Heartburn

Heartburn is the common classical symptom of the disorder gastro-oesophageal reflux disease (GORD). Heartburn is experienced as a gripping, substernal (below the breastbone) discomfort that may be made worse by lying, eating or bending. In some cases heartburn may be confused with cardiac chest pain but the former is relieved by antacids whilst pain associated with ischaemic heart disease is relieved by nitrate sprays.

Heartburn is extremely common in the Australian population and is most cases can be easily managed with simple lifestyle changes and over-the-counter antacid medications. However, if the pain is persistent you may require further investigations as severe disease can progress to adenocarcinoma of the oesophagus. This is a type of cancer that develops in a very small number of patients.

Heartburn is the hallmark symptom of gastro-oesphageal reflux disease (GORD) and a common complaint amongst the general population. Heartburn is described as an intermittent retrosternal (behind the breastbone) burning discomfort that is exacerbated by eating, lying down, bending, stooping or straining. The pain is typically central but it may spread across the chest and into the neck and may be mistaken for the pain associated with ischaemic heart disease.

Virtually everyone will experience some mild heartburn at some time during their lives whilst up to 20% of the population will experience it weekly and 40% on a monthly basis. Doctors are faced with the challenge of deciding who needs further investigation for this extremely common complaint to identify those patients with gastro-oesophageal reflux that may progress to oesophagitis (erosion and destruction of the lining of the oesophagus), cellular morphological changes (called Barrett's oesophagus) and occasionally adenocarcinoma.

As forementioned, heartburn is commonly caused by gastro-oesophageal reflux disease. In this disorder the sphincter mechanism at the lower end of the oesophagus (the tube from the back of your throat to your stomach) is faulty. This means that when food enters the stomach, the gap between the oesophagus and stomach doesn't close properly and food can move backwards (reflux) into the oesophagus. This causes damage to the oesophagus and pain because the lining of the oesophagus is not designed to withstand the acidic environment of the stomach. In addition, the muscular walls are thought to spasm when food is refluxed further contributing to pain.

There are a number of conditions that can predispose to dysfunction of the lower oesophageal sphincter or make heartburn symptoms worse. These include:

Hiatus hernia- In this condition the top part of the stomach pushes up through a defect in the diaphragm (a muscular structure dividing the chest from the abdomen). This causes weakening of the sphincter and upsets the stomach's closure mechanisms. Food is more likely to propel back from the stomach to the oesophagus. Obesity. Pregnancy- Presumably predisposes to reflux due to increased abdominal pressure and loosening of ligaments and muscles (including those of the sphincter mechanism in the diaphragm) in the body in preparation for childbirth. Smoking and alcohol consumption. Medications- Certain medications used to treat blood pressure problems, depression or asthma have been associated with heartburn symptoms. If you suspect one of your medications is causing heartburn do not hesitate to consult your doctor.

In many cases the doctor can make the diagnosis of your condition from history of your symptoms alone. They will ask you detailed questions about the location of the pain and whether it spreads anywhere. The timing of the pain in relationship to meals, effects of posture and duration of the pain is also important information. Your doctor will also ask questions about your diet, smoking, alcohol and current medications. You will also be questioned about other symptoms such as blood or black material in your vomit or stools. In particular, weight loss and difficulty swallowing are important symptoms as they may suggest a serious problem.

Not all patients will have the classic symptoms of heartburn and sometimes your symptoms may seem more like a respiratory problem such as a cough or wheeze at night. Along with chest discomfort you may also have other symptoms of oesophageal dysfunction including:

Difficulty swallowing. Painful swallowing due to damage to the lining of the oesophagus. Acid regurgitation. Excessive salivation.

Unfortunately the severity of your symptoms does not correspond well with the severity of the damage to your oesophagus. This is a problem if patients have mild symptoms but there is extensive damage that may progress to more sinister conditions.

In many cases no further investigation is required, particularly if you are young with longstanding classic symptoms of heartburn. However, if you are older or you doctor is concerned they may order further tests to confirm the diagnosis of reflux and grade the severity.

These tests may include:

Upper gastrointestinal endoscopy and biopsy (tissue sampling)- This lets the doctor visualise damaged areas. Tissue samples can help exclude early precancerous changes. Barium studies- This may detect a hiatus hernia. Manometry- A tube is inserted down the nose to measure the pressures generated by the lower oesophageal sphincter. Oesophageal pH monitoring- This is done over a 24 hour period with a special device positioned in the lower oesophagus. The device can detect reflux episodes by the degree of acidity.

In most cases the main aim of treatment will be to relieve your symptoms. However in some cases the doctor may be more concerned that the oesophagus is completely healed, particularly if you have severe disease or are at risk of complications. In these cases follow-up endoscopies and biopsies may be needed. At least half of patients will respond to lifestyle changes and simple antacid medications.

Lifestyle changes

Lose weight if overweight. Raise the head of the bed- Placing blocks or bricks securely under the legs of the head of the bed can reduce the risk of stomach contents flowing back up into the oesophagus. Eat small, regular meals and avoid intake of food or beverages within three hours of bedtime. Avoid lying, bending or exercising just after eating. Avoid drugs such as NSAIDs that damage the oesophageal mucosa and drugs that impair oesophageal motility (nitrites, anticholinergics, certain antidepressants etc.). ask your doctor for advice regarding your current medications. Avoid smoking and alcohol. Avoid foods that are known to exacerbate your symptoms such as spicy foods, tomatoes, citris fruits and peppermint. Reduce stress.

Medications

If the above measures don't work you can try medications such as:

Antacids: For example Mylanta can neutralise stomach acid and is available at chemists and supermarkets. They can however alter bowel motions and cause fluid retention. Alginates: These are also over-the-counter drugs and work by forming a gel or 'foam raft' on top of the stomach contents to provide a physical barrier to reflux. If the above two types of drugs do not relieve symptoms within four weeks it is best to see a doctor who may arrange an endoscopy investigation (tube with a camera down the throat to have a look). Acid suppression therapy: Your doctor can prescribe two classes of drugs called H2-receptor antagonist or Proton-pump inhibitors (PPIs) which markedly reduce acid production. The latter is the best treatment for severe disease and can be used long-term to prevent recurrence. Your doctor may also try agents that speed up the stomach's emptying activity to reduce reflux.

Surgery

In a small number of patients surgery is indicated. This is only suitable if you have very severe symptoms of heartburn and the condition is confirmed by radiology or pH-monitoring. Surgery is normally done laparoscopically (key-hole surgery) and aims to fix defects in the diaphragm and sphincter mechanism. This may be considered a favourable option for young patients who would require long-term maintenance therapy.

For more information on acid reflux and heartburn and related investigations, treatments and supportive care, see Acid Reflux and Heartburn. de Caestecker J. ABC of the upper gastrointestinal tract. Oesophagus: Heartburn. BMJ. 2001;323(7315):736-9. [Abstract | Full text]Cohen S, Parkman HP. Heartburn: A serious symptom. N Engl J Med. 1999;340(11):878-9. [Abstract]Kumar P, Clark M (eds). Clinical Medicine (5th edition). Edinburgh: WB Saunders Company; 2002. [Publisher] Longmore M, Wilkinson I, Rajagopalan S. Oxford Handbook of Clinical Medicine (6th edition). Oxford: Oxford University Press; 2004. [Publisher] Longstreth GF. Heartburn [online]. Bethesday, MD: MedlinePlus; 2005. Available from: URL link Talley N, Moore M, Sprogis A, Katelaris P. Randomised controlled trial of pantoprazole versus ranitidine for the treatment of uninvestigated heartburn in primary care. Med J Aust. 2002;177(8):423-7. [Abstract | Full text] Product Information: Somac Heartburn Relief Tablets. North Ryde, NSW: Nycomed Pty Ltd; 31 July 2008.Fox M. Gastro-oesophageal reflux disease. Clinical review. BMJ. 2006; 332: 88-93. [Abstract | Full text]
Duggan AE. The management of upper gastrointestinal symptoms- is endoscopy indicated? Med J Aust. 2007; 186(4): 166-7. [Full Text]Braunwald E, Fauci AS, Kasper DL, et al. Harrison's Principles of Internal Medicine (15th edition). New York: McGraw-Hill Publishing; 2001. [Publisher]Tierney LM, McPhee SJ, Papadakis MA (eds). Current Medical Diagnosis and Treatment (45th edition). New York: McGraw-Hill; 2006. [Publisher]DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005; 100(1): 190-200. [Abstract]Murtagh J. General Practice (3rd edition). Sydney: McGraw-Hill; 2003. [Publisher]

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Gastric Banding

Gastric banding is an operation performed under general anaesthetic. A surgeon will place an adjustable band around the top of the stomach to create a small pouch to hold food. The band is attached via a thin tube to a small "port" or reservoir, which is placed under the abdominal skin at the time of surgery. This port allows the surgeon to increase the tightness of the band (by injecting fluid into the reservoir) at a later stage. In Australia, laparoscopic (key-hole surgery) is the most common method used to perform gastric banding. This procedure is considered simple and safe for people who are very overweight and experience complications because of their weight.

Surgery is considered to help morbidly obese patients lose weight. This is because a person who is obese is more likely to suffer from physical and psychological illness than a healthy weight person. In particular, overweight patients are more at risk of heart disease, diabetes, high blood pressure, high cholesterol, heart attacks or stroke, sleep apnoea, depression, and osteoarthritis. Losing weight has been shown to reverse or reduce these conditions. Laparoscopic gastric banding is performed on people who are morbidly obese. This means they have a Body Mass Index (BMI) of more than 40. (The normal BMI is 18.5 - 24.9. Calculate your own BMI here.) A person's weight is not the only consideration in having this procedure. Some people who have a BMI of 35 or more may be considered if they also have medical problems such as heart disease, diabetes, high blood pressure, high cholesterol or severe arthritis. Before a person can be considered for surgery, they must have made multiple, previous significant attempts to lose weight on their own. This includes dieting, exercise, and possibly medications for aiding weight loss. Most surgeons require a patient to show they are motivated to lose weight before they have surgery. If a person is highly motivated they are more likely to follow their specialised eating plan and attend regular follow-up after surgery.

Gastric banding creates a small pouch before the stomach in which food becomes trapped when it is ingested. The benefit of this is there is a smaller capacity for solid food to be held and a person will feel full more quickly. Food in the pouch is digested more slowly and so a person's sense of "fullness" can last longer after meals. Studies have shown that this procedure cause an average of 23kg of weight loss at 2 years, and up to 43kg of weight loss at 5 years. Most patients who try to lose weight without this surgery do not lose any weight at all over a long period. Laparoscopic banding surgery is considered the safest of all the types of surgery performed to reduce weight. In most cases, patients will only be in hospital for 24 hours. After surgery, there is an improvement in many obesity related diseases. Studies 2 years after the laparoscopic banding procedure have shown improvements in;

Blood pressureCholesterolAsthmaDiabetesGastro-oesophageal refluxHeart failureSleep apnoeaDepressionInfertilityBlood clots

Laparoscopic gastric banding surgery is more complex to perform than some other types of surgery. However most surgeons who perform this operation are highly experienced. The surgeon who performs this procedure should discuss the complications with you prior to the operation. The overall rate of complications is also low. There is a very low risk of death with this operation, less than 0.5%. As with any form of surgery, there is a small risk of infection, wound problems, blood clots or lung problems. There are measures to minimise these complications that your doctor may prescribe. There is a risk of the band slipping or the pouch dilating. These problems may require further surgery in about 25% of cases. In less than 2% of people there is a risk that the band may erode into the stomach lining. After the surgery, some patients can have vomiting related to eating. This does not happen in all patients and can be reduced by eating small portions. This procedure is not always successful. A small number of patients will not lose weight with this surgery. However, in those patients who lose weight rapidly, there is a risk that they can develop gallbladder inflammation, which may require removal of the gallbladder.

A person is usually referred to see a surgeon by their GP. The surgeon will discuss the procedure, its risks and benefits. There are also a number of criteria a patient should meet. The person should have a BMI of more than 40. In some situations a person with a lower BMI may be considered for surgery if they have medical problems such as high blood pressure or diabetes. To be eligible a person must also have made multiple, significant attempts to lose weight on their own. There are a number of professionals that form a team to look after patients who have gastric banding surgery. The team may include nurses, a dietician, social worker, physiotherapist and anaesthetist. A person will have to attend multiple appointments with these professionals. In most cases a person will need to see at least the surgeon, dietician and anaesthetist, prior to surgery. Many centres also ask patients to see a psychologist before they are considered for surgery. The role of the psychologist is to interview the patient and discuss emotional and social factors, which might influence their ability to lose weight. Their involvement is important to help identify those people who will do well, or not-so-well following this surgery. After surgery, a person will attend follow-up sessions with many health professionals. It is important to understand prior to surgery that long-term follow-up is a part of the treatment plan.

The laparoscopic gastric banding surgery involves an adjustable silicone band being placed around the top portion of the stomach. During this procedure, a person will be kept asleep by a general anaesthetic. The surgeon will use several small probes to introduce the band into the abdomen and then place it around the top portion of the stomach. There will be several small cuts on the surface of the abdomen from the probes used. Attached to the silicone band is a small port or reservoir, which will be inserted under the skin at the time of surgery. The person will be able to feel a lump under the skin where the port is situated. This port will allow the surgeon to adjust the tightness of the band at a later stage.

After the surgery, a patient will wake up either in the operating room or just outside. It can take a few hours to feel back to normal after an anaesthetic. In most cases, a person will be ready to return home a day after surgery. It is advisable that a family member or friend be available to pick a patient up from hospital and stay with them for the first 24 - 48 hours. It is expected that you may be a bit sore following the operation over the wounds. However most people are able to resume daily activities soon after the surgery. Discuss with the surgeon prior to the operation how much time they would recommend off work. There is a strict follow-up plan after the operation. The plan for review is different for each surgeon and hospital. It is important to attend all appointments made for you after surgery. In a hospital setting, the patient may visit with allied health (such as physiotherapy, dietician) and a surgeon. If you suspect there is a problem after surgery it is a good idea to visit with your general practitioner and call your surgeon to discuss your concerns. A person who follows the eating plan set out by the dietician and exercises regularly, will have the best chance of losing weight. It is important to see your doctor regularly for check-ups. This will allow doctors to monitor how much weight you lose and the speed of weight loss. Some patients will also be monitored with regular blood tests. If you plan to become pregnant after this surgery you should discuss this with your doctor. The most important part of follow-up after the surgery is learning to adjust your diet. After surgery, patients need to eat more slowly. You should eat three standard meals a day and try not to snack between. A dietician will advise people on which specific foods are best. All patients should avoid sugary drinks (e.g. ice-cream shakes, soft drinks) and liquid meals (e.g. protein shakes) as these will pass straight through the pouch created by the stomach band, and will not give a person a sense of "fullness". These drinks are a potential cause of failure to lose weight after surgery. It is possible that the band may need to be adjusted at a later stage to maintain weight loss. Your doctor will advise you of any symptoms to watch out for that may require special treatment. It is also important to tell other doctors you may see about having had this procedure.

This tool needs Javascript enabled to run.

The formula for calculating your body mass index is:
BMI = weight (kilograms) / (height (metres) * height (metres))

For example:
A man who weighs 85 kilograms and is 1.8 metres tall would have a BMI of
BMI = 85 / (1.8 * 1.8)
BMI = 85 / 3.24
BMI = 26.2

This information will be collected for educational purposes, however it will remain anonymous.

Morris, P. Wood, W. (2000) [2nd edition] Oxford textbook of Surgery: Chapter 25; Surgery for Obesity [chapter author Grace, M.] Oxford University Press: Oxford.Allergan Australia (2007) About laparoscopic gastric banding [cited 11th December 2007] Available online [http://www.gastricbandingsurgery.com.au/ about_gastric_banding.php]Kral, J. (2006) ABC of Obesity: Management: Part III - Surgery [5th article in series] British Medical Journal 333; p 900 - 903. Available online [http://www.bmj.com]Snow, V. Barry, P. Fitterman, N. Qaseem, A. Weiss, K. et al (2005) Clinical Guidelines: Pharmacologic and Surgical Management of Obesity in Primary Care: A clinical practice guidelines from the American College of Physicians. Annals of Internal Medicine 142: 7; p 525 - 531.Sjorstom, L. Lindroos, A. Peltonen, M. Torgson, J. Bouchard, C. Carlsson, B. et al (2004) Lifestyle, diabtes and cardiovascular risk factors 10 years after bariatric surgery. New England Journal of Medicine 351; 26: p 2683 - 2693.Sjostrom, C. Lissner, L. Wedel, H. Sjostrom, L. (1999) Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obesity Research 7: p477- 484.Northern Rivers General Practice Network (cited 12th December 2007) What GPs should know about lap banding. Available online [http://www.medicineau.net.au/ clinical/obesity/obesit3160.html]Colquitt, J. Clegg, A. Loveman, E. Royle, P. Sidhu, M. (2005) Surgery for morbid obesity. [Cochrane clinical review] Available online: [http://www.mrw.interscience.wiley.com/ cochrane/clsysrev/articles/CD003641/frame.html]Wilkinson, S. (cited December 21st 2007) Obesity Surgery: Lap-Band Surgery, Am I a suitable candidate? Available online: [http://www.tasmaniaobesitysurgery.com.au/ lapband.html]National Health and Medical Research Council (2003) Clinical Practice Guidelines for the management of overweight and obesity in Australia [update 19th March 2004] Commonwealth of Australia, Department of Health and Ageing [Available online: www.obesityguidelines.gov.au]

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Meal Replacement Programs

Effective weight loss strategies are needed to help overweight and obese people lose weight and maintain weight loss in the long term. Meal replacements for weight loss are available in the community and have become popular for helping many people successfully start losing weight.  

Obesity is an important condition and causes significant health problems. These can be lifelong and many result in a poorer quality of life. People who are overweight or obese show increased rates of type 2 diabetes mellitus, cardiovascular disease, some cancer and arthritis amongst other conditions. The term obese is assigned to a male individual who weighs 20% or more over the maximum desirable for a man's height. In females the term obese is assigned to individuals who weigh 25% or more over the maximum desirable for a woman's height. Obesity is also defined as a BMI (body mass index) over 30 kg/m2. BMI is calculated by dividing your weight by your height squared. Calculate your BMI using the calculator below:

This tool needs Javascript enabled to run.

The formula for calculating your body mass index is:
BMI = weight (kilograms) / (height (metres) * height (metres))

For example:
A man who weighs 85 kilograms and is 1.8 metres tall would have a BMI of
BMI = 85 / (1.8 * 1.8)
BMI = 85 / 3.24
BMI = 26.2

This information will be collected for educational purposes, however it will remain anonymous.

Specially formulated meal replacements have been used in Australia for a long time as treatments against the rising rates of obesity and disorders associated with obesity. In many research studies conducted in Australia by the CSIRO and researchers overseas, meal replacement programs have been associated with successful weight loss.

To lose weight we need to take in fewer calories than our body needs. When this happens, we draw on our fat stores to provide us with the extra energy we require to function properly. In the long term, this means we lose fat, and in turn lose weight. These programs work by replacing meals per day with specialised formula food, which are a complete meal. Meal replacement programs combine a meal replacement regimen with additional health supports such as physiotherapists.

The program is a combination of LCD (Low Calorie Diet) and the natural process of ketosis. Ketosis happens after 48 hours when body detects that it doesn't have getting enough carbohydrates to operate as it usually does. The body therefore 'switches over' to a different method of providing fuel for itself - your fat stores.

Formulated meal replacements take various forms, including powders, drinks, soups, bars and biscuits. Some products are designed to replace all meals whilst others are designed to replace only one or two meals per day. The formulas contain adequate vitamins and minerals.

Meal replacement products are always very low in fat and often have added fibre. A good meal replacement program provides extensive educational material and recipes to educate people about healthy eating and lifestyle habits.

Major health organisations with an interest in helping the public to lose weight now suggest meal replacements are a suitable option for some people. Organisations such as the National Obesity Forum, the British Dietetic Association and Dietitians in Obesity Management UK believe meal replacements offer an alternative to other more conventional dietary treatments and may prove beneficial for some people. Meal replacements have been shown to be part of a successful therapeutic approach to weight loss especially when used in combination with lifestyle and diet education and professional support.

The first line of therapy for weight loss is a healthy diet (which provides appropriate energy) and regular physical activity. For people who have not achieved success with these first line therapies, meal replacements are an option to add to their regime. A healthy diet plan including meal replacements may result in the success they have been striving for. As well as cutting calories in a controlled way, many nutrition experts also think meal replacement diets are effective because they offer a structured plan and are the ultimate convenience food as they require little or no preparation or cooking. Furthermore, they take away the 'pressure' of deciding what to eat for two meals each day, yet still allow an element of choice for one meal.

Many people like meal replacement products because they are convenient, they take away the need to think about food during the day. The meals are strictly portion controlled. Meals are usually designed to be filling, reducing hunger between meals. Furthermore meal replacement diets are advantageous as the amount of calories in each portion has already been calculated. This makes it easier to keep energy intake down leading to greater success with weight loss.

Many people who enjoy cooking or preparing food may find the program too disciplined. In addition there is a limited amount of variety available when consuming whole foods. The flavours can also be limited and many people who are lactose intolerant may find that some sachets/shakes are milk/skimmed milk based.

Getting started involves choosing a reputable program that provides a holistic approach to weight loss; One that provides both the tools and support to sustain you through the weight loss process. The main providers of programs that meet or approach the minimum standard for nutritionally balanced meal replacements include KicStart VLCD (Pharmacy Health Solutions), Optifast VLCD (Novartis), Dr MacLeod's (Orfam) and Ultra Slim (Associated British Foods).

 For more information on nutrition, including information on types and composition of food, nutrition and people, conditions related to nutrition, and diets and recipes, as well as some useful videos and tools, see Nutrition. 

For more information on obesity, health and social issues, and methods of weight loss, as well as some useful tools, see Weight Loss.

Virtual Gastro Centre, Obesity, http://www.virtualgastrocentre.com/diseases.asp?did=474, 27th April 2007National Health and Medical Research Council of Australia, Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, NHMRC Australia, Commonwealth of Australia, Canberra, 2003Egger G., Editorial, 'Are meal replacements an effective tool for weight loss', MJA 2006 Vol 184:2 52-53Dieticians Association of Australia, http://www.daa.asn.au/index.asp?PageID=2145834478, 20th December 2006Food Standards Australia New Zealand. Australia New Zealand food standards code. Available at: http://www.foodstandards.gov.au (accessed Sep 2005)Heymsfield SB, van Mierlo CA, van der Knaap HC, Heo M, Frier HI., Weight management using a meal replacement strategy: meta and pooling analysis from six studies. Int J Obes Relat Metab Disord. 2003 May;27(5):537-49.Clifton PM, Noakes M, Keogh J, Foster P. How effective are meal replacements for treating obesity?, Asia Pac J Clin Nutr. 2003;12 Suppl:S51.Flechtner-Mors M., Ditschnueit HH., Johnson TT. et.al., Metabolic and weight loss effects of long-term dietary intervention in obese patients: Four-year results. Obes Res. 2000;8:399-402.Winick C, Rothacker DQ, Norman RL. Four worksite weight loss programs with high-stress occupations using a meal replacement product. Occup Med (Lond) 2002; 52: 25-30.Metz JA, Stern JS, Kris-Etherton P, Reusser ME, Morris CD, Hatton DC et al. A randomized trial of improved weight loss with a prepared meal plan in overweight and obese patients: impact on cardiovascular risk reduction. Arch Intern Med 2000;160(14):2150-8Wadden TA, Stunkard AJ, Liebschutz J. Three-year follow-up of the treatment of obesity by very low calorie diet, behavior therapy, and their combination. J Consult Clin Psychol 1988;56(6):925-8.Ashley JM, St Jeor ST, Schrage JP, Perumean-Chaney SE, Gilbertson MC, McCall NL et al. Weight control in the physician's office. Arch Intern Med 2001;161(13):1599-604.Noakes M., Foster PR., Keogh JB., Clifton, PM., Meal Replacements Are as Effective as Structured Weight-Loss Diets for Treating Obesity in Adults with Features of Metabolic Syndrome, J. Nutr. 134: 1894-1899, 2004.

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Ban trans fats!

Banning the use of trans fats in the preparation of foodstuffs is one of the most effective ways to prevent some of the world's biggest killer diseases, but many governments are not taking such action because they do not think these bans work, according to a University of Sydney study published in the Bulletin of the World Health Organisation.

Shauna Downs, lead author and researcher at the University's Menzies Centre for Health Policy at the University of Sydney, Australia said trans fats policies in Brazil, Canada, Costa Rica, Denmark, the Netherlands, the Republic of Korea and the United States of America (USA) over the last two decades had proven to be effective in removing trans fats from the food supply.

She said the study's findings were particularly relevant for low- and middle-income countries where such measures have been identified as a "best-buy" policy for health - ie one that is expected to provide a high return on investment in terms of health gains.

"We found for example, that a national ban in Denmark virtually eliminated trans fats from the food supply, while local bans in Canada and the USA were successful in removing trans fats from fried foods," Ms Downs said.

"While some of the government policies we studied imposed voluntary self-regulation and others took mandatory measures, such as labelling, local and national bans on trans fats proved to be the most effective policies for removing trans fats.

"Our findings show that these policies are not only feasible and achievable - they are also likely to improve public health."

Trans fats - also known as trans fatty acids - are naturally found in dairy and meat products but also generated by industrial processes to produce hard fats from vegetable oils. The industrially produced trans fats are also known as partially hydrogenated vegetable oils.

Consumption of trans fats is associated with an increased risk of non-communicable diseases, including cardiovascular disease, such as heart disease, as well as stroke and diabetes.

These partially hydrogenated vegetable oils are, however, favoured by the food industry and fast food outlets because they are cheap, have a long shelf life, are semisolid at room temperature, which makes them easier to use in baked products, and can withstand repeated heating.

The World Health Organization (WHO) has called for the elimination of trans fats from the global food supply in response to the rise in the prevalence of non-communicable diseases and has identified it as a "best-buy" public health intervention for low- and middle-income countries. This proposed policy measure was advocated in the Political Declaration of the High-level Meeting of the UN General Assembly on the Prevention and Control of Non-communicable Diseases in September 2011.

Dr Francesco Branca, department director for Nutrition for Health and Development at WHO, said the University study was important because it gave an overview of current policy approaches and compared their effectiveness.

"It provides a rationale for strong regulations, such as national bans, and challenges voluntary approaches, given that their outcomes have been less satisfactory than mandatory measures."

(Source: University of Sydney: World Health Organisation)

Article Date: 16/4/2013

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Slim evidence for weight loss product

The use of celebrity endorsements by Nicole Kidman and others needs a rethink in light of a Therapeutic Goods Administration decision to ban a Swisse appetite suppressant after finding the scientific evidence does not support the product claims, says CHF CEO Carol Bennett.

"We congratulate the TGA for its firm action on this issue. The market is being flooded with these heavily-promoted but lightly-proven products," Ms Bennett said.

"Often because they are sold in pharmacies, consumers may have the mistaken impression that, like mainstream medicines, they have therapeutic worth. The reality is that for most people their hardearned cash could be better spent elsewhere".

"The industry has deployed a number of movie and sports stars to spruik their products in the media".

"While they might believe these products do what they claim to do, there is little or no independent medical evidence to support them.
"Many products being promoted by prominent people including Nicole Kidman, Lleyton Hewitt, Ricky Ponting and even the Wallabies rugby team, for most provide no more benefit than a wholesome diet would.

"But buyer beware! These companies' use of VIPs may add to their profits but provide little value for money.

"Celebrities' fame carries responsibilities. Just as they do not like the public and the media prying into their personal lives, they should be mindful of the way their personal endorsement of a product may directly influence the lives of thousands in negative ways, such as paying $20 for a largely worthless product when they could be using that money to buy nutritious food."

(Source: Consumers Health Forum of Australia)

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.For more information on nutrition, including information on types and composition of food, nutrition and people, conditions related to nutrition, and diets and recipes, as well as some useful videos and tools, see Nutrition.
Article Date: 15/5/2013

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Pizza Pointers

A cut here, a slice there! By making a few simple changes, you can cut 50 to 100 calories per serving of pizza.

Clipart.com Pizza is a favorite food for many of us thanks to its convenience and well ... it just plain tastes good! But if you're not careful, you can blow an entire day's calories in one sitting at the pizzeria. A few simple changes can help you keep your calorie count in check. Here's how to cut calories from pizza: A typical slice of pizza chain hand-tossed cheese pizza provides around 220 calories. Simply asking for "half cheese" will save you around 50 calories per slice and reduce saturated fat by about a third. You will probably be pleasantly surprised at how much cheese is still left on your pizza after cutting it by half.

If you just can't cut your cheese-fix by half, request part-skim cheese instead of whole-fat cheese. Or, some pizzerias may substitute a sprinkling of Feta instead of regular cheese which is lower in calories.

If you would like to go virtually cheese-free, order "no cheese" and then dust each slice lightly with grated Parmesan.

Bonus Tip: Going topping-free? Sprinkle on red pepper flakes to add extra "zip" to plain pizza.

For counting calories, assume that each type of meat topping adds around 40 calories per slice. Of course, that can vary if your pizza chef is heavy handed, and by the size of your serving. But if nutrition info isn't readily available, it's a good estimate. (Be sure to check About.com's Calorie Count to see if your favorite pizza variety's caloric content is listed.)

What is undoubtedly the top pizza topper, pepperoni, provides 130 calories per ounce. A typical slice of pepperoni pizza contains between 200 and 250 calories. As an alternative, try chorizo -- a spicy Mexican smoked sausage variety -- which will save about 20 calories per serving while still providing that smoky hot flavor you crave. Or try Canadian bacon instead for about 80 calories per ounce.

Is sausage your favorite pizza variety? Swap it with lean ham and you'll cut a third of the calories. Plus, ham provides more protein per ounce than sausage, so you will feel fuller after eating. (Which may help you stop at two slices instead of progressing to three!)

Extra lean ground beef or ground turkey breast are also good alternatives to higher-cal meat toppings, if they're available. It may cost a little more, but grilled or roasted chicken is a delicious and diet-friendly topping, so it's worth the splurge.

Bonus Tip: Use an absorbent paper towel or several paper napkins to soak up some of the grease from your pizza and you could save around 15 to 25 calories per slice. This is really important with pepperoni or sausage because these toppings result in a "layer" of grease during cooking.

Try eating a bowl of vegetable soup, minestrone or another broth-based soup as an appetizer before your pizza. Or, eat your salad first instead of with your pizza to curb your appetite.

Consider eating a cooked vegetable as a side dish with your pizza as you would any other type of entree. Green vegetables seem to go well with pizza. Try different sides until you find what you like.

Choosing veggie toppings like green peppers, tomatoes and onions in lieu of meats will add filling fiber and antioxidants while cutting calories. While peppers and onions may not be the most highly nutritious, they're certainly healthier than meat, so try adding them first and then remove meat. Then, try spinach or even broccoli for a change. You may find in time you prefer these to meat toppings.

If you are eating at home and your veggie toppings are skimpy, add your own from the fridge and simply re-heat the pizza for a few minutes under the broiler or in your toaster oven.

The size of your slice (and thereby, its calorie count) can vary greatly from restaurant to restaurant. A 14-inch pie at one location may be sliced into 12 pieces, while at another it is reduced to eight slices.

Order thin crust when available to save calories. For instance, deep dish crust contains about 100 calories more per slice than thin crust.

Replace regular crust with whole-wheat crust where available and you'll get in nearly 20% of your fiber needs for the day.

Dipping sauce like garlic butter or ranch can add hundreds of calories to your pizza, especially if you double (or triple...) dip your slices. Simply avoid them altogether because they're just not worth the extra calories.

Skip the bread sticks too -- they also tack on some serious calories. Indulging in just one bread stick will add about 200 calories to your meal.

White sauce pizza is popular these days, but it is actually higher in calories than traditional tomato-based sauce pizzas. With just one vegetable topping, a typical slice of white pizza provides close to 300 calories. Asking for "half sauce" on a white pizza will save about 30 calories per slice.

Pay a visit to a locally owned pizzeria -- they may offer a greater variety of healthy toppings than chain restaurants. Options could include grilled shrimp, green peas, asparagus spears, artichoke hearts, black beans, corn, spicy fajita chicken, lemon grilled chicken or fresh minced garlic. Yum!

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How Many Calories Should I Eat?

Q: How many calories should I eat? I am a 32-year-old man.

A: That answer varies a little based on your lifestyle. It also depends on whether you are hoping to simply avoid weight gain or you want to lose weight. A male between the ages of 31 and 35 who is sedentary -- meaning you get less than 30 minutes a day of moderate physical activity -- can consume roughly 2,200 calories per day and maintain your weight, according to USDA recommendations. If you are active, you can consume between 2,400 and 3,000 calories daily without experiencing weight gain.

You can calculate your BMR (basal metabolic rate) using a simple math formula and factor in your own personal activity level. If you want to lose weight (and save yourself some math), check out Calories Needed for Goal Weight at About.com's Calorie Count. Simply enter your current weight and your goal weight to find out your caloric recommendations.

If you do want to lose weight, most people find it most comfortable to cut a set number of calories (around 250-500) per day, rather than making drastic dietary changes. Another option is to burn more calories with exercise, or, ideally to do a combination of both (e.g. cut 250 from your diet and burn an extra 250 with activity). As a rule of thumb, 3,500 calories is equal to one pound, so if you cut or burn a total of 500 calories daily, you could lose one pound a week, which is a safe rate at which to lose.

The following resources can help you understand your caloric needs a little better:

About.com's Calorie Count offers a way for you to enter your personal information to find your daily calorie expenditure. The site also offers free tools to track your caloric intake throughout the day with an online food diary and keep up with your "burn" (the calories you use up).

You may also find mypyramid.gov helpful.

Losing weight by cutting calories isn't just about eating less, but also getting the most "bang" for you calorie buck. It's important to educate yourself on nutrition and healthy food choices. After all, if you're only going to "spend" a certain number of calories each day, you'll want to use them on the most healthful, nutritious foods.

Source:
MyPyramid.gov. Inside the Pyramid - How many discretionary calories can I have?. 11 Sept 2008.

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Weight Loss Tips for Women Over 40

Weight loss is harder when you get older, but it's not impossible. You just need to take a few extra things into consideration. Use these tips, designed just for women over 40, to help you lose weight and get the body you've always dreamed of.Burke:Triolo Productions/Getty Images

Make sure that you are healthy enough for diet and exercise. Find out if a health condition such as hypertension or diabetes might affect the type of diet you should choose. If you’ve been struggling with your weight for some time, make sure that there are no medical or physical barriers to losing weight.

zSB(3,3)Ralf Nau/Getty Images

Is menopause affecting your weight? Many women struggle with weight loss before, during, and sometimes even long after menopause. This is also a time when many women make changes to their daily routines that may affect their weight. For example, after the kids leave home some women are not as busy during the day with non-exercise physical activities like carrying groceries, lifting laundry baskets and other household chores. Evaluate your lifestyle to make sure that a change in your daily habits isn’t affecting your weight.

Richard Boll/Getty ImagesYes, you read that right. Get sexy, get confident and get empowered. You might think that you’ll feel better about your body after the diet, but the truth is that the better you feel about yourself before you diet, the more likely you are to have the confidence to endure the lifestyle changes necessary for weight loss. Indulge in a few things that make you feel good about yourself: bubble bath, a new hairstyle, or a sexy new pair of pumps. Marcy Maloy Photography/Getty Images

Goal setting is one of the most important parts of any successful weight loss process. If you want to lose ten pounds or less, you can stick to short-term goals. But if you want to lose more weight, set long-term goals and them create short-term mini-goals to reach along the way

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If you’re like most women over 40, you’ve dieted before. And it’s possible that many of those plans didn’t work. What weight loss barriers have stood in the way of your success in the past? Come up with a game plan before the challenges arise and you’ll be more likely to overcome them.

Peter Dazeley/Getty ImagesIf you’ve never exercised before, now is the time to start. If you’ve always been active, you need to shake things up and create a new plan. Are you healthy enough for vigorous exercise? Then make sure you add at least one day per week of intervals. Never exercised before? Start slow and build gradually. Use these resources to set up a plan: Jose Luis Pelaez/Getty Images

The best diet for you depends on your goal and your lifestyle. There is no single plan that works for everyone. But you can begin by evaluating your daily eating pattern to see what simple changes you can make. For example, can you drink coffee with fewer calories? Do you have a glass or two of wine at night? Can you cook with less fat? Start with small changes and build from there.

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Weight Loss Surgery - A Rising Trend

Are you tired of constantly combating with the heavy bulge? Are you fed up with the repeated attempts of dieting and exercising? Most experts agree that a balanced diet along with regular exercise is the optimum way of losing weight, but the customary path to weight loss doesn't work for everyone.

With obesity on its peak, many countries are evolving as growing hubs of the billion dollar global market for weight loss surgery. A large number of weight loss operations are carried out in popularity in the urban centers all across the world. Today, people are getting more and more conscious about the way they look and how the present themselves to the world. Moreover, the people who are obese do not have just the extra kilos that they need to shed out. They are usually suffering from other weight related co-morbidities too.

Smoking greatly increases the risks from surgery by astringent blood vessels and reducing blood flow. Most surgeons will carry out surgeries on people who have been non-smokers for at least a few months before the surgery. A history of drug or alcohol abuse can also increase the risk for complications and surgery failure. Obesity surgery can be performed on adults between the ages of 18 to 65 although it's becoming more common among adolescents to consider a bariatric surgery.

Undergoing an obesity surgery is an emerging trend among youngsters nowadays. They look at it as a shortcut for losing weight. Moreover, people don't mind paying up, hoping that they will look slim and trim after the surgery. However, a surgery should be considered as an option only if non surgical and natural dieting methods fail.

An increasing number of high profile politicians, Bollywood actors and actresses and even business tycoons are opting for this procedure as they can afford it. Patients usually lose approximately 36% to 90% of their excess body fat in six months to two years of undergoing such surgeries. Bariatric surgery has proven a reduction in the rate of mortality from 40 percent to 23 percent.

In medical language, obesity is considered as a 'killer lifestyle' disease. According to the World Health Organization, approximately 1.2 billion people worldwide are recorded as overweight.

It is important to consult a bariatric surgeon before being a part of this growing fad. It is not just about looking good. There are a number of post surgical restrictions to be considered. If you are unable to follow them properly then it may to lead to weight regain and other complications.

Undergoing a weight loss surgery is a growing fad amongst youngsters today. The article above highlights the importance of consulting a good bariatric surgeon before making this decision.

This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

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Weight Loss Surgery - A Rising Trend

Are you tired of constantly combating with the heavy bulge? Are you fed up with the repeated attempts of dieting and exercising? Most experts agree that a balanced diet along with regular exercise is the optimum way of losing weight, but the customary path to weight loss doesn't work for everyone.

With obesity on its peak, many countries are evolving as growing hubs of the billion dollar global market for weight loss surgery. A large number of weight loss operations are carried out in popularity in the urban centers all across the world. Today, people are getting more and more conscious about the way they look and how the present themselves to the world. Moreover, the people who are obese do not have just the extra kilos that they need to shed out. They are usually suffering from other weight related co-morbidities too.

Smoking greatly increases the risks from surgery by astringent blood vessels and reducing blood flow. Most surgeons will carry out surgeries on people who have been non-smokers for at least a few months before the surgery. A history of drug or alcohol abuse can also increase the risk for complications and surgery failure. Obesity surgery can be performed on adults between the ages of 18 to 65 although it's becoming more common among adolescents to consider a bariatric surgery.

Undergoing an obesity surgery is an emerging trend among youngsters nowadays. They look at it as a shortcut for losing weight. Moreover, people don't mind paying up, hoping that they will look slim and trim after the surgery. However, a surgery should be considered as an option only if non surgical and natural dieting methods fail.

An increasing number of high profile politicians, Bollywood actors and actresses and even business tycoons are opting for this procedure as they can afford it. Patients usually lose approximately 36% to 90% of their excess body fat in six months to two years of undergoing such surgeries. Bariatric surgery has proven a reduction in the rate of mortality from 40 percent to 23 percent.

In medical language, obesity is considered as a 'killer lifestyle' disease. According to the World Health Organization, approximately 1.2 billion people worldwide are recorded as overweight.

It is important to consult a bariatric surgeon before being a part of this growing fad. It is not just about looking good. There are a number of post surgical restrictions to be considered. If you are unable to follow them properly then it may to lead to weight regain and other complications.

Undergoing a weight loss surgery is a growing fad amongst youngsters today. The article above highlights the importance of consulting a good bariatric surgeon before making this decision.

This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

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