Quick Start Weight Loss Program for Families

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PROFESSOR TRIM’S QUICK START

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PROFESSOR TRIM’S PROFESSORS Professor John Blundell PhD, C Psychol, MBPS Professor of Bio-Psychology, Leeds University, UK and Board Member of the International Association for the Study of Obesity (IASSO) Professor Wendy Brown BSc (Hons), MSc, Dip Phys Ed, PhD Professor of Physical Activity and Health, University of Queensland Professor Ian Caterson MBBS, BSc (Med), PhD, FRACP Boden Professor of Human Nutrition, Sydney University and Vice President, IASSO Professor Terry Dwyer MBBS, MPH, MD, FAFPHM Director Menzies School of Health Sciences Hobart, and University of Tasmania Professor Garry Egger MPH, PhD, MAPS Director, Centre for Health Promotion and Research Sydney Adjunct Professor of Health Sciences, Deakin University Professor James Hill PhD Director, Center for Human Nutrition, University of Colorado Health Sciences Center and Co-Founder, National Weight Control Registry Professor Kerin O’Dea BSc, PhD Director of Menzies School of Health Research, Darwin Professor Stephan Rossner MD, PhD Director, Obesity Research Program, Luddinge Hospital, Stockholm, Sweden and Past President of IASSO Professor Boyd Swinburn MD, MBChB, FRACP Professor of Population Health and Nutrition, Deakin University Professor Klaas Westerterp PhD Professor of Human Energetics, Head of Department of Human Biology, Maastricht University, The Netherlands

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PROFESSOR TRIM’S THE

QUICK START WEIGHT-LOSS PROGRAM

for families Dr Garry Egger MPH, PhD, MAPS By the originator of the ‘GutBusters’ waist-loss program

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First published in 2003 Copyright © Garry Egger 2003 All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without prior permission in writing from the publisher. The Australian Copyright Act 1968 (the Act) allows a maximum of one chapter or 10% of this book, whichever is the greater, to be photocopied by any educational institution for its educational purposes provided that the educational institution (or body that administers it) has given a remuneration notice to Copyright Agency Limited (CAL) under the Act. Allen & Unwin 83 Alexander Street Crows Nest NSW 2065 Australia Phone: (61 2) 8425 0100 Fax: (61 2) 9906 2218 Email: [email protected] Web: www.allenandunwin.com National Library of Australia Cataloguing-in-Publication entry: Egger, Garry. Quick start weight-loss program for families. ISBN 1 74114 116 8. 1. Weight loss. 2. Family—Nutrition. 3. Physical fitness. I. Title. (Series: Professor Trim’s medically supervised weight loss programs). Set in 11/12.5 pt Adobe Garamond by Midland Typesetters, Maryborough, Victoria Printed by Griffin Press, South Australia 10 9 8 7 6 5 4 3 2 1

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CONTENTS Introduction: How to use Professor Trim’s Quick Start Weight-Loss Program for Families 1 2 3 4 5 6 7 8 9 10

Why is your family overweight? Why is it so hard to lose weight? Why bother anyway? Measuring your family’s risk What works, what might and what doesn’t Changing your (micro) environment The family diet Moving more—not exercising! Problems for individual members of the family Other options

Appendix: Purchasing Professor Trim’s Medically Supervised Weight-Loss Programs

vii 1 7 11 17 22 27 31 41 50 61

66

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ABOUT THE AUTHOR Garry Egger is Director of the Centre for Health Promotion and Research in Sydney and Adjunct Professor of Health Sciences at Deakin University. He has been involved in health promotion for almost 30 years and is the author of more than 25 books.

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INTRODUCTION: How to use Professor Trim’s Quick Start Weight-loss Program for Families The Professor Trim’s (PT) Quick Start Weight-Loss Program for Families is an introduction not only to effective and sustainable weight loss, but to a lifetime of weight management for the whole family. You can read it by and for yourself, or as a family. You can also take part in the program under the supervision of your specially selected and trained PT doctor. Several thousand Australian doctors have now had special training in weight management as part of a Post-Graduate Medical Certificate in Weight Control and Obesity Management from Sydney University. These doctors (who you can find at www.professortrim.com) will help you lose and maintain your weight through a sharedcare system that provides the best information available.

PROFESSOR TRIM’S—THE HISTORY Professor Trim’s evolved from the ‘GutBuster’ program, which started as a men’s ‘waist loss’ program in 1991. GutBusters became the biggest, and most successful, men’s weight-loss program in the world. It had an vii

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internationally acclaimed scientific advisory board and was consistently rated by consumer groups as among the best weight-loss programs available. GutBusters was initially designed for men. However it soon became clear that other groups, such as women, were interested in a similar type of program, even though their issues and needs were quite different. This led to the development of the Professor Trim programs for men and women, Becoming Gut Less and Becoming Slimmer and, in turn, these specific ‘Quick Start’ programs.

PROFESSOR TRIM’S QUICK START WEIGHT-LOSS PROGRAMS Some people don’t find it too hard to lose weight. It’s just a matter of gathering the right information about diet and exercise then putting it into practice. For these people a ‘quick start’ program like those in the current series will be enough. Others need information and advice that is tailored to their specific needs, as well as additional support along the way. It is now generally recognised that getting the whole family involved is the best way for one or all family members to manage their weight effectively for life. Indeed, a family program is the only effective way to help an overweight child manage their eating and exercise habits. There are great advantages in treating the family as a unit, which is why we have designed this Professor Trim Quick Start program. There are, however, specific factors that need to be considered for individual members of the family, and these are covered in Chapter 9. Mum and dad may want to continue the quick start to weight loss they will get from this program with more intensive individual programs. For that reason, information viii

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INTRODUCTION

about the full Professor Trim’s men’s and women’s weightloss programs, Becoming Gut Less and Becoming Slimmer, is contained in the back of this book. You can also purchase these programs privately or directly from your Professor Trim’s doctor and work with him or her through the full 12 months of the program. To get the best effects from this Quick Start weight-loss program, first read the book. You can then find regular updates on current research and information from the Professor Trim Internet site at www.professortrim.com. In addition, at the end of each chapter in this booklet you will find an easy-to-follow summary of its contents, contained in a ‘Professor Trim’s Prescription Pad’. Use these summaries as your checklist for putting the program into action. You’ve taken the first important step by buying this book—you and your family are now on your way to becoming leaner, healthier and happier. Good luck!

Professor Trim’s Prescription Pad • Read this booklet as a family. • Try to put the recommendations at the end of each chapter into action. • Check in at the Professor Trim Website (www.professortrim.com). • Check in with your Professor Trim doctor for ongoing help. • For more specific programs, and how to contact a ‘personal weight coach’, see page 25. ix

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Chapter 1 WHY IS YOUR FAMILY OVERWEIGHT? FAT RULES OK? When I was a boy (back in the dim and distant past), there was only one overweight kid in my school. He was always allowed to get away with things that we couldn’t (come to think of it, that’s probably why I’ve spent my life working in obesity). ‘Fatty’ Foster was excused from doing anything active because ‘. . . Fatty’s got a bit of a problem’. The problem was, though, that Fatty was also excluded—he was the last to be picked for the footy team, and so on. Look around any primary school today and you’ll find that it’s now the lean kids that are in the minority. Fat rules! And nationwide surveys support this observation. Up to 30 per cent of under-18s and 15 per cent of under12s are now classified as overweight or obese. The statistics for adults paint an even more dismal picture. At the turn of the millennium, 2 out of every 3 Australian men and 1 in 2 women were medically overweight. We have no comparative figures from 50 years ago, but it’s a fair guess that it would have been less than 1 in 50—for men and women! In fact, being overweight has been an aberration throughout human history, limited to the unfortunate few with a genetic pre-disposition, or the very wealthy, who could afford to stuff themselves stupid while their much leaner servants ran around after them. 1

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THE WEIGHT-LOSS PROGRAM FOR FAMILIES

THE GAIN IN THE NATION’S WAIST So how has one of the fittest nations on Earth become one of the fattest? Despite popular belief, it’s not necessarily the amount of food we eat. Records show that around the turn of the twentieth century, Australians, on average, were eating about one-third more than we are today. Nor is it a decline in our interest in sport. Although we’ve always been a sporting nation, our zeal (and prowess) in such endeavours really hit its straps with the introduction of colour TV in the 1970s and reached its zenith at the 2000 Sydney Olympics. There’s also a far greater proportion of the population bouncing around inside gyms than at any other time in our history. You’d be excused, of course, for blaming ‘Ronald McDonald’ and, of course, fast and fatty foods doubtless have had an impact on our waistlines. But let’s be honest, it’s not that much worse in terms of calories and fat than what great-granny used to dish up to greatgrandad. Taste might be a different matter, though! The answer lies not so much in the individual, but in their modern environment. For thousands of years of evolution, we have sought comfort—food on the table at the end of the day without having to expend too much effort to get it. Thanks to the industrial revolution of the nineteenth century and the technological revolution of the twentieth, this is something we have now achieved. Technology not only entertains, it also means that we don’t have to work as hard on a day-to-day basis. The ‘labour-saving’ wonders of the 1950s have developed to such an extent that now almost everything can be available at the push of a button. Unfortunately, now that we have all this surplus energy, the easiest place for our bodies to store it is as fat cells. So it’s Bill Gates and Henry Ford as much, or more, than Ronald McDonald, 2

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WHY IS YOUR FAMILY OVERWEIGHT?

who should be blamed for the modern obesity epidemic. Computers, televisions, microwave ovens and remote controls all should come with a health warning: Guaranteed to increase the size of your family’s collective rear end.

WHAT ABOUT GENETICS? The most common scapegoat people will blame for their weight problem is their genes. ‘It’s in the family,’ they say. But if this was the case, why is the obesity epidemic only 30 years old? Before that, ‘Fatty Fosters’ were the exceptions, rather than the rule. The obesity epidemic is also too recent to suggest that the gene pool could have changed, so how do we explain the family-gene excuse? Humans have always had the genes (there are more than one by the way) to get fat. But except in those rare ‘Fatty Foster’ cases, they were not enough to overcome our environment, one in which we have had to move around a lot to survive—not just to find food but also to avoid our enemies. Since the technological revolution, however, we don’t have to do this any more. In this new environment, just about everybody has the potential to get fat. Those Fatty Fosters with the greatest genetic payload (who incidentally would have survived longer in times of famine), get fattest—in fact morbidly obese. Those with just a few fat-gaining genes become overweight. The changing influence of genes and the environment with increasing body weight, as measured by Body Mass Index (BMI), are shown in Figure 1.1. You can find out your BMI by using the following simple formula: weight (kg) = BMI height2 The recommended healthy BMI range for women is 19–24; for men it is 20–25. 3

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Figure 1.1: The relative influence of genes and environment at different body weights or Body Mass Indexes (BMIs)

Genes

Environment

20

30

40

50

60

BMI

WHO CAN WE BLAME? The bottom line is that your weight problem is probably not your fault—at least not all of it. A lot of the responsibility lies in the obesogenic environment in which you live, and the genes you inherit make the most of that environment. However, because genes can’t be changed (yet!), your environment, as much as your lifestyle, has to be managed and manipulated if you are to have any success in reducing your, and your family’s, weight. Within families, the tendency to inherited weight problems is clear. If both mum and dad are overweight, and have been since childhood (which is a fairly clear indication of a genetic predisposition), there is an 80 per cent chance that their children will have weight problems. Where either mum or dad has a problem, the chances drop to 40 per cent (i.e., 2 out of 5 kids might have a problem). Where both mum and dad are lean, there is only an 8 per cent chance that their kids will pick 4

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WHY IS YOUR FAMILY OVERWEIGHT?

up a weight problem—and it will probably be more a result of their lifestyle than genetics. This is why this booklet is aimed at the family unit. As well as providing social support for each other, it’s only by working together that the family can change the circumstances in which its fat intake is increased. You may not be able to change the macro-environment that exists in the country or the world, but you can change the micro-environments in your home, school and workplace, and this will go a long way towards reducing the family’s fat load. There are other reasons why and how the family should be involved in any weight loss program, and these include: • • • • • • • •

Being there to support each other Changing the home environment Saving money, which can go towards a reward for the whole family—perhaps a holiday Cutting down on medical bills Having more energy to do things together Providing competition for each other Keeping the family together Showing up the relos at Christmas gatherings.

So while the information in this Quick Start program has implications for each individual in the family, it should be taken in by the family as a whole for the best benefits. Keep this in mind as we go through the rest of the booklet.

5

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Professor Trim’s Prescription Pad • • • •

6

Don’t blame yourself for your weight. It’s probably not your fault (at least not all of it). Start to consider your environment as the most fattening thing around you. Get started on a weight-loss mission and involve the whole family. Get the family to help each other out with their weight control efforts.

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Chapter 2 WHY IS IT SO HARD TO LOSE WEIGHT? Our environment has a lot to do with how hard we find it to lose those extra kilos (or not gain them in the first place). But even if their environment is ideally suited to losing weight, some people do it easy, while others do it tough. Why is this? In general, men will lose weight much more easily than women. This is because female fat is designed to ensure the survival of the species by providing enough energy for a woman to survive any famine that might hit while she is pregnant. Don’t be surprised then if dad loses faster than mum, and sons lose faster than daughters in this whole family package. The differences between men and women when it comes to weight loss are summarised on page 8. Also, within men and women, some people lose weight more easily than others. There can be a range of reasons for this but again, in general, those with more upper body fat (or who are ‘apple-shaped’) will lose weight faster than those with more lower body fat (who are ‘pear-shaped’). Those who are genetically prone to get fat tend to carry more fat all over (more like the box that the apples and pears come in) and they find it harder than others who are not genetically prone to be fat. Even within the one family, genes can play a funny hand, affecting one member much more than others. Little 7

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A summary of sex differences in fat loss In losing body fat, women differ from men in that they generally have: • • • • • •

a higher proportion of body fat (15–35 per cent of body mass compared with 12–24 per cent in males) a greater proportion of their fat stored in the lower body, gluteal fat cells (fat stored in gluteal cells is harder to shift, even with food restriction) less lean muscle tissue, therefore a lower resting metabolic rate and lower overall need for energy greater compensation of energy intake following exercise a potentially greater appetite for high energy or ‘energy-dense’ foods which can lead to yo-yo dieting, or frequent ups and downs in body weight more labile fat stores on the breast and upper body than on the hips and lower body.

Bobby can be the spitting image of great-uncle Fred, or Jeannie have the hips of her grandmother Marge. That’s the luck of the draw. It doesn’t mean that nothing can be done to help, but it does mean that some family members will find it harder to keep their weight stable than others.

CAUSES—OR EXCUSES? Other factors can also make weight loss more difficult. Among the most common ‘excuses’ are a slow metabolism 8

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WHY IS IT SO HARD TO LOSE WEIGHT?

or a thyroid problem. Both of these can be measured if necessary, but thyroid problems, at least, are unlikely to be the cause, except in a very small number of people. Studies have shown that overweight people don’t have slower metabolisms—in fact, they tend to be faster because it takes more energy to move a heavier body mass. Gaining and losing weight in ‘cycles’ from early adolescence is one way to slow metabolism. For this reason any program of weight loss you undertake, such as this Quick Start program, has to be something you can do for life. If you expect to lose weight by putting the family on a ‘diet’ and then going off it when you’ve lost the weight, you’re sadly mistaken. You’re also looking at the wrong program, because you’ll be advised strongly against such an approach. In any case, even if a slow metabolism is your problem, there’s no need for you to do anything different from what we’ll be doing here. Almost everything designed to help you and the family lose weight will help speed up your metabolism and keep the weight off.

GET AWAY FROM BLAME There are other factors that make some people lose weight more easily than others, but we don’t need to go into these here. Suffice it to say that any particular member of the family must not be ‘blamed’ for not losing weight as quickly as others on this, or any other program (unless, of course, they’re obviously not playing the game). Everyone needs to run their own race—but with the family offering support as a unit. Another piece of good news is that even if you, or other family members, don’t lose weight despite following the 9

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recommendations in this program, your health will be improved dramatically. As you’ll see, you can actually prevent diseases like diabetes by being more active— regardless of whether or not you lose weight. A change in diet can also lower the risk of heart disease in the absence of weight loss, even more so with a 5–10 per cent loss in body weight. So look at the program to follow as a health program for life, not just a weight-loss program for a few months.

Professor Trim’s Prescription Pad • • •

10

Don’t expect everyone in the family to lose weight at the same rate. Forget the idea of ‘going on a diet’—it won’t work! Work for long-term improvements in your health—even if you don’t lose any weight.

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Chapter 3 WHY BOTHER ANYWAY? THE USUAL REASONS FOR WANTING TO LOSE WEIGHT If you’re a woman, you probably want to lose weight to look better or to fit into your favourite clothes again. If your children are overweight, you’re probably more concerned about them being picked on at school, or their long-term health being jeopardised. If you’re a man, the chances are you don’t really care about your weight, but if you’ve thought about it at all, it’s probably because carrying that extra protuberance above the belt makes you feel uncomfortable.

SOME REAL REASONS TO DO SOMETHING All of these reasons may be valid, but they’re not really important. A much more important reason is the effect excess body fat can have on you and your family’s health. Excess weight can contribute to many physical and mental conditions, which are shown in Figure 3.1. Excess body fat (note we’re talking fat, not weight) affects metabolic factors such as blood fats and blood sugars, leading to an increased risk of diseases such as diabetes, heart disease and stroke. Excess weight also causes mechanical problems such as sore knees, sore back, snoring and ‘asthma’. Together these effects are known as the ‘M and M’ syndrome—Metabolic and Mechanical problems. 11

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Table 3.1: Adverse effects of excess body weight on your health Level of risk

Metabolic disorders

Mechanical problems

Greatly

Sleep apnoea and snoring*

increased

Breathlessness* Asthma* Social isolation/depression* Fatigue/daytime sleepiness*

Moderately

Heart attack

increased

Stroke

Reflux (‘Heartburn’) Osteo-arthritis*

Gout

Respiratory disease* Psychological problems*

Slightly

Some cancers

increased

Reproductive problems Musculo-skeletal problems*

Varicose veins

Reduced fertility

Bad back*

Polycystic ovaries Skin complications Cataracts

Stress incontinence* Oedema/cellulitis

* Likely to negatively affect motivation

The mechanical problems with an * in Table 3.1 are those that are also likely to affect a third ‘M’ and that’s ‘Motivation’. If you suffer from breathlessness, ‘arthritis’, a bad back, or incontinence, you’re less likely to be motivated to want to do that thing that is most likely to help you reduce weight—physical activity. This can lead to a ‘vicious cycle’ in which your weight continues to increase and the physical problems get progressively worse. As part of this Quick Start program, you’ll learn how to break into that cycle. 12

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WHY BOTHER ANYWAY?

NOT IF, BUT WHERE It’s not necessarily if you’re fat, but where you’re fat that’s important. The fat that women store around the hips and buttocks is designed to help them survive pregnancy in times when food is scarce and is, therefore, not dangerous to their health. The fat that men, and post-menopausal women, store around their waists, however, is much more dangerous. Its more central location allows it to be released easily into the bloodstream, where it clogs up and raises blood sugar levels, leading ultimately to conditions such as diabetes and heart disease. Carrying too much fat around the middle is the first visible sign of a problem. Raised blood sugars, or increased blood fats (like cholesterol) are the first metabolic signs. If these continue untreated long enough, diabetes will be the first illness sign. Because there is a genetic factor involved in this, any incidence of diabetes anywhere in the family—even a distant relative—should be a warning to you to start being proactive about your weight.

ARE YOUR FAMILY OBMNIs? If improving your family’s health is the main reason for considering a family weight loss program, it’s worth knowing if losing weight is really necessary. Research since the 1950s at Harvard University has found that there is a small sub-group of overweight people who seem not to suffer any health problems as a result of being overweight. In fact, they are every bit as healthy as those who are not overweight. In a recent review published in the prestigious journal Metabolism, Professor Ernest Sims from Vermont University has called these 13

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people OBMNIs, or Obese but Metabolically Normal Individuals. Although they are well above the prescribed recommended level of body fatness, these people have normal blood pressure, blood sugars and blood fats. There is usually no family history of disease or early death and Dr Sims concludes that forcing these people into a weight-loss program could in fact be counterproductive, as it might cause psychological problems. If members of your family fit into this category, getting them to eat properly and exercise obviously won’t do them any harm but health maintenance, rather than weight loss, should be the issue. Discuss with your PT doctor whether it’s worth putting them under pressure to lose that extra kilo.

AND SOME MORE GOOD NEWS . . . Not only is the fat women store in their hips and buttocks not dangerous to their health, it may actually be a sign of good health. Research carried out in Sweden has shown that increased hip size is independently associated with reduced risk of heart disease. It’s the fat around the waist that is more dangerous. Despite what most fashion designers would have us believe, it appears that women are designed to have ample hips. And some more . . . type 2 diabetes, which is primarily caused by being too fat and/or too unfit, can almost always be prevented. Even if you can’t lose weight, becoming more active can help keep this disease (which is now one of the fastest growing diseases in the modern world) at bay, and can even help ‘cure’ it after it has developed. (For more about this see Professor Trim’s Quick Start program for people with diabetes). 14

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WHY BOTHER ANYWAY?

EXPECTATIONS—REALISTIC AND OTHERWISE Most overweight individuals probably expect to lose up to 35 per cent of their initial body weight on any kind of weight-loss program—including this one. Yet years of research shows us that this is an unrealistic expectation. Most people lose only 5–10 per cent of their initial weight but again, the good news is that this is enough. Medical researchers have shown conclusively that a 5– 10 per cent decrease in weight can lead to a big improvement in health and may prevent the onset of any of those restrictive diseases listed in Table 3.1.

Setting goals It’s always important to set goals in life. It’s also important to make sure that these goals are realistic. Also, sometimes a goal should be to change the process of what you are doing rather than just the outcome. For example, as well as setting a long-term goal to lose say 5–10 kilos, a short-term process goal of walking 3–4 km at least 3 days a week will help you achieve a short-term target. It will also help you on your way to your possible outcome goals. Table 3.2 lists some short-, medium- and long-term process and outcome goals. It also provides space for you to write in your own goals.

15

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Table 3.2: Setting goals

Process Goals

Short-term

Medium-term

Long-term

Walking 1–3 km a day

Eating no more than 40 g of fat a day

Being active every day as part of lifestyle

Losing 1 per cent of waist a week

Losing 1–2 kilos in a month

Reducing waist to 100 cm

Dad Mum Child 1 Child 2 Outcome Goals Mum Dad Child 1 Child 2

Professor Trim’s Prescription Pad • • • • • •

16

Beware of the cyclical problems of the ‘M and M’ syndrome. Aim to lose fat, not weight and go for the fat around the waist first. Be especially conscious of your weight if there is diabetes in the immediate family. If you are a woman, don’t worry about having big hips—they can be very healthy! Set realistic expectations for weight loss—5–10 per cent is a good start. Set process goals, as well as outcome goals and make these short-term, medium-term and long-term.

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Chapter 4 MEASURING YOUR FAMILY’S RISK TARGET FAT, NOT WEIGHT Because it’s fat, not weight that’s important, and because it’s fat around the middle rather than the hips that’s even more important, measuring the health risks of being overweight is relatively simple. Forget the scales. In fact after weighing yourself and each member of your family at the start of this program and writing the weights down in the measurement chart provided later on, hide the scales and don’t use them again unless told to later in this program. The measurements that we use instead are based on fat, and fat distribution. The most important measurement is your waist. There are some other measurements that are relevant for different members of the family and these should be entered in the measurement chart (Table 4.1) in this chapter.

MEASURING UP THE FAMILY

Dad Measure around the waist at the navel and write down the result, in centimetres, in Table 4.1. Your long-term goal is to get below 100 cm if you’re Caucasian and 90 cm if you’re Indian, Asian or Aboriginal. For Pacific Islanders, the aim should be to get below 110 cm. Get on 17

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the scales at the start of the program and write your weight down, then take your height and work out your Body Mass Index (BMI) using the formula BMI = weight in kg divided by height in cm (squared).

Mum Feel for your bottom rib and the top of your hip-bone on the dominant side of your body. Then measure around the waist at the mid-point between the lowest rib and the top of the hip. Your long-term goal is to get below 90 cm around the waist if you’re Causasian and 80 cm if you’re Indian, Asian or Aboriginal. If you are a Pacific Islander, 100 cm should be the goal for good health. Also measure around your bust, hips, mid-point of the thigh and hips at a spot that you think you will remember for future comparisons. Write down the results in Table 4.1. Write down your weight and then put the scales away. For good measure work out your BMI.

Sons Measure around the waist as for dad. Also make a note of your weight and write these measures in Table 4.1. Up to the age of 18, aim for a waist circumference of 90 cm. Measure your height and calculate your BMI. Compare the result with the range for normal BMIs on pages 3.

Daughters Measure as for mum, then calculate your BMI. Don’t weigh yourself again until advised to by the program, unless you are using BIA scales to check your body fat percentage (Body Impedance Analysis (BIA) scales can be found in sports stores, exercise stores and gyms, and are designed to measure the percentage of your weight that is body fat.). Now that you have all the family’s measurements, the next thing is to try to forget about them. Concentrating 18

Weight (kg)

Waist starting (cm) measurement

BMI

Dad Son (1) Son (2) etc. Hips (cm) Mum Daughter (1) Daughter (2) etc.

Thigh (cm)

Bust (cm)

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Table 4.1: Family measurement chart

19

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Table 4.2: Overweight and obese cut-offs for BMI from ages 5–18

Age (years) 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13 13.5 14 14.5 15 15.5 16 16.5 17 17.5 18 20

Overweight Males Females

Obese Males Females

17.4 17.5 17.6 17.7 17.9 18.2 18.4 18.8 19.1 19.5 19.8 20.2 20.6 20.9 21.2 21.6 21.9 22.3 22.6 23.0 23.3 23.6 23.9 24.2 24.5 24.7 25

19.3 19.5 19.8 20.2 20.6 21.1 21.6 22.2 22.8 23.4 24.0 24.6 25.1 25.6 26.0 26.4 26.8 27.2 27.6 28.0 28.3 28.6 28.9 29.1 29.4 29.7 30

17.1 17.2 17.3 17.5 17.8 18.0 18.3 18.7 19.1 19.5 19.9 20.3 20.7 21.2 21.7 22.1 22.6 23.0 23.3 23.7 23.9 24.2 24.4 24.5 24.7 24.8 25

19.2 19.3 19.7 20.1 20.5 21.0 21.6 22.2 22.8 23.5 24.1 24.8 25.4 26.1 26.7 27.2 27.8 28.2 28.6 28.9 29.1 29.3 29.4 29.6 29.7 29.8 30

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Professor Trim’s Prescription Pad • • •

Weigh yourself once at the start of this program, write your weight down, work out your BMI and then put away the scales. Take the relevant measurements for each member of the family and write them down in the family measurement chart. Don’t become obsessed with measurements.

too much on the outcome of a weight-loss program can have an adverse effect on its progress. Instead, at least in the early stages, try to concentrate on the processes you listed in Table 3.2. Although you can collect the family’s measurements as a guide to ongoing progress, I’d advise against it as it’s too easy for individual family members to start becoming obsessive about these measurements—especially young girls. Young girls have it pretty tough if they are overweight, so it is best not to focus on the numbers too much and just get on with the process of creating a healthy lifestyle for your family. Concentrating on the outcome, rather than the process, of losing weight can lead to all kinds of problems, because any deviation, no matter how slight, from the expected can cause disillusionment, a sense of failure and a desire to give up. Keep the starting measurements as a record, then move on to better things.

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Chapter 5 WHAT WORKS, WHAT MIGHT AND WHAT DOESN’T ACTION AND RE-ACTION There’s no shortage of weight-loss programs in the world, and just about all of them work—for a while at least! In fact, if they didn’t no one would ever try them. The reason they work—for a while—is because anything that changes your energy balance, that is the ratio between energy you take in from the food you eat and the energy you expend in activity and your metabolic rate, will lead to (short-term) weight loss (albeit at different rates in different people). Unfortunately though, the way this energy imbalance is created will determine how quick the loss is, and how long it stays off. Unlike calculations made on a piece of paper, the human body reacts to changes in food intake and energy expenditure—if it didn’t, we’d lose weight continuously until we faded away and died—and being dead is just not a healthy state to be in.

‘Reactive’ losses If you lose too much weight too quickly, the weight will come back as soon as you stop dieting—with interest. Women are more prone than men to this ‘cycle’ of regular weight gain and loss (known in the trade as the ‘rhythm 22

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method of girth control’). Unfortunately these women will probably wind up the fattest later in life. This is because the extra fat becomes even harder to shift since the body tries harder and harder to protect itself from those periods of starvation.

How weight loss happens Decreasing energy intake through food can happen in a number of ways: You can decrease the total calories you take in—but just counting these can become an obsession and has its own problems. Alternatively, you can decrease the ‘carbs’ or carbohydrates in your diet, one of the current popular approaches. This will guarantee a quick weight loss (from the water stored in each gram of carbohydrate or ‘sugar’ in the body), but because sugars from carbohydrates are our best source of real energy, this diet will make you pretty tired and lethargic after a month or two. You won’t feel like doing the exercise that will help you maintain your weight loss. You can decrease your total calorie intake by going on one of the crazy diets that are around—the grapefruit diet, the Israeli Army diet, the Fit for Life diet, etc.—but you can guarantee that you won’t be able to sustain a ‘diet’ like this for life. Going on a diet means coming off it at some stage—so it will probably make you fatter in the long-term. Without labouring the point, any of these ‘programs’ or ‘diets’ will work because you are decreasing your total energy intake. But they can’t be kept up for a lifetime, and that’s what has to happen if you’re going to lose and maintain weight loss in your family. True, this won’t happen without you making changes. But change has to be permanent and therefore has to be based on learning—what the best foods are, what the worst foods 23

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are. We’ll look at just what this learning involves in later chapters.

WHAT DOESN’T WORK We can say with some conviction that what won’t work for permanent weight loss is just about 100 per cent of the pills or potions you can buy over-the-counter at your chemist or health food shop. While many have seemingly cast-iron guarantees and promise you the body of your dreams, about the only thing they’ll lighten over the long term is your family budget. If they do work, and remember anything can work for a while, they work through the diet and exercise program that goes with them, which usually can’t be maintained for life. If you need more proof, check out the research.1

WHAT DOES WORK Carbohydrate and protein each have only 17 kJ of energy per gram. Alcohol has 30, but the body has no mechanism for converting alcohol to fat. Fats and oils, on the other hand, have 38 kJ per gram. So reducing the fat in your diet will be the quickest way to arrive at an energy imbalance. Because fat can also be ‘addictive’, a decrease in fat can also make it easier to maintain a low-energy eating plan for life. Over the past ten years research has shown that a combination of lower fat and high fibre in the diet, but without calorie counting or restrictive dieting, will lead to a steady but constant weight loss. It’s this combination that we’ll look at when we examine dietary changes in Chapter 7. 24

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WHERE CAN YOU GET HELP? Unfortunately, there are surprisingly few professionals well-versed in the modern research relating to weight loss. Dietitians should be expected to be expert in the area, but look for those with affiliations with groups like the Australian Society for the Study of Obesity (ASSO). By definition most dietitians will concentrate on diet and may tend to neglect the physical and psychological components of weight loss. Exercise and fitness specialists take the opposite approach, and still tend to adhere to the ‘. . . if it doesn’t hurt it doesn’t help’ philosophy. In Australia, psychologists who specialise in weight control are about as common as underpants with pockets. Health food stores are usually interested only in selling a product. So who’s left? Fortunately, Australian general practitioners have been making a determined effort to update themselves in this field. Over 4000 have completed at least part of the Certificate in Weight Control Management I developed for Sydney University. In conjunction with Professor Trim’s programs, they represent perhaps the best point of ongoing contact for you. New developments in the health care system mean that doctors can now work with other health professionals (such as dietitians and exercise specialists) to help you and your family devise an effective action plan for weight loss. You can check for a GP who is qualified in weight control in your area on the Professor Trim (PT) Website (www.professortrim.com). PT doctors now also have access to specialist ‘weight coaches’ who have been trained under the PT program. Your PT doctor can refer you to a coach for individual or group help, particularly with your exercise program and motivation. 25

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If your family has a chronic and severe weight problem, it might be best to check out the specialist Metabolic Units now operating in the big hospitals in most states. These have doctors, dietitians, psychologists and exercise people all there to help with this problem. A list is given on the PT Website (www.professortrim.com).

Professor Trim’s Prescription Pad • • • • • • •

1

Be careful about big, quick weight losses—the weight will come back even quicker. Avoid ‘fad’ diets. Resign yourself to the fact that some lifestyle changes are necessary for permanent weight loss. Make sure any changes make your life more enjoyable than it is now. Avoid ‘fantastic’, ‘magic’, ‘new’, ‘miracle’ pills or potions for weight loss. Check in with your special ‘Professsor Trim’ GP, weight coach or qualified health professional for ongoing help. If your family has a chronic weight problem approach the Metabolic Unit at a major hospital near you for help.

Egger, G., Stanton, R. and Cameron Smith, D. (1999), ‘The effectiveness of popular non-prescription weight-loss supplements, Medical Journal of Australia, 171, pp. 604–8.

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Chapter 6 CHANGING YOUR (MICRO) ENVIRONMENT As we’ve seen, it’s our modern environment that makes us fat. And while we can’t do much in the immediate term about the macro-environment of our city, country or the world around us, we can do something about our micro-environment—that around our home and, to some extent, our neighbourhood. There are four types of environments we need to look at: physical, policy, economic and socio-cultural. Within each of these, there are environments relating to food and those relating to physical activity. A quick glance at each of these will give you an idea of what can be done to make each more family ‘fat loss friendly’.

THE PHYSICAL ENVIRONMENT This can be represented by the question ‘what is available?’. It includes things like the available foods in the house, opportunities for exercise and the presence of effort-saving devices like remote controls, cordless phones, etc. Here are a few tips for making this less fat-friendly: • •

Keep the fatty foods in the house to a minimum (see Chapter 7). Keep treats like chocolate out of eyesight—if they are kept in the house at all. 27

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• • • • •

If you open a bar of chocolate, turn the bar around so that only the unopened end can be seen. Leave the remote control on the TV (or put it away in a drawer) and get up and change the channels manually. Don’t have a TV in the children’s bedrooms. Don’t shop while you are hungry (you’ll just buy more of the wrong types of food). Plant a home vegetable garden.

THE POLICY ENVIRONMENT This refers to the house rules and mainly applies to the rules for children. Examples might include the following: • •

• •

• • 28

Don’t allow ‘treats’ like sweets or chocolate on an empty stomach. This only encourages cravings for such foods. Make up a list of food rules, such as water instead of soft drinks or fruit juices, and stick to it! (In general, to avoid arguments and promote a healthy attitude to food, adults should decide ‘what type of food’ and ‘when’ and children should decide ‘if ’ and ‘how much’.) Don’t do active things for your kids. Make them do it themselves. Allow only a certain amount (e.g., a maximum of 2 hours a day) of passive entertainment (e.g., watching TV, playing video games or surfing the Net). Have stipulated non-TV/video games times of the day, week or month. Make pocket money contingent on completing a certain number of active chores.

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• • •

Get a dog, with rules that it must be walked a certain number of times a week (otherwise it will drive you crazy). Walk wherever you can: to school, the shops, or the park. Set rules about playing outside and in the neighbourhood that promote active play but keep children safe. Encourage participation in team sports—this doesn’t have to be as formal as joining a club; neighbourhood knock-abouts are far more fun!

THE ECONOMIC ENVIRONMENT This refers to the economic cost, or value, of certain fatness or fat loss-creating activities within the immediate or ‘micro’ environment. Some examples might be: • • • • • • • • •

Make pocket money contingent on eating e.g., 3 different fruits and 4 vegetables a day. Buy whole, rather than processed foods (they’re cheaper and less energy dense). Learn to cook wholesome, low-fat meals from scratch. Join a sports association. Give up privileges (e.g., TV) if certain goals are not met (e.g., eating a healthy meal). Save money by not using petrol (e.g., by parking the car, or not having a car). Work out the savings of eating less, and of eating more healthy food and then put this towards some family reward. Run a family weight-loss competition and put the money in a pool for the winner. Reduce the number of meals that you eat outside the home. 29

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THE SOCIO-CULTURAL ENVIRONMENT This refers to the attitudes, perceptions, beliefs and values (that are often based in wider cultural, religious, social and ethnic factors). Some cultural factors (often family myths) that can influence body weight are: • • • • • • • • •

The belief that fat is good. The idea that ‘puppy fat’ is harmless and will disappear when a child gets older. Gender stresses suffered in some families, which can lead to over-eating. The belief in some cultures that pregnant women shouldn’t be active. The old-fashioned belief that an expectant mother must ‘eat for two’ and put on as much weight as possible. The idea that the plate should always be emptied, no matter how big the serving. Encouraging children to eat everything on their plate and ‘think of the starving children in the third world’. Feasting at religious ceremonies and other cultural festivities. Seeing overweight parents as role models.

Professor Trim’s Prescription Pad • •

30

Start to see your environment, not just your diet or lack of gym membership, as fattening. Check the list of things you can do to change your fattening micro-environment.

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Chapter 7 THE FAMILY DIET ‘GOOD’ AND ‘BAD’ FOODS What your family eats will be closely connected with how you monitor the food environment in the household. If you have the wrong foods on hand, you’ll eat the wrong foods. If you shop when you’re hungry, you’ll more than likely bring back the wrong foods to the kitchen larder. So what are the ‘right’ and ‘wrong’ foods? A good place to start is to suggest that you stop thinking in terms of ‘right’ or ‘wrong’. If a food is thought of as ‘wrong’, it will become even more desirable—like the forbidden fruit. If it’s thought of as ‘right’, you might eat too much of it. In terms of weight control, foods should be thought of on a continuum; from those that, eaten often, will cause big weight gains, to those that, eaten prudently, can result in steady weight loss. But food isn’t all there is to nutrition. We don’t eat just because food is there or not there. We eat because we are hungry, or because we think we’re hungry. So in this chapter we’ll look at two important factors for family weight control—how to manage food and how to manage hunger.

MANAGING FOOD There are four things to do more of and three things to do less of, if you want to establish healthier eating 31

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patterns for your family. The four things to do more of are: • • • •

Eat more fibre. Eat more lean protein. Eat a greater variety of foods. Eat regularly.

The three things to do less of are: • • •

Eat less food that contains too much fat and sugar. Eat fewer foods that are energy dense. Eat less food in total.

Let’s consider these separately, taking the positive first.

Increase Fibre Fibre is usually found in the ‘stringy’ part of foods, like the bits of an orange that hold it together, or the husk on the outside of a grain food. There are different types of fibre, but for our purpose, we’ll consider them all together and make a blanket assumption that the most high-fibre, low energy-dense foods are edible plants, such as fruits and vegetables. However some manufactured foods such as bread, pasta and cereals have good fibre levels. By increasing your family’s fibre intake, you’ll decrease their fat intake and have a double impact on the family’s weight problem. A simple formula for this is to eat at least three different fruits and four different vegetables a day, and increase your intake of pasta, breads (without fatty or sugary sauces and spreads) and cereals.

Eat a greater propor tion of protein in the diet Protein is muscle food. Its main source is the muscle of other animals we eat, but other good low-fat sources are beans, legumes and some other vegetables. 32

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Because protein is turned into muscle in our bodies, and muscle is active, protein helps to increase our metabolic rate—provided we combine its intake with exercise (see Chapter 8). Protein generally does not turn to fat, because any excess is either lost as body heat or passed out through the urine or sweat. It’s important that you increase the proportion of protein in your diet, not necessarily the total amount. You shouldn’t be eating more food, as protein is still a significant source of food energy in small quantities. It’s also important to make sure that any increase in protein in the family diet comes from low-fat sources. Some examples of good, low-fat sources of protein are shown in Table 7.1. Table 7.1: Good low-fat sources of protein

Meat Kangaroo Crocodile Chicken breast (without skin) Lamb (trimmed of all visible fat) Lean pork Lean beef

Seafood Fish (most kinds) Prawns Lobster Crab Squid/octopus Oysters

Vegetables Legumes Lentils

Increase the variety in your diet This may raise a few eyebrows, given that it implies eating more food. But that’s not necessarily the case. The Japanese, for example, eat a wide variety of foods, but 33

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don’t necessarily eat more in total. They do this by incorporating small amounts of herbs, spices, vegetables and protein in foods like sushi. Eating as wide a variety of foods as possible will guarantee your family all the vitamins, minerals and nutrients they need—even if this food is low in energy. Try to get each member of the family to eat at least 40 different (good) foods a week. Remember though, this has to tie in with the other rules, which means low-fat, low energy-dense and less food. So you’ll be looking for a variety of fruits, vegetables and other unprocessed foods—even herbs and spices.

Eat regularly Again, this may sound a bit cockeyed, but eating often doesn’t mean eating more. In fact it can mean you eat less, because your hunger is better satisfied by small, regular intakes of food. Recent research also suggests that eating several small meals a day, instead of one or two large meals, will decrease cholesterol levels in the blood. The first thing this means is that no family member should go without breakfast. Then, if possible, try to eat at least every 4 hours—but make sure you eat something healthy, like fruit, veggies or low-fat snacks. Now let’s look at what you should be eating less of.

Fat There’s been a lot of controversy in the media recently about whether you should decrease your intake of fat or carbohydrate when you are trying to lose weight, but there should be no controversy because the answer is cut and dried: it’s the total energy you take in (calories or kilojoules) which is important, as we saw in Chapter 1. 34

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But because fats and oils contain 38 kilojoules per gram (remember oil is just a liquid form of fat) as opposed to the 17 kilojoules per gram in carbohydrate and protein, it’s much easier to take in more calories if those calories are in the form of fat. So the long and the short of it is, if you can reduce all fats in the diet (even those commonly regarded as ‘good’ fats, such as olive oil), you’ll go a long way to solving your family’s weight problem. Here’s some simple ways you can do this: • • • • •

Don’t use spreads like butter and margarine (or, if you must, spread them very thinly). Take the skin off chicken before cooking it. Don’t fry food in oils. Cut all visible fat off meat. Avoid full-fat dairy or soy products.

To take the low-fat issue further, you’ll need to understand a bit about fat. The PT program has a couple of simple rules you can work by: Avoid foods with more than 10 per cent fat. How do you know if a food is more than 10 per cent fat? Look for Professor Trim’s Ultimate Food Energy Guide at any bookstore (you get a copy with each full PT program, see p. 66). This handy, pocket-sized guide will tell you the number of grams of fat per 100 gm in a stack of different foods. If it’s more than 10 g/100 g (ie. 10 per cent) fat, avoid that food. In fact, ban it from the house. Reduce daily fat intake. Again, your Ultimate Food Energy Guide will tell you just how much fat you and your family are eating in your diet. Check the quantity of each food eaten and the number of grams of fat, then compare the totals to the recommended daily fat intakes for each member of the family in Table 7.2. 35

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Table 7.2: Recommended daily intakes (RDFIs) of fat for different family members

Dad Mum Son (very active) Son (not very active) Daughter

RDFI 40–60 g 30–50 g 70 g 40–50 g 30–40 g

Eat less high energy-dense foods ‘Energy density’ is a relatively new term which refers to the number of calories (kilojoules) per gram of food. The reason for this new term is that we’ve discovered that sometimes it’s not just fat which blows out the total calories, but high quantities of sugar and/or fat. We won’t go into this in much detail in this program as it’s considered in more detail in the main Professor Trim programs. It’s enough at this stage to say that energy density is calculated by dividing the number of kilojoules in a food by the number of grams of that food. Where this turns out to be more than 12.5 kJ per gram of food (1 calorie = 4.2 kJ, so 12.5 kJ/g = ~3 cals/g), it implies a high-energy dense food that should be avoided. Between 7.5 and 12.5 kJ/g is medium and below 7.5 kJ/g is low energy-density. These foods can be eaten in (almost) unlimited quantities.

Reduce the total energy (cals/kJs) you take in Whether we look at fat, carbohydrate or protein, at the end of the day it’s still the total amount of energy (calories or kilojoules) you take in that causes a weight 36

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problem. If you’ve truly cut back on fatty foods and high energy-dense foods it’s almost impossible to eat too much food—almost! Still, taking in too much food can still be a problem for some people. If you think this might be you, cut back on your total food intake and eat smaller portion sizes, just to make sure.

MANAGING HUNGER To talk about ‘managing’ hunger is really grabbing the snake at the wrong end. This is because genuine hunger is almost impossible to manage. We’ve been trying to do it with drugs for years and it hasn’t worked—at least not very effectively. So how could we do it by just talking about it? The answer is that we are not interested in managing genuine biological hunger. What we are interested in is managing learned appetite. You see, these days few of us eat when we are genuinely hungry. We eat when it’s time to eat, when we are with friends, when we have a cup of tea, when we feel sad or need to relax, or when some other learned stimulus tells us we should eat. The first way to deal with this is to learn to recognise genuine hunger rather than stimulus-driven hunger. Many of the stimuli in our modern environment, such as fast food take-aways, eye-catching packaging and food courts, are designed to make us eat at times in the day when we don’t really need to. If we start doing this in association with some other normal, daily activity, the chances are that you will feel hungry the next time you are in that situation. For example, driving into a take-away every time you go somewhere with the kids means that they’ll expect takeaways on every trip. If you always get the kids a treat at the supermarket to keep them quiet in the checkout queue, the supermarket will come to symbolise ‘treat’. 37

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This is called a ‘conditioned response’ and, like rats that learn to press a bar for food, the only way to stop this pattern of behaviour is to not deliver the food until the rat stops pressing the bar. It may be hard at first, but the rat pretty soon learns. Now I’m not suggesting your kids be equated with furry rodents, but thinking of them this way (as you may already do sometimes), could help reduce their weight problem—or prevent them having a weight problem in the future. So what we often consider to be hunger is what could be called ‘pseudo-hunger’, and someone with a ‘big appetite’ is possibly someone who has learned to eat too much. It’s important to differentiate between the pseudo-hunger and the real thing, so here are some other tips to help you: • • • • •

Deal with or avoid completely those situations where ‘pseudo-hunger’ is making your family fat. Recognise the difference between real hunger and learned appetite. Don’t eat treats (i.e., chocolate) when you are hungry—it conditions you to believe that only treats satisfy hunger. Fill up with high-fibre, low-fat foods. Don’t get hungry—eat small, eat often.

SUMMARY Nutrition is a complex science and not something we can go into in detail in only a few pages. But nutrition for weight management is not complicated when the surrounding environment is controlled. A hundred years ago, our ancestors had much less healthy diets than we have now, yet very few of them had a weight problem because they lived in a different environment. Your first 38

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task then, if you’re concerned about your family’s health, is to change your immediate environment. This will help you improve your family’s nutrition and manage their weight over the long-term. After that, successful weight management boils down to volume—the total number of calories that is eaten over the course of the day, the week or the year.

Professor Trim’s Prescription Pad • • • • • • • • • • • •

Don’t think of food as ‘good’ or ‘bad’—just ‘better’ and ‘best’. Eat at least three different fruits and four different vegetables a day. Increase the proportion (NOT total amount) of low-fat protein in the family diet. Increase the variety of foods the family eats to more than 40 different foods a week. Eat small, eat often. NEVER miss breakfast; don’t go for longer than about four hours without something to eat. Don’t use (or, if you must, use them very sparingly and spread thinly) butter and margarine. Take the skin off the chook or the turkey— before cooking. Don’t fry foods in oils. Cut all visible fat off meat. Avoid full-fat dairy or soy products. Avoid foods with more than 10 per cent fat and always check the labels for fat in the ingredients. 39

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• • •

40

Eat more low energy-dense and less high energy-dense foods. Eat smaller portion sizes. Recognise genuine hunger and teach yourself not to respond to ‘learned appetite’.

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Chapter 8 MOVING MORE—NOT EXERCISING! MOVEMENT AND WEIGHT LOSS This is the chapter that most people will want to avoid, because they think movement = exercise and exercise = pain. In addition, you’ll also have heard that exercise doesn’t really work for weight loss; that you have to jog for 32 km to lose half a kilo of fat; and that you’ll never get your family more active. Well here’s the good news. None of this is true. Rather than just accepting this statement at face value, let’s put the issue into perspective. For almost all of the millionodd years of human evolution, humans had never even heard of, let alone frequented, gyms or fitness centres. They had no Reeboks or Nikes and only ever jogged if they had to catch their lunch. Yet virtually everyone was lean. And if they weren’t lean, they were fit—at least fit enough to be extra-ordinarily active. And that’s the crux of the matter—to be active, you need a reasonable level of physical fitness. But to be fit, you have to get active. Technology and labour-saving machines have turned FITness into FATness. Unfortunately, this is nowhere more evident than in twenty-first-century schoolchildren and will probably explain your own children’s weight problems. Kids don’t walk to school anymore, whether because of safety concerns or their parents’ time constraints. Physical education is no longer compulsory in 41

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most schools and playgrounds are getting smaller and smaller. If children aren’t playing as much on the streets, or going out to the park alone or in groups, the most popular alternative indoor activities are sitting still watching TV, playing computer games or watching videos. So how hard is it to increase the family’s activity levels in order to reduce the aggregate body weight? Also, should we approach individual family members’ needs differently?

FAT LOSS, NOT FITNESS The answer to the first question is ‘not difficult at all’, but most popular weight-loss programs have totally misunderstood, or neglected, the issue of movement in weight loss. Blind Freddy could see that it’s lack of movement, not over-consumption or eating the wrong type of food that is the primary cause of the nation’s obesity epidemic. In fact, the issue of exercise for weight loss is so simple, it will probably surprise you. Basically, it boils down to movement. The more you move your body, the less chance it has of storing unused energy as fat. It doesn’t matter whether this movement is in the form of walking, crawling or bouncing along on your bottom—all human movement burns energy, and our excess energy is stored as fat. Even more importantly, regular physical activity will help prevent you regaining the weight you lose. What distinguishes people who successfully lose weight and keep it off, as compared to people who lose weight initially but regain, is daily physical activity, such as walking. Obviously, some forms of movement will be more effective than others, but in general we can say that it’s those forms of movement that are non-weight supportive, 42

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i.e. where you have to carry your own body weight, that use up the most energy. In fact, for the average 75 kg person, every 25 steps he or she takes will burn up roughly a calorie. It doesn’t matter whether these steps are in the form of a brisk walk, a jog, or just a walk around the house or office.

FAST OR SLOW . . . So the simple answer to what best burns fat is ‘movement’ and there is nothing better for burning off fat than plain old walking. True, jogging is a great form of exercise for cardiovascular fitness, and you can burn the same amount of energy in less time. But jogging can be painful and potentially dangerous for most overweight people and is therefore best avoided. It’s much better to slow down and make sure that fat, rather than sugar, is the fuel that you are burning off. Now if we go back to those times in history we’ve already talked about, when humans have not been overweight, the main reason for this is because they walked everywhere. They had to; to get food, to socialise, to gather fuel—just to exist. There were no cars or other machines to help them. We are never going to live in that kind of environment again. We have achieved everything we need for our continued survival, but now we have to re-create an artificial situation where walking (or some other form of activity) becomes part of the daily routine. A good starting point is to begin moving around more at home, at work and at leisure; by not using machines; and by thinking of physical activity as an opportunity, not an inconvenience. So instead of parking the car as close as you can to the entrance at your local shopping centre, park it at the other side of the car park and walk to the shops. 43

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Planning more movement As technology continues to progress it becomes even harder to do enough movement to compensate for the decreases in our activity levels caused by machines and modern living. In fact, one study carried out by one of my students, comparing the difference in movement between nineteenth-century Australians and those today, estimates that we are now moving the equivalent of a 16-kilometre walk less per day than we were 100 years ago. It’s almost impossible to make up this kind of distance just by moving around more during the day, although that is important to increase energy use. What you need to do is organise some form of ‘planned’ activity the whole family can enjoy. Here are some ideas for ways in which you can encourage the family to get active. You may only be able to act on some, but anything will be better than nothing: • • • •

Get the kids to play actively—chase, tag, hideand-seek—and play with them if possible. Use equipment like balls, frisbees, bats and bikes, etc., where those are going to get family members more active. Plan activity time ahead of time, because if it’s not planned, it’s not likely to happen. Buy a dog: that way you’ll be encouraged (by the dog if no-one else!) to get out for a daily walk.

How far do you need to walk? As part of the full PT program you’ll get a digital pedometer which measures the number of steps you take each day. You’ll also be given a table which will help you set your stepping rate so that you can achieve weight loss at different levels. For this introductory program 44

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however, it’s enough to say that any amount of walking will do you good. The optimal amount would add up to around 4 km per day. But don’t get discouraged—this doesn’t have to be completed all in one go. Accumulated activity is just as good for weight loss as continuous activity. So 4 lots of 1 kilometre—or even 40 lots of 100 metres—will have the same effect as going out for a 4 km walk.

What if you’re too big? For some people, their weight problem severely limits their range of movement. Let’s face it, it’s painful to get around when you’re big. It’s that vicious circle again, though, because as a result of not getting around, you then get bigger, and the problem gets worse. We need to find a starting point and that is in activities where the body weight is supported. Now I know I’ve said that nonweight supportive activity is best for weight loss, but to get the very big started, weight supportive activities such as cycling, rowing or walking in water—anything where the weight is taken off the legs—is likely to be less painful and therefore more likely to be completed successfully. As your program progresses and these forms of activity become less painful, you can then move more on to the non-weight supportive activities like walking. This can be very short distances to start (i.e., walking to the letter box and back), but these can be increased gradually as your fitness improves and your weight goes down. Ironically, as you find your chosen activity becoming easier your weight loss will ‘plateau’ or slow down. This is because your body has adjusted to the increased level of physical activity and has become more energy-efficient. For this reason it’s good to have variety in your physical activities. Walking should remain the basis of all your 45

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family weight loss activities, but other activities should be added—it helps if these are things that you enjoy. Check the activities in Table 8.1 to see which are the most effective for weight loss. Table 8.1: Rating physical activities for effective weight loss* Activity

Rating

Activity

Rating

Walking

10

Walking in water

9

Jogging

9

Weight training

7

Cycling

6

Rowing

6

Tennis/Golf

6

Aerobics

6

Swimming

5

Squash

4

Kids Stuff

10

Family Stuff

10

—swings/roundabouts

—picnics

—ball games

—becoming a tourist

—dancing

—museums/galleries

—chasing games

—bush walks

—Frisbee throwing

—beach walks

—Totem tennis

—sand castle building

—Shuttlecock —French cricket * Rating is based on safety, effectiveness, fun and enjoyment

Remember, you don’t have to choose only the best weight-loss activity because all movement is beneficial and, if you enjoy doing something, you’re more likely to keep it up than something you don’t enjoy. The family goal should be to carry out the National Physical Activity Guidelines as shown in the pyramid in Figure 8.1. At the bottom, it urges you to consider ‘movement as an opportunity not an inconvenience’. 46

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Next up the pyramid is ‘be active every day in as many ways as you can’. This means any form of activity including gardening, washing, even walking around the house. Once you are doing this, you’ll get extra benefits from the third guideline which says ‘put together at least 30 minutes of moderate intensity physical activity on most days’. This is where walking, and any of the other activities that you may have decided on in Table 8.1 can come to the fore. At the top of the pyramid, the guideline says ‘if you are able, also carry out some regular, vigorous physical activity’. This is more likely to apply to the males in the household and is not vital for weight loss. However, it can carry extra health benefits and help break through those plateaus where weight loss no longer seems to be happening. If you are going to exercise at a vigorous level, though, you should have a thorough medical check up before you start, as it could be dangerous for the unfit. Figure 8.1: National Physical Activity Guidelines

If you are able, also carry out some regular vigorous activity

3–4 days/week

Put together at least 30 mins of moderate intensity physical activity on most days Be active every day in as many ways as you can Think of movement as an opportunity not an inconvenience

Most days

Daily

Always

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NOT BEING INACTIVE CAN MEAN BEING MORE ACTIVE Research carried out in the US has shown that one of the best ways to get younger members of the family to lose weight is to reduce the amount of time they spend being inactive, that is, watching TV, playing on computers or playing video games, etc. This actually works better than trying to get them active by forcing them into some form of sport that they may not like. On this basis then, it’s vital that you restrict passive activity time, such as TV viewing. Better still, it should be earned. You can draw up a chart where kids get to watch units of TV or play units of video games (in the form of quarter- or half-hour lots) in compensation for completing units of NOT doing these things. The ratio of non-active to active hours should be at least 1:4; that is, if the kids want to watch a TV program that’s an hour long, they have to have completed at least four hours without doing anything else passive. The following statement taken from the National Clinical Obesity Guidelines might help to put physical activity for weight loss in perspective: ‘The main goal of physical activity for weight loss should be to restore the human energy once carried out as part of day-to-day living and now replaced by technology, and to change attitudes so that movement is seen as an opportunity for weight control and health advancement, rather than a troublesome inconvenience.’1 1

Egger, G., ‘Lifestyle management for obesity and weight control. Workshops for GPs’, CHPR, Australia, 2000.

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Professor Trim’s Prescription Pad • • • • • • • • • • • • • • • • •

Move more—as part of your daily lifestyle. Do non-weight supportive movement (e.g., walking) for the most effective fat loss. Walk as much as possible instead of driving. Stand, don’t sit. Consciously move your hands, feet arms and legs by deliberate ‘fidgeting’. Catch public transport instead of taking the car. Do things for yourself and don’t get others to do them for you (unless they need to lose weight too). Don’t use remote controls for the stereo or the TV. Get up and change the channels by hand. Set up a family competition to see who can be the most active. Regularly record your daily activity levels. Get rid of the four-wheel drive—or at least use it less and walk some of the tough terrain. Have dedicated ‘no TV’ periods for the whole family. Take active holidays. Allow extra time for appointments so you can walk rather than drive. Use the stairs wherever possible and not the elevators. Think of movement—any movement—as an opportunity, not an inconvenience. Introduce some ‘planned’ movement activity into the family’s day.

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Chapter 9 PROBLEMS FOR INDIVIDUAL MEMBERS OF THE FAMILY Although the general issues about weight loss we have looked at so far apply to all members of the family, there are some specific issues for different family members. For example, men and women gain and lose weight at different rates, with men generally finding it much easier than women to lose weight. The main issue for most men is a lack of knowledge—of nutrition, exercise and other health issues. More women, on the other hand, have the knowledge, but battle more psychological issues, including coping with the relentless media pressure to lose weight, that limit their success. Children are more likely to find it harder to gain weight, but sometimes face particular difficulties in losing excess kilos. In this chapter we look at specific factors which may need to be added to the general rules for each member of the family.

DAD Lack of knowledge about issues related to weight loss is generally the major stumbling block for men. In addition, many men aren’t prepared to admit that this is the problem. They think that because they were lean 50

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when they were young, because of training for football or other sports, all they have to do to lose the excess weight they are carrying now is some vigorous exercise. In fact this is not the case. Coming to terms with the key issues in this book will help the males of the household lose weight, and hopefully maintain that loss in the long term. Getting Dad even to admit he has a weight problem is a major hurdle. In general, men are less restricted by their body image than women. Men tend to be less concerned about a bit of lard hanging over the belt; in fact, some men might think of it as a positive sign of good health, whereas, in reality, even a little bit of extra weight stored around the waist is much more dangerous than female fat which is stored more typically around the hips and buttocks. The cut-off waist size of 100 cm we’ve used here for Caucasian men is the first indication that Dad does have a problem. If he’s gone up more than about 3 trouser sizes since he was 20, this would also indicate that he’s developing a weight problem. Where he’s no different from the other members of the family is in getting him to accept that he needs to do something about his weight. Alcohol can also be an issue for many men and, understandably, they don’t want to give it up completely. The good news is that they don’t have to and, in fact they shouldn’t, if they want to lose weight for life. The PT program, like its predecessor GutBusters, is notable for its innovative approach to alcohol intake and weight loss. Alcohol per se does not form fat. It’s only where the total energy intake, particularly the fat intake, is high that the fat piles on. Hence, it’s not a ‘beer gut’ that Dad sports, but a ‘beer + peanuts gut’, or a ‘beer + chips gut’. Get rid of the chips and peanuts and he’ll get rid of the gut. Just 51

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to make sure however, PT suggests that men trade off walking one kilometre for every standard measure of alcohol (beer, wine, nip of spirits) that is consumed in a day (up to a maximum of four glasses a day). Saving up the weekly allowance to have 24 drinks on Friday night is not acting in the spirit of the arrangement! Finally, while having said that men lose weight easier than women, it should be noted that this is not the case for all men. Those who have a genetic predisposition to store weight, or who have a more female or ‘pear-shaped’ physique will, like most women, find it more difficult to lose weight than those who are apple-shaped with just a little ‘patio above the playground’.

MUM Starting with generalities again, we can say that most women won’t lose as much weight or as quickly as their male partners. This is because female fat, which is generally stored around the hips, buttocks and breasts, is there to enable women to survive the nine months of pregnancy and thus allow the human species to carry on. After menopause, however, women begin to store more fat on the upper body, like men. This means that they then have to pay even more attention to their pre-menopausal stores of lower body fat. Hormone replacement therapy (HRT) is available for women (but not yet recommended for men), and this can help keep down the postmenopausal fat gain—despite recent controversies about it in other respects. Many women on HRT would disagree. However, there are now several well-conducted studies to show that most women put on weight after menopause (at an average rate of around 0.5 kg a year), but that those on HRT put on less than those on a placebo. 52

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Throughout their lives, women are typically under much more pressure than men to maintain an unrealistically lean body shape, and this can have genuine psychological consequences, particularly for those women who are genetically predisposed not to look like an anorexic European model. As a result, many women have lost and gained weight more than once, through trying a range of different crazy and unproven diet and weight-loss techniques. Consequently, they now find it even harder to lose weight because their bodies have gone on strike. The body is saying to the mind, ‘I’m never going to go through that severe weight loss again in case there’s a famine and I disappear’. So it decides to hang on to what it has even more grimly than it would otherwise. When taken together, these factors can cause what is known as a ‘vicious cycle of dieting’ as shown in Figure 9.1. Figure 9.1: The vicious cycle of dieting Decide to restrict food Think ‘I'm fat and ugly’

Restrict food intake

Deprivation

Eat for comfort

Anger ‘Why me?’

Feel guilty

Rebel against food rules

Feel out of control

Gorge

Binge Think ‘all or nothing’

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A woman may feel unhappy about her body image and decide to go on a diet. As a result, she feels deprived, then angry. In this state of mind she’s likely to binge, which will make her feel anxious and depressed. And of course one of the best treatments for depression is . . . you guessed it . . . food! The cycle continues. As a result of this complex psychology, many women are what is known as ‘overly-restrained eaters’, that is, they go for long periods on very restrictive diets or purposely trying not to eat. But this is totally counter-productive. As soon as they are faced by one of life’s inevitable problems, overly-restricted eaters reach for the nosebag and begin to gorge. The cycle of gorging and bingeing is one of the most dangerous there is for weight gain. Dealing with such a cycle often requires sophisticated counselling techniques. For our purposes here, it’s worth pointing out that a key factor is to reduce the guilt about eating. If, as a woman, you can stop yourself feeling guilty about everything you eat, you will break into that vicious cycle and actually eat less. It’s like the forbidden fruit: if you are allowed to have it you don’t desire it as much. Practise seeing food, not as anything special, but something you need to survive. Another critical period for women is pregnancy. For some women this is the time they gain weight which they then seem to have much more trouble losing. Many women think that they must have undergone some physiological change that causes them to keep that weight on. However most of the research done to date suggests this is not the case. The weight gains are due primarily to the changes in behaviour that occur with nursing babies and bringing up children—it’s harder to eat balanced meals, for example, when you’re concentrating on bringing up a baby. 54

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Some women (particularly those ‘restrained eaters’ referred to above) use pregnancy as an excuse to ‘eat for two’. They then put on large amounts of weight which they think will just drop off after they give birth. But the more weight that’s put on, the harder it is to get off. Really, a weight gain of around 9 kg during pregnancy is enough for most women, although most pregnancy guidelines advocate a weight gain of between 11 and 15 kg for women of average weight. A woman who is overweight before becoming pregnant should aim to gain no more than 10 kg, ideally around about 6–7 kg. There is an old wives’ tale that the quantity or quality of your breast-milk will be adversely affected if you return to physical activity too soon after giving birth, but modern research would seem to have disproved this. One of the most effective ways to lose the weight you gain during pregnancy is to establish a good level of physical activity during your pregnancy. This will create a residual level of fitness which will keep your body ‘prepped’ for exercise for a few weeks until you are ready to start exercising again. If you are finding it hard to lose those extra kilos you gained, don’t despair—you don’t have to be stuck with them for life. It’s your environment rather than your body which is the main stumbling block, and making some of the recommended lifestyle changes in this book will be bound to help. Finally, it’s worth repeating that women generally don’t lose weight as fast as men, and so a straight-out competition with Dad is not fair. Also, Dad will tend to lose more off the waist than off other parts of the body such as the breasts, arms and hips. While a competition in the family may help everyone, let’s make the competition (a) relative to different parts of the body and (b) between females and females and males and males. 55

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THE KIDS Weight problems in childhood should really be dealt with as soon, and as effectively, as possible, because the longer they persist, the greater the chance of overweight children becoming obese adults. But you must remember that your children are a genetic product of their parents. So if your family genes are towards a bigger body size, the children might also have a problem in losing weight but provided they follow the lifestyle and diet recommendations spelled out in this book, their health risks will diminish markedly and they could end up as OBMNIs (see Chapter 2). If this is the case, and they are always going to be big, you may need to do some work on body image, particularly for girls who can suffer mightily at the hands of cruel peers for something over which they have little control. In this case, the first challenge is to enable the child to recognise, accept and if possible, be proud of the fact that he or she will always be a different body shape. Health professionals who specialise in body image or some of the doctors on the PT Website might be able to help with this.

Kids and the twenty-first centur y Children today are faced with two major problems: first, they have access to all the tastiest but fattiest foods and take-aways of any generation throughout history. Second, modern technology provides them with a huge range of passive entertainment devices such as TVs, computer games and videos. Parents despair at trying to get kids to eat less fatty foods because it’s so easy to give in and give them what they want. If this is the case, some reverse psychology might be considered. 56

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Paying for good behaviour Draw up a plan whereby your kids are rewarded for eating a certain amount of good food. For example, their pocket money can depend on them eating three different bits of fruit and four different vegetables a day. Or, if they don’t eat these, their allocated time for watching TV or doing some other favourite ‘passive’ activity can be restricted. Fitting them up with low energy-dense foods means they have less room to fill up with high energydense foods. We’ve already seen that finding ways to cut down on periods of inactivity is likely to work better than forcing a child into a program of sport or exercise that he or she doesn’t like. That being said, it’s a good idea to find some organised activity that they enjoy, especially for adolescent girls, because this is a stage of their lives when their level of activity tends to drop off dramatically. Unfortunately, they then try to deal with the resultant increase in weight through overly restricted dieting which, as we have seen, only makes the problem worse. Finding the right type of activity may be problematic but persevere—it’s a question of trying everything until you find something that your child actually enjoys going to rather than staying at home.

Activity levels and ‘stranger danger’ Some parents are apprehensive about their children taking part in activity outside the home because of the perils they see in ‘stranger danger’ or traffic. And while the latter are real, the former are based on error. Although crimes against children seem to have escalated over the last 50 years, this is because more incidents are covered in the press and our steadily increasing population, rather 57

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than the crime rate per head. It’s also still true that up to 90 per cent of violent crimes against children are perpetrated by a close relative. It’s important to be aware of these facts when you are weighing up whether to allow your child to be outside and active or inside and inactive.

The family as role models Finally, placing too much importance on your child’s weight can create psychological problems that are counter-productive and potentially dangerous to the child. He or she may react by doing the opposite to what you suggest and, sub-consciously at least, deciding to become even fatter. It’s important therefore for the family to act as (good) role models for the child and for weight care and maintenance to become a family issue. Don’t let your child feel targeted as different or inferior because of their size. As repeatedly said here, it’s difficult to change the outside environment, but if the family environment is conducive to good weight management, it can at least partially compensate for the bigger environment. Most major hospitals in Australian cities now offer specialised Paediatric Obesity Units. Their specialists may or may not wish to see your child in your presence as they may feel that deeper issues may be causing his or her problems and they may make better progress on a one-to-one basis. This book should be seen as just the starting point for an effective weight-loss and management program—more intensive care is often recommended.

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Professor Trim’s Prescription Pad FOR DAD • • •

Get Dad to admit he just could have a weight problem—that protuberance over the belt isn’t just relaxed muscle. Let him have a beer or two with a clear conscience—but not the chips or peanuts that go with it! Get him to trade off alcohol with extra walking.

FOR MUM • • • • • •

Give Mum a bit more lee-way when it comes to losing weight. Beware of overly-restricted eating (dieting) and the tendency to binge when things go wrong. Practise at eating to live—not living to eat. Watch for pregnancy as a time of too much weight gain. Return to an active lifestyle as soon after pregnancy as possible. Don’t try to compete directly with Dad.

FOR THE KIDS • • • •

Use rewards to encourage good eating and active leisure pursuits. Reduce inactivity. Choose active pasttimes/leisure activities that kids like. Don’t over-emphasise weight loss in your children—particularly adolescent girls.

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• • • • • •

60

Get kids to eat in the one place only (not in front of TV). Get kids to keep a food diary. Drink water or (low-fat) milk instead of sugarladen soft drinks. Take lunch to school instead of using the tuckshop. Give presents at Christmas and birthdays that promote activity. Contact the Pediatric Obesity Unit in your nearest major hospital for more help.

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Chapter 10 OTHER OPTIONS It’s an unfortunate fact of life that, other than a permanent change in lifestyle, there aren’t very many options for successful, long-term weight loss. In terms of available teatment, there are three levels, as shown in Figure 10.1. Figure 10.1: Different levels of treatment for weight loss

Medicine/Surgery VLEDs + Cognitive and Behavioural change + Education and Information

Source: G. Egger and A.A. Binns, ‘A model approach to obesity’, Medicine Today, 2001, Oct. pp. 39–46

EDUCATION AND INFORMATION The bottom level requires just information, which is what these ‘Quick Start’ booklets are meant to provide. 61

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Armed with the knowledge of the right food to eat and the right physical activity to take part in, many people find it relatively easy to lose weight and, more importantly, keep that weight off. The majority of these successes, however, are those whose excess weight is mainly influenced by their environment, rather than their genes.

COGNITIVE AND BEHAVIOURAL CHANGE The second level requires more psychological input, especially for women, who have the knowledge about what to do and what not do, but have difficulty putting this into practice because of physical and psychological factors. Stress management can be a component of this type of treatment, but other more intensive psychological interventions are sometimes necessary to deal with issues such as early experiences, physical and sexual abuse and family inter-dynamics. If you think this kind of approach would be helpful for you, seek out a good psychologist with weight control experience. Your family doctor should be able to help with counselling, referrals and advice.

MEDICINE, SURGERY AND VERY LOW ENERGY DIETS (VLEDS) The third level discussed above is more for the genetically and morbidly obese, that is, the very big: those who have had difficulty shifting weight in the past, who may have tried everything, and who have other, lifethreatening problems such as heart disease associated with their obesity. At this level, there are three possible treatments. 62

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Prescription drugs Drugs for weight control come and go, with few being successful over the long-term, and even fewer being purely safe over the long-term. Currently, there is one prescription drug, Xenical, which appears to be safe and can help in reducing fat intake in the diet. Like all medications, however, it is only successful while it is being taken and even then, only in conjunction with a lifestyle change. Xenical can be most effectively used as a behaviour modification drug to teach the patient that he or she shouldn’t be eating certain fatty foods. Reductil is an appetite suppressant also currently available, which some patients have found effective over the long term. Like Xenical, however, Reductil needs to be taken continuously to get results.

Ver y Low Energy Diets (VLEDs) These usually involve taking only nutritionally balanced drinks such as milk shakes for a set period and then gradually reintroducing foods after a lot of weight has been lost. As with all diets, there is the potential for more weight to be gained when the patient comes off the VLED, so they should only be used under strict supervision. You can talk to your PT doctor about this. VLEDs are often particularly useful as a short-term strategy to help break through a plateau (where an individual is stuck at a certain weight and unable to reduce this further). Where VLEDs are used for this purpose, however, a strictly supervised regime of re-feeding has to be in place, which can only be supervised by an experienced professional. Some VLEDs such as Optifast can be purchased at a pharmacy. 63

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Surger y For the morbidly obese for whom nothing has worked, and whose health is at risk, some forms of newly developed surgery are the most effective option. Laparoscopic banding for example, is a simple operation which involves placing a band around the top of the stomach, which can be tightened or loosened to allow less or more food into the stomach. In a sense, it is a modern form of ‘jaw wiring’. It can have a high rate of success, but only if the patient is motivated to make lifestyle changes in his or her life. Your PT doctor will have access to surgeons who are specialist in this area.

Other approaches New techniques for safe and effective weight loss are constantly being sought. As you might imagine, there is a pot of gold at the end of the rainbow waiting for anyone who comes up with a pain-free approach that works. Unfortunately none of the simple, effortless promises that have been made over the years have been found to have any long-term success—at least without potential dangers. Real weight loss always comes down to doing the hard yards—changing your lifestyle. But as we’ve seen throughout this little book, this doesn’t have to be too difficult. Our modern environment, with its increased access to high energy-dense takeaway food, inactive, techno-based leisure pursuits but less leisure time, and increased pressures and strains on individuals and families has made it necessary for humans to change this lifestyle in order to maintain their weight and good health. I sincerely hope this little book has been a useful starting point for you and your family to make this change. 64

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OTHER OPTIONS

Professor Trim’s Prescription Pad • • • • •

Look to other options for weight loss if the standard methods are not working. Consider whether underlying psychological issues could be important and require treatment. Talk to your doctor about a very low energy diet (VLED) to help break through a plateau. If a healthier diet is still not having the desired effect, discuss a medication like Xenical or Reductil with your doctor. Where your long-term obesity is causing other health risks, talk to your doctor about the possibility of surgery.

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APPENDIX: PURCHASING PROFESSOR TRIM’S MEDICALLY SUPERVISED WEIGHT-LOSS PROGRAMS Professor Trim’s is a series of medically supervised weightloss programs with (a) minimal supervision (‘Quick Start’) programs for: • • •

families, new mothers and mothers-to-be, and people with diabetes or high blood sugars

(b) medium supervision programs over 3–12 months for: • •

men (‘Becoming Gut Less’), women (‘Becoming Slimmer’)

and (c) intensive supervision programs for: •

the long-term and very overweight.

All programs can be carried out at home alone, or on a shared-care basis with your local GP, and (if required) a fully-qualified personal weight coach (PWC).

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Professor Trim’s Programs Of fer • • • • • •

A balanced, medically supervised approach to weight loss. No diets, tricks, fads or gimmicks—just up-tothe moment scientific sense. Individualised care. A concentration on long-term maintenance, not just short-term losses. 12 months’ care and supervision from the PT team and your GP. Toll-free advice as needed.

For more information or to purchase a Professor Trim’s medium or intensive supervision program, visit the Website at www.professortrim.com or ring toll free on 1300 768 300.

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