083Fields H, Martin J. Pain: Pathophysiology and Management. Harrison's Principles of Internal Medicine. McGraw-Hill, London, 2007.McCarberg, B. Contemporary management of chronic pain disorders. The Journal of Family Practice, 2004; 53(10 supp): pS11-S22.Murtagh, J. General Practice (Third Edition). McGraw-Hill, Sydney, 2005.

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Salt levels in food still dangerously high

The dangerously high salt levels in processed food and fast food remain essentially unchanged, despite numerous calls from public and private health agencies for the food industry to voluntarily reduce sodium levels, reports a new Northwestern Medicine study conducted with the Center for Science in the Public Interest.

The study, published May 13 in JAMA Internal Medicine, assessed the sodium content in selected processed food and in fast-food restaurants in 2005, 2008 and 2011. The main finding was that the sodium content of food is as high as ever.

“The voluntary approach has failed,“ said Stephen Havas, M.D., corresponding author of the paper and a research professor of preventive medicine at Northwestern University Feinberg School of Medicine. “The study demonstrates that the food industry has been dragging its feet and making very few changes. This issue will not go away unless the government steps in to protect the public. The amount of sodium in our food supply needs to be regulated.”  

Excess sodium prematurely kills as many as 150,000 people in the U.S. each year. About 90 percent of the U.S. population develops high blood pressure and high salt in the diet is a major cause. High blood pressure increases the risk of developing heart attacks and strokes, often resulting in death or disability. 

“High salt content in food benefits the food industry,” Havas said. “High salt masks the flavor of ingredients that are often not the best quality and also stimulates people to drink more soda and alcohol, which the industry profits from.”

A typical American consumes an average of almost two teaspoons a day of salt, vastly higher than the recommended amount of three-fifths of a teaspoon or no more than 1,500 milligrams, as recommended by the American Heart Association. About 80 percent of our daily sodium consumption comes from eating processed or restaurant foods. Very little comes from salt we add to food.

“The only way for most people to meet the current sodium recommendation is to cook from scratch and not use salt,” Havas said. “But that’s not realistic for most people.”

The FDA needs to begin regulating food processors and the restaurant industry -- as has been recommended by the Institute of Medicine and others –- as soon as possible, Havas said. 

Havas noted that our taste buds rapidly adapt to less salt. “If it’s reduced by 20 percent a year, no one would know the difference,” he said.

The study found that between 2005 and 2011, the sodium content in 402 processed foods declined by approximately 3.5 percent, while the sodium content in 78 fast-food restaurant products increased by 2.6 percent. Although some products showed decreases of at least 30 percent, a greater number of products showed increases of at least 30 percent. The predominant finding was the absence of any appreciable or statistically significant changes in sodium content during six years.

Source Northwestern University

Article Date: 14/6/2013

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Just weight until menopause

Women tend to carry excess fat in their hips and thighs, while men tend to carry it on their stomachs. But after menopause, things start to change: many women's fat storage patterns start to resemble those of men. This indicates that there's a link between estrogen and body fat storage. This connection is well documented, but the underlying mechanisms remained poorly understood until now.

New research conducted by Sylvia Santosa, assistant professor in Concordia University's Department of Exercise Science and Canada Research Chair in Clinical Nutrition, gives us a new look at the connection between fat storage and estrogen. By examining the fat storage process at a cellular level, Santosa and co-author Michael D. Jensen of the Mayo Clinic in Rochester, Minnesota, reveal that certain proteins and enzymes are more active in post-menopausal women. These proteins correspond with fat storage. Their findings were published in the March 2013 issue of Diabetes.

"The fat stored on our hips and thighs, is relatively harmless," explains Santosa, who is also a member of Concordia's PERFORM Centre for better health through prevention. "But the fat stored around the abdomen is more dangerous. It has been associated with diabetes, heart disease, stroke and even some cancers. When post-menopausal women put on more abdominal fat, they dramatically increase their risk for these health problems. Given these dangers, it is very important to understand the how the lower levels of estrogen associated with menopause changes where fat is stored."

Santosa's research compared fat storage in pre- and post-menopausal women. The 23 women who participated in the study were in the same age range, and had similar Body Mass Indices and body fat composition. These similarities allowed Santosa to isolate the effects of estrogen on fat absorption and storage.

She and Jensen were able to examine the activity of certain enzymes and proteins that regulate fat storage in post-menopausal women's abdomens and thighs. By considering these factors together rather than in isolation, the researchers determined conclusively that the overall fat storage "machinery" is more active in post-menopausal women. In other words, these cells now store more fat than they did before menopause.

In addition, post-menopausal women burned less fat than their pre-menopausal colleagues. These changes mean that their cells are not only storing more fat, but are also less willing to part with it. This combination is a recipe for rapid weight gain. "Taken together, these changes in bodily processes may be more than a little surprising – and upsetting – for women who previously had little trouble managing their weight," comments Santosa.

Though the increased cellular activity revealed by this study was not specific to the abdominal region, more fat stored overall means more abdominal fat. Evidence of changes in the fat storage pathways after menopause is an important contribution to understanding why post-menopausal women begin to put on more visceral fat.

Says Santosa, "the information revealed by our study is valuable not only to post-menopausal women and their doctors, but to obesity studies more generally. A clearer picture of which proteins and enzymes increase fat storage makes those productive targets for future medical advances in the fight against obesity."

(Source: Concordia University : Diabetes)

For more information on menopause, including symptoms and management of menopause, as well as some useful animations and videos, see Menopause.
For more information on obesity, health and social issues, and methods of weight loss, as well as some useful tools, see Obesity and Weight Loss.
Article Date: 11/4/2013

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Xenical vs Alli: What's the Difference Between...

Choosing to take a weight loss medication is a serious decision. When an over-the counter version of Xenical (orlistat) became available for dieters as Alli (orlistat), access to the drug became easier. But just because the drug is easier to get doesn’t mean that you should necessarily take it.

Find out more about this diet medication before you make a decision about which weight loss treatment is right for you. Also, be sure to talk to your health care provider as new medications for weight loss, Belviq and Qsymia have recently become available.

What is Xenical?

Xenical is the prescription dose (120 mg) of orlistat. This type of medication is called a lipase inhibitor because it helps your body to absorb less fat from the food that you eat. The undigested fat is removed from the body in your stool.

Xenical is designed to be used along with a low-fat, low-calorie diet. The higher, prescription dose of the drug is often used for patients who have weight-related illnesses like type 2 diabetes, high blood pressure or heart disease. Xenical can also be used for people who lost weight and want to prevent weight regain.

What the Difference Between Alli and Xenical?

You’ll see boxes of Alli displayed in pharmacies, drug stores and other locations. Alli is a lower dose (60 mg) of the same medication, orlistat, that is in Xenical. Alli works the same way that Xenical works by blocking the absorption of fat. Alli is also meant to be used in partnership with a low-calorie, low-fat diet.

What Are Side Effects of Taking Orlistat?

For most people, the most noticeable side effect of Xenical or Alli is the change in their stool and bowel habits. Because fat is removed through the stool, bowel movements can become loose and oily. If you eat too much fat while taking the medication, the side effects can become more severe and can interfere with typical daily activities.

Because fat content is important, dieters taking the medication need to be especially careful about dividing their fat and calorie intake evenly throughout the day. No single food that you eat should contain more than 30% of the total calories from fat. In addition, since food and nutrient absorption is affected by this medication, the FDA recommends that users take a multivitamin while on the diet drug.

Other side effects may include hives, itching or stomach pain. Talk to your doctor about your medical history to determine which side effects may impact you.

How Much Does Orlistat Cost?

A starter pack of Alli, that contains 60 pills costs about $40 at your local drug store. If you compare prices you may also find 120-pill bottles for slightly more. A 30-pill prescription of Xenical may cost significantly more, ranging from $150-160. Patients are usually directed to take one pill with each main meal to help them lose weight.

In some cases, insurance providers may pay for a weight loss medication if your weight is the cause of a related illness. But all policies vary, so be sure to check with your own insurance carrier to find out if the drug is covered for you.

Should I Take Alli or Xenical?

Orlistat has been shown to be effective at helping some people lose weight and keep it off. But significant lifestyle modifications must be made, or the consequences can be uncomfortable and embarrassing. Think about the changes you are willing to make before talking to your health care provider. Then discuss further potential side effects and medical considerations with your doctor before making a final decision.

Sources:

Medline Plus. Orlistat. National Institutes of Health. Accessed: February 19, 2013. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601244.html

Kopelman P, Groot Gde H, Rissanen A, Rossner S, Toubro S, Palmer R, Hallam R, Bryson A, Hickling RI."Weight loss, HbA1c reduction, and tolerability of cetilistat in a randomized, placebo-controlled phase 2 trial in obese diabetics: comparison with orlistat (Xenical)" Obesity January 2010 .

Torgerson JS, Hauptman J, Boldrin MN, Sjöström L. "XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients." Diabetes Care March 2004 .

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Does This Medication Make Me Gain Weight?

(LifeWire) - In addition to poor diet and lack of exercise, one other culprit has been blamed for contributing to obesity: medication. Some of the most widely prescribed drugs in the United States -- for common conditions like diabetes, migraines, high blood pressure, depression and bipolar disorder -- have been found to cause weight gain.

Medications That Can Contribute to Weight Gain

Medication can add pounds to your figure in several ways:

Metabolism changes: Some drugs change the body's metabolism, and calories are burned more slowly.

Corticosteroids: Corticosteroids are known to stimulate appetite while reducing the body's ability to absorb glucose, which can promote fat deposits in the midsection.

Beta-blockers: Beta-blockers can cause shortness of breath and fatigue, making it difficult for patients taking them to exercise.

Calcium channel blockers: Calcium channel blockers taken for high blood pressure can cause users to retain water.

Antipsychotic medications: Drugs used to treat psychiatric conditions and mood disorders, like depression and bipolar disorder, are among those most closely associated with weight gain. It is so common with drugs like Paxil (paroxetine), Zoloft (sertraline), Clozaril (clozapine), Seroquel (quetiapine), Zyprexa (olanzapine) and Risperdal (risperidone) that researchers have called it "an epidemic within an epidemic."

As a result, the FDA has, since 2004, required manufacturers of certain antipsychotic medications to add a warning statement to doctors prescribing these drugs. The warning outlines the increased risk of diabetes and hyperglycemia that can result from use of the drugs.

Side Effects of Weight Gain

How much weight is gained varies from patient to patient and from drug to drug. Some patients may gain a few pounds over the course of a year; others experience weight gains in excess of 100 pounds in a matter of months. Because many of these drugs are taken for chronic conditions, their use over a period of several years can contribute to substantial weight gains patients often experience.

In addition to the emotional and social dimension of weight gain, patients can also experience serious health conditions -- diabetes, high blood pressure, osteoarthritis, metabolic syndrome, high cholesterol -- that are created or made worse by added weight.

Perhaps the most serious result of drug-induced weight gain is that many patients stop taking their medication or decide on their own to switch to a lower dosage. As a result, potentially serious underlying health conditions may go untreated. Lack of compliance with a drug regimen because of weight gain has been cited as a particular problem with patients taking antipsychotic and antidepressant drugs.

Some healthcare providers proactively tell their patients about the potential for weight gain when prescribing certain drugs and advise the patients to moderate their diet and increase their aerobic exercise to offset any weight increases.

Alternative Medications

All patients, regardless of condition, should talk to their healthcare provider before stopping medication or changing doses.

In many cases, your doctor may be able to recommend a drug that works just as well without the added pounds. Or, your doctor may decide to prescribe an additional drug to treat any weight gain you might experience.

Sources:

"2004 Safety Alert: Zyprexa (Olanzapine)." fda.gov. 22 Mar. 2004. Food and Drug Administration. 27 Feb. 2009 .

Deshmukh, Rashmi and Kathleen Franco. "Managing Weight Gain as a Side Effect of Antidepressant Therapy." Cleveland Clinic Journal of Medicine 70:7 (2003): 614-23. 27 Feb. 2009 .

Fenton, Wayne S. and Mark R. Chavez. "Medication-Induced Weight Gain and Dyslipidemia in Patients With Schizophrenia." American Journal of Psychiatry 163 (2006): 1697-704. 27 Feb. 2009 .

"Prescription Drugs That Cause Weight Gain." Johns Hopkins Health Alert. Jun. 2008. Johns Hopkins Medicine. 27 Feb. 2009 .

Simpson, MM, et al. "Weight Gain and Antipsychotic Medication: Differences Between Antipsychotic-Free and Treatment Periods." Journal of Clinical Psychiatry 62:9 (2001): 694-700. 27 Feb. 2009 .

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Marc Lallanilla is a New York-based freelance writer and editor. He has written extensively on health, science, the environment, design, architecture, business, lifestyle and travel.

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Easy Workouts to Lose Weight

If you think you have to exercise to the point of exhaustion every day to lose weight, you’re wrong. In fact, easy workouts are essential if you want to burn fat and lose weight with exercise. But how you set up your easy workout plan depends on your workout history.

Beginning and advanced exercisers use easy workouts differently. For beginners, low intensity exercise lays the groundwork for building a fitness program. If you are new to exercise or if you’ve had no luck maintaining an exercise program, start with a program of easy weight loss workouts. But if you are an intermediate or advanced exerciser, use easy exercise on your active recovery days.

An active rest day, or a recovery day, is part of a complete workout program that includes high intensity, moderate intensity and low intensity exercise. During the low intensity recovery days you still exercise, but you keep your heart rate low (no higher than 70% of your maximum heart rate) and focus on activities that loosen the muscles, increase your range of motion, and allow your body and mind to recover from more intense sessions.

During a typical week, you should schedule a recovery day after each high intensity workout day. So, if you do high intensity intervals on Mondays and Thursdays, you should schedule easy workouts for Tuesday and Friday. If you do a high intensity workout on Sunday, make Monday your active rest day.

Weight Loss Benefits of Easy Workout Days

It’s tempting to flop on the couch the day after a high intensity exercise session, but if you’re trying to lose weight, you should choose to do an active recovery workout instead. The weight loss benefits add up.

Burn calories. Even low intensity exercise burns calories, especially if you compare it to sitting on the couch. You may only burn 200 calories during your easy workout, but over the course of an eight-week exercise program, that adds up to almost 3500 extra calories burned or one extra pound of weight lost if you do it twice per week Build/Maintain Consistent Workout Schedule. The hardest part of starting an exercise program is building a new routine. You’ll build the routine faster if you get into the habit of exercising every day. With active rest days, you are more likely to be able to maintain a daily exercise habit. Increased Range of Motion. Active recovery days are great opportunities to do exercises and activities that use your muscles in new and different ways. This helps to create a healthy balanced body that remains injury-free for more intense calorie-blasting workouts. Decrease Stress. Easy workouts should make you feel good. They are a great way to blow off steam and avoid emotional binge eating.

Easy Workout Ideas

There are countless options for your active recovery days. To maximize the health benefits of your fitness program, try to do easy workouts with muscles that are different than the ones you use during your hard day workouts, or that stretch the muscles that are tired and sore. For example,

if you complete a high intensity run on Monday, a good rest day workout might include a walk. Even though you are still using your legs, walking focuses on the muscles in the back of your legs (glutes and hamstrings) and walking lengthens the hip flexors that tighten when you run. if you ride your bike to lose weight, try swimming or yoga on your recovery day. Cycling primarily works the lower body. Swimming and yoga help build upper body strength and depending on how you do the workout, can help to increase range of motion in your legs.If you completed a high intensity circuit workout, use your easy exercise day to focus on flexibility and stretching. Take a dance class, do restorative yoga, or aqua jog for 20 minutes followed by 10 minutes of poolside stretching.

The Best Recovery Day Workout

The best recovery day workout is the one that you do. Remember, the purpose of this easy workout is not just to burn calories, but it is to help you to maintain a consistent daily exercise program. Rest days are also opportunities to destress and give your mind a break, so don't worry about doing the right workout or the right exercise. Just do something. If you do a workout, any workout, no matter what it is, you’ve gained a benefit.

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10 Tips for Eating Out on a Diet

Focus on your friends, not the food, and you'll enjoy eating out on a diet even more.

© [2009] Jupiterimages Corporation Eating out on a diet doesn't have to be cause for panic. Sure, you hear about oversize restaurant portions and the plethora of fattening menu choices available all the time, but that doesn't mean dining out will doom your dieting efforts! Just use these 10 simple tips for eating out on a diet: Cram for tonight's dinner. Many eateries post their entire menu online so you can print it out for reference. If you often eat at "mom and pop" type restaurants that aren't online, call and ask for the menu to be faxed to you, or pick up a takeout menu on your next visit. Highlight the healthiest options for each menu and store them all in a central location. Then, when you are planning your next night out, take the time to decide on your dishes at home before you've been tempted by the sight of other choices. Order your main dish from the appetizer menu. Not only are appetizers more reasonably-portioned, they will save you some money as well. (This is a great way to save enough calories and cash to split dessert with someone!) Too peckish to be satisfied with just a starter? Order a side salad, too -- the fiber-rich veggies will round out your meal. Soup is super-filling, so it's an awesome appetizer add-on, too (just steer clear of cream-based ones).Beware these high-fat menu buzz words: Cream sauce, butter, oil, au gratin, breaded, Alfredo, battered or batter-dipped, "with gravy," or smothered. Unless you've spared yourself treats for several days and snacked on salad greens all day, these little "extras" aren't worth the extra calories.Modify the menu. In my neck of the woods, anything and everything can be batter-dipped and fried, so I make special requests all the time. Many restaurants will take your dietary needs into account so you'll be a happy customer and return. Don't hesitate to request anything on the menu to be prepared in a more diet-friendly and for sauces or dressings to be served on the side. It's not likely that you will be denied.The meat is on. As tempting as that bucket of fried chicken looked on the commercial before you left home, order poultry steamed, poached, roasted, broiled, boiled, grilled or baked. Ask for skinless chicken whenever possible or remove it yourself. If you do treat yourself to fried chicken, choose white meat as it has fewer calories than dark. Of course, chicken, chicken and more chicken gets old after a while, so if you're asking, "Where's the beef?" allow yourself red meat a few times a week -- just be sure to choose leaner cuts of meat like loin or flank.Keep tabs on that tubini. Endless pasta at your favorite Italian restaurant may be carb-lovers' heaven (Darn near nirvana for yours truly!), but it's a waist-widening trap for those of us who tend to overeat (How are you supposed to know when to say "when" if they keep bringing more?). As tempting as the great "value" for your money that infinitely-refilling pasta bowl seems, it's certainly not a bargain for your calorie budget. Order a portion-controlled main dish instead. "Ixnay" on the endless breadsticks, too! "Wrap it up, I'll take it!" You know you're at a nice restaurant when the server takes your plate away and wraps up your leftover food for you at the end of the meal. (And if you're in a really nice restaurant, you'll get the eating out equivalent of a balloon animal -- the tin foil swan!) To ensure you don't leave sans swan, keep temptation at bay and ask the server to wrap up half of your as soon as it is served.Take control of takeout. You don't have to swear off takeout when you're dieting -- there are many healthy options at ethnic restaurants. Portion control is key, though: Take out half of your takeout before dishing up your dinner, put the food in microwave containers and tuck it away in the fridge before you even start eating. (Instant will power and instant next-day lunch!)Banish buffets. Portion control can become a foreign concept for even the most determined dieter at an all-you-can-eat buffet. (Who can practice moderation when there are new, clean plates just beckoning to be filled?) The sheer variety of foods available at buffets is also daunting -- studies have shown that when we're given more choices, we tend to eat more without realizing it. Simply avoid buffet restaurants and you won't have to face this temptation.Mini meals are a must. It's smart to eat smaller meals during the day when you're planning to dine out. Just don't eat too sparingly, though -- you don't want to be so famished by the evening that you overeat. (It was a dark day when I ate too-mini mini meals and -- clearly ignoring my own tip number 9! -- visited a buffet in a ravenous state with a fellow waist-watcher ... the look of sheer horror on her face as I went for round number four is not something I will soon forget!) If mini meals don't tide you over, have a small, healthful snack in the afternoon to curb your appetite and you'll be much more in control come dinner time.

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3 Reasons to LOVE Your Workout: Confessions of a Fitness Addict

I sometimes get strange stares when I tell people I love to workout. But it's true! I look forward to that time of day when I can step away from everything else and just concentrate on my body. I have truly become an addict. I get cranky when I miss a workout and my day somehow feels incomplete. I absolutely love the feeling I get from working out.

You, too can love your workout. The longer you stick with it, the more engrained it will be in your habits and the more results you'll see. Even in 6 weeks, the results can be dramatic.

What are 3 things you can love about your workout?

1-Relieves stress

Exercise lowers cortisol, a stress hormone. You can take what could be a negative emotion like anger, frustration or anger and use it as fuel for your workout. You can successfully redirect that negative emotion into a positive outcome.

Exercise is also a great distraction to get your mind off problems and put you in a better state to be able to deal with them. If nothing else, it can get you out of the four walls you normally stare at, giving you a fresh perspective.

That deep breath and sense of calm you get while doing cardio is hard to replace with anything else. Everything feels clear - your lungs, your skin, your thoughts. It's a great time to think as you're pounding away the miles.

2-Feels great

Have you ever heard anyone say, "Man, I sure do regret that I worked out today." Probably not! But you most likely have heard someone talk about how proud she was that she DID workout today or three times this week.

It just plain feels good to workout. Exercise increases endorphins which are your body's "feel-good" chemicals. There is often a feeling of euphoria with working out; a "high." Who can't use some of that? There is a sense of accomplishment and pride that comes with it. It's what keeps people coming back time after time... and the fact that they like the way their clothes are fitting and the positive comments they are receiving from people who are noticing a change in them.

Besides, when else do you get to listen to obnoxiously loud music in the middle of the day? Playlists make great workout buddies. You can adjust your music to the type of activity you're doing, the speed at which you want to do it and your overall mood or the mood you want to have. Music is a great pick-me-up. At the end of a workout, not only will you feel good from the workout, but from the music as well.

3-See progress & succeed at something

When you work out consistently, you will see progress. You'll see progress towards your goals whether that be fat loss or muscle gain. You'll also notice that you can do things today that you couldn't do last month. You'll notice you can go longer, faster and at a higher resistance doing cardio and that it becomes easier. Maybe last week you couldn't walk on the treadmill and carry on a conversation without being winded but now you can talk with ease. Maybe you started out doing a chest press with 10 pounds and now you use 20. Progress means success. And we all like the feeling of success. If you succeed in one area, it gives you confidence to succeed in another.

Did anything of those sound familiar? You've probably heard or experienced some or all of these things already.

And here's a bonus reason to love your workout:

When you workout, it gives you added incentive to stay on your meal plan. If you go to the gym an hour a day, there are still twenty three hours in a day to screw up your results. Who wants to work that hard in the gym just to blow it with her diet? Working out regularly adds some incentive to eat right.

Stacie Dickerson is the CEO of the Healthy Lifestyle Institute for Women. Access their free article archive, become a member absolutely free and get your health & fitness tools at  http://hliwconnect.com/.

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I Need to Lose Weight Fast, What Can I Do?

Nutrition: Contrary to popular belief, you do not have to eat less to lose weight. You body will adapt to maintain and retain energy when it recognizes a decline in the amount of calories it consumes. Now obviously, eating no food will eventually lead to rapid weight loss, but there are problems associated with starving yourself that aren't worth that trip. Actually, eating less can weaken your immune system, subjecting you to get sick easily, and eating less may cause headaches. So naturally, if I said "I need to lose weight fast, what can I do ?", many people would tell me to lose my appetite and consume less food. This is no longer the solution you should take.

Proper nutrition consists of eating foods in all of the food groups to give your body the energy and nutrients it needs. There are many vitamins, minerals, and micro-substances out there, so we won't list all of the ones your body needs, but it does need sufficient calories, Carbohydrates, Protein, Amino Acids, and each of the Vitamins to remain healthy. This is very basic, but it is a great foundation for structuring your diet. Remember, fats and oils are not bad for you. None of the food categories are actually bad for you. It is when they are not taken in moderation, that they become "bad".

In essence, losing weight through dieting requires you to eat, but to eat in moderation. Try lowering your daily calorie intake by 1,000, and eating wholesome foods. This will, most definitely get you to start seeing some results.

Exercise: I need to lose weight fast, what can I do? Once again, we come to this question, but in regards to exercise, there's actually not much you need to do. Many people who want to lose weight think that they need to get in the gym, do compound movements, isolation movements, and all sorts of other body building and strength training exercises to get thinner. What? This isn't the case at all. To lose weight, you need to burn more calories than you consume. The easiest, and fastest, way to do this is to do cardiovascular exercises. This includes, running, really. You can jog, run, or ride a bike, but any exercises in these categories work. Running, in particular, is great. Running on an incline is even better. The more energy, intensity, and time you put into an exercise, the more calories you will burn (important to remember). With this being said, you don't need a gym membership, and you may not even need to leave your house. A great exercise is running up and down your stairs for 30-45 minutes. Now, if you don't want your family to laugh at you, let's change the boundaries a bit; okay, so you may have to leave your house, but you certainly don't have to leave your neighborhood! Try doing laps around the block. Even if you can't run fast, it doesn't matter. If you want an extra burn, try running up a hill. The great thing is, the hill doesn't have to be steep.

Conclusion: Weight loss can be very challenging because of the confusion surrounding it. It is sort of like the old saying that too many hands in the soup will spoil it. In order to re-focus sometimes it is best to trust yourself just to a few basics from one source, because it is hard enough to stay on path with that alone.

To check out a friend of mine's transformation, click here.

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How to Leverage a Weight Loss Program, 5 Ways to Turn Yourself Into a Ferocious Health Monster

"Give me a lever long enough and I could move the world." - from Archimedes.

Me: "I would like to do that at some point".

Response: "When?"

Me: "Ummm... soon?".

The conversation at hand was of the topic 'vipasinna'. Where one basically sits in silence for 10 days to quieten the mind. Clearly the words came easily, giving myself the comfort of the idea that I would do it 'one day'. And for that moment, the idea of 'one day' sat well with me. It gave me the sense of gratification that I was going to take action on something at some stage. I felt committed without the commitment. I had happily tricked myself and it was like buying organic chocolate instead of a Mars Bar.

This conversation started to magnify what I was hearing in the gym too.

If only I could find the right weight loss program. I want to lose weight. I want to eat healthier. I want to stop drinking for a month. I want to exercise more. I should do this or I should do that. It's seems as human beings we easily should all over ourselves. A common theme I was beginning to hear more and more (including my own head).

With many great intentions for a healthier existence or improvement, it is certainly a human trait for a constant tug of war. But as long as we point ourselves in the right direction, even it's 3 steps forward and two back, we are still moving forward right? Which is better than standing on the spot.

SO ASK YOURSELF HONESTLY

Do you really want to lose weight? Those few extra kilos. Run a charity race? Improve your diet? Get lean this summer? Have that beach look? Run faster? Lift more? Live a healthier lifestyle? Create new habits? A life with more purpose? Be more grateful?

If you had the ultimate weight loss program, would you implement it correctly and follow it through? From my experience, it's not the weight loss program that's the problem, it is the person applying it.

All these wants can lead you to a healthier more vibrant self. If you answered yes to all of the above but are struggling to get there, then maybe it's time for a different approach and get some leverage - emotional leverage, which is working for me every time.

Be careful though, as I have seen this happen quite often - A person stops questioning things too much, they stop thinking, quieten the brain and just start doing the five things I have listed in this post, and before they know it, they've turned themselves into a ferocious health monster!

1. CREATE PAIN

Think about this for a moment. As human beings, we tend to move away from pain with more intention, than we do moving towards a more pleasurable experience that we want. We tend to tread water and stay in our comfort zone no mater how murky the water is, as apposed to swimming towards new waters that bring change, but along with change comes a sense of uncertainty. Usually we only start swimming when the pain becomes unbearable, or we do things without real purpose and intention behind it.

i.e. If I asked you to run 100m as fast as you can, the chances are you would do it, but not to your greatest ability. But if I pinned two dozen prime rare steak pieces all over you and let loose a ravenous pit-bull terrier that hadn't eaten for a week, do you think you would run faster? Of course!

But the pain we have is never short and sharp like the dog chasing, it's usually slow and gradual. A far off distant drum beat that's so faint you can hardly hear it. But the pain slowly builds like a pressure cooker and finally one day it explodes. That distant drum beat becomes so loud it feels like someone is beating it on your head and this jolts you into action!

I believe in each and every one of us, there is a tipping point that moves us to greater health (or anything for that matter). That tipping point usually comes from a painful experience. A 'that would be nice to have' turns into a 'must have' from one decision. The decision only takes a moment to make, but for some, a life time to get there.

Here is the most important point I am going to make - Why wait for the pain to arrive? Create the pain now.

Time and time again I see people who leave their health until it's a major threshold and that drum is beating so loud they finally want to create change. But by hitting the fast forward button and bringing the circumstances to the forefront, it's usually just a slap across the face as a posed to a sledge hammer.

So how do we create the pain?

First thing you must do is be brutally honest with yourself and not camouflage the truth. This is probably one of the toughest things you will have to do, but worth it. As humans we have a tendency to justify our actions daily. But ask yourself this: Would you rather be right or happy?

When I was sitting on the fence regarding the detox I underwent, I finally had some tests done to see where I was at. I knew they wouldn't be great, but as usual, the longer we leave it, the worse it gets. I also knew if I didn't like the results, it would be the kick-start I needed to get the detox under way, as it was quite a commitment.

So let's say it is weight loss you want to achieve and you know deep down there is a fair bit to shift. We all know the complications and connotations that being overweight can have on the body over time, and when that time comes how painful could that be?

So time for honesty. Take a full length photograph of yourself in your swimmers or underwear (only has to be for your eyes only), front, side and back. Remember, brutally honest right?

By doing this, it will give you a different perspective of yourself. There's no hiding now. I know by this point you may rather stick needles in your eyes, but what are the true consequences if you don't? Smaller pain now or bigger pain later? Which one do you want. The ostrich head burying approach will only work for so long before someone comes along and kicks you up the ass!

Parting with hard earned money is another great motivator. Not a member of a gym? You could pay for a membership for 3 months. If you are a member but you are not utilising the facilities well or just stuck in a rut, hire a personal trainer for 3 months. This money well spent will magnify the pain if you don't begin to follow through to an outcome deep down you truly want.

2. SET GOALS AND VISUALISE

Goal setting sounds as exciting as reading the NY Times financial review, but when implemented correctly, it has a very powerful effect on one's self. There are dozen of books written on this topic, so one I'm not going to go into to much detail with.

In the meantime, is there something you can commit to? A weight loss challenge? A fun run? Something with a timeframe. When I did my detox my Naturopath told me I needed to commit for 6 weeks. This instantly gave me a timeframe.

If you need to lose 10kg, how about 1kg a week for 10 weeks? That's realistic and achievable if you are committed.

Still not convinced? If you want to know what commitment is, you should know the story of my friend Kelli who was diagnosed with a brain tumour and not given much hope. So the next time you catch yourself complaining about it all being to hard, you should put yourself in her shoes. You will soon find that your goal will probably feel very achievable and the excuses you make are futile.

So once you have made pain your friend, you must set an achievable goal with a timeframe.

But not only do you have to set a goal, you have to visualise yourself already achieving it. As you can imagine, there are going to be many hurdles and you will be tested every step of the way to achieving what you want. So when faced with these hurdles we can either look for obstacles or opportunities.

By continually visualising yourself already achieving what you want, you will be training the most powerful resource you have - your subconsciousness. This will then enable you to see opportunities arise when previously all you could see were obstacles.

To help this process, place your goals or images/pics somewhere you will see them constantly. Bedroom mirror, fridge, toilet door. I have even known someone to laminate their goals and hang it up in the shower! Just do whatever works for you, as long it keeps you on track and moving forward. But make sure you follow this process through!

Just remember, if you are sailing to Tasmania in a head on wind, you don't turn around and go back, you adjust your sails accordingly.

3. REFERENCE POINT

Once you know what you want to achieve, you have to create reference points along the way of your committed timeframe and record as much information as possible. If you don't do this, how do you know if you are making progress?

By now you should know what you want, but you also have to know where you have come from and also be able to track your progress along the way.

You could have a diary dedicated to your weight loss plan. You have probably jumped on the scales to see what your weight is. But this only tells a small part of the story. Break that weight down. Measure your body fat %. Calculate your muscle mass kg. Measure body girth circumferences. (If you not sure how to do all this, pop into your local gym for them to do it).

See how many push ups or sit ups you can do in a minute. Test yourself once a month.

You have taken a picture of yourself, why not take one once a month to compare any body changes. Nothing will give you more motivation than seeing your body shape changing in front of your very own eyes.

Keep a food diary. Write everything down that goes into your mouth. You could even keep a photo diary. Take pictures of the foods and drinks you have for a couple of weeks and track your progress. If you are not hitting your targets, you can look back at what you have been eating to see if you are sticking to the plan.

You have to make your goals measurable. The more data you collect the better and the more it will help you along the way.

4. PROXIMITY

By this point, if you have followed through with the first three principles wholeheartedly, right now you should be chomping at the bit with all the momentum you are gathering. But for this momentum to last and if you are to go the distance with any weight loss program, ignore this word at your peril: Proximity.

This one can be a slightly delicate topic, and for me, one that took a while in life before the penny really dropped. But once it did, it had a MASSIVE implication on my direction in certain aspects of my life and the environment I put myself in on a daily basis.

Simply put, the people and the environment you surround yourself with will have a major impact on whether you follow through until the end or not.

A fantastic form of leverage is to spend time with someone who has achieved what you want. Someone who will make you raise your standards. We generally shy away from people like this, but it's a must if you want to achieve a different result.

When I migrated to Australia five years ago, I was fearful of the ocean. Here I was living 500 meters from the beach and not even able to swim a lap of a pool, let alone get amongst the waves! But this was something I wanted to overcome.

I started meeting a mate of mine for swimming, but he was not a very strong swimmer either. Before we knew it, we were talking each other out of it and coming up with great excuses. It all came down to FEAR.

As great as my mate is, he was unable to push me because he was suffering the same problem. Eventually I got so desperate and determined, I walked into the local surf lifesaving club and asked what it took to be one, at this point, this was WAY beyond my wildest thoughts, and the bottom line was, if I was willing to commit, they were willing to commit too. So I went for it.

The next thing I knew, I was surrounded by people who had been involved with beaches and surf rescue for most of their lives. Every time I wanted to back off or didn't have the belief I could get through my bronze medallion, there was someone there to tell me otherwise. Because of this I passed and it challenged me every step of the way, but it is still one of my greatest personal achievements to this day.

There's a saying in South America: "burn the ships", because that's what the settlers did when they arrived and there was no turning back. And to get what we want, I feel sometimes that's what we have to do in life to get there. So ask yourself... have you burnt the ships?

Be careful of who you surround yourself with and make no doubt about it.. Proximity is power.

5. THE FINAL PIECE OF THE PUZZLE

The final piece of the puzzle is to go public. By this I don't mean walking down the high-street with a megaphone or telling your mates how you are to undergo a healthy lifestyle change at a party over some extravagant dessert your eating, but actually putting it out there to the world by any means possible that connects us in today's society.

Do you have a Facebook profile? You could tell your friends and family what your about to do and then update it every day. If you are shy, not to worry as most people won't actually give a shit, and the ones who do will support you and give encouragement. I think we can spend so much time thinking what others think, it holds us back. But if everyone is thinking what others think of them, then nobody is really thinking about you are they? Are we really that important to be consumed by other peoples thoughts?? Probably not. If they do judge you, it's only fleeting at best. So don't sweat it and just put it out there, because the world will keep turning whether you do or don't.

You could blog your progress. You can set up a simple blog within 15 minutes these days. When I was about to do my detox, I decided to blog it. This made it VERY REAL. It was the final tipping point and it helped get me through. Not only did it get me through, I had a lot of fun doing it! People got very curious and what surprised me most, there was a lot of support and talk around the topic as others began to look at what they were doing daily too.

The bottom line is, if you are going to do something about it. TELL EVERYONE!

Final Thoughts

If you read this post to the end:

a. You've got to much time on your hands

or

b. You actually can relate to the points I have made and know that not only can they be applied to a weight loss program, but any parts of your life for that matter.

If you are struggling with your weight or health. My view is that it's 80% attitude and 20% applied knowledge. If you find yourself saying mmmmm that's an interesting post, but do nothing, you have simply learned and not applied that knowledge.

So when in doubt, just do SOMETHING. If you do this, the pieces of the puzzle will fall into place in ways you could have never imagined, and before you know it. You've turned yourself into ferocious health monster.

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