DELHI PUBLIC SCHOOL BANGALORE SOUTH

FITNESS AND FAT

PHYSICAL FITNESS - It is a state of health and well-being and, more specifically, the ability to perform aspects of sports, occupations and daily
activities, generally achieved through proper nutrition, moderate-vigorous physical exercise and sufficient rest.
It is a measure of the body's ability to function efficiently and effectively in work and leisure activities, to be healthy, to resist hypo kinetic, and to meet
emergency situations.

OBESITY - a medical condition in which excess body fat has accumulated to an extent, leading to negative effect on health.
People are generally considered obese when their body mass index (BMI), is over 30 kg/m2; the range 25–30 kg/m2 is defined as overweight.

BMI is defined as the subject's weight divided by the square of their height = m / hxh
BMI = (where m and h are the subject's weight in kilograms and height in meter, respectively)

On average, obese people have greater energy expenditure than their normal counterparts due to the energy required to maintain an increased body mass.
For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn't directly measure body fat, so some people, such as muscular athletes,
may have a BMI in the obese category even though they don't have excess body fat.

CAUSES OF OBESITY – Contributing factors, include -

- most common causes - excessive food intake, lack of physical activity, and genetic susceptibility.
 Genetics –

- Your genes may affect the amount of body fat you store, and where that fat is distributed.
- Genetics may also play a role in how efficiently your body converts food into energy and how your body burns calories during exercise
 Family lifestyle –

- If one or both of your parents are obese, your risk of being obese is increased. That's not just because of genetics.
Family members tend to share similar eating and activity habits.
- With a decreasing number of mothers who breast-feed, more infants become obese children as they grow up and are reared on infant formula
instead.
- Children's food choices and family meal-time also plays a role in rates of childhood obesity.
Parents of children, ranging in ages 11–21, let their children make their own food decisions. Adolescents who ate three or fewer meals per week,
with family, have poor consumption of vegetables, fruits, and dairy foods, than those Adolescents who ate six to seven family meals per week.
- As family sizes decrease, the children's pester power, their ability to force adults to do what they want, increases. This ability enables them to have
easier access to calorie-packed foods, such as candy and soda drinks.

 Physical activity –

- If you're not very active, you don't burn as many calories. With a sedentary lifestyle, you can easily take in more calories every day than you burn
through exercise and routine daily activities.
- Many children fail to exercise because they spend long periods of time engaging in sedentary activities and active play as technologies, such as the
television, computer usage and video games, keep children indoors.
- Rather than walking or biking to a bus-stop or directly to school, more school-age children are driven to school by their parents, reducing physical
activity.
- Parents would rather have their children stay inside the home because they fear that gang, drug violence, and other dangers might harm them.

 Unhealthy diet –

- Increase in snacks and portion size of meals. The primary sources of these extra food energy carbohydrates consumption are sweetened beverages
such as soft drinks, fruit drinks, iced tea, and energy and vitamin water drinks and fast-food consumption, energy-dense, big-portions, all
contributing to the rising rates of obesity and to an increased risk of metabolic syndrome and type 2 diabetes.
- Eating disorders such as binge eating disorder and night eating syndrome.
- Vitamin D deficiency, due to lack of exposure to sun light, is related to diseases associated with obesity.

 Medical problems – leading to Obesity.

- Arthritis, also can lead to decreased activity, which may result in weight gain.
- Metabolic syndrome is a cluster of conditions — excess body fat around the waist, increased blood pressure, high blood sugar and abnormal
cholesterol or triglyceride levels — that occur together, increases risk of heart disease, stroke and diabetes.
  Certain medications –
- Some medications can lead to weight gain if you don't compensate through diet or activity. These medications include some antidepressants, anti-
seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers, hormonal contraception.
 Hormones -
- When we were younger, our bodies produced hormones. Estrogen in women, testosterone in men. These hormones helped regulate the "flow" of
fat, spreading it to our arms, legs, and hips. As we age, those hormones are no longer being produced, and fat starts to accumulate more deeply
inside our bodies, most notably around our middles.
- Hypothyroidism, an underactive thyroid gland, slows metabolism, causes fatigue and weakness, hence weight gain.
- PCOS, or polycystic ovary syndrome, makes it more difficult for the body to use Insulin Hormone, used for the metabolism of sugars and starches
from food, into energy and can also lead to excess body hair and reproductive problems and weight gain.
- Cushing's syndrome, which stems from an overproduction of the hormone Cortisol by the adrenal glands, is characterized by weight gain in the
upper body, face and neck.
- Prader-Willi syndrome, a rare genetic condition in which people never feel full, and so they want to eat constantly.
 Psychological factors -
- A positive correlation between obesity and low self-esteem, feelings of depression can cause a child to overeat.
- Stress can influence a child's eating habits.
- Several studies have also explored the connection between Attention-deficit Hyperactivity Disorder (ADHD) and obesity in children.

 Social and economic issues –

- Avoiding obesity is difficult if you don't have safe areas to exercise.
- You may not have been taught healthy ways of cooking, or you may not have money to buy healthier foods.
- In addition, the people you spend time with may influence your weight — you're more likely to become obese if you have obese friends or
relatives.
 Age –
- Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. As
we age, the rate at which our bodies burn calories, called our metabolism, slows down.
- In addition, the amount of muscle in your body tends to decrease with age. This lower muscle mass leads to a decrease in metabolism. These
changes also reduce calorie needs, and can make it harder to keep off excess weight.
- If you don't consciously control what you eat and become more physically active as you age, you'll likely gain weight.
 Pregnancy –
- During pregnancy, a woman's weight necessarily increases.
- Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.
- Pregnancy at a later age of mother, may cause susceptibility to obesity in her children.
 Lack of sleep –
- Not getting enough sleep or getting too much sleep can cause changes in hormones that increase your appetite.
- You may also crave foods high in calories and carbohydrates, which can contribute to weight gain.
 Gut bacteria / viruses –
- Gut flora has been shown to differ between lean and obese humans, can affect the metabolic potential, and is believed to confer a greater capacity
to harvest energy contributing to obesity.
- The use of antibiotics among children has also been associated with obesity later in life, as Antibiotics kill the Gut micro biota.

CONSEQUENCES – of Obesity in our Body

The Hidden Dangers of Belly Fat –
- The most important result of our study is the finding that not just being overweight, but also the distribution of body fat, (adipose cells), affects the risk
of “premature death”
 Interference in functions - with liver function, and the processing of cholesterol and insulin, is associated with an increased risk for diabetes,
heart disease, and even some forms of cancer.
 Visceral fat The fat that resides deeper in our bodies, and it can harm us. This visceral fat, later in life, tends to collect around our tummies, and
creates the spare tire effect. Excess belly fat is an active organ in your body, it is more metabolically active than subcutaneous fat, which lies just
under the skin in other parts of the body.
  Produces Angiotensin, a chemical messenger that can elevate blood pressure by causing the constriction of blood vessels.
 Releases inflammatory cytokines such as C-reactive protein (CRP) and Interleukin (IL)-6, and triggers changes in hormones, causing a chain
reaction, which contribute to chronic systemic inflammation.
 Central Obesity - people who carry their excess weight around their middles -- those who are apple-shaped instead of pear-shaped -- have a
higher risk for heart attacks and strokes.
- Men and women with the largest waists (more than 40 inches for men and 35 inches for women) had roughly doubled the risk of premature
death as men and women with the smallest waists (less than 34 inches for men and 28 for women).

 Sarcopenic obesity -"Sarcopenia" meaning loss of muscle and "Obesity" which is the increase in fat percentage. It is a medical condition
which refers to the presence of low muscle mass and either low muscular strength or low physical performance. When this is accompanied by a
high fat mass, the condition is known as sarcopenic obesity. The individual may show a BMI that is appropriate and healthy to his or her age but
will look fat in appearance.

Health consequences –

Medical field Condition Medical field Condition

 coronary heart disease-angina, myocardial infarction  stretch marks

 congestive heart failure, high blood pressure  acanthosis nigricans
Cardiology Dermatology
 abnormal cholesterol levels  lymphedema, intertrigo
 deep vein thrombosis and pulmonary embolism  cellulitis, hirsutism
  diabetes mellitus, infertility, birth defects
Endocrinology  gastroesophageal reflux disease
/ Reproductive
 polycystic ovarian syndrome, menstrual disorders Gastroenterology
 fatty liver disease, cholelithiasis (gallstones)
 complications during pregnancy, intrauterine fetal death

 stroke, meralgia paresthetica  esophageal, colorectal

 migraines, dementia  pancreatic, gallbladder
Neurology  multiple sclerosis Oncology  endometrial, kidney
 carpal tunnel syndrome  Leukemia, malignant melanoma
 idiopathic intracranial hypertension  Hepatocellular carcinoma

 depression in women  obstructive sleep apnea, hypoventilation syndrome

Psychiatry Respiratory
 social stigmatization  asthma, complications during general anaesthesia

Rheumatology  gout, osteoarthritis Urology  erectile dysfunction, hypogonadism, buried penis

/ Orthopedics  poor mobility, low back pain / Nephrology  urinary incontinence, chronic renal failure

IMPACT OF OBESITY – in our Lives

Economic impact -
In addition to its health impacts, Obesity can lead to social stigmatization and disadvantages in employment. When compared to their normal
weight counterparts, obese workers on average have higher rates of absenteeism from work and take more disability leave, thus increasing costs
for employers and decreasing productivity, hence increased business costs. These effects are felt by all levels of society from individuals, to
corporations, to governments.
Psychological Impact -
The first problems to occur in obese children are usually emotional or psychological. Obese children often experience bullying by their peers. Some
are harassed or discriminated against by their own family. Stereotypes abound and may lead to low self-esteem and depression.

Advertising and its Impact -

Advertising of unhealthy foods correlates with childhood obesity rates. In some nations, advertising of candy, cereal, and fast-food restaurants is
illegal or limited on children's television channels. The media defends itself by blaming the parents for yielding to their children's demands for
unhealthy foods.

Socioeconomic status -
 It is much more common for young people who come from a racial or ethnic minority, or for those who have a lower socioeconomic status, to be
overweight and to engage in less healthy behaviors and sedentary activities.
Impact on the Quality of life –

When you're obese, your overall quality of life may be diminished. You may not be able to do things you used to do, such as participating in
enjoyable activities. You may avoid public places. They may even encounter discrimination.
Other weight-related issues that may affect your quality of life include -
- Depression, Shame and guilt, Social isolation,
- Disability, Sexual problems
- Lower work achievement

MANAGEMENT OF OBESITY – ( Prevention / Exercise / Diet / Lifestyle / Psychological / Surgical or Endoscopic Intervention )

Prevention – Obesity is mostly preventable through a combination of social changes and personal choices.

 Schools - play a large role in preventing childhood obesity by providing a safe and supporting environment with policies and practices that
support healthy behaviors.
Screening for obesity is recommended in those over the age of six.
 At home - parents can help prevent their children from becoming overweight by changing the way the family eats and exercises together. The
best way children learn is by example, so parents should lead by example by living a healthy lifestyle.
 Social policies and Practices - Obesity prevention programs have been found to reduce the cost of treating obesity-related disease. However, the
longer obese people live, the more medical costs they incur. Researchers, therefore, conclude that reducing obesity may improve the public's
health.
 Different communities and nations have adopted varying social practices and policies that are either beneficial or detrimental to children's
physical health. These social factors, include -
 the improvement and maintenance of the quality of school lunches
 the emphasis of schools on physical activity
 decreased access to vending machines and fast-food restaurants
 prevalence of and access to parks, bike paths, and sidewalks
 controlled government subsidies for corn oil and sugar
 decrease the advertising of fast-food restaurants and candy
 economical and affordable prices of healthy foods over unhealthy foods
 access to fresh, healthy, and affordable food

* Measure your waist –

 Stand and place a tape measure around your bare stomach, just above your hipbone, level with your belly button. Pull the tape measure until it fits
snugly around you, but doesn't push into your skin. Relax, exhale and measure your waist, resisting the urge to suck in your stomach.
 ( For your best health, your waist should be less than 40 inches around for men, and less than 35 inches for women ).

 Another way to check the circumference around the waist is – check the height from tip of head to toe, with a string. Fold this string into half, and place it
around the waist at the level of belly button, after expiration, when the stomach is not pulled in. ( The two ends of the half folded string should meet. If not,
the waist circumference is broader than required and measures should be taken to reduce this central obesity ).
 Following exercises help in reducing Central Obesity -

What are the treatments for obesity ?

1. Exercising
2. Changes to Diet
3. Lifestyle Changes with Intensive Behavioral Interventions
4. Bariatric approach.

EXERCISE –

Weight-loss programs - The 3 major phases of any successful weight-loss program are as follows -
 Pre inclusion screening phase
 Weight-loss phase
 Maintenance phase - This may last for the rest of the patient's life but ideally lasts for at least 1 year after the weight-loss program has been
completed
 Walking - You might start at 30 minutes a day, or 30 minutes at least several times a week. Work up until you can comfortably exercise for an
hour, three to five times a week.

 Moderately intense physical activities – gets better outcomes in the long and short term.(60 to 90 minutes on most days of the week)
- Fast walking and swimming.
- Using the stairs instead of the elevator.
- Getting off the bus or train one stop earlier and walking the rest of the way.
- Doing chores such as gardening, housework, or walking the dog all contribute.
- Identify ways to incorporate healthy habits into your daily routine, such as taking a walk at lunchtime.
 Set specific but realistic goals for weight-loss and exercise, such as having a salad with dinner and walking for 15 minutes in the evening.
Once you've lost weight, regular physical activity can help keep weight off, with constant BMI checking.
 Change Your Workout - Your body also may not be experiencing the changes that it did when you first started working out. Just like your mind
gets comfortable, your body does too. Your body gets used to all of the movements you do during your workouts. Your muscles become more
efficient and start to burn fewer calories. This is why it’s important to switch up your routine every once in a while.

 Add More Steps. Get yourself a pedometer and gradually add more steps until you reach 10,000 per day. Throughout the day, do whatever you can to be
more active pace while you talk on the phone, take the dog out for an extra walk, and march in place during television commercials. Having a pedometer
serves as a constant motivator and reminder.
 Reduction of inactivity - In addition to increasing physical inactivity which is common with adults, children need to be actively encouraged to
change behaviors that tend to increase inactivity. Prime examples include reducing screen time (television viewing, internet use, mobile phone use,
and general computer use and computer games), and indulging in more out-door time with family / friends, enjoying some physical activities,
along with fun.
DIET/ NUTRITION –

- The word Healthy Diet often implies the use of specific intake of Nutrition to promote health or weight-management. Dietary habits and choices
play a significant role in the quality of life, health and longevity, is a way to prevent health problems, and will provide the body with complete
nutrition through the right balance of ingestion and absorption of vitamins, minerals, and other nutrients like essential amino acids from protein
and essential fatty acids from fat-containing food, also food energy in the form of carbohydrate, protein, and fat.
- “Hunger” is the requirement of food by the Body, whereas “Appetite” is the feeling or craving for the satisfaction achieved by the taste buds on
the tongue, or the satiety centre in the Brain.

CARBOHYDRATES –
Uses -
- Carbohydrates provide energy and regulation of blood glucose.
- It will prevent the degradation of skeletal muscle and other tissues such as the heart, liver, and kidneys.
- It prevents the breakdown of proteins for energy.
- Carbohydrates help with fat metabolism, long-term food storage molecules, protective membranes for organisms and cells, main structural
support for plants.
- The brain needs carbohydrates, specifically glucose, because neurons cannot burn fat.

Carbohydrate intake and weight management –

- Carbohydrates are among the macronutrients that provide energy and can thus contribute to excess carbohydrate / energy intake and subsequent
weight gain.
- In the short-term, low carbohydrate diets appear better than low fat diets for weight loss. Decreased intake of sweet drinks helps in weight-loss.
- In the long term, however, all types of low-carbohydrate and low-fat diets appear equally beneficial.

Sources of good Carbs for weight loss –

 - Whole Grain Bread, Whole Grains wheat, bajra, jowar, and Ragi,, Beans and Legumes, Oatmeal(does not increase insulin levels at a
go. Vegetables contain fiber - cabbage, carrots, tomatoes and peppers, Potatoes and sweet potatoes, Beans and Carrots. ,
- Nuts, Seeds, Fruits contain natural sugar called fructose, which is good for you in portioned doses. They provide valuable minerals
and nutrients without an excessive amount of calories.
- Banana and Apple are great pre-workout snacks. Eating moderate to high GI fruits, c itrus Fruits, Berries, Apricots and Peaches, after
a workout, enhances your muscles' capacity to replenish energy for the next session.

PROTEINS-
Uses -
- An essential component for every type of cell in the body, including muscles, bones, organs, tendons, and ligaments.
- Also needed in the formation of enzymes, antibodies, hormones, blood-clotting factors, and blood-transport proteins.

Protein intake and weight management -

- Dietary protein is effective for body-weight management, promotes satiety, energy expenditure, and changes body-composition in favor of fat-free
body mass.
- Helps to stabilize blood sugar, curb hunger, potentially increase the number of calories you burn through digestion.
- Takes longer to digest compared to carbohydrates, thus makes you feel more satisfied when trying to cut calories.
- Also supports exercise efforts, prevents losing too much muscle mass as you create a calorie deficit to lose weight.

Sources of Proteins in Diet –

- lean meat, poultry and fish, eggs, dairy products like milk, yoghurt and cheese, seeds and nuts, beans and legumes (such as lentils and chickpeas),
soy products like tofu, some grain and cereal-based products are also sources of protein, but are generally not as high in protein as meat and
meat alternative products.
FATS –
Uses -
- Fats are sources of essential fatty acids, an important dietary requirement, as a major source of energy, supports and balances hormones
- It’s a catalyst for absorbing certain vitamins and minerals. Vitamins A, D, E, and K are fat-soluble, meaning they can only be digested, absorbed,
and transported in conjunction with fats.
- Critical to building cell membranes, the important lining of each cell, promoting homeostasis and protects the cells
- play a vital role in maintaining healthy skin and hair,
- Insulating body organs against shock,
- Maintaining body temperature and promoting healthy cell function.
- Fat also serves as a useful buffer against a host of diseases. When a particular substance, whether chemical or biotic, reaches unsafe levels in the
bloodstream, the body can effectively dilute—or at least maintain equilibrium of—the offending substances by storing it in new fat tissue. This
helps to protect vital organs, until such time as the offending substances can be metabolized or removed from the body by such means
as excretion, urination, accidental or intentional bloodletting, sebum excretion, and hair growth.

Saturated fats - We recommend these healthy choices - Coconut oil for its many health benefits, Raw butter
Monounsaturated fats - protect the heart and support insulin sensitivity, fat storage, weight loss, and healthy energy levels. Healthy choices include –
Avocado, Olives and olive oil
Polyunsaturated fats - include Omega 3 and Omega 6 fats. Omega 3’s reduce inflammation, support healthy hormone levels and cell membranes,
decreases blood cholesterol levels, Omega 6 fatty acids are important to support healthy brain and muscle functions. - flax, clean salmon.
Trans fats - This is the worst type of fat. Eating foods rich in trans fats increases the amount of harmful LDL cholesterol in the bloodstream and reduces
the amount of beneficial HDL cholesterol. Trans fats create inflammation, which is linked to heart disease, stroke, diabetes, and other chronic conditions.
It is a byproduct of a process called hydrogenation that is used to turn healthy oils into solids and to prevent them from becoming rancid. It also makes
healthy vegetable oils more like not-so-healthy saturated fats.

Sources of Foods high in good fats - 10 High-Fat Foods That Are Actually Super Healthy –
  Avocados- They are an excellent source of potassium and fiber, and have been shown to have major benefits for cardiovascular health.
 Cheese- is incredibly nutritious. A single slice contains a similar amount of nutrients as a glass of milk. It is a great source of vitamins, minerals,
quality proteins and healthy fats.
 Dark Chocolate- is high in fat, but loaded with nutrients and antioxidants, very effective at improving cardiovascular health.
 Whole Eggs- are among the most nutrient dense foods. Despite being high in fat and cholesterol, they are incredibly nutritious and healthy.
 Fatty Fish- like salmon is loaded with important nutrients, especially omega-3 fatty acids, to improved health, reduce risk of many diseases.
 Nuts - Nuts are loaded with healthy fats, protein, vitamin E and magnesium, and are among the best sources of plant-based protein.
 Chia Seeds - very high in healthy fats, especially an omega-3 fatty acid called ALA, also loaded with fiber and minerals.
 Extra Virgin Olive Oil - has many powerful health benefits, and is incredibly effective at improving cardiovascular health.
 Coconuts and Coconut Oil - Coconuts are very high in medium-chain fatty acids, which are metabolized differently than other fats. They can
reduce appetite, increase fat burning and provide numerous health benefits, help fight heart disease and obesity
 Full-Fat Yogurt - is incredibly healthy and it's also loaded with healthy, probiotic bacteria, that can have powerful effects on your health, major
improvements in digestive health.

Fat intake and weight management –

- Choose foods with “good” unsaturated fats, limit foods high in saturated fat, and avoid “bad” trans fat.
- The best choice for your health is to incorporate clean fats and the least processed fats and always organic.
- For healthy body-fat percentage ranges based on your fitness level, follow these guidelines –
-

FIBERS –
Uses -
- High-fiber foods may have health benefits - reducing blood pressure, inflammation, the risk of heart disease and some cancers
- Help stabilizes your blood sugar levels and also maintain cholesterol levels within a normal range,
- Help you maintain a healthy colon and digestive tract, normalizes your bowel movements and reduce the risk of inflammatory bowel diseases.

Fiber intake and weight management –

 Foods, high in fiber generally take longer to chew and eat. This makes your body feel fuller quicker, also keep you feeling fuller for longer and
slowly release energy, meaning you will actually eat less over the course of the day.

Sources of fiber –
 Soluble Fiber are oats, barley, fruit, vegetable and pulses (beans, lentils, chickpeas). Insoluble fiber are Wholegrain cereals and whole meal bread.

VITAMINS and MINERALS –

Uses –
- they are considered essential nutrients—because acting in concert, they perform hundreds of roles in the body. They help build up bones, heal
wounds, and bolster your immune system, convert food into energy, repair cellular damage, protect vision, protect the body.
Vitamins / Minerals and Weight Management –
 Signals your cells to burn fat, helps to use the stored energy in food.
 Metabolizes carbohydrates, proteins, and fats, helps the body cells convert carbohydrates into energy.
 These are some of the most important vitamins that your body needs when it is going through the process of shedding weight. In fact, specific
vitamin deficiencies can slow down or prevent weight loss. Check your multi-vitamin and Minerals to make sure you are getting all of these key
components -
Vitamin A: helps to support the genes that keep food from storing up as fat, thereby reducing the size of fat cells.
Vitamin B3: as it increases the bodies rates of adiponectin, which is an important weight loss hormone secreted by fat cells.
Vitamin D: is a powerhouse when it comes to weight loss. An ample amount leads to better metabolism of carbohydrates.
Vitamin E: stops pre-fat cells from transitioning into mature fat cells, which leads to lower levels of body fat.
Vitamin K: Low levels of vitamin K have been associated with increased fat tissue.
Calcium: mineral works with vitamin D to help you shed fat. It is stored in fat cells, the more calcium a fat cell has, the more fat that cell will release to be
burned.
Chromium: makes our bodies more insulin sensitive, which helps reduce body fat and increase lean muscle mass.
Inositol: helps increase adiponectin levels, which plays an important role in weight loss and fat burning.
Lipoic Acid: This important form of acid helps improve glucose uptake into cells, which helps our bodies burn more carbohydrates.
Magnesium: Low levels of magnesium in cells are linked with an inability to use glucose for energy, which means glucose gets stored as fat instead.
Omega-3 Fatty Acids: facilitate weight loss by activating the enzymes that trigger fat-burning in cells.
Biotin: boosts metabolism by helping stabilize blood sugar and lowering insulin.
Zinc: . Low levels of this important element have also been linked with increased appetite.

Including a multi-vitamin when starting a weight-loss program is a great way to make sure your body has the nutrients it needs to lose weight and stay
healthy. By adding a top quality vitamin supplement you can ensure your health while on the path to your ideal weight.

Sources of Vitamins –

 Water soluble -
- Vitamin B - watermelon, milk, yogurt, eggs, cheese, whole and enriched grains and cereals, meat, poultry, fish, mushrooms, potatoes,
broccoli, avocados, legumes, tofu and other soy products, bananas, spinach, broccoli, legumes (black-eyed peas and chickpeas), orange
juice
- Vitamin C - Citrus fruit, potatoes, broccoli, bell peppers, spinach, strawberries, tomatoes, sprouts
 Fat soluble -
- Vitamin A - beef, liver, eggs, shrimp, fish, fortified milk, sweet potatoes, carrots, pumpkins, spinach, mangoes
- Vitamin D - Fortified milk and cereals, fatty fish
- Vitamin E - vegetables oils, leafy green vegetables, whole grains, nuts
- Vitamin K - Cabbage, eggs, milk, spinach, broccoli, kale

Sources of Minerals –
(Calcium, Chloride, Magnesium, Potassium, Sodium, Chromium, Copper, Fluoride, Iodine, Iron, Manganese, Selenium, Zinc)
- yogurt, cheese, milk, leafy green vegetables, Iodized salt, broccoli, legumes, seeds, whole-wheat bread, fruits, vegetables, grains,
legumes, beans, prunes , poultry, fish, seafood, nuts

TECHNIQUES FOR WEIGHT MANAGEMENT THROUGH - FOOD HABITS

 Keep a daily food diary, which can make people more aware of what foods they eat, when they eat them and how much they consume, as well
as identify potentially unhealthy eating habits, such as eating when stressed or not hungry.
 Make small changes to your eating habits, such as eating more slowly, putting your fork down between bites and drinking more water, which
can all help to reduce the number of calories people consume.
 Eat Slower - Slowing the speed of eating to let signals for fullness to come into play. Techniques include concentrating on tastes, pausing in
between meals and drinking water in between meals.It takes your body about 20 minutes for your body to start having that full feeling when you
are eating. Because of this, if you start to slow down while you are eating, you won’t be risking overeating. Slow eating allows you to enjoy your
food that much more as well. Eating too fast can also lead to stomach pains because you aren’t giving your body time to adjust to the food you
are shoving down your throat. Your stomach will get overflowed too quickly and that’s never fun for anybody.
 Get the Right Portion Sizes - Depending on what you’re eating, the portion size is going to vary. So not only do you need to know what you’re
about to put in your body, you need to understand how too much or too little of what you’re about to eat is going to affect your weight.
 Trim Portions. If you did nothing else but reduce your portions by 10%-20%, you would lose weight. Most of the portions served both in restaurants and at
home are bigger than you need
 Eating small, frequent meals and snacks (every 3-4 hours), to keep your blood sugar levels steady and to avoid overindulging.
 Follow a healthy eating plan. Eat Breakfast Every Day. Focus on low-calorie, nutrient-dense foods, such as fruits, vegetables and whole grains.
One advantage of a high-fiber diet is that the body feels full more quickly, making it less tempting to eat more. Whole grains help a person to feel
full for longer, because they release their energy more slowly. Fiber and whole grains can also help to reduce the risk of a number of conditions
related to metabolic syndrome.
 Eat Your Veggies First - If you are looking to keep weight off, you should eat your vegetables first. This is going to keep you from overeating
during your meal. The veggies give you that satiated feeling faster than other foods that are on your plate.
 Eat More Produce. Eating lots of low-calorie, high-volume fruits and vegetables crowds out other foods that are higher in fat and calories.
 Go for the Grain. Choose whole-wheat breads and pastas, brown rice, bran flakes, popcorn, and whole-rye crackers.
 Avoid saturated fat and limit sweets and alcohol. Eat three regular meals a day with limited snacking. You can still enjoy small amounts of
high-fat, high-calorie foods as an infrequent treat.
 Know and avoid the food traps that cause you to eat. Identify situations that trigger out-of-control eating. Try keeping a journal and write
down what you eat, how much you eat, when you eat, how you're feeling and how hungry you are. After a while, you should see patterns emerge.
You can plan ahead and develop strategies for handling these types of situations and stay in control of your eating behaviors. Avoid Crash Dieting.
 Don’t Be Scared of the Crunch - Healthy foods that are naturally crunchy usually tend to contain more fiber, which will help aid in slimming
down your waist. Fresh veggies or nuts are foods that will give you the crunch and fiber you are looking for. While eating these foods, you are
going to feel satiated for a longer time. Sometimes you may not even feel full, you just won’t be hungry. This means that you won’t feel the need
to eat more food during your next meal.
 Stay Away from the Processed Foods - Processed foods are packed with extra fat and other unnecessary ingredients that you don’t need.
Number of calories that processed foods have is significantly more than foods that are part of a healthy diet. It may taste delicious and
convenient, but you are hurting your body more than helping it, especially if you are looking to lose pounds for good.
Sometimes you don’t set yourself up for success by taking the time to prepare clean foods. It’s easier to grab a bag of chips. Cut that out!
 Switch to Lighter Alternatives. Whenever you can, use the low-fat versions of salad dressings, mayonnaise, dairy products, and other products. Eat plain
roasted sweet potatoes instead of loaded white potatoes; use skim milk instead of cream in your coffee
 Reduce Added Sugar Intake - You just need to watch the sugar that doesn’t come in foods naturally. Refined sugars create more fat cells in your
body. The problem many people have is that they consume more carbs than their body can burn, then your body converts that into fat.
 Don’t Drink Your Calories - drinking soda, coffee, or even sports drinks. People don’t see the significance of drinking these calories because they
don’t necessarily have any effect on how full you feel.
Eating 300 calories and drinking 300 calories is still going to be the same no matter how you look at it. The only difference is that 300 calories
worth of food usually takes up more space than 300 calories of a liquid. Water is the best option and has zero calories and will just pass through
your body while helping make sure everything is running properly. Satisfy your thirst with water, sparkling water with citrus, skim or low-fat milk, or
small portions of 100% fruit juice. Try a glass of nutritious and low-calorie vegetable juice to hold you over if you get hungry between meals.
 Close the Kitchen at Night. Establish a time when you will stop eating so you won't give in to the late-night munchies or mindless snacking while
watching television. "Have a cup of tea, suck on a piece of hard candy or enjoy a small bowl of light ice cream or frozen yogurt if you want something
sweet after dinner, but then brush your teeth so you will be less likely to eat or drink anything else
 Control Your Environments. Everything from stocking your kitchen with lots of healthy options to choosing the right restaurants. And when it comes to
parties, "eat a healthy snack before so you won't be starving, and be selective when you fill your plate at the buffet," Before going back for more food, wait
at least 15 minutes and have a big glass of water.
 Control the risk for mindless eating. Figure out how to stop the behavior or avoid following situations altogether -
 Whenever you feel bored, sad, or tired
 When someone brings donuts to the staff meeting at work
 Before or after a stressful meeting at work, or any other stressful event
 After arriving home from work with nothing planned for dinner
 While watching television

 Add Protein and Fiber to Breakfast – Apart from Fiber, Protein is something that should be added to every meal as well. Never skip Breakfast.
  Have Protein at Every Meal and Snack. Adding a source of lean or low-fat protein to each meal and snack will help keep you feeling full longer so
you're less likely to overeat. Try low-fat yogurt, small portion of nuts, peanut butter, eggs, beans, or lean meats.
 Ketogenic diet - It has many of the benefits of fasting – including weight loss – without having to fast. It allows the body to produce small fuel
molecules called “ketones”, if you eat very few carbs (that are quickly broken down into blood sugar) and only moderate amounts of protein
(excess protein can also be converted to blood sugar). The liver produces ketones from fat, which then serve as a fuel source throughout the body,
especially for the brain, used when blood sugar (glucose) is in short supply The brain is a hungry organ that consumes lots of energy every day,
and it can’t run on fat directly. It can only run on glucose or ketones. On a ketogenic diet, your entire body switches its fuel supply to run mostly
on fat, burning fat 24-7. There are also other less obvious benefits, such as less hunger and a steady supply of energy. This may help keep you
alert and focused. A keto diet, can be eaten indefinitely.

LIFESTYLE –

 To decrease the obesity levels in children - Exclusive breast-feeding is recommended in all newborn infants for its nutritional and other
beneficial effects.
 Parents changing the diet and lifestyle - of their offspring by offering appropriate food portions, increasing physical activity, and keeping
sedentary behaviors at a minimum. Parents should recognize the signs and encourage their children to be more physically active. By walking or
riding a bike, instead of using motorized transport or watching television, they will reduce sedentary activity.
 Monitor your weight regularly. People who weigh themselves at least once a week are more successful in keeping off excess pounds. Monitoring
your weight can tell you whether your efforts are working and can help you detect small weight gains before they become big problems.
 Be consistent. Sticking to your healthy-weight plan during the week, on the weekends, and amidst vacation and holidays as much as possible
increases your chances of long-term success.

BEHAVIORAL THERAPY (BT)-

- Optimal treatment of on overweight/obese patient is initiated with a combination of diet and exercise. Adherence to both these
treatment plans requires changes in behavior which can only be brought about by Behavioral Therapy.
- The two most powerful strategies among the various components available are monitoring food intake and increasing physical activity.
 - BT needs to be added to the treatment plans of patients who intend to lose weight and should also be continued in patients who have
lost weight regardless of how they lost weight including those who lost weight following bariatric surgery.

Most of the following components, used in the common behavioral packages for weight control, are as follows –
1. Self-monitoring - Self-monitoring includes maintaining food diaries and activity logs. In a food diary, the participant writes down everything that
they eat, the calories consumed and the situation in which the eating was done. Maintaining these diaries for the first 6 months is predictive of
success at losing weight

2. Stimulus control - Here, the focus is on altering the environment that activates eating and modifying it to help in avoiding overeating. Stimulus
control includes proper purchase of food items, excluding energy-dense processed food from the shopping basket and introduction of more fruits and
vegetables. Others include altering the amount of food served on the table or reducing the size of plates and containers, concentrating on eating
without being distracted by television or reading material and reducing proximity to food.
3. Goal setting - realistic goals for the patient intending to lose weight in terms of weight loss per week/ month.
4. Behavioral contracting - Reinforcement of successful outcomes or rewarding good behaviors, could include small tokens or even financial
incentives.
5. Education - A structured meal plan devised and educated to an individual patient, in consultation with a dietician results in a greater weight loss.
6. Parental involvement - For successful outcomes. In the initial interview, the physician should gauge the degree of parental readiness to change,
which may be classified as pre-contemplation (no intention to change), contemplation (considering to make the change, but not yet committed),
preparation (intention to change), action (modifying behavior), and maintenance (maintaining the behavior change). Only the children of parents
willing to change should be enrolled into BT programs.
7. Social support and Self-help groups - Enhancing social support by including spouses, family members and Self-help groups, is one of the best
ways to accomplish this.
8. Clinic setting - BT can be administered in the clinic by trained personnel, either individually or as part of a group. Most weight loss studies include
an initial phase (weekly group meetings/3–6 months) followed by a maintenance phase of biweekly meetings (6–12 months) and monthly
meetings thereafter.
- Over long term, that is, after 2 years of contact, some kind of intervention is required to preserve the benefits accrued. These include some kind of
ongoing contact with the patient or some interactive technology-based intervention.
9. Other less proven components -
 Cognitive restructuring and adopting positive outlooks
 Problem solving
 Assertiveness training includes learning to say no
 Stress reduction
10. Food provision - Patients who received food provision along with standard BT package lost more weight
11. Commercial weight loss programs - to participants at a cost and include prepared meals, regular meetings and printed materials
12. Meal replacements - When patients had one or two meals replaced with a liquid or solid replacement meal, they tended to lose more weight
13. Pharmacotherapy - Combination of BT with drugs that modify appetite or the absorption of food, works in tandem by modifying the external
environment (BT) and the internal environment (drugs).
14. Internet based programs - are available with both non-profit self-help groups and commercial entities, include behavioral modification
components and these packages are more effective than the others
15. The non-adherent patient - Like in any other field where new skills are being learned, setbacks are very common in the practice of BT in the
management of the obese patients. Hence, effective management of non-adherence is vital to both the patient and the practitioner. The following
tips are designed to help the health care provider deal with non-adherence
 Assume non-adherence is a consequence of a lack of planning rather than a lack of motivation.
 Analyze with the patient what went wrong and try and work out solutions to these with the patient.
 Help obese patients recognize non-adherence and help them to assume responsibility for the same.
 Avoid criticisms. This helps preserve patient's self-esteem.

SURGICAL CORRECTION OF OBESITY –

The most effective treatment for Complicated and resistant Obesity is ”Bariatric surgery”, associated with long-term weight loss, improvement in obesity-
related conditions and decreased overall mortality. In the short term, weight loss from bariatric surgeries is associated with reductions in some co
morbidities of obesity, such as diabetes, metabolic syndrome and sleep apnea,
Bariatric surgery (or weight loss surgery) includes a variety of procedures performed on people who have obesity. Weight loss is achieved by reducing the size
of the stomach with
 Gastric band – (Laparoscopic Adjustable) In this type of surgery, the surgeon places a ring with an inner inflatable band around the top of your
stomach to create a small pouch. This makes you feel full after eating a small amount of food. The band has a circular balloon inside that is filled
with salt solution. The surgeon can adjust the size of the opening from the pouch to the rest of your stomach by injecting or removing the solution
through a small device called a port placed under your skin.
After surgery, you will need several follow-up visits to adjust the size of the band opening. If the band causes problems or is not helping you lose
enough weight, the surgeon may remove it.
 Sleeve gastrectomy - also called Vertical Sleeve Gastrectomy, a surgeon removes most of your stomach, leaving only a banana-shaped section
that is closed with staples. This surgery reduces the amount of food that can fit in your stomach, making you feel full sooner.
- Taking out part of your stomach may also affect gut hormones or other factors such as gut bacteria that may affect appetite and metabolism. This
type of surgery cannot be reversed because some of the stomach is permanently removed.
 Duodenal Switch - also called Biliopancreatic diversion with duodenal switch, is more complex than the others. The duodenal switch involves two
separate surgeries. The first is similar to gastric sleeve surgery. The second surgery redirects food to bypass most of your small intestine. The
surgeon also reattaches the bypassed section to the last part of the small intestine, allowing digestive juices to mix with food.
- This type of surgery allows you to lose more weight than the other three. However, this surgery is also the most likely to cause surgery-related
problems and a shortage of vitamins, minerals, and protein in your body. For these reasons, surgeons do not perform this surgery as often.
 Gastric bypass surgery - by resecting and re-routing the small intestine to a small stomach pouch. It is also called Roux-en-Y gastric bypass, has
two parts. First, the surgeon staples your stomach, creating a small pouch in the upper section. The staples make your stomach much smaller, so
you eat less and feel full sooner.
- Next, the surgeon cuts your small intestine and attaches the lower part of it directly to the small stomach pouch. Food then bypasses most of the
stomach and the upper part of your small intestine so your body absorbs fewer calories. The surgeon connects the bypassed section farther down
to the lower part of the small intestine. This bypassed section is still attached to the main part of your stomach, so digestive juices can move from
your stomach and the first part of your small intestine into the lower part of your small intestine.
- The bypass also changes gut hormones, gut bacteria, and other factors that may affect appetite and metabolism. Gastric bypass is difficult to
reverse, although a surgeon may do it if medically necessary.

What is the difference between open and laparoscopic surgery ?

- In open bariatric surgery, surgeons make a single, large cut in the abdomen. More often, surgeons now use laparoscopic surgery, in which they
make several small cuts and insert thin surgical tools through the cuts. Surgeons also insert a small scope attached to a camera that projects
images onto a video monitor. Laparoscopic surgery has fewer risks than open surgery and may cause less pain and scarring than open surgery
and also may lead to a faster recovery.
- Open surgery may be a better option for certain people. If you have a high level of obesity, have had stomach surgery before, or have other
complex medical problems, you may need open surgery.

What should I expect before surgery ?

Before surgery, you will meet with several health care providers, such as a dietitian, a psychiatrist or psychologist, an internist, and a bariatric surgeon.
 The doctor will ask about your medical history, do a thorough physical exam, and order blood tests. If you are a smoker, he or she will likely
ask you to stop smoking at least 6 weeks before your surgery.
 The surgeon will tell you more about the surgery, including how to prepare for it and what type of follow-up you will need.
 The dietitian will explain what and how much you will be able to eat and drink after surgery and help you to prepare for how your life will
change after surgery.
 The psychiatrist or psychologist may do an assessment to see if bariatric surgery is an option for you.
These health care providers also will advise you to become more active and adopt a healthy eating plan before and after surgery. In some cases, losing
weight and bringing your blood sugar levels closer to normal before surgery may lower your chances of having surgery-related problems.

What should I expect after surgery ?

- After surgery, you will need to rest and recover. Although the type of follow-up varies by type of surgery, you will need to take supplements that
your doctor prescribes to make sure you are getting enough vitamins and minerals.
- Walking and moving around the house may help you recover more quickly. Start slowly and follow your doctor’s advice about the type of physical
activity you can do safely. As you feel more comfortable, add more physical activity.
Eating after bariatric surgery –
 Immediately after bariatric surgery, the patient is restricted to a clear liquid diet, which includes foods such as clear broth, diluted fruit juices or
sugar-free drinks and gelatin desserts. This diet is continued until the gastrointestinal tract has recovered somewhat from the surgery.
 The next stage provides a blended or pureed sugar-free diet for at least two weeks. This may consist of high protein, liquid or soft foods such as
protein shakes, soft meats and dairy products. Foods high in carbohydrates are usually avoided when possible during the initial weight loss period.
 Post-surgery, overeating is curbed because exceeding the capacity of the stomach causes nausea and vomiting. Diet restrictions after recovery
from surgery depend in part on the type of surgery. Many patients will need to take a daily multivitamin pill for life to compensate for reduced
absorption of essential nutrients. Because patients cannot eat a large quantity of food, physicians typically recommend a diet that is relatively high
in protein and low in fats and alcohol.
 Fluid recommendations - It is very common, within the first month post-surgery, for a patient to undergo volume depletion and dehydration.
Patients have difficulty drinking the appropriate amount of fluids as they adapt to their new gastric volume. Limitations on oral fluid intake,
reduced calorie intake, and a higher incidence of vomiting and diarrhea are all factors that have a significant contribution to dehydration. In order
to prevent fluid volume depletion and dehydration, a minimum of 1.4-1.9 Liters, should be consumed by repetitive small sips all day.
 Your doctor, nurse, or dietitian will tell you which foods and beverages you may have and which ones you should avoid. You will need to eat small
meals and chew your food well.
How much weight can I expect to lose, after Surgery ?
The amount of weight people lose after bariatric surgery depends on the individual and on the type of surgery he or she had. A study following people for 3
years after surgery found that those who had gastric band surgery lost an average of about 45 pounds. People who had gastric bypass lost an average of 90
pounds. Most people regained some weight over time, but weight regain was usually small compared to their initial weight loss.
Remember, reaching your goal depends not just on the surgery but also on sticking with healthy lifestyle habits throughout your life.

Endoscopic Options for Weight Loss – Endoscopic weight loss procedures are a great option between medication and surgery. They work better than
medication, but are less invasive than surgery and carry fewer side effects and risks. Unlike bariatric weight loss surgery, which can require months of prep
and several days of recovery, endoscopy is a one-day procedure.
- Endoscopy is a procedure where doctors insert a thin, flexible tube equipped with a camera through your mouth into your digestive tract. This
allows them to access your digestive system without open surgery. Before the procedure, the doctor provides medication to make patients sleepy
so they don’t feel any discomfort.
- These procedures work by allowing doctors to place special devices or medications into the gastrointestinal tract to limit how much you can eat.

Gastric Balloon –
- One of the most common endoscopic weight loss procedures is the gastric balloon. This treatment places a silicone balloon in the stomach to take
up volume. With less room in your stomach, delay in gastric emptying, you feel fuller longer and eat less. Doctors may use a single balloon or a
newer model that looks more like a dumbbell.
- Doctors leave the balloon in place for about six months and patients can expect to lose up to 15 percent of their body weight. The procedure is
approved for people with a body mass index (BMI) of 30 to 40.
- People who have a hiatus hernia, previous gastric surgery, acid reflux, are not eligible for the gastric balloon, since it can make symptoms worse.

Aspiration Therapy -
- Aspiration therapy is a new procedure that lets you remove calories from the stomach after you eat. During the procedure, an endoscopy specialist
places a small tube with an access port into your stomach. Two weeks later, doctors connect the port to the skin surface, allowing the patient to
empty about 30 percent of calories from the stomach after each meal.
- The procedure is ideal for obese people with a BMI greater than 35, and patients typically lose about 16 percent of their body weight during the
initial one-year treatment period. Weight loss is more gradual than with gastric balloon. It’s very simple and extremely safe.
- The device also helps people learn better eating habits that last after the device is removed. Aside from removing calories, patients learn to drink
more water, chew food more vigorously and snack less. This helps the device function better. People also tend to eat less when they know they will
have to make a special trip to the bathroom afterward.

Endoscopic Sleeve Gastroplasty –

- During an endoscopic sleeve gastroplasty, a specialist places stitches inside the stomach to reduce its volume by 70 percent. The patient is
completely asleep under general anesthesia for the procedure. The stitches last about a year before the body reabsorbs them.
- Patients typically lose about 20 percent of their body weight with this procedure, which has more predictable results than a gastric balloon, seems
to work well in almost everyone.

Gastric Injections
- Gastric injections work by freezing the stomach muscles, which slows digestion and helps patients feel fuller faster. This treatment helps with more
moderate weight loss goals, typically leading to a 5–10 percent weight loss.
- It’s also one of the least invasive procedures, requiring a single series of injections in the stomach that you can repeat after six months.
- It takes 10 minutes and is completely painless. It’s a good option for those pursing weight loss for cosmetic reasons, such as weight gain after
pregnancy.

Medications - There are no medications currently approved for the treatment of obesity in children, and in adults also it should be discourage.