15BPDO01 – GENERIC ELECTIVE COURSE

Exercise and Weight Management for Teens

UNIT – I

Exercise

Activity requiring physical effort, carried out to sustain or improve health and fitness.

Definition

Exercise is physical activity that is planned, structured, and repetitive for the purpose of conditioning any part of the body. Exercise is used to improve health, maintain fitness and is important as a means of physical rehabilitation.

Exercise is about more than keeping in shape. It also can help with your emotional and mental health. Exercise can help you improve your self-esteem, keep your mind off problems, and give you a sense of control. In general, people who are fit have less anxiety, depression, and stress than people who are not active.

Research suggests that exercise can help specific mental health problems. Exercise may help prevent depression from coming back (relapse) and improve symptoms of mild depression.

Purpose

Exercise is useful in preventing or treating coronary heart disease, osteoporosis, weakness, diabetes, obesity, and depression. Range of motion is one aspect of exercise important for increasing or maintaining joint function. Strengthening exercises provide appropriate resistance to the muscles to increase endurance and strength. Cardiac rehabilitation exercises are developed and individualized to improve the cardiovascular system for prevention and rehabilitation of cardiac disorders and diseases. A well-balanced exercise program can improve general health, build endurance, and slow many of the effects of aging. The benefits of exercise not only improve physical health, but also enhance emotional well-being.

TYPES OF EXERCISE

· Strengthening exercise

· Isometric exercise

· Isotonic exercise

· Isokinetic exercise

INTRODUCTION TO BODY WEIGHT
The term human body weight is used colloquially and in the biological and medical sciences to refer to a person's mass or weight. Body weight is measured in kilograms, a measure of mass, throughout the world, although in some countries such as the United States it is measured in pounds, or as in the United Kingdom, stones and pounds. Most hospitals, even in the United States, now use kilograms for calculations, but use kilograms and pounds together for other purposes.
Strictly speaking, body weight is the measurement of weight without items located on the person. Practically though, body weight may be measured with clothes on, but without shoes or heavy accessories such as mobile phones and wallets and using manual or digital weighing scales. Excess or reduced body weight is regarded as an indicator of determining a person's health, with body volume measurement providing an extra dimension by calculating the distribution of body weight.

ROLES AND RESPONSIBILITIES OF BODY WEIGHT

Body weight is determined by energy intake on one hand and energy expenditure on the other. Imbalance between energy intake and expenditure results in a change in body weight. Organisms expend energy to perform daily work required for survival, such as finding food or evading predators. Metabolic efficiency refers to the amount of energy an organism has to exert to perform a given amount of work.
Metabolic efficiency varies among different species of organisms and among different individuals within a species. An individual with high metabolic efficiency will expend less energy to perform a specific task, such as climbing a set of stairs, than an individual with low metabolic efficiency. Compared with an individual with low metabolic efficiency, an individual with high metabolic efficiency is better able to preserve body weight during negative daily energy balance (expenditure exceeding intake), but likely to gain more weight during positive energy balance (intake exceeding expenditure). The ability of an organism to minimize reduction in body weight during long periods of starvation is likely associated with its survival. As a result, millions of years of evolution may have favored organisms with high metabolic efficiency.^12–15
Organisms are very adept at acquiring and storing energy. Most of vertebrates' energy reserve exists in the form of fat. One pound of fat contains more energy than one pound of dynamite. Complicating matters is the fact that we gravitate toward our food sources. It would be much easier to achieve and maintain weight loss if we treated our daily sustenance with the same disgust as we do cough syrup. In fact, it's just the opposite; foods with high energy density, such as sugar and fat, tend to be more palatable.¹⁶ Perhaps the human association of eating with pleasure may have an evolutionary origin similar to our aversion to the bitter taste of toxic plant compounds.¹⁷

FACTORS THAT IMPACT BODY WEIGHT
Physically demanding work – Having a physically demanding job often resulted in illnesses and/or injuries, influencing workers’ ability to participate in physical activity outside of the job. Physical fatigue from work also played a role in the quantity of food consumed at the end of the workday.
Psychosocial stressors – Experiences of high demands in the workplace led some workers to feel stressed and consume more high-calorie foods, such as candy and soda. Workers also reported feelings of exhaustion, having multiple jobs and responsibilities, and scheduling as elements of a heavy workload.
One study respondent commented, “The work that three people used to do is given to one person. That creates more stress and eating more.”
Time pressure – Many workers reported having only 15 minutes to eat during their working hours, making it difficult to prepare and eat healthy food in a short period of time. Female workers often discussed the interaction between work and family, specifically how the combination of responsibilities at work and at home reduced available time to engage in physical activity and eat healthy. For these workers, reliance on convenience foods was a particularly important time-saving strategy.
“At 10 a.m., they give me a 15-minute break. I don’t have time to eat healthy food, even if I bring homemade food,” said one worker, adding, “I don’t have time to do exercise.”
Food environment at work – Workers reported having limited access to healthy food, due to their limited mealtime and the location of their workplace. According to workers, many of their workplaces fail to provide them with the appropriate equipment and space to eat meals, which influences their diet.

Today everyone wants to be lean and mean. We all want to, not only feel good, but look good too. Everyday we work our butts off to get there and everyday we think we are one step closer. But soon a week, a month, even a year goes by and nothing has changed. What could I possible be doing wrong, you ask?

Truth be known, you aren't doing anything wrong. You are doing exactly what you have been told time and time again. Unfortunately the information you have been given is based on research and studies that have nothing to do with what you want to accomplish.
"You have to work in the fat burning zone if you want to loose weight." We've all heard that before, right? But have you ever stopped to ask what exactly that means? Lets take a brief look at what this really means.
Fat burning is the process where free fatty acids are used for fuel as opposed to glucose (human blood sugar). During times of very low intensity (less than 50% VO2 max) the preferred fuel is fat. About 75-80% of the energy used is supplied by fat.

We All Want To Feel & Look Good.

This does not mean that it is the only source. It just means that there is a larger contribution of energy from fat than glucose. There is never a time when there is a shift from one source to the other. The two are always contributing to the energy production pathways. One may be favored or dominant, but never exclusive.

Fat Burning Will Equate To Fat Loss

The fact of the matter is, "fat burning" has nothing to do with fat loss 1,2,3. Fat is the preferred fuel for low intensity activity. So while you watch T.V, sit behind a desk or while you sleep! We are "burning" fat all of the time, 24 hours a day, 7 days a week.
For there to effectively be a loss of whole body fat, a negative energy balance must be maintained for a prolonged period of time. Meaning, weeks, months and years. Not minutes or hours. This is most important point to understand and it is the one that virtually every fitness buff and expert seems to neglect.
The vast majority of us will work out for about an hour and remain sedentary for the rest of the day. That's 23 hours of little to no activity. Our workouts contribute less than 10% of our total caloric output. This is where all that research comes into play.
Lower intensity exercise for long durations may burn a bit of calories, but it does nothing to your resting metabolic rate 5,6,9. In other words, it doesn't increase the amount of energy you expend during those other 23 hours of the day. This is the critical component of fat loss that we all seem to forget about.

Do The Math

Working at a heart rate of about 120 beats per min will "burn" 8 calories per min. Because of the low intensity, 80% or 6.5 calories will be coming from fat. Working at 160 beats per minute will "burn" 18 calories a min.
Even if fat oxidation drops to 50% of the energy supplied, this is still 9 calories from fat every minute. So we can clearly see that if there was any validity to this "Fat burning zone" it really isn't burning all that much fat to begin with.
We can clearly see that working at a higher intensity would in fact "burn up" more fat, even if the relative contribution of fat energy is lower than at a lower intensity of exercise.
Lets make this clear, just because you burn more fat during the actual exercise, does NOT mean you will actually lose more body fat 5. Isn't about time you asked why you haven't lost the weight you want by now?

What Is EPOC?

Excess Post-exercise Oxygen Consumption. How much oxygen you consume during the other 23 hours of the day. Why is that important? Well, the amount of oxygen consumed is a very accurate way to determine how many calories your are burning. Lower intensity exercise does not create this effect 6, 9.


	EPOC Excess post-exercise oxygen consumption (EPOC) is a measurably increased rate of oxygen intake following strenuous activity. The extra oxygen is used in the processes that restore the body to a resting state and adapt it to the exercise just performed.

On the other hand both High intensity cardiovascular and weight training do. When intensities reach levels of approx 85% VO2 Max, the EPOC can last for up to 2-3 days 11, 12. You metabolism will literally be a Colorado forest fire! You can work out for shorter durations (15min) and get better results 7,8,9.
How do you know when you've reached the right level of intensity? Well to make it simple, if you can talk to someone while your are doing it, then you aren't even close! It is uncomfortable, yes. Start slow and work your way up to it. There is no point to just spinning your wheels any longer.

And no, doing 3 sets of 12-15 will not enhance fat burning or create a more defined body. This type of weight training actually conditions muscular enzymes to become more efficient at handling lactic acid. Lactic acid is basically a glucose molecule split in two, and being an acid, it burns. It is not, however, an indication that you are burning more fat.

Diet

As mentioned before, total fat loss comes down to burning off more calories than you take in. This is where the trainer can only educate and the trainee has to take over. Monitoring your food intake is very important to your overall fat loss goals. And if you have a high level of body fat, you will have to be more cautious on your food selections.
It is well documented that people with a greater amount of body fat, have a greater ability to store dietary fat. That's right, the human body loves its energy stores and its gets greedy!
You have to make a conscious effort to know how many calories you eat EVERY DAY. If you are working your butt off and you can't loose any fat, then you are most likely eating too much. However, do not confuse weight and fat.
It is very possible to loose body fat with out seeing the scale drop. So keep that in mind. In the next article, I will show you just what food selections are good, which are bad, and I'll even tell you why!

Understanding weight loss
Calories are found in most foods. When you consume calories your body uses them as fuel. The leftover calories that your body doesn't use are stored as fat.
One pound of fat is roughly 3,500 calories.
Your BMR, also known as your Basal Metabolic Rate, is the number of calories your body burns in a single day from performing basic functions like breathing and pumping blood. Think of it as the calories you would burn if you sat on the couch all day. This is the number of calories your body needs to function.
When you create a deficit your body will turn to the in your fat stores to function properly -- burning those unwanted pounds away.
In order to lose one pound of fat, you need to create a caloric deficit of 3,500 calories. This means you need a deficit of around 500 calories per day in order to lose one pound per week.

How to Create a Calorie Deficit

Change your diet and eat fewer calories than you burn each day. If you eat 500 fewer calories than your BMR each day for a week, you'll lose about one pound of fat.

Introducing physical activity and burning more calories than you consume. If you eat enough calories to support your BMR, but exercise more, you'll create a caloric deficit simply by burning extra calories.

A combination of eating fewer calories and exercising to burn more calories. If you cut just 200 calories a day from your diet and burned just 300 extra calories a day by exercising, you'd lose about one pound per week.

A combination of diet and exercise is the easiest way to lose weight because it requires only small tweaks to your lifestyle.

Example

Eliminate Calories

1 Can of Soda = 140 Calories
1 TBSP of Butter = 102 Calories

Add Physical Activity

20 Minutes of Circuit Training = 113 Calories
30 Minutes of Walking = 179 Calories

___________________________
Total Deficit: 525 Calories

Calculate your BMR

Keep in mind that this formula isn't fool proof—there are a lot of complicated factors that determine your BMR and how you lose weight. Understanding how calorie deficit works is just the first step to finding and sticking to a weight loss program that works for you.

Burn calories in a fitness class.

Dena Stern is a certified personal trainer and the Content & Community Manager for Exercise.com. She works with a highly trained group of nutritionists, trainers, yoga and Pilates instructors and athletes to provide the best information, tools and motivation related to exercise and fitness.

Methods for Assessing Body Composition

Numerous techniques have been used to estimate body composition. None of the methods currently used actually measure %BF; the only way to truly measure the volume of fat in the body would be to dissect and chemically analyze tissues in the body. The techniques routinely used to estimate %BF are based on the relationship between %BF and other factors that can be accurately measured, such as skinfold thicknesses or underwater weight. Because of the predictable relationship between the measured value and body composition, %BF can be estimated through these indirect methods.

Each of the techniques described in the following sections has advantages and disadvantages. Knowing these characteristics will help you decide wisely when choosing the method for body composition assessment. A comparison of important considerations can be found in table 8.2. For fitness professionals, ease of measurement, relative accuracy, and cost are the primary considerations when choosing a technique. In other situations (for research or clinical applications), the accuracy of the measurement may outweigh other considerations.

Anthropometric Methods: Body Mass Index

A widely used clinical assessment of the appropriateness of a person’s weight is the body mass index (BMI), or Quetelet index. This value is calculated by dividing the weight in kilograms by height in meters squared.

BMI is a quick and easy method for determining if body weight is appropriate for body height. Table 8.3 lists the adult BMI categories. In the past, height–weight charts were used for this purpose, but BMI is currently the accepted method for interpreting the height–weight relationship. BMI does not differentiate between fat and fat-free weight, which is problematic when testing athletic individuals with a large lean mass. For example, a football linebacker who is 6 ft 2 in. (1.9 m) and weighs 220 lb (100 kg) is considered overweight according to BMI standards (BMI = 28.3 kg · m−2), when in fact he may have a very low %BF. On the other hand, an inactive person with a similar height and weight is probably carrying excess adipose tissue.

Even with its limitations, for most adults there is a clear correlation between elevated BMI and negative health consequences (26). The recommended BMI range is 18.5 to 24.9 kg · m−2. Overweight is classified as a BMI of 25 to 29.9 kg · m−2, and a BMI of 30 kg · m−2 or higher is considered obese (1, 26). In screening situations where estimating body fat is impossible or impractical, BMI can be useful for providing feedback to people about the appropriateness of their body weight. It is important to note that BMI standards for children are age and sex specific (28, 29). Children at the 95th percentile or greater for their age and sex are considered obese. Consult the CDC growth charts for BMI standards for children (29).

Girth Measurements

Several girth measurements (body and limb circumferences) are used to either estimate body composition or describe body proportions. Girth measurements provide quick and reliable information. They are sometimes used in equations to predict body composition and may also be used to track changes in body shape and size during weight loss. The major disadvantage is that they provide little information about the fat and fat-free components of the body. For example, a bodybuilder’s thigh can have a larger circumference yet less fat than that of an individual who is obese. A list of several commonly measured girths follows; refer to the Anthropometric Standardization Reference Manual (22) for additional circumference sites.

Waist—narrowest part of the torso between the xiphoid process and the umbilicus
Abdomen—circumference of the torso at the level of the umbilicus
Hips—maximal circumference of the buttocks above the gluteal fold
Thigh—largest circumference of the right thigh below the gluteal fold

WHR is a frequently used clinical application of girth measurements. This value is often used to reflect the degree of abdominal, or android-type, obesity. A WHR greater than 0.95 for young men or 0.86 for young women is associated with elevated health risks, while for men and women 60 to 69 yr old, a WHR of >1.03 and >0.9, respectively, is linked with disease risk (30).

Waist circumference (WC) alone can also provide valuable information about disease risk (13, 17, 26). A WC of greater than 102 cm (40 in.) in men or 88 cm (35 in.) in women significantly increases the risk of obesity-related disease (1). ACSM now uses BMI and WC as the techniques for classifying obesity for risk stratification (1).

When assessing girths, use the following procedures to standardize the measurements:

Make sure the measuring tape is horizontal when measuring trunk circumference and is perpendicular to the long axis of the limb when measuring limbs. Use either a mirror or an assistant to help ensure that the tape is placed properly.
Apply constant pressure to the tape without pinching the skin. Use a tape measure fitted with a handle that indicates the amount of tension exerted.
When measuring limbs, measure on the right side of the body. Alternatively, measure on both sides and record the values for both right and left.
Ensure that the person stands erect, relaxed, and with feet together.
When measuring girths of the trunk, take the measurement after the person exhales and before the next breath begins.

Skinfold Measurements

Measuring skinfold thickness is one of the most frequently performed tests to estimate %BF. This quick, noninvasive, inexpensive method can provide a fairly accurate assessment of %BF. The value obtained by skinfold measurement is typically within 3.5% of the value measured with underwater weighing (30). Skinfold measurement is based on the assumption that, as a person gains adipose tissue, the increase in skinfold thickness is proportional to the additional fat weight.

Because of the widespread use of skinfold measurement, fitness professionals should master the skills involved. Accurately assessing skinfold thickness requires the correct performance of several steps: locating the skinfold site, pinching the skinfold away from the underlying tissue, measuring with the caliper, and choosing the proper equation. The following sections address each of these concerns.

Locating the Skinfold Site

It is critical to accurately determine the site of the skinfold measurement. To increase the accuracy of the measurement, especially for the inexperienced technician, the site should be located and then marked with a washable marker. This helps ensure that the calipers are placed in the correct position each time the skinfold is measured. All skinfold measurements should be taken on the right side of the body unless otherwise specified. Refer to table 8.4 and figure 8.1 for some of the most commonly used measurement sites. For a more complete description of determining skinfold sites, refer to the Anthropometric Standardization Reference Manual (22). Measuring skinfolds immediately after exercise should be avoided because exercise can shift fluid volume, leading to inaccurate results.

Pinching the Skinfold

Once the correct location for the skinfold measurement is determined, the tester gently but firmly pinches and lifts the skinfold away from the underlying muscle in order to measure it. The following are guidelines for measuring skinfolds correctly:

1. Place the fingers perpendicular to the skinfold approximately 1 cm from the site to be measured.

2. Gently yet firmly pinch the skinfold between the thumb and the first two fingers and lift away from the underlying tissues. Place the jaws of the caliper perpendicular to the skinfold at the measurement site. The jaws of the caliper should be halfway between the bottom and top of the fold. Maintain the pinch while taking the measurement.

3. Read the measurement on the caliper 1 to 2 sec after the jaws contact the skin.

4. Wait at least 15 sec before taking a subsequent measurement. To allow time for the fold to return to normal, take one measurement at each site and then repeat measurements. If the second measurement varies by more than 1 to 2 mm, repeat the measurement a third time.

Measuring the skinfolds of individuals who are obese can be difficult, if not impossible. If the jaws of the caliper will not open wide enough to measure the skinfold, use an alternative method for assessing body composition. Girth measurements for predicting %BF (33, 34) along with BMI, WC, and WHR may be used instead.

Measuring With the Caliper

Skinfold thickness is measured with a skinfold caliper. The numerous commercially available calipers vary in price and accuracy. Lange and Harpenden calipers are the ones most often used in research settings because of their precision and reliability; however, other calipers may also be used effectively (2). Obviously, if the calipers do not measure skinfolds accurately, they will compromise the estimate of body fat. Measure with calipers that closely match those used in the development of the equation you are using.

Choosing the Proper Equation

Most skinfold equations were developed using underwater weighing as the criterion method and actually are designed to estimate body density. To develop skinfold equations, the body density of many people was measured (typically using hydrostatic weighing), and these values were compared with skinfold thickness through a statistical method called regression analysis. This statistical technique results in the development of an equation that reflects the relationship between skinfolds and body density. Inserting a client’s skinfold measurements (and sometimes other information such as age) into these equations produces an estimate of the client’s body density. Body density then is converted to %BF by using a two-compartment model equation such as the Siri equation, described later in this chapter.

Both generalized and population-specific skinfold equations have been developed (15, 30). Generalized equations estimate body composition in groups of people who vary greatly in age, body composition, and fitness. An advantage of these equations is that they can be used to estimate body composition in most people; however, the equations lose accuracy when testing individuals who are dissimilar to those used to develop the equations. These equations are also less accurate for people at either end of the fatness continuum.

Population-specific equations predict body composition in a particular subgroup of the population, such as female runners. The advantage of using population-specific equations is that they tend to have higher accuracy when testing people who fit the physical profile of those in the subgroup of interest.

Because sex influences the areas where fat is stored, separate skinfold equations for men and women have been developed. The Jackson and Pollock (14) equations for men and the Jackson, Pollock, and Ward (16) equations for women are generalized equations that are used widely. Note that the client’s age is used in these equations. This is because the relationship between total body fat and subcutaneous fat changes with age; as a person ages, proportionally less fat is stored subcutaneously. Equations from these authors that require three or seven skinfold sites are listed in the sidebar Equations for Estimating Body Density From Skinfold Thicknesses. In addition, tables 8.5 and 8.6 provide quick references for estimating body fatness from skinfold thicknesses for men and women. To use these tables, total the sum of your client’s skinfolds (chest, abdominal, and thigh sites for men; triceps, suprailiac, and thigh sites for women) and locate the corresponding value in the far left column. Then, locate the client’s age in the top row. The intersection of the row and column is the client’s estimated %BF.

Key Point

Skinfold measurements are a quick and relatively accurate method for estimating %BF; however, care must be taken in making these measurements if the values are to be reliable. Girth measurements, particularly WHR and WC, can be useful in assessing risk of obesity-related disease, and BMI is useful for classifying individuals into overweight and obese categories. The recommended BMI range is 18.5 to 24.9 kg · m−2.

Densitometry

The density of an object is defined as the ratio of its weight to its volume (Density = weight ÷ volume). Two common procedures that estimate body composition based on densitometry are hydrostatic weighing and air displacement plethysmography. The foundation of these techniques is that various types of tissues in the body have different and consistent densities. Fat tissue has a density far less than either muscle or bone. Each of these techniques results in the assessment of total body volume and subsequently the calculation of body density.

Once the body density is calculated, it must be converted into %BF. To make this conversion, a two-compartment model is used. In a two-compartment model, all body tissues are classified as either fat or fat free. One of the most commonly used equations for this procedure is the Siri (32) equation: %BF = (495 ÷ Db) − 450. In this model, the fat-free portion of the body is composed of all tissues except lipids and is assumed to have a density of 1.1 kg · L−1. Fat is assumed to have a density of 0.9 kg · L−1. It has been suggested that the inherent error (caused by variations in hydration or bone density) of this method is 2% to 2.8% in young Caucasian adults (20).

Fat density is fairly consistent among individuals; however, there are situations in which the density of the fat-free body is different from the assumed 1.1 kg · L−1. For example, if a person’s bone density is different from the standard used by Siri, then the assumption that the fat-free body density equals 1.1 kg · L−1 becomes invalid. This is the case for African Americans, who typically have a higher bone density than their Caucasian counterparts, and Schutte and colleagues (31) proposed that a different equation be used to calculate %BF for African American men. Many equations have been proposed to convert body density into %BF. Some of these are listed in table 8.7. For more equations and information on converting body density into %BF, see ACSM’s Guidelines for Exercise Testing and Prescription (1) and Heyward and Wagner (12). Researchers sometimes use techniques more advanced than two-compartment models. Although these techniques are currently impractical for nonresearch settings, they are briefly described in the sidebar Body Composition Techniques in Research Settings: Multicompartment Models.

Hydrostatic Weighing

Hydrostatic (underwater) weighing is one of the most common means for estimating body composition in research settings and is often used as the criterion method for assessing %BF. A criterion method provides the standard against which other methodologies are compared. In this procedure, the participant is submerged in a tank of warm water and then exhales fully while technicians record the body mass (figure 8.2). The body mass while submerged and the body mass on land are used to calculate %BF.

Hydrostatic weighing is based on Archimedes’ principle, which states that a submerged object is buoyed up by a force equal to the volume.

Maintain healthy lifestyle
Being healthy should be part of your overall lifestyle, not just a New Year’s resolution. Living a healthy lifestyle can help prevent chronic diseases and long-term illnesses. Feeling good about yourself and taking care of your health are important for your self-esteem and self-image. Maintain a healthy lifestyle by doing what is right for your body.

Step 1

Maintain a healthy weight. Determine whether you are overweight by checking your body mass index. If you are overweight, it can lead to a higher risk of chronic disease such as cardiovascular disease, diabetes, stroke and certain cancers.

Step 2

Stick with healthy food from each food group. This means staying away from food high in saturated fats, sodium and added sugars. Eat more whole grains, lean proteins such as chicken or legumes and beans, low-fat or non-fat dairy, and increase your fruits and vegetables.

Step 3

Visit your doctor for an annual physical exam. Depending on your age, certain lab tests and screenings, such as mammograms, colonoscopies and heart tests, are necessary. Stay up to date on your health screenings to identify whether there are medical problems to address.

Step 4

Make sure your relationships are positive and healthy ones. Surround yourself with people who support you and who you feel good around. Your partner in life, friends and others who are in your life should respect you. If you find yourself in an unhealthy relationship, take steps to improve it or move on.

Step 5

Engage in physical activity for at least 30 minutes every day. Take an exercise class, join the gym or just take a brisk walk outside. Making the time for physical activity is a necessity and not a luxury.

Step 6

Know when and how to de-stress. Taking care of your mental health is just as important as taking care of your physical health. Make sure that you have positive ways of dealing with stressors in your life. This might be exercising, meditating, yoga or just doing deep-breathing exercises. If stress becomes so severe that it is interfering with your sleep or ability to cope, talk to your doctor or a counselor.

Step 7

Do not smoke. Smoking can cause preventable diseases such as lung cancer and other cancers. Stay away from secondhand smoke, since this can also be hazardous to your health.

Identifying and Overcoming Barriers to Lifestyle Change

The difficulties of making lifestyle changes can be identified in many different ways and we all have that one unique barrier that makes it all the more challenging for us to make those desired lifestyle changes.

It is likely we have made some goals to improve certain aspects of our life, especially those that are health-related and are focused on improving diet or exercising more often. In order to best help ourselves reach these health-related goals, it is important to identify barriers that have previously kept us from reaching them. These barriers are more commonly identified as lack of self-motivation, lack of time, being too busy, etc. Barriers to improving health by eating better or exercising more can also be lifestyle habits which include drinking high calorie beverages, eating large portion sizes, snacking frequently, watching TV for extended periods of time, etc.

Which barriers in the table listed below apply most to you?

Lack of self-motivation	Busy schedule	Lack of time
Drinking lots of high calorie beverages	Eating fast food often	Snacking on high calorie foods
Eating high fat foods	Eating quickly	Skipping meals
Breading or frying foods	Eating late (after 8:00 PM)	Eating in front of TV
Using lots of high fat/calorie condiments and salad dressings	Eating large portion sizes	Frequently eating high calorie desserts
Significant others	Work	Home environment
Making excuses	Saying “I will start tomorrow”	Snacking often/mindless snacking
Environmental barriers	Physical barriers to exercise	Job that requires a lot of sitting
Spending extended periods of time sitting in front of TV or computer at home
Feeling tired all the time

Identifying your individual barriers to lifestyle change and improving health is the first step to creating strategies in order to overcome them. First ask yourself, “If I make these changes, how will my life be different than it is today?” Next, brainstorm and provide yourself with realistic solutions to the problem or barrier to change. Consider a variety of options - even ones that you have not tried before – but be creative. Evaluate if this is a realistic solution for you by listing the pros and cons. Think about how this solution will help you achieve your goals. Finally, select the best solution that will help you make those desired lifestyle changes.

Six Essential Steps to Making a Healthy Lifestyle Change

Making a healthy lifestyle change can be quite challenging. In fact, the mere thought of it can be downright terrifying or at least intimidating, even if you have been through this process before. After all, it is a rather big decision. You are considering changing the way in which you live your life….or at least part of it.
Many of us mortal humans have tried and failed on countless occasions to make these seemingly simple adjustments in our daily or weekly routines. The problem is that most of us have no idea what we are getting into when we make these commitments to ourselves. How difficult could it be to set aside an extra thirty minutes a day to fit in some exercise or drink an additional 20 ounces of water per day? Are you lazy or do you just lack will power?
Chances are the reason you have failed to succeed before has nothing to do with laziness or will power. You cannot just pass this one off as a character flaw. The more likely explanation is that your brain doesn’t work the way you thought it did. This is not a bad thing. It’s just something you need to be aware of.
What many of us fail to recognize is that we are going up against years of behavior and habit. An individual does not become overweight or arthritic or diabetic overnight. Maybe we should not expect to be able to change it all in a day or a week, or even a month. While we have within ourselves the ability to make these changes, whether we actually take the actions necessary to bring about these changes and stick to them is a matter of how well we know ourselves. Here are six essential steps to learning more about what makes you tick and how to make a healthy lifestyle change.

1. Identify Your Priorities and Commitments

Have you ever considered the fact that your behaviors and habits are determined by your priorities? Doesn’t it make sense then that if you change your priorities your behavior will also change? The problem with this scenario is that changing your priorities is much more difficult than changing your behavior and attempting to do one without the other is rarely successful. If we focus on the behavior without determining the priorities, the behavior will always revert back.
The first thing to do is to identify your priorities. Make a written list of what is important to you (e.g., family, work, health, etc.) and then organizing these items in order of importance. Typically, the things you spend the most time doing are the things that are most important to you. For instance, do you spend more time each week surfing the internet or watching T.V. than you do exercising or preparing healthy meals for yourself. Most of us at one time or another have probably claimed, “I simply do not have time to exercise” or “I can’t afford to eat that healthy”. These are not matters of time or money. They are matters of priorities. These priorities are not right or wrong, good or bad. They are just your priorities. So don’t fall into the self-judgment trap. That is a sure-fire way to fail at achieving your goal before you even begin to try.
At least now having done this little exercise, you are more aware of your priorities then you were before. If this causes you to want to change your priorities, this is an important step toward making a healthy lifestyle change. Remember, if we can change the priorities, the behavior will follow. But don’t make any changes until you consider the remaining steps and understand what is involved in this process.
People often say, “My problem is not priorities, it is lack of commitment.” So what’s the difference? Without getting into semantics, we come back to the real question: Are you spending the most time on the things that are most important to you? If you doubt that your behavior is not reflecting your priorities and instead feel that you simply lack commitment, then ask yourself why you think you are more committed to something that is not so important to you. Does that make sense?

2. Become Aware of Your Belief Systems

Now that you are more aware of your priorities, consider this: An individual’s priorities are determined by his belief system, and that belief system is based on past experiences and conscious choice. Here is an example. We have been told for years that eating eggs and butter will raise our cholesterol and lead to heart disease. We believed this because our doctors and the media told us it was so. From the moment we chose to believe it we changed our behavior and avoided eating eggs and butter. However, we are now being told that, based on current scientific research, dietary cholesterol from eggs and butter has very little, if any, impact on cholesterol levels in the blood, and that the bigger dietary culprits in elevated blood cholesterol levels are trans fats, refined sugars and processed carbohydrates. Furthermore, elevated cholesterol may not even be a culprit in heart disease at all!
The question of which studies or positions you will follow does not necessarily depend on which ones are correct. It depends more on which ones make the most sense to you — which ones you believe. This is often the most difficult concept to grasp because it goes against everything we have been taught with regard to nutrition and health. We have been taught to believe that there is a right way and a wrong way and these rules apply to everyone. I am sure you can think of many instances when you did something despite your knowledge that it was wrong.
Another way to look at this is to realize that the past does not equal the present or the future. If you look at the sources of your beliefs or behaviors, you will realize that most of them exist because of an experience you had or lesson you learned in the past. If you realize that this belief or behavior is holding you back today, you must ask yourself why you continue to believe or behave in this manner. This belief or behavior may have served you well then in that prior situation. But is it serving you well today? And do you think it will serve you well in the future?
The more aware you are of what you really believe in, the more likely you are to make the choices and behave in the manner that suits your best interests. If you want your lifestyle to change then you must be ready to change your self-image.

3. Create an Individualized Strategy

The standardized one-size-fits-all approach is ineffective and may even be hazardous to your health. We are all individuals and, as such, are as different on the inside as we are on the outside. As human beings, we are each biochemically and physiologically unique. This is precisely why no single diet or exercise program works for everyone. If there was such a program, we would all be on it and there wouldn’t be several completely different approaches represented on the New York Times best-sellers list every week.
Your goal should be to determine which method or approach will work best for you, not what has worked for someone else. This depends as much on your biochemical and physiological individuality as it does on your ability and willingness to adhere to a new exercise program or diet plan. It has been my experience that an individual will not make any such lifestyle change unless it feels right or makes sense to the individual. The largest institutions in the world – religions – are based on belief. If you practice any one particular religion you chose that religion because, based on all of the information available to you at the time, it made the most sense to you or it felt right in your heart. James Allen said: “As a man thinketh in his heart, so shall he be.”
Once you acknowledge and appreciate the need for an individualized strategy, how do you actually create one? I recommend you find a qualified professional within the area of expertise appropriate for your goal. If you want to focus on improving your eating habits, find a certified nutritional consultant. If you want to begin or change your exercise program, find a certified fitness trainer. If you need an overall lifestyle change, you may need a lifestyle coach or engage the services of more than one consultant. In any case, you should seek the guidance of a trained professional who will not simply give you a standardized or one-size-fits-all approach. You need someone who will take your health history and current lifestyle into consideration before helping you to develop a personalized approach.

4. Know Your “Why?”

If you don’t know why you want to change, you are more likely to lose your motivation at some point to stay on course. In fact, not knowing your “why” is the single most common reason for failing to reach one’s goal. Your “why” is the real reason underneath your stated reason for changing. It is your inspiration and your motivation.
Believe it or not, many people actually embark on a lifestyle change, following many of the steps towards whatever goal they have in mind, without even making the decision to change in the first place. Sounds crazy, right? They heard or read about what it takes to achieve a certain goal and they begin blindly following a plan that worked for someone else and sort of go on autopilot. Their actions become very unconscious. They never made the conscious decision to do it for their own reason(s).
Anyone who has ever quit smoking will tell you that they did not quit until they wanted to quit—until they had the desire to quit. Even when they acknowledged that smoking was bad for them or their friends and loved ones begged them to quit, it was not enough. They had to reach a point where they wanted better health for themselves. They had to desire these things more than the pleasure they got from smoking.
Many people, when asked why they want to lose weight or start exercising, will say, “because I want to be healthy.” While that may seem like a good reason, it is typically not the real reason. When I get that kind of response, I will typically ask a follow-up question: “Why do you want to be healthy?” I am looking for a reason that has more emotion behind it—one that comes from the heart. Recently, a client in her 50′s said, “because I want to be able to play with my grandkids for the next 5-10 years.” A man in his 40′s said, “because I don’t want to develop diabetes like my father.” And a woman in her 30′s said, “because I’m tired of feeling crappy all day. I want to feel good every day.” Your “why” must come from your heart, not from your head.

5. Visualize Your Success

Once you have your “why,” you must create an image around it to make it real. The best way to do this is to visualize a day in your life when you have attained your goal. Imagine yourself on a day sometime in the near future when you are healthier and happier because you have changed your lifestyle. Imagine that you have reached your ideal weight, or you are no longer ashamed of your body, or you have reached your desired level of strength, energy and endurance. Get a clear picture in your mind of yourself going about your new daily routine. Imagine it as if it was happening right at this moment. Carl Jung called this “active imagination.” Check in with your senses. How does it feel? How does it smell? How does it look and sound? Enjoy the experience of a healthier lifestyle – of success. Was it worth the commitment you made to yourself? Are you happy? That’s what it’s all about, isn’t it?
Numerous studies have shown that visualization is an extremely effective tool used by professional athletes, celebrities, millionaires, and successful people in all walks of life. Perhaps it is so effective because it taps into the emotional aspect of your determination. Perhaps visualization is a way of implanting your success within your unconscious mind. Jung also said that our unconscious mind communicates with our conscious mind through pictures or images, not through words. Once you have created that picture in your mind, it is easy to bring it back up whenever you want or need to see it again. If you can see something, then you can believe it and you can achieve it.
So find yourself a quiet place where you go without being distracted and sit for 15-20 minutes and get that picture of success in your mind. Then live every day as if you are still in that movie because if you are sticking to your plan, you are living what you imagined. Live as if you have already succeeded. Going back to that image whenever you feel distracted will recharge your batteries. It will literally change your attitude and the way you live your life.

6. Make the Decision – Make the Commitment

Probably the most overlooked and most difficult step in making a change is making the decision to change. Everyone has within himself the power to change. While it is true that in light of the variety of circumstances and life situations in which we find ourselves it is more difficult for some people to change than it is for others, we all have the power to change. Many times, the difference between someone who succeeds and someone who does not is that the successful person made the decision to succeed. You can have the best of intentions and make all of the plans necessary to make a change, but until you actually decide to take action nothing will ever come of those intentions and plans.
This is about asking yourself if you are ready. Any lifestyle change must be viewed as a commitment. A decision stated in language such as, “I think I can do that”, or “I’ll try to do this” is not really a decision at all. This is you thinking about making a decision. A former assistant of mine, Rosemary, used to say, “Oh, he’s fixin’ to get ready. He ain’t really ready.” Thinking about being ready is just another stall technique. If you have always viewed yourself as an “indecisive” person, remember what we discussed in step number 2 — the past does not equal the present or the future. If you want your lifestyle to change, then you must change your self-image. Get serious about your commitment to yourself. You can waiver all you want beforehand, but when you have finally made the decision, you must actually decide that you will attain your goal and nothing will stand in your way. It’s a matter of choice.
The magical thing about a true commitment is that once you actually make the decision, attaining your goal suddenly becomes a much more likely result. It’s what we all want, and we can have it if we really, truly want it. It’s a matter of choice.
Priorities. Commitment. Awareness of your belief system. An individualized strategy. And the desire to make it all happen. These are the keys to making a healthy lifestyle change, or any change for that matter. Just make the decision and watch it happen!

Unit – II

OBESITY

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health

Obesity is most commonly caused by a combination of excessive food intake, lack of physical activity, and genetic susceptibility.^[1][4] A few cases are caused primarily by genes, endocrine disorders, medications, or mental illness.^[5] Evidence to support the view that obese people eat little yet gain weight due to a slow metabolism is not generally supported.^[6] On average, obese people have a greater energy expenditure than their thin counterparts due to the energy required to maintain an increased body mass.^[6][7]
Obesity is mostly preventable through a combination of social changes and personal choices.^[1] Changes to diet and exercising are the main treatments.^[3] Diet quality can be improved by reducing the consumption of energy-dense foods, such as those high in fat and sugars, and by increasing the intake of dietary fiber.^[1] Medications may be taken, along with a suitable diet, to reduce appetite or decrease fat absorption.^[8] If diet, exercise, and medication are not effective, a gastric balloon or surgery may be performed to reduce stomach volume or bowel length, leading to feeling full earlier or a reduced ability to absorb nutrients from food.^[9][10]
Obesity is a leading preventable cause of death worldwide, with increasing rates in adults and children.^[1][11] In 2014, 600 million adults (13%) and 42 million children under the age of five were obese.^[1] Obesity is more common in women than men.^[1] Authorities view it as one of the most serious public health problems of the 21st century.^[12] Obesity is stigmatized in much of the modern world (particularly in the Western world), though it was seen as a symbol of wealth and fertility at other times in history and still is in some parts of the world.^[3][13] In 2013, the American Medical Association classified obesity as a disease

Causes

At an individual level, a combination of excessive food energy intake and a lack of physical activity is thought to explain most cases of obesity.^[77] A limited number of cases are due primarily to genetics, medical reasons, or psychiatric illness.^[5] In contrast, increasing rates of obesity at a societal level are felt to be due to an easily accessible and palatable diet,^[78] increased reliance on cars, and mechanized manufacturing.^[79][80]
A 2006 review identified ten other possible contributors to the recent increase of obesity: (1) insufficient sleep, (2) endocrine disruptors (environmental pollutants that interfere with lipid metabolism), (3) decreased variability in ambient temperature, (4) decreased rates of smoking, because smoking suppresses appetite, (5) increased use of medications that can cause weight gain (e.g., atypical antipsychotics), (6) proportional increases in ethnic and age groups that tend to be heavier, (7) pregnancy at a later age (which may cause susceptibility to obesity in children), (8) epigenetic risk factors passed on generationally, (9) natural selection for higher BMI, and (10) assortative mating leading to increased concentration of obesity risk factors (this would increase the number of obese people by increasing population variance in weight)

Health Risk Of Obesity

Obesity increases the risk of many physical and mental conditions.

Medical field			Condition	Medical field	Condition
Cardiology			coronary heart disease:^[50] angina and myocardial infarction congestive heart failure^[3] high blood pressure^[3] abnormal cholesterol levels^[3] deep vein thrombosis and pulmonary embolism^[51]	Dermatology	stretch marks^[52] acanthosis nigricans^[52] lymphedema^[52] cellulitis^[52] hirsutism^[52] intertrigo^[53]
Endocrinology and Reproductive medicine			diabetes mellitus^[3] polycystic ovarian syndrome^[3] menstrual disorders^[3] infertility^[3][54] complications during pregnancy^[3][54] birth defects^[3] intrauterine fetal death^[54]	Gastroenterology	gastroesophageal reflux disease^[12] fatty liver disease^[12] cholelithiasis (gallstones)^[12]
Neurology			stroke^[3] meralgia paresthetica^[55] migraines^[56] carpal tunnel syndrome^[57] dementia^[58] idiopathic intracranial hypertension^[59] multiple sclerosis^[60]	Oncology^[61]	esophageal colorectal pancreatic gallbladder, endometrial kidney Leukemia Hepatocellular carcinoma^[12] malignant melanoma
Psychiatry			depression in women^[3] social stigmatization^[3]	Respirology	obstructive sleep apnea^[3][27] obesity hypoventilation syndrome^[3][27] asthma^[3][27] increased complications during general anaesthesia^[3]
Rheumatology and Orthopedics			gout^[62] poor mobility^[63] osteoarthritis^[3] low back pain^[64]	Urology and Nephrology	erectile dysfunction^[65] urinary incontinence^[66] chronic renal failure^[67] hypogonadism^[68] buried penis^[69]
Types of Obesity BMI (kg/m²)		Classification^[23]
from	up to
	18.5	underweight
18.5	25.0	normal weight
25.0	30.0	overweight
30.0	35.0	class I obesity
35.0	40.0	class II obesity
40.0		class III obesity

The most commonly used definitions, established by the World Health Organization (WHO) in 1997 and published in 2000, provide the values listed in the table.^[24]

Some modifications to the WHO definitions have been made by particular bodies. The surgical literature breaks down "class III" obesity into further categories whose exact values are still disputed.^[25]

· Any BMI ≥ 35 or 40 kg/m² is severe obesity.

· A BMI of ≥ 35 kg/m² and experiencing obesity-related health conditions or ≥40–44.9 kg/m² is morbid obesity.

· A BMI of ≥ 45 or 50 kg/m² is super obesity.

Causes of Weight Gain

1. Genetics

Obesity has a strong genetic component. Off springs of obese parents are much more likely to become obese than off springs of lean parents.
This is not to say that obesity is completely predetermined because our genes aren’t as set in stone as you may think… the signals we send our genes can have a major effect on which genes are expressed and which are not.
Non-industrialized societies rapidly become obese when they start eating a typical Western diet. Their genes didn’t change the environment and the signals they sent to their genes changed.
It does seem clear that there are genetic components that do affect our susceptibility to gain weight. Studies on identical twins demonstrate this very well.

2. Engineered “Hyper palatable” Junk Foods

Today, foods are often little more than refined ingredients mixed in with a bunch of chemicals.
These products are engineered to be cheap, last long on the shelf and taste so incredibly good that we just can’t get enough.
By making foods “hyper palatable,” the food manufacturers ensure that we eat a lot and decide to buy and eat them again and again.
Most processed foods today don’t resemble food at all. These are highly engineered products, with massive budgets spent on making the foods taste so good that we become “hooked.”

3. Food Addiction

These highly engineered junk foods cause powerful stimulation of the reward centers in our brains.
You know what else does that? Drugs of abuse like alcohol, cocaine, nicotine and cannabis.
The fact is that junk foods can cause full-blown addiction in susceptible individuals. People lose control over their eating behavior, in the same way as alcoholics lose control over their drinking behavior.
Addiction is a complex issue with a biological basis that can be very difficult to overcome. When you become addicted to something, you lose your freedom of choice and the biochemistry in your brain starts calling the shots for you.

4. Aggressive Marketing (Especially Towards Children)

The junk food companies are very aggressive marketers.
Their tactics can get unethical at times and they constantly market very unhealthy products as if they are health foods.
The food companies make misleading claims and they spend massive amounts of money sponsoring scientists and major health organizations to influence their research and guidelines.
In my opinion, the junk food companies are even worse than the tobacco companies ever were, because they target their marketing specifically towards children.
Children are becoming obese, diabetic and addicted to junk foods way before they’re old enough to make conscious decisions about these things.

5. Insulin

Insulin is a very important hormone that regulates energy storage, among other things.
One of the functions of insulin is to tell fat cells to store fat and to hold on to the fat that they already carry.
The Western diet causes insulin resistance in many individuals (4). This elevates insulin levels all over the body, making energy selectively get stored in the fat cells instead of being available for use.
The best way to lower insulin is to cut back on carbohydrates, which usually leads to an automatic reduction in calorie intake and effortless weight loss. No calorie counting or portion control required (5, 6).

6. Certain Medications

There are many pharmaceutical drugs that can cause weight gain as a side effect.
Examples include diabetes medication, antidepressants, antipsychotics, etc.
These drugs don’t cause a “willpower deficiency” – they alter the function of the body and brain, making it selectively store fat instead of burning it.

7. Leptin

Another hormone that is crucial in obesity is Leptin.
This hormone is produced by the fat cells and is supposed to send signals to the hypothalamus (the part of our brain that controls food intake) that we’re full and need to stop eating.
Obese people have lots of fat and lots of leptin. The problem is that the leptin isn’t working as it should, because for some reason the brain becomes resistant to it (7).
This is called leptin resistance and is believed to be a leading factor in the pathogenesis of obesity.

8. Food Availability

One factor that has dramatically influenced the collective waistline of the world is a massive increase in food availability.
Food (especially junk food) is everywhere now. Even gas stations sell food and merchants stack tempting products like candy bars in areas that maximize the chances of impulse purchases.
Another problem related to availability is that junk food is often cheaper than real food, especially in America.
Some people, especially in poorer neighborhoods, don’t even have the option of purchasing real foods. The convenience stores in these areas only sell sodas, candy and processed, packaged junk foods.

9. Sugar

In my opinion, sugar is the single worst part of the modern diet.
The reason is that when consumed in excess, sugar changes the hormones and biochemistry of the body, contributing to weight gain.
Added sugar is half glucose, half fructose. We get glucose from all sorts of foods, including starches, but we get the majority of our fructose from added sugars.
Excess fructose consumption causes insulin resistance and elevated insulin levels. It may cause leptin resistance, at least in rats. It also doesn’t cause satiety in the same way as glucose.

10. Misinformation

People all over the world are being misinformed about health and nutrition.
I think the main reason for this is that the food companies sponsor scientists and major health organizations all around the world.
For example, the Academy of Nutrition and Dietetics (the biggest organization of nutrition professionals in the world) is heavily sponsored by the likes of Coca Cola, Kellogg’s and PepsiCo.
The American Diabetes Association is sponsored by drug companies by millions of dollars per year, companies which directly profit from the failed low-fat advice.
Even the official guidelines promoted by the government seem to be designed to protect the interests of the corporations instead of promoting the health of individuals.
Solutions for overcoming Obesity

Set realistic goals: Losing 1 to 2 pounds per week is generally doable.
Adhere to a healthy daily eating pattern: Eat a variety of foods, including whole grains, vegetables, lean proteins, healthy fats and fruits.
Eat breakfast daily to avoid overeating later in the day.
Avoid sugary beverages: Drink water or unsweetened tea.
Don’t skip meals.
Eat small portions.
Avoid or limit intake of sugar and refined carbohydrates.
Replace high-calorie snacks with vegetables and fruits.
Make healthy choices, especially when eating at restaurants.
Maintain adequate hydration with water.
Be as physically active as you can by maintaining an exercise routine several times a week for at least 30 minutes each time.
Get a sufficient amount of sleep, because poor sleep is associated with weight gain and obesity.
Reduce stress, and relax when needed.
Get support from family, friends and support groups.
Monitor weight loss not only by weighing yourself but also by using a tape measure and noting how your clothes fit.
Keep a weight loss journal to chart your progress and caloric intake.
Because of potential drug interactions and contraindications, never use an over-the-counter dietary supplement without first discussing it with your health care provider or pharmacist.
Always maintain routine visits with your health care provider, especially if you have any medical conditions or are taking any medications.

Unit – III

To transform your body, to get fit, to be healthy and to feel great you gotta exercise. Just like the air you breathe, your body needs physical exercise. And it needs exercise in a way that is so far-reaching that scientists are only just starting to unravel some of the amazing effects exercise has on our bodies. Did you know, that exercise can actually reprogram your DNA? And while you may think that by not doing exercise you’re not doing any harm, lack of exercise itself can alter your DNA – but unfavourably!

Putting aside all the complicated, scientific reasons to exercise, exercise offers benefits that dieting just can’t. Exercise allows you to boost your metabolism and turn your body into a fat blasting furnace. Exercise builds muscle in the places you want, improves body shape and gives you a firm, toned body. Dieting, on the other hand, doesn’t promise a firm body – you can lose weight dieting and still be jiggly! And of course, in conjunction with diet, exercise speeds up the whole weight loss process, and who doesn’t want that?

This workout plan is between 4 and 12 weeks long, depending on how much weight you want to lose. Follow this workout plan and practice healthy eating and portion control, which means eating the right food in the right quantities at the right times, and you’ll be able to burn off at least a pound or two of body fat each week. But remember, you’ll also be doing resistance training to gain muscle in all the right places, so you’ll want to keep track of your progress with body measurements and, if you can, body fat percentage.

FITNESS LEVEL: BEGINNER TO ADVANCED WORKOUT PLANS

There is a plan for beginners and for more advanced exercisers. If you haven’t exercised for a long time start with the beginner weight loss workout plan. If you have been exercising regularly for the last few months several times a week and been increasing your fitness levels, try the more advanced weight loss program.

If in doubt, start at a lower level. You can always skip ahead if you feel it is too easy or switch to a more difficult plan. The great thing is that all of the plans burn calories and all of the plans require commitment. As long as you give it your best at every workout (and watch your calorie intake!), you will make progress, will burn calories, will drop the pounds and will get stronger.

Remember:

Check with your doctor before starting a new exercise program, especially if you have a medical condition.
Don’t forget to warm-up for 5 – 10 minutes before you start your workout and to cool-down. Stretch after your workout.

See next page about how to follow this workout plan and for the more advanced workout plans.

Here are the workouts:

Total body workout
Upper body workout (arm & shoulders)
Core workout (abs and back)

Beginner weight loss workout plan (this page – see immediately below)
Intermediate weight loss workout plan
Advanced weight loss workout plan

How hard you should exercise

Note: IT = interval training, HIIT = high intensity interval training

Health benefits of regular exercise

Regular physical activity has amazing benefits. Here are just a few:

Physical activity helps you live longer and prevent many chronic diseases, such as heart disease, high blood pressure, abnormal blood lipid (cholesterol and triglyceride) profile, stroke, type 2 diabetes, metabolic syndrome, and colon and breast cancers.
Physical activity improves cardiorespiratory and muscular fitness.
Physical activity raises your metabolism and helps you lose weight more easily (or eat more without gaining weight).
Physical activity helps reduce stress, anxiety, and depression and improve your mood. .
Physical activity helps maintain brain function in older adults.
Physical activity helps with digestion and promotes regular bowel movements.
Physical activity increases bone density.
Physical activity helps you age more gracefully by maintaining your looks and your agility.
Physical activity improves sleep quality.
Physical activity improves your overall quality of life.

Principles for Weight Loss

Focus on calorie deficit first and budget calories wisely
Start building every meal with lean protein
Eat vegetables (fibrous carbs) with every meal
Eat omega-3 and other healthy fats every day
Eat at least two fruits every day
Eat natural starches and grains in small amounts if you are inactive and in moderate amounts if you are exercising
Eat mostly foods that pass the “natural test” (ie. unprocessed foods or foods that come in nature’s packaging)
Eat five to six times a day – a meal or snack every three hours (I’m not a stickler for this one. If it works for your lifestyle and you are happy with your results, use it. If you prefer to have fewer eating sessions in a day, recent research has found a variety of health benefits in occasionally experiencing hunger, including reducing obesity, diabetes and dementia.)
Limit or avoid liquid calories and drink mostly water or green tea instead
Follow the 90/100 compliance rule. There are no forbidden foods. Simply comply with the principles above 90% of the time for a healthy and effective weight loss plan.

How to Set a Caloric Deficit for Fat Loss

By Armi Legge | October 15, 2013 |

Fat loss is about calories in versus calories out, but how much less should you eat to lose fat?
This is one of the hardest and most important parts of dieting. There are pros and cons to large and small deficits, and you may want to use both depending on your goals.
In this article, you’ll learn how different size deficits affect your body, and how to decide which is best for you.

The Top 4 Ways You Can Set a Caloric Deficit

1. Pick a specific number to achieve a certain rate of fat loss.
This is how most people set a deficit.
They decide they want to lose a certain amount of fat per week, usually about one pound. They know that one pound of fat has about 3,500 calories, so they figure out how many fewer calories they’ll need to eat per day to lose one pound of fat — 500.(1)
For most people this works well. It’s simple and achievable.
The problem, however, is that this size deficit might be too aggressive for some and too slow for others. If you’re already maintaining your weight at 2,000 calories per day, cutting your food intake by 25% might be too drastic.
In contrast, if you maintain your weight at 4,000 calories per day, you might be able to achieve a faster rate of fat loss with a larger deficit.
2. Set your calorie intake according to your body weight.
Instead of estimating your maintenance intake and then subtracting an arbitrary number, you set your calorie intake with fat loss in mind from the beginning.
For example, bodybuilders often use 10-12 calories per pound (22-26.4 kcal/kg) as a starting place for fat loss.
This approach is a little more customized to your individual needs since it accounts for differences in body size. However, this only takes into account your bodyweight, which is not always an accurate predictor of your total energy needs.
People who exercise more are going to have higher energy needs, and setting your total calorie intake according to your body weight could create an excessive deficit. For instance, if you have a 150 pound endurance athlete who burns 4,000 calories per day, they’d only be eating 1,500 to 1,800 calories per day if they followed the same guidelines as many bodybuilders.
For sedentary people with lower than average calorie needs, this deficit might be too small relative to their goals.
3. Cut calories as much as you can.
Instead of worrying about your maintenance needs, achieving a certain rate of fat loss, or setting calories according to your bodyweight, you simply eat as little as possible. You might find that you can eat 800 calories per day without chewing off your hand, so you set that as your daily calorie intake.
This option is generally not a great plan. As you’ll learn in a moment, large deficits are not appropriate in all situations.
Most of the people who use this method aren’t great at estimating their calorie intake, which is why they avoid figuring out their calorie needs in the first place.
This approach also makes it hard to adjust your calorie intake as you diet. This isn’t to say that large deficits are always bad, but using “as little as possible” as a guide is not an optimal way to set your calorie intake.
4. Set calories as a percentage of your maintenance intake.
You estimate your maintenance calorie intake, and then subtract a percentage from your maintenance. If you need 2,000 calories per day to maintain your body weight, and you slash your calorie intake by 20%, then you’d eat 400 calories less per day, or 1600 calories.
This is generally the best way to set your calorie deficit.
This method scales your calorie intake to your energy needs instead of assigning an arbitrary number to achieve a certain rate of fat loss.
People with higher energy needs will be able to eat proportionally more and lose fat. People with lower energy needs will have a deficit that’s more appropriate for their calorie intake.
With that in mind, let’s learn which size deficits are most appropriate for your goals.

How Different Size Deficits Affect Your Body

Big and small deficits can be perfect or completely inappropriate, depending on the context. To decide which is right for you, you need to learn the pros and cons of both approaches.
Here’s how we’re going to define the size of caloric deficits:
Small: 15% below maintenance calories.
Medium: 15-25% below maintenance calories.
Large: 25% below maintenance calories.
Think of your caloric deficit as a spectrum from small to large. Smaller deficits tend to cause fewer changes, both positive and negative, and larger deficits tend to do the opposite. Here are the different variables that change based on the size of your caloric deficit.
1. Your rate of fat loss.
Larger deficits produce the highest rates of fat loss and vice versa.(2-4)
If you severely cut calories, then you don’t have to diet for as long and you’ll reach your goal weight sooner.
Assuming you need a more typical 2,500 calories per day to maintain your weight, here’s what your rate of fat loss would look like using these three deficits:

If you have higher than average energy needs, a small deficit can still help you lose fat at a decent rate. If you need 4,000 calories per day to maintain your weight, a 10% deficit will give you about 0.8 pounds of fat loss per week. This is one of the reasons bodybuilders often do lots of cardio (5) — having higher total energy needs means you can lose more fat at a proportionally smaller deficit.
2. Your adherence.
Some people are better at sticking to small deficits, and some people prefer large ones.
Larger deficits tend to be harder to stick to as they require more exercise and/or food restriction and are generally harder to achieve. Smaller deficits are usually easier to maintain. That’s not always true, however, because larger deficits also help you lose weight faster. For some people, losing a lot of weight quickly makes it much easier to stick to the diet over the long-term.(2,6)
Larger deficits can also make some people unbearably hungry. This isn’t true for everyone, however. Some data has shown that hunger tends to drop at about 800-1200 calories per day.(7-10<) Other people don’t mind the hunger and are willing to put up with it if it means they get lean faster.
3. Impact on your training.
Large deficits make it harder to train, recover from workouts, and improve your performance.(11-14) In some cases, the negative effects of dieting don’t outweigh the performance benefits of getting leaner.
Even if you’re not a performance athlete, maintaining the intensity of your strength workouts is essential for [preserving your lean body mass while dieting](http://evidencemag.com/fat-loss-podcast/). If you massively slash calories and your strength drops, it’s more likely you’ll lose muscle.
4. Muscle loss.
Most studies have found that the larger your caloric deficit, the more muscle you’ll lose.(15-21) However, most of the people in these studies were not strength training or eating enough protein to prevent muscle loss.
If you set up your diet correctly with adequate protein and strength training, then you can usually limit muscle loss to a very small amount, if any.
If you’re already fairly lean, larger deficits will generally make you lose some muscle even with strength training and adequate protein.(22,23)
If you’re overweight, however, then you can usually restrict your calorie intake more without losing as much, if any, muscle. Your body has thousands of extra calories to burn from fat, so it’s less likely to break down your muscle for energy.
5. Metabolic adaptation.
When you cut calories you burn fewer calories for a variety of reasons, mostly because you move less.(24-27) This is generally more of a problem with larger caloric deficits.
Larger deficits also tend to cause a greater drop in leptin, thyroid, and other hormones while smaller deficits have a smaller impact. Any time you cut calories, you’re going to experience some of these effects, but they tend to be less severe with smaller deficits.
Here is a summary of the pros and cons of large, medium, and small deficits.

Large Calorie Deficit = >25% Below Maintenance

Pros

Fastest rate of fat loss — you can get lean in weeks rather than months.
Provides huge immediate gratification, which can encourage long-term adherence to weight loss. Kickstarts your motivation to diet.
Reduces the chance you’ll eat too much. The size of the deficit gives you a larger margin of error when monitoring your calorie intake.

Cons

Destroys high volume and/or intensity exercise performance. Increases the risk of illness or injury and makes training miserable.
Requires you to eat much less food. Most of the people who need to lose massive amounts of fat can’t or won’t exercise much, so the deficit is going to have to come from their diet.
Intimidates some people, which could compromise their adherence.
Requires extreme self-deprivation and food restriction which can encourage eating disorder symptoms like binge eating and yo-yo dieting. After setting your protein intake, there isn’t much room for anything else.
Increases risk of nutrient deficiencies if sustained for too long.
Causes more muscle loss than less severe deficits, especially in lean people. Very overweight people can sometimes use large deficits without losing muscle, however, if they strength train and eat enough protein.
Causes a larger drop in movement such as NEAT and NEPA and a larger drop in resting metabolic rate.
Increases potential for disappointment. If people don’t set up their crash diet correctly and they don’t see the results they want, they often give up and assume that no diet will work.
Diminishes long-term habits to stay lean.

Medium Calorie Deficit = 15-25% Below Maintenance

Pros

Provides strong, immediate, sustainable gratification. Decent and motivating rate of fat loss, often around 1-2 pounds per week.
Causes some hunger, but usually manageable.
Gives you more food choices, still room for treats and less nutrient dense foods.
Usually causes training progress to decrease or stall, but rarely to regress. Recovery from workouts is usually slower, but not horrible.
Allows you to keep training, so you can create a deficit through diet and exercise.
Reduces risk of muscle loss for overweight or average people.
Causes fewer instances of mood issues, lethargy, and metabolic slowdown.

Cons

Increases risk of muscle and strength loss for lean people despite strength training and adequate protein intake.
Elevates risk of decreased performance too much for high level athletes.
Viewed as boring, since this is how most people diet.
Slows fat loss compared to large deficits.
Reduces margin of error when restricting calories. Easier to sabotage if you are bad at counting calories or get bored with your diet.
Intimidates some people.

Small Calorie Deficit = <15% Below Maintenance

Pros

Makes dieting easier. Reduces number of lifestyle changes needed. Often as simple as giving up soda or moving a little more throughout the day, like using a standing workstation.
Lowers hunger to almost nonexistent levels (for many).
Lower barrier to entry for people who are anxious about dieting. Easy to get the ball-rolling.
Reduces lethargy, mood problems, or decreases in activity levels or metabolic rate.
Reduces the risk of decreasing performance or recovery. Training might be slightly harder, but you can still maintain your intensity and volume.
Drastically reduces the risk of muscle loss for lean people. You can sometimes completely prevent muscle loss if you also lift weights and eat enough protein.
May increase long-term adherence if you are patient and consistent.

Cons

Drastically reduces rate of fat loss. You have to diet longer and you often don’t notice any change in your appearance or weight for weeks.
Requires more patience and consistency.
Lowers your margin of error for food intake. You have to be very diligent about making sure you’re in a caloric deficit. If you eat even a few hundred calories more than you think, you won’t lose fat.
These are all great options depending on the context. However, in the real world you’ll rarely need to stick perfectly to any of these approaches.

What is a health check?

A health check is an examination of your current state of health, often carried out by your GP. From the moment we are born, and even before, we undergo a variety of tests to ensure we are on the right track to good health. As we get older, many of us become more vulnerable to illness. In order to reduce this risk, a number of health checks or screening tests are recommended at different stages of our lives.

Why are health checks important?

The aim of a health check is to help find, prevent or lessen the effect of health issues. It’s like getting your car serviced before it breaks down. It’s better to avoid disease than to treat it. Although some checks can be uncomfortable, they provide your GP or specialist with an opportunity to look at your lifestyle, medical history and family history to find out if you’re at risk.
Having a regular doctor or practice has several advantages. Most importantly, you will build a relationship over time and are more likely to feel comfortable talking openly. Also, your doctor will get to know you and understand your health needs and concerns. By having a regular doctor or practice, your medical history stays in the one place, and is more likely to be kept up to date.

1. Balance

Critics of popular diets frequently claim that such diets encourage unbalanced eating by declaring certain foods and even whole food groups off-limits. The example they almost invariably point to is the infamous cabbage soup diet. But that’s a pretty extreme example.
What the critics overlook is the fact that the average American diet is rather unbalanced to begin with: heavy on animal foods, processed foods, fried foods, and sweets and light on fruits, vegetables and whole grains. It’s hard to find a popular diet that doesn’t encourage dieters to consume a variety of fresh, natural plant foods, and thereby support, if not a perfectly balanced diet, then at least a more balanced one.
In Cracking the Metabolic Code, James LaValle, a pharmacist and naturopathic physician based in Cincinnati, OH, explains how nutrient imbalances of various sorts can lead to weight gain, and conversely, how improving nutrient balance can facilitate weight loss.
To give one example, an underactive thyroid gland is a common cause of slow metabolism and, consequently, weight gain. Among the many factors that can lower thyroid function are high levels of adrenal stress hormones such as cortisol, and as LaValle points out, “Eating a lot of sugar triggers the release of adrenal hormones.” The average American diet comprises 18% sugar. The average popular diet most certainly does not!

2. Nutrient Timing

A spate of recent research has shown that when we eat is almost as important as what we eat with respect to optimizing our body composition. “We’ve learned that it’s essential to coordinate energy intake with energy expenditure,” explains John Ivy, Ph.D. and coauthor of Nutrient Timing (Basic Health, 2004). “Calories are put to their best possible use when they are consumed at times when there is a strong demand for them in the body.”
Morning is a time of relatively high caloric demand. Calories consumed in the morning are more likely than calories consumed later in the day to be used for energy than stored as fat. In fact, a study from the University of Massachusetts found that those who regularly skip breakfast are 4.5 times more likely to be overweight than those who eat it most mornings.
Eating smaller meals more frequently (five or six times a day) is another proven way to better coordinate food intake with energy needs. According to statistical data, the average American eats three large meals per day.

3. Self-Monitoring

Research has shown that simply paying attention to what you eat is one of the more effective ways to reduce your caloric intake. Self-monitoring strategies are a key habit among members of the National Weight Control Registry, a research pool comprising several thousand men and women who have lost an average of 66 pounds apiece and kept the weight off an average of 6 years. “They’re very conscious of their eating,” says Suzanne Phelan, Ph.D., a spokesperson for the NWCR. “About half of them report that they are still counting calories and fat grams.”
Another useful self-monitoring habit that is common among both the NWCR subjects and those pursuing weight loss on popular diets is weighing. According to Phelan, this habit allows the subjects of her study to avoid the insidious upward creep that is the undoing of many initially successful diets. “Because they are weighing themselves as often as they do, they can catch these slips,” she says. “If they do something about it right away, they’re much more likely to be successful in the long term.”

4. Selective Restrictions

Just about every popular diet has a “forbidden foods” list. The specific foods and food types that make the list and how strictly they are forbidden differ from one program to the next. The Atkins diet forbids virtually all high-carbohydrate foods. The Ornish diet forbids animal foods. Peter D’Adamo’s blood type diet forbids a long laundry list of seemingly unrelated foods for each of the four basic bloods types.
No weight loss diet can succeed without restriction of the foods that are most responsible for creating large body fat stores. A majority of mainstream nutrition experts agree that the “bad fats” found in many processed foods and animal foods and the “bad carbs” in sweets and processed foods are the primary culprits. Interestingly, nearly all of the members of the NWCR choose to restrict intake of high-fat foods. “Only seven percent are on a low-carb diet,” says Phelan.
Mainstream nutrition experts warn against taking food restrictions too far, however. “To eliminate specific foods and food groups, especially those people enjoy, is a recipe for disaster and can lead to feelings of deprivation, not to mention nutritional imbalances,” says Elisa Zied, M.S., R.D., a spokesperson for the American Dietetic Association.
James LaValle prescribes only “soft” restrictions to his clients and in the many nutrition books he’s written. “You get gurus who say, ‘You can never eat another dessert again,’” he says. “That sets up a guilt complex in people.” When the options are all or nothing, there is no happy medium between being on the diet and miserable and being off it completely.

5. Low Caloric Density

The concept of caloric density, or energy density, refers to the number of calories per unit volume in a given food. A food that packs a lot of calories in a small area is said to have high caloric density. Because water and dietary fiber are non-caloric, foods that contain a lot of water and/or fiber tend to have low caloric density. Generally speaking, processed foods are calorically dense, while fruits and vegetables, with their high water and fiber content, are less dense.
Caloric density is important for those seeking to lose weight because research has shown that people tend to eat a consistent volume of food regardless of the number of calories it contains. In a Penn State study, women were fed either a high-density, medium-density, or low-density meal three times a day. The subjects in all three groups ate the same weight of food, but the women eating the high-density meals took in 30% more calories than the women eating the low-density meals.

6. Consistency

Healthy eating is not like a vaccine: one shot and you’re covered for life. Instead it requires a daily, lifelong commitment. There is growing evidence that the more consistent you are in your wholesome eating habits, the greater your chances of maintaining a healthy body weight.
Again, the members of the National Weight Control Registry set an example. “One of our most recent findings is that they do maintain a very consistent eating pattern,” says Phelan. “Unlike many dieters, they tend to eat the same during the week as on the weekends. The same holds for the holidays versus the rest of the year. They tend to have a consistent eating pattern throughout the year.”
A persistent myth of dieting is that those who achieve long-term success start off with a more moderate, slow-and-steady approach than the crash dieters who take on severe restrictions only to bail out after a few weeks or months and regain their weight. According to Phelan, there is no evidence that the long-term successes start off differently. The real difference is that they simply keep doing what they started doing!

7. Motivation

Why are some dieters able to maintain their healthy new lifestyle indefinitely while most others peter out after a few weeks or months? This is currently one of the hottest questions in weight loss research. As yet there is no definitive answer, but there are indications that it’s mostly about motivation.
Certain types of triggers for weight loss diets are more likely to yield long-term success than others. For example, “One thing we’ve found is that people who have medical triggers for their weight loss are more successful in the long term than people who don’t,” says Phelan. There’s nothing like a near-death experience to keep you on the straight and narrow path of healthy eating!
More evidence for the motivation explanation comes from the fact that just about every other explanation can be eliminated.
It is often assumed that successful dieters have more inherent willpower. However, most members of the NWCR actually failed in several weight loss initiatives before they finally succeeded, indicating that something about their circumstances rather than their psychological makeup was the key.
“Bad genes” that resist weight loss are also frequently blamed. And yet, says Phelan, “Many of [the NWCR members] have parents who were overweight or were overweight themselves as children, which suggests they may have a genetic predisposition to obesity, but they still manage to lose weight.”

Finding the Perfect Fit

Each of us is unique – metabolically, psychologically, and circumstantially. For this reason, there’s no single diet plan that works well for everyone. “Each person needs to find what works for him- or herself,” says Zied. But there are underlying principles of healthy nutrition and dieting that do apply universally. Understanding these principles is essential to finding the right plan for you.

Weight Management for Teens

Definition

· Strengthening exercise

· Isometric exercise

· Isotonic exercise

· Isokinetic exercise

ROLES AND RESPONSIBILITIES OF BODY WEIGHT

How to Create a Calorie Deficit

Example

Eliminate Calories

Calculate your BMR

Step 1

Step 2

Step 3

Step 4

Step 5

Step 6

Step 7

Identifying and Overcoming Barriers to Lifestyle Change

Which barriers in the table listed below apply most to you?

Six Essential Steps to Making a Healthy Lifestyle Change

1. Identify Your Priorities and Commitments

2. Become Aware of Your Belief Systems

3. Create an Individualized Strategy

4. Know Your “Why?”

5. Visualize Your Success

6. Make the Decision – Make the Commitment

Causes

Causes of Weight Gain

1. Genetics

2. Engineered “Hyper palatable” Junk Foods

3. Food Addiction

4. Aggressive Marketing (Especially Towards Children)

5. Insulin

6. Certain Medications

7. Leptin

8. Food Availability

9. Sugar

10. Misinformation

FITNESS LEVEL: BEGINNER TO ADVANCED WORKOUT PLANS

How to Set a Caloric Deficit for Fat Loss

The Top 4 Ways You Can Set a Caloric Deficit

How Different Size Deficits Affect Your Body

Large Calorie Deficit = >25% Below Maintenance

Medium Calorie Deficit = 15-25% Below Maintenance

Small Calorie Deficit = <15% Below Maintenance

What is a health check?

Why are health checks important?

1. Balance

2. Nutrient Timing

3. Self-Monitoring

4. Selective Restrictions

5. Low Caloric Density

6. Consistency

7. Motivation

Finding the Perfect Fit

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