Pain

Pain is an unpleasant sensory and emotional experience common to many different diseases. It can be caused by damage to tissues, or by damage to nerve cells and pathways. For more information about the mechanisms and different types of pain, see the anatomy and physiology of pain. Most diseases are associated with some degree of pain. For more specific information about pain in different areas of the body, see:

If you visit your health practitioner complaining of pain, he or she will ask a number of questions about the quality and location of the pain. This may help to identify the cause of pain. Questions may include:

Site: The exact location of the pain should be determined. In many cases, pointing to the site of worst pain is helpful. Is the pain well or poorly localised? Radiation: Any radiation of pain (e.g. pain which is felt mostly in one place, but which "goes through" to another) may be characteristic of certain diseases. Onset and offset: Did the pain develop acutely? Is it continuously present or intermittent? Was the onset of pain associated with any identifiable event, such as the onset of back pain while lifting something heavy? Quality: Descriptions such as sharp, dull, stabbing, cramp-like (colicky) or burning may help to characterise the pain as being directly due to tissue damage, or due to nerve damage (known as neuropathic pain). Severity: This may be recorded on a scale of one to ten, where ten is the worst pain possible. It is also important to discuss whether the pain interferes with sleep or normal daily activities. Aggravating and relieving factors: Do certain positions make the pain better or worse? Has any pain-relieving medication been tried, and was it effective? Associated symptoms: Including nausea and vomiting, muscle weakness etc.

Your health practitioner will then need to examine you. The type of examination will depend on the location and type of pain.

The tests performed will depend on the location and type of pain. They may include blood tests such as full blood picture or imaging tests such as x-ray, CT scans, ultrasound or MRI. Patients with chronic pain may be asked to complete specialised pain questionnaires such as the Pain Disability Index or McGill Pain Questionnaire. These are designed to assess the level of pain and the degree to which pain impairs functional abilities.

Pain management is a complex subject. Depending on the cause, type and location of pain, a different treatment strategy will be needed. Some pain will be self-limiting (meaning it will go away by itself), and need pain-relief medications only temporarily or not at all; whereas chronic pain may last years, be resistant to most of the normal pain treatment options, and require a more holistic (whole-person) approach. Management of chronic pain is best managed with a multidisciplinary approach. Some of the different methods that may be used are discussed below.

Analgesics

The World Health Organisation (WHO) groups analgesics for the management of severe, chronic pain into three groups:

Non-opioid drugs: Simple analgesics, including paracetamol, aspirin and non-steroidal antiinflammatory drugsWeak opioid drugs: Include codeine and dextropropoxypheneStrong opioid drugs: Include fentanyl (Durogesic), morphine (Kapanol), methadone and buprenorphine

One or more of these agents may be required to achieve pain control. The approach should be individualised according to patient requirements.

Co-analgesics

Co-analgesic medications are those which are not specifically designed to relieve pain, but which can help improve pain either alone or in combination with other medications. They are often particularly useful in the management of neuropathic pain. Examples of some co-analgesic drugs include:

Psychological and social aspects

Depression is a common problem in patients with chronic pain. It is a serious condition which requires treatment. Managing depression appropriately can also improve perception of pain.

Behavioural approaches

Behavioural approaches include relaxation techniques, hypnotic techniques, biofeedback and cognitive-behavioural therapy. They have all been shown to reduce pain intensity and improve long-term functioning in patients with chronic pain. These methods should generally be used as part of an integrated multidisciplinary approach.

For information about the management of pain in children, see paediatric pain management.

Ashburn MA, Staats PS. Management of chronic pain. Lancet. 1999;353(9167):1865-9. [Abstract]Braunwald E, Fauci AS, Kasper DL, et al. Harrison's Principles of Internal Medicine (16th edition). New York: McGraw-Hill Publishing; 2005. [Publisher]Jones JB. Pathophysiology of acute pain: Implications for clinical management. Emerg Med (Fremantle). 2001;13(3):288-92. [Abstract]Kumar P, Clark M (eds). Clinical Medicine (6th edition). Edinburgh: WB Saunders Company; 2005. [Publisher] Murtagh J. General Practice (3rd edition). New York: McGraw-Hill; 2003. [Publisher]Talley NJ, O'Connor S. Clinical Examination: A Systematic Guide to Physical Diagnosis (4th edition). Eastgardens, NSW: MacLennan & Petty; 2001. [Publisher]

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Fatigue in Cancer Treatment

Fatigue is a vague yet common complaint. Fatigue can be defined as a daily lack of energy, an unusual or excessive whole-body tiredness not relieved by sleep. It can be acute (lasting a month or less) or chronic (lasting for months or longer). Fatigue can prevent a person from functioning normally and have significant impact on a person's quality of life.

Fatigue is the most frequently reported symptom of cancer and cancer treatment. Although well recognised by health professionals as a significant problem, cancer fatigue is still poorly understood. It manifests as a chronic or long-lasting sense of exhaustion and decreased ability to do normal activities that is not relieved by rest or sleep.  

There are many possible causes of fatigue, most of which are completely unrelated to cancer.

General causes 

Some general causes include:

Cancer-related causes 

How exactly cancer causes fatigue is still poorly understood.

Cancer treatments commonly associated with fatigue include:

Chemotherapy: Any chemotherapy drug may cause fatigue. For some patients, fatigue lasts only a few days, while for others it may persist throughout the course of treatment and continuing after the treatment is complete. The fatigue may be due to anaemia which chemotherapy drugs can cause. Radiotherapy: Radiotherapy can cause fatigue that increases over time. This can occur regardless of the treatment site. Fatigue usually lasts from 3 to 4 weeks after treatment stops but can continue for up to 2 to 3 months. In addition, radiation therapy to the neck area can affect the thyroid gland and cause hypothyroidism (which can contribute to fatigue). Bone marrow transplant: Bone marrow transplant can cause fatigue that lasting up to one year. Biological agents: Interferons and interleukins are cytokines, chemicals that are normally released by white blood cells in response to infection. They carry messages that regulate other elements of the immune and endocrine systems. At high levels, these cytokines can be toxic and lead to persistent fatigue. Combination therapy: if more than one type of treatment is used, eg. chemotherapy and radiotherapy, the chances of treatment related fatigue will increase.

Other factors that may contribute to cancer-related fatigue include:

Tumour-induced "hypermetabolic" state: Due to tumour cells competing for nutrients, often at the expense of the normal cells' growth. Poor nutrition: Due to weight loss and nausea from the side effects of treatments can contribute to fatigue. Other medications: Medications used to treat side effects (e.g. nausea, pain, depression, anxiety, seizures) can cause fatigue. Pain and stress: Research shows that chronic pain increases fatigue, as does stress. Depression: Depression/adjustment disorder which may be pre-existing or related to stress caused by the diagnosis of cancer.

Treating fatigue is often difficult as usually there is no obvious cause or there may be many contributing causes. When there is an obvious cause, such as anaemia or low thyroid hormone levels, then this should be treated appropriately.

Exercise

In terms of cancer related fatigue, so far the only treatment which has been proven to improve energy levels is exercise. Studies have shown that a properly designed exercise programme helps maintain muscle strength, prevent worsening fatigue, and in many people, can actually lead to an increase in energy levels. Patients should be encouraged to keep active for as long as possible, within their abilities. Physiotherapy may also help people to stay active.

Pharmacotherapy

Appetite stimulants

A number of studies have suggested that drugs can be used to treat anorexia. The most commonly used drugs include corticosteroids and progesterone. Patients who have problems with nutritional intake may also be advised to take a high calorie diet. Referral to a dietician may be helpful.

Other drug intervention

Any treatments that relieve the effects of cancer or side effects of treatment may also affect energy levels. Effectively treating problems such as pain, nausea, anaemia or depression, is likely to have an impact on symptoms of fatigue.

Treatment of anaemia

Anaemia is a common problem in cancer patients, with frequency related to the type of cancer and the way it is being treated. There are medications available which can encourage the patient's body to produce more red blood cells, resulting in reduced anaemia-related fatigue and improvement in patient's ability to perform daily tasks.

Antidepressants

Depression or adjustment disorder can commonly occur in patients with cancer, particularly those with advanced disease. Antidepressants may be of value when patients have fatigue associated with depression.

Psychological support

Patients may receive helpful advice on managing their anxiety through professional and self-help sources, such as counselling, patient support groups, psychological support and occupational therapy. Other methods that may reduce fatigue include relaxation methods, yoga and massage. Activities such as music, humour and socialising with friends and family may help, and so may energy conserving strategies such as planning and pacing activities and work, and eliminating unnecessary tasks.

For more information on cancer, including breast, prostate, kidney and stomach cancer, see Cancer: Overview.

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Diarrhoea

Diarrhoea is a common digestive disorder that virtually all people will suffer at some stage during their lives. The definition of diarrhoea varies but it can generally be taken to mean increased stool water causing an increase in stool frequency or the passage of soft stools. Passage of greater than 3 stools per day or a stool volume of greater than 200 mL suggests the diagnosis of diarrhoea.

Diarrhoea is called acute if lasts for less than two weeks or chronic if it lasts for greater than 4 weeks. Diarrhoea can occur in virtually any person regardless of their age and general health. Diarrhoea can range from a mild discomfort to a severe and life threatening illness due to the risks of dehydration. In fact diarrrhoeal diseases are one of the top causes of death worldwide and it bcomes particularly common in developing countires with poor food practices and hygiene.

Children and the elderly are particularly prone to dehydration secondary to diarrhoea. However, the great majority of cases of diarrhoea follow short courses which don't really require specific diarrhoea treatment to resolve.

Diarrhoea basically develops when there is a defect in the absorptive mechanism working in the intestines. This may be due to damage to the mucosa (lining of the bowel) from infections or inflammation or excess secretion of fluid and electrolytes from particular toxins (e.g. cholera). Sometimes there may be too much sugary material in the lumen of the bowel which draws more fluid across the membranes. In other patients the bowel may just be overactive from hormone disorders which causes very frequent bowel motions but the overall volume should remin approximately the same.

By far the most common cause of diarrhoea is infection. Most cases are just mild viral infections caused by rotavirus (which some people may refer to as the stomach flu). This can be easily spread through daycare cantres, schools or families. Bacteria such salmonella, campylobacter and shigella are other common causes of diarrhoea. These cases tend to be more severe than viral diarrhoea and are caused by eating food or drinking water contaminated with these bacteria.

Diarrhoea can sometimes be caused by parasites which are transmitted by similar mechanisms. Giardia lamblia and cryptosporidium are possible parasitic causes of diarrhoea. Chronic diarrhoea can be caused by a number of medical problems. Irritable bowel syndrome is relatively common and associated with alternating periods of diarrhoea, constipation and bloating.

Certain medications, particularly antibiotics and anti-cancer drugs can cause diarrhoea because they disrupt the normal healthy bugs in the intestines and inhibit mucosal cell regeneration respectively. Inflammatory bowel diseases which include Crohn's disease and ulcerative colitis also cause recurrent attacks of diarrhoea often stained with blood and mucus. Colorectal cancer or any other defects in the intestines may also cause diarrhoea.

The signs and symptoms of diarrhoea include:

Passage of frequent, loose and watery stools; Abdominal cramps or pain;Fever- Particularly if there is an infectious cause;Bleeding- Bacteria and parasites often can produce bloody diarrhoea (dysentery). In addition inflammatory bowel disease, polyps and colorectal cancer cause blood and mucus in the stools;Nausea and vomiting may also be present in the case of infection.

Important points in the history of diarrhoea

Your doctor will ask you lots of questions so they can try to determine the likely cause of your diarrhoea in order to treat it. These questions will include:

How long have you had diarrhoea? What is the clour and consistency of your stool? Any blood or mucus? Any other symptoms or fever? Do you have abdominal pain with the diarrhoea? Anybody else in the family sick? Have you recently been overseaes? Which medications do you take? Do you smoke? How much alcohol do you drink? Are you on a special diet?

The doctor will then briefly examine you to to check for signs of anaemia and dehydration. Your abdomen will also be caefully examined.

The doctor will then order a number of tests to determine the likely cause. These will include:

Blood tests: Looking at blood counts and haemoglobin to determine any anaemia due to bleeding and to look for the possibility of infection;Stool examination: Samples of stool will be examined under the microscope to see if there are any pathogens identifiable;Sigmoidoscopy, colonoscopy or barium examination may be used to visualise the bowel to determine if inflammatory bowel disease, polyps or suspected malignancy (cancers) are present. Patients with chronic diarrhoea often have extensive tests to determine the most likely cause.

Most cases of diarrhoea are self-limiting so treatment of diarrhoea is primarily supportive. Many patients become dehydrated so may require fluid resuscitation. If you experience diarrhoea at home you should drink lots of water to avoid dehydration and minimise your intake of caffeine and alcohol (as these aggravate diarrhoea and dehydration). You can also help yourself by eating lots of semi-solid foods such as dry toast, rice and bananas and taking probiotics (e.g. yoghurt) to replenish the good bacteria in your bowel.

If you have severe symptoms, bloody stools, fever, vomiting or persistent diarrhoea it is advisable to consult a doctor. Other diarrhoea treatment largely depends on the cause of the diarrhoea. Some patients will be given certain diarrhoea medications to decrease movements of the bowel and reduce the volume of stool such as bismuth sulphate, loperamide or codeine phosphate. However, if you have an infection, it may be better not to inhibit your bowel motions because this is the way your body is attempting to clear the body of nasty bugs. If infection is present you may require antibiotic for the diarrhoea.

Diarrhoea prevention

Washing your hand thoroughly before all meals and when preparing food;When travelling to developing countries- Drink bottled water, only drink well-cooked meals, avoid raw fruit and vegetables and milk products;When taking antibiotics, try taking probiotics such as Lactobacillus acidophilus, as this helps to replenish the natural flora that antibiotics can destroy.

Note: Probiotics are not recommended for patients having chemotherapy or who are immunosuppressed as they may have harmful effects.

Dietary management of diarrhoea

Take anti-diarrhoeal medication only as prescribed by your doctor;Drink plenty of fluids as your body may lose a lot of fluid while you have diarrhoea (e.g. water, diluted soft drinks and weak cordials);Avoid highly spiced and fatty foods, very hot or cold food/drinks, and alcohol, and limit caffeine (coffee and strong tea) as these may make diarrhoea worse;While you have diarrhoea, reduce your fibre intake by replacing wholemeal bread and cereals with white varieties. Avoid raw fruit and vegetables with skins, seeds, nuts and legumes (e.g. baked beans);Sometimes diarrhoea can cause temporary lactose intolerance, where ordinary milk may make the diarrhoea worse. In such case it may be helpful to change to soy milk or low lactose milk until diarrhoea ceases. Cheese and yoghurt in small amounts are usually tolerated;Speak with your dietitian about other dietary management strategies for diarrhoea.

Article kindly reviewed by:

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

Guandalini S, Frye RE, Tamer MA. Diarrhea [online]. Omaha, NE: eMedicine; 2006 [cited 21 June 2006]. Available from: URL link Gorbach SL. Treating diarrhoea. BMJ. 1997;314(7097):1776-7. [Abstract | Full text]Kumar P, Clark M (eds). Clinical Medicine (5th edition). Edinburgh: WB Saunders Company; 2002. [Book]Longmore M, Wilkinson I, Rajagopalan SR. Oxford Handbook of Clinical Medicine (6th edition). Oxford: Oxford University Press; 2004. [Book]Diarrhea [online]. Bethesda, MD: MedlinePlus; 2004 [cited 21 June 2006]. Available from: URL linkThielman NM, Guerrant RL. Clinical practice: Acute infectious diarrhea. N Engl J Med. 2004;350(1):38-47. [Abstract]Wanke CA. Approach to the patient with acute diarrhea in developed countries [online]. Waltham, MA: UpToDate; 2006 [cited 21 June 2006]. Available from: URL link

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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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Exercise: Cardio Training

Cardio training is a form of exercise that makes the heart beat a little faster. This includes walking, running, football and tennis. Dr Joe Kosterich talks about the purpose of cardio training, the importance of exercise, and the need to start small.

When people think of exercise, the one that generally comes to mind is cardio training. Cardio training is short for cardiovascular training, so it's a form of exercise that causes our heart to beat a little bit faster, causes the blood to pump around, and gets us to breathe a little bit more quickly.

Obvious sorts of cardio training are walking, running, bike riding and swimming. Most sports, with the exception of things like weight lifting and rifle shooting, are cardio type exercises. So football, cricket, tennis and even golf, to a degree, are all cardio type exercises and sports.

Cardio training is really, really important as the heart is an important part of the body. The brain is really important as well, but you probably hear a lot more about heart attacks than most other forms of diseases. And like most parts of the body, if you use it in the right way and look after it, it will keep you going for longer.

So with cardio training, what are we trying to do? We're trying to get the heart a little bit stronger and more resilient. How do we do that? By basically stressing it a little bit - stressing it to the degree that we get it to work a little bit harder. It's always those last two reps or that last 50 metres that pushes you that little bit further. So in looking to build up a cardio regimen, we're looking to improve our stamina, fitness and overall energy capabilities. This happens gradually. Nobody who's run a marathon has ever gone out and done it the first day - they've built it up over time. Swimmers who excel at 1,500 metres haven't started doing that the first day - they probably started at 25 or 50 metres.

So for those of you who haven't been doing much exercise, you need to start at a small level. For some of you who haven't done exercise for a long time, you may want to check with your doctor and have a little bit of a check-up before starting out. But for most people, if you start out at a low level, away you can go.

Walking is a really good form of exercise. You don't have to raise a major sweat, but you do want to be walking at a pace that is a little bit quicker than just ambling to the letter box. Power walking was very popular for a while and is still a reasonable form of exercise, but just walking itself hits all the buttons in terms of cardio exercise.

Other things we spoke of before, jogging and running are quite good as well. Swimming is an excellent form of cardio exercise. For those who don't like walking or running and perhaps have problems with their joints, walking through water is also a very good form of exercise. Bike riding is fine and you can do that out and about, or you can do it on an exercise bike at the gym, or in front of the TV if you're that way inclined. All of these are good forms of exercise. 

Now, a lot of cardio games or sports - like squash, tennis, football, basketball, the list goes on - are good forms of exercise. If you haven't done them for a while, you need to be training for them. There's often been an executive in particular who hasn't played squash for 15 years, decides they want to get fit, tears out on the squash court and suddenly has problems with a heart attack because they haven't done the preparation or the training. So it's really important that if you want to do sports like that, that you do some cardio exercise.  

Start at a low level, at something that's appropriate to you. If you're not quite sure where to start, have a chat to your doctor. A physio or personal trainer may be able to guide you on the exercise specifics, but for almost everybody you can start at a level of comfort and gradually build up. How do you know you're building up? Your walking distance goes further. You can go the same distance as last week and not feel quite as tired - that's the signal to go a little bit further.

For most people, aim for some cardio exercise 3-4 times a week if you can and for a minimum of 30-40 minutes per day. By the end of it, you raise a little bit of a sweat. You don't have to be drenched with sweat if that's not your thing, but you do need to have known that you've done a little bit of work. If you have, that's going to stand your health in a really good stead in general, and your cardiac system (which is your heart) in particular.

For more information on fitness and exercise, including stretches, types of exercise, exercise recovery and exercise with health conditions, as well as some useful videos, see Fitness and Exercise.

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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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Future doctors unaware of their obesity bias

Two out of five medical students have an unconscious bias against obese people, according to a new study by researchers at Wake Forest Baptist Medical Center. The study is published online ahead of print in the Journal of Academic Medicine. 

"Bias can affect clinical care and the doctore-patient relationship, and even a patient's willingness or desire to go see their physician, so its crucial that we try to deal with any bias during medical school," said David Miller, M.D., associate professor of internal medicine at Wake Forest Baptist and lead author of the study.

"Previous research has shown that on average, physicians have a strong anti-fat bias similiar to that of the general population. Doctors are more likely to assume that obese individuals won't follow treatment plans, and they are less likely to respect obese patients than average weight patients," Miller said. 

Miller and colleagues conducted the study as part of their efforts to update the medical school's curcciculum on obesity. The goa was to measure the prevalence of unconscious weight related biases among medical students and to determine whether the students were aware of those biases.

The three-year study included more than 300 third-year medical students at a medical school in southeastern United States from 2008 through 2011. The students were geographically diverse, representing at least 25 differemt states and 12 countries outside the United States.

The researchers used a computer program called the Weight Implicity Association Test (IAT) to measures students' unconscious preferences for "fat" or "thin" individuals. Students also answered a survey assessing their conscious weight preferences. The authors determined if the students were aware of their bias by seeing if their IAT results matched their stated preferences.

Overall, 39 percent of medical students had a moderate to strong uncoscious anti-fat bias as compared to 17 percent who had a moderate to strong anti-thin bias. Less than 25 percent of students were aware of their biases.

"Because anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity, teaching medical students to recognise and mitigate this bias is crucial to imrpoving the care for the two-thirds of American adults who are now overwight or obese," Miller said. "Medical schools should address weight bias as part of a comprehensive obesity curriculum."

While this study did not address which teaching strategies are most effective, Miller said that a prerequisite to combating prejudice is to first acknowledge its existence. At Wake Forest Baptist, all third-year medical students in the family medicine clerkshop must complete the online IAT, and then participate in an in-class discussion of their experience with bias. In addition students must accept that their bias could affect their actions and adopt new strategies to mitigate bias, he said.

(Source: Wake Forest Baptist Medical Center: Journal of Academic Medicine)

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: 22/6/2013

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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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Link found between lifestyle and developing rheumatoid arthritis

Researchers in Manchester have found a link between several lifestyle factors and pre-existing conditions, including smoking cigarettes and diabetes, and an increased risk of developing rheumatoid arthritis.

Rheumatoid Arthritis (RA) is a chronic disease which affects around 0.8% of the population; and its causes are of great interest to the medical world. Research led by Professor Ian Bruce, NIHR Senior Investigator and Professor of Rheumatology at The University of Manchester and consultant at Central Manchester University Hospitals NHS Foundation Trust, looked into the association between lifestyle factors and the risk of developing RA.

The research group at the Arthritis Research UK Epidemiology, which is part of the National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, looked at a sample of over 25,000 people, aged 40-79 years old who have been followed over a number of years to discover if lifestyle factors had an affect on developing the disease.

When they compared 184 participants who went on to develop arthritis to those who did not, they found that smoking, obesity and having diabetes all increased the risk. It was also found that drinking a small amount of alcohol and being in a higher social class were associated with a reduced risk of developing the disease.

The study, funded by Arthritis Research UK, also examined gender specific factors and found women who had more than two children and breastfed for a shorter amount of time also had a higher risk of developing RA.

The research team also conclude that this information could be used to develop a simple screening tool, used by GPs and primary care workers, to identify patients with a higher risk of developing RA who could be offered advice to reduce their risk.

Professor Ian Bruce said: “The factors we studied give us vital clues to the early events in the process that ends in someone developing RA. They are also simple to ask about and can be used as part of a prevention programme. Our new wave of funding from the Medical Research Council and National Institute of Health Research has allowed us to move forward to the next stage in our attempt to prevent the development of this distressing condition.”

(Source: The University of Manchester)

Article Date: 2/4/2013

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Want kids to eat healthier? Dont tell them, show them

If given the choice between eating a salad loaded with veggies or a burger and fries, most kids -- and for that matter, most adults -- would likely pick the less healthful option. But instead of telling kids to eat more fruits and vegetables, Iowa State University researchers found the trick may be to convince them visually.    

Laura Smarandescu, an assistant professor of marketing, and Brian Mennecke, an associate professor of information systems, did just that using a digital display featuring a rotating image of a salad along with menu information. They found salad consumption among kids increased as much as 90 percent when a digital display showed a rotating image of the salad. The results are from a field study conducted in July at the YMCA of Greater Des Moines camp in Boone. The camp is for children with diabetes, ages 6-12.

Campers were offered a nutritionally balanced daily menu, which included foods like tacos, sloppy joes, fruits and vegetables and had the additional option of a salad bar. The kitchen staff weighed the salad bar items before and after each meal to calculate how much was consumed. The digital sign had the greatest appeal among boys at the camp, who were 50 to 70 percent more likely to serve themselves lettuce, cucumbers, tomatoes and carrots when the digital display showcased a vivid picture of a salad.

“The cool effect that we found and didn’t expect was with boys,” Smarandescu said. “It makes sense because boys like video games and interact more with technology. We noticed many boys stopping to look at the display and their behavior seemed to be more influenced by the presence of the display.”  

The results from the field study mirror what Smarandescu and Mennecke discovered in the lab. When given the choice between a still photo of a particular food or a rotating image, participants in the lab opted for the rotating menu item. Mennecke said the studies show the influence of environmental cues and images on consumer behavior.

“The more vivid the image, in terms of movement, color and accuracy of representation, the more realistic, the more it’s going to stimulate your response to it,” Mennecke said. “You respond to the image on the display like you would respond to a plate in front of you. If you’re hungry you respond by saying, ‘I’ll have what’s in that picture.’”

Taking the technology to the lunchroom

Fast food companies, like Burger King, have embraced the technology by using digital menu boards to feature new items or target key demographics. ISU researchers believe the displays could have a positive impact in school cafeterias and influence students to make better choices. The concept is similar to the “Smarter Lunchrooms Movement” developed by Brian Wansink at Cornell University, who has partnered with Smarandescu and Mennecke on their project.

By displaying nutritious foods and drinks in a way that makes them more accessible and attractive in the lunchroom, Wansink has found students greatly increase their choice for more healthful options. Iowa State researchers believe a digital display can motivate students to make better choices in the same way.

“We’re hoping that these displays – a small, low-cost intervention – could lead to large-scale behavior changes,” Smarandescu said. “Students will feel like they made the decision themselves as opposed to being told to take the healthier option.”

Ann Wolf, executive director of the diabetes Camp Hertko Hollow, who worked with researchers on the field study, is interested in adding a permanent digital display for next summer’s camp. Not only do campers relate to the technology, but Wolf said it reinforces a lesson they hope to teach campers.

“Children need to make healthy choices,” Wolf said. “We try to educate our children to eat well and manage their diabetes to live a long and healthy life.”

Using digital displays to boost sales

Targeting kids at camp or consumers at the point of purchase can have a powerful effect, Smarandescu said. If people are hungry and the digital display is right in front of them, research suggests the display will have more impact than a traditional advertisement. The more detail incorporated into the display, the better.   

“A lot of times these videos are very vivid and they look very good. Sometimes they zoom in on the food and just by having that fine detail they make the food look better,” Smarandescu said. “If you can’t see what an item looks like you have more uncertainty in a way. By seeing a picture of an item that looks good, that will likely influence choice.”

To test this, researchers plan to use a digital display to feature daily menu items at restaurants and determine the effectiveness by tracking sales. They also want to determine the importance of content. Just because a display is there for consumers to see, doesn’t mean they are tuned in.   

“People will ignore a sign that they see every day if the content doesn’t change,” Mennecke said. “That’s the challenge – getting the imagery and making it look nice and having varied content. That’s not a trivial issue; you have to worry about the content and be creative. This is the hard part of using digital signage.”

Source Iowa State University 

Article Date: 26/7/2013

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South Beach Diet A to Z - Phase 1 Acceptable...

South Beach Diet A to Z: Phase 1 Acceptable Foods

The following foods are acceptable during Phase 1 of The South Beach Diet: Certain Meats and PoultryBeans Certain vegetablesOne serving of nuts dailyLow-fat cheesesEggsFats and oilsSugar substitutesSpecific treats such as sugar-free gelatin, hard sugar-free candy, and fudge pops

You will find a more extensive list of allowable foods in our South Beach Diet 101 section. Return to
South Beach Diet A to Z

Suggested Reading:
 The South Beach Diet by Arthur Agatston, MD
 The South Beach Diet Good Fats Good Fats Guide
 The South Beach Diet Cookbook
 The South Beach Diet Quick & Easy Cookbook

Source:
The South Beach Diet : The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss, Arthur Agatston, MD, St. Martin's Griffin (April 19, 2005 edition).

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DASH Diet: Lower Your Blood Pressure and Lose...

Lower your blood pressure with DASH

A.D.A.M.

High blood pressure affects over 65 million people in the United States. That’s about 1 in every 3 adults. If you’re one of those people, your doctor may have suggested that you lose weight to lower your blood pressure. So what’s the best weight loss plan to control hypertension? Many experts recommend the DASH diet, along with a program for moderate exercise.

DASH stands for Dietary Approaches to Stop Hypertension. The DASH diet was developed based on research that evaluated how different eating plans and different types of food affected blood pressure in large groups of people. DASH research also evaluated diets containing various sodium levels to see how lowering your salt intake affects hypertension.

The research revealed that a low-fat diet, rich in fruits, vegetables, lean protein and low-fat dairy foods can substantially lower your blood pressure. Lowering sodium levels and increasing your intake of potassium and fiber will also help you to lose weight and improve your blood pressure.

Mary Moon, M.D., a family practice physician, counsels her patients with high blood pressure to use the DASH diet. She says that patients benefit not only from the reduced salt intake but also from the reduced calorie intake and from eating foods with high nutritional value. This helps patients to lose weight and improve their health.

Dieters who choose the DASH eating plan can choose a sodium intake of either 2300 mg per day or 1500 mg per day. If you want to lower your blood pressure, the lower sodium level is recommended. However, the DASH program recommends that you make changes slowly, so if you are currently not monitoring your salt intake at all, your physician may recommend that you start at the higher level.

When you’re on the DASH diet, you consume foods from the following food groups:

Grains: 6-8 servings per day
Vegetables: 4-5 servings per day
Fruit: 4-5 servings per day
Milk: 2-3 servings per day
Meat/Fish or Poultry: 6 servings or less per day
Nuts/Legumes/Seeds: less than one per day (4-5 total per week)
Oils: 2-3 servings per day
Sweets and Sugars: less than 5 per week.

The nutrient breakdown for a 2,000 calorie per day DASH program at the 2,300 sodium level is listed below.

Total fat: 27%
Saturated fat: 6%
Protein: 18%
Carbohydrate: 55%
Cholesterol: 150 mg
Sodium 2300 mg
Potassium: 4,700 mg
Fiber: 30g
Magnesium: 500 mg
Calcium: 1,250 mg

Pros and cons of the DASH diet

The DASH diet is not a commercial diet, like Weight Watchers or Jenny Craig. You won’t find pre-packaged meals and snack bars to order online for this eating plan. This might be a bonus for some people and a drawback for others.

The DASH diet does take some work in the beginning to learn about which foods to eat and which foods to avoid, but there is no cost to be on this eating plan. And because the foods are generally unprocessed, unpackaged goods, they may be less expensive than many of the prepared foods that you find in the store.

This eating plan can be customized for people who need to lose weight or for those who just want to control their blood pressure. Ask your physician which goal is best for you. Then get more information about the specific eating plan to follow at the National Heart Lung and Blood Institute website. Their free booklet Your Guide to Lowering Your Blood Pressure with DASH is available in several formats including a downloadable pdf.

Sources:

Appel, Lawrence, M.D., M.P.H., et al " A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure." New England Journal of Medicine April 1997.

High Blood Pressure. Centers for Disease Control and Prevention. Accessed: August 21, 2012. http://www.cdc.gov/bloodpressure/about.htm

Mary Moon, M.D., Interview. August 21, 2012.

Prevention and Treatment of High Blood Pressure. Title of Page. American Heart Association. Accessed: August 21, 2012. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/PreventionTreatmentofHighBloodPressure/Prevention-Treatment-of-High-Blood-Pressure_UCM_002054_Article.jsp

What is the DASH Eating Plan? National Heart, Lung and Blood Institute. Accessed: August 21, 2012.. http://www.nhlbi.nih.gov/health/health-topics/topics/dash/

Your Guide to Lowering Blood Pressure. National Heart Lung and Blood Institute. Accessed: August 21, 2012. http://www.nhlbi.nih.gov/hbp/bp/bp.htm

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What You Need to Know About The 90/10 Diet

The 90/10 diet can be found in a book written by nutritionist Joy Bauer called The 90/10 Weight-Loss Plan: A Scientifically Designed Balance of Healthy Foods and Fun Foods. The book can be purchased for approximately $18 online or at other book retailers. There are no required foods or expensive recipes necessary to follow this plan. The basic premise of the 90/10 plan is that you eat a healthful diet 90 percent of the time, and enjoy what Bauer calls “fun foods” 10 percent of the time. Bauer’s theory is that by allowing yourself your favorite foods some of the time, you will feel less deprived and more able to stick with the healthy changes the rest of the time. The book outlines diets for three different daily calorie levels -- 1,200, 1,400, and 1,600. There are two weeks worth of meals outlined in this plan. Once you are accustomed to practicing portion control, monitoring your calories, and planning your fun foods, you will also be able to customize your meals to your own preferences as long as you stay within your caloric allowance.

During my trial of the diet, a typical day’s menu was oatmeal with fruit for breakfast, a tuna melt with low-fat cheese for lunch, an apple for snack, chicken and vegetables with brown rice for dinner, and chocolate chip cookies as my fun food.

What I liked about this diet was being able to continue to allow myself a controlled portion of nearly any food as long as I followed the guidelines the rest of the time. I was able to enjoy “old favorites” that other diets forbid. (So many other diets ask you to go "cold turkey" on favorite foods, especially during the first week or so, or during the first “phases” of the plan. I often find those diets too difficult to stick to for any period of time, but did not have that problem with this plan.) The only "catch" to this plan is that you have to work the fun foods into your daily calorie allotment; I was on the 1,600 calorie plan, so those 260 calories from my cookies left me 1,340 calories to utilize for the rest of the day. Since my calorie allotment was on the higher end, I did not often have a problem working in everything I needed to round out my day’s food intake.

However, I can see that this may be challenging to someone on the lower end of the spectrum, at 1,200 calories, especially if you are not accustomed to monitoring your food or calorie intake. For example, let’s say you plan tomorrow morning for a 300 calorie treat as your "fun food" and then you decide to have a soda with it, too. If you only have 750 calories remaining for your entire day after your treat, you have used too many calories and did not allow sufficient calories for other more nutritious, filling choices. That’s why planning is so important so you “spend” your calories the best way possible.

During my 30-day trial of this plan, I lost just under eight pounds. I found this plan to be effective and reasonably easy to follow.

You can easily track your daily calories and search for foods’ caloric content at a free Web site such as Calorie Count Plus. I searched their food database on a daily basis to find out the calorie counts of foods that I did not have a nutrition label for.

In my opinion, the inclusion of “fun foods” makes this diet ideal for people who have found other diets to be too restrictive. I think most people would be able to stick to this plan. If you are allowed 1,600 or 1,800 calories you will undoubtedly have enough calories to eat plenty of the healthy foods recommended on the plan and still have your “fun foods”.

Maintenance may be a little more challenging for some after following this plan; you will need to continue being conscious of your food choices and caloric intake. Once you’re at your goal weight, you will need fewer calories than you were previously accustomed to eating before you lost weight, so it is important that you continue monitoring you caloric intake (You can do so easily by tracking your food intake with Calorie Count Plus.). Remember, if you return to consuming more calories than you need -- after this or any other diet -- you will begin to gain weight again.

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Emotions and Weight Loss - Get Past Your Barriers

Having trouble losing weight? The solution might not be in the kitchen or the gym, but in your head and in your heart. Emotions and weight loss go hand in hand.

If you simply can't shed the pounds, and you know that there are no medical causes or environmental barriers that are standing in the way, take some time to think about how your feelings might affect your eating habits. Getting past emotional barriers might be the key to your weight loss success.

Stress. There is a good reason that comfort food got its name. For most people, eating feels good. And in times of stress, some people use food as the best way to calm their emotions. While emotional eating doesn't result in weight gain for everyone, it can be a cause of obesity in some.

In a study about the eating and exercise habits of obese mothers, researchers found that stressful experiences triggered overeating and prevented the women from practicing healthier habits. Of course, isolated cases of overeating won't cause long-term weight gain, but researchers in other studies have found that for some people, overeating can become a chronic coping mechanism for managing life's stressors.

Avoiding stress is not always possible. But relaxation techniques can be a healthy alternative for managing emotions during stressful times. In a published study about using relaxation training with obese women, study participants received relaxation techniques under the guidance of a licensed mental health professional. A specific type of relaxation technique, guided imagery, helped them reach weight loss success.

Even if you are not working with a therapist, it's possible to learn guided imagery on your own. It takes some time to master, but guided imagery may be the most effective technique for weight loss if your emotions are causing you to eat during stressful times.

Depression. The link between depression and weight loss is a hazy one, and researchers are not sure of their exact relationship. For example, some studies have found that depression can be a cause of obesity, while others have not.

In a review of obesity literature, one group of researchers identified several ways in which depression may cause obesity. Some commonly prescribed antidepressants can cause weight gain. The researchers also noted that lack of sleep, a common symptom of depression, is also a risk factor for obesity. Inactivity, another common symptom, can spark increased weight.

If you find yourself battling obesity or if you simply can't lose weight, getting screened for depression may be a reasonable step to take. Consider speaking to your primary care physician about getting a referral to a mental health professional. He or she will be able to investigate further and determine whether you have depression and give you reasonable strategies for moving forward.

Personal or Childhood Trauma. Some researchers have found that people who were exposed to physical abuse, sexual abuse or peer bullying are at higher risk for obesity.

According to one published report, researchers speculated that weight gain can be used as an emotionally protective "solution" for survivors of abuse. The study was conducted by a group of California physicians affiliated with the Positive Choice Weight Loss Program in San Diego. The researchers noted that the sexual, physical and social protective benefits of being obese were hard for many non-obese individuals to accept or understand.

If you have experienced emotional trauma, it could be affecting your eating habits and your weight. It might be worth your time to find a behavioral health specialist who is skilled at treating the underlying emotional causes of overeating and weight gain. Your primary-care provider may be able to provide a referral. If not, there are other ways to find a therapist. The American Psychological Association provides resources to help consumers get the help they need, including a locator service to find practitioners in your area.

If you are struggling unsuccessfully to lose weight, there may be more than one factor that is contributing to your battle. Try to consider all of the underlying causes to find out which barriers stand in the way of reaching a healthy weight.

Sources:

António L Palmeira, David A Markland, Marlene N Silva, Teresa L Branco, Sandra C Martins, Cláudia S Minderico, Paulo N Vieira, José T Barata, Sidónio O Serpa, Luis B Sardinha and Pedro J Teixeira. "Reciprocal effects among changes in weight, body image, and other psychological factors during behavioral obesity treatment: a mediation analysis." International Journal of Behavioral Nutrition and Physical Activity 2009, 6:9 .

Chang MW, Nitzke S, Guilford E, Adair CH, Hazard DL. " Motivators and Barriers to Healthful Eating and Physical Activity among Low-Income Overweight and Obese Mothers." Journal of the American Dietetic Association 2008 Jun;108(6):1023-8..

Floriana S. Luppino, MD; Leonore M. de Wit, MS; Paul F. Bouvy, MD, PhD; Theo Stijnen, PhD; Pim Cuijpers, PhD; Brenda W. J. H. Penninx, PhD; Frans G. Zitman, MD, PhD. "Overweight, Obesity, and Depression, A Systematic Review and Meta-analysis of Longitudinal Studies" Archives of General Psychiatry 2010;67(3):220-229.

Gian Mauro Manzoni, Francesco Pagnini, Alessandra Gorini, Alessandra Preziosa, Gianluca Castelnuovo, Enrico Molinari, Giuseppe Riva. " Can Relaxation Training Reduce Emotional Eating in Women with Obesity? An Exploratory Study with 3 Months of Follow-Up." Journal of the American Dietetic Association August 2009.

Gregory E. Simon, Evette J. Ludman, Jennifer A. Linde, Belinda H. Operskalski, Laura Ichikawa, Paul Rohde, Emily A. Finch, Robert W. Jeffery. " Association between obesity and depression in middle-aged women." General Hospital PsychiatryJanuary 2008.

Kinzl JF. " Change in body image and psychological well-being during behavioral obesity treatment: Associations with weight loss and maintenance." Eating and Weight Disorders 2010 Dec;15(4):e275-80.

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Sanjay R. Patel and Frank B. Hu. "Short Sleep Duration and Weight Gain: A Systematic Review." Obesity January 2008.

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15 Facts for Weight Loss Newbies!

1. Your weight affects you in many ways other than your appearance: Your overall quality of life;self-esteem;health risks;depression;and physical abilities are also influenced.

Think of all the positive changes you can experience by losing weight.

2. You will need to see your doctor for a physical if you haven't had one recently and you really should get her approval before starting a weight loss regime.

3. You should ask yourself these questions as you begin: Why do you want to lose weight?Are you truly committed? Do you have a support system set up?Can you accept mistakes without giving up altogether?

4. To lose weight effectively, you will have to permanently change four aspects of your life:
1.) what you eat
2.) how you eat
3.) your behavior and
4.) your activity level.

5. You shouldn't set your sights too high (... like losing 30 pounds in a month. Those signs advertising weight loss pills are not true!).

Small goals (e.g. 5 pounds; 10 percent of your current weight) are far more attainable and easier to stay focused on.

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Basal Metabolic Rate

Definition: Basal metabolic rate (BMR) refers to the minimum amount of energy -- in the form of calories -- that your body requires to complete its normal functions, such as breathing, breaking down food, and keeping your heart and brain working. Age, gender, weight, and physical activity directly effect on basal metabolic rate.

BMR varies from person to person and increases with your amount of muscle tissue. Exercising increases your BMR, and it can stay raised after 30 minutes of moderate physical activity. Many people's BMR stays increased for approximately 48 hours following exercise.

Common Misspellings: basil metabolic rateBasal metabolic rate is typically reduced as we age.

Weight Loss Glossary

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How to Choose a Good Diet Plan for Weight Loss?

The truth behind weight loss may not be always what you see at the face value.

First, you should realize that weight loss involves 100% dedication and a diligent adherence on your part towards the set diet plan. Make sure there is not even a slight deviation from your target.

Prepare a checklist to chalk out a good diet plan, which includes:

i. Your lifestyle

You may not be ready to remodel your lifestyle drastically. For example, if you practice just 2 meals/day and the schedule stresses on 4-5 times/day, then you may not feel comfortable with it.

ii. The level of exercises you undertake

In case you like to take up exercise sessions on your own, with no rigid conditions, whereas the proposal forces you to do exhaustive exercises at a stretch, then you should think twice before choosing it.

iii. Suitability to continue

It is not wise to stick to a diet plan just temporarily; you should feel good to follow it throughout your life.

iv. The ingredients

Sometimes, you may be required to replace the usual items with food that is prepared in a special manner or has some unusual ingredients. Check if you are comfortable with such a requirement.

v. The pace at which you aim to lose weight

Understand the difference between the actual loss of weight and the seemingly quicker loss of water, which may give a wrong impression. So, it is advised that you aim at reducing your weight in a slow and steady manner.

vi. The elimination of any kind of undesirable habit you possess

You may have to give up habits like spending the night time in a bar or being a couch potato to accommodate the new plan of diet.

vii. The possibility of including your all-time favorite items

Denial of your favorite foods can lead to an unstoppable urge to indulge in overeating binges, which is detrimental to your weight loss preparation.

viii. Your ability to adapt to changes that are recommended

Determine the nature of changes you will need to adapt to so that you can prepare your mind and body!

ix. The need to use any supplements or detox techniques

Most of the times, you don't need any kind of supplements as a perfectly followed schedule of food intake and exercises is self-sufficient in managing the pounds you gain and lose for a healthy body.

x. The nature of the plan

If you like flexibility, you should choose a plan that allows you to select your own menu that is by all means a healthy platter.

Fiber-rich foods help you in reducing weight considerably by removing unwanted collections of fats from your body. Make sure your diet plan includes high fiber foods like soups, vegetables and fruits to maintain the intake and expenditure levels of calories in a healthy way.

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