Obesity

Are You Getting Enough Grains?

Around the world, breads and grain products are a staple in the diet of many cultures. Breads and grains have been adapted regionally, taking into account ethnic, racial, cultural, and religious beliefs. The form, texture, and taste of grains and breads vary based on the diversity of the culture and where it is prepared.

Barley, rye, and oats can be used alone or mixed with wheat flour. Depending on the region and culture of the area, potatoes, squash, pumpkin, lentils, beans, corn, and/or rice may be prepared as a grist (meal) and used instead of flour. The cooking methods can include baking, frying, grilling, and steaming. In addition, breads and grains can be eaten hot or cold.

Breads and grains that are from around the world can add variety to your meals. Many are good sources of fiber, too. Any additional ingredients such as toppings, sauces, herbs, spices, sweeteners, fruits, vegetables, meats, fats, oil or additional condiments, may add calories to the grain or bread product.

How do you include new kinds of breads and grains into your meal plan?

Many different breads and grains can be found in the meal-planning guide Choose Your Foods – Exchange Lists for Meal Planning. A carbohydrate (carb) choice is a unit of measurement that helps to determine the amount of carbs you are eating. One carb choice equals 15 grams of carbs. For example, one carb choice of rice equals 1/3 cup brown rice. If you eat 1 cup of brown rice, the total amount of carbs is 45 grams. Many different breads and grains are listed below.

You can also look on the food label or bulk bin for the nutrition fact panel to discover how many carbs are in the new bread or grain. Find the amount of Total Carbohydrates listed in grams. Also, look for the serving size. Remember, the portion you eat may be larger than the portion listed on the nutrition label. Measuring your portions of starchy foods every so often can help you to find out “how much” of carbs you are actually eating.

The following are examples of one (1) carb choice of starch from various cultural/ethnic foods:

The following are examples of one (1) carb choice and are also very good sources of fiber and plant-based protein:

The following are examples of bread and starchy foods that equal one (1) carb choice, as well as some additional fat:

Most people need at least six servings every day. Younger and more active people may need 9-11 servings. Give some thought to what you add to or put on these foods if you are concerned about the amount of calories and/or fat in your diet.

The following is an example of what happens to calories by the addition of jam, and then jam and butter to more typical frybread serving of the whole piece:

Dr. Eric A. Orzeck is in the private practice of endocrinology in Houston, Texas. He is a fellow of the American College of Endocrinology and a fellow of the American College of Physicians. Dr. Orzeck has been a certified diabetes educator since 1989 and has served on the Board of Directors of The National Certification Board for Diabetes Educators. He is currently on the Board of Directors of AACE and is Chair of the AACE Socioeconomics & Member Advocacy Committee.

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Supplements and Weight Loss: Are There Natural Ways to Lose Weight?

Who does not want to shed some pounds? But, it’s so difficult! It’s not rare to hear the question as to whether “something out there” could help with the weight loss. People want something “natural.” Often this means not using prescription pills or having surgery. Let me share with you the advice I share with those who come to see me.

First, if you are overweight or obese, you will have to make some changes. To lose fat weight, you have to eat fewer calories, or burn more calories, or both. And you have to sustain this over time, which is the hard part. No matter what else you do, you always have to return to this basic rule.

Weight loss can be supported in many ways. Appetite can be suppressed, more calories can be burned by stimulating metabolism, or digestion can be inhibited to decrease how many calories are absorbed by the body. All of these methods also can be combined.

So, what is out there to consider using? Well, there are many claims but much less science to support that any of these really do what they are “advertised” to do. You are your own experiment. Be careful in your choices because you do not want the risks of a supplement to outweigh any benefits. And, watch the cost! These can be expensive and hurt your personal finances.

Here are some of the products you may find in your quest for “natural” weight-loss treatments.

APPETITE SUPPRESSANTS
Anti-depressant medications that increase a substance called serotonin [ser-o-TONE-in] in the brain can sometimes cause weight loss. St. John’s Wort and 5-HTP work the same way. 5-HTP decreases carb (sugar and starch) intake, causes early fullness, and helps weight loss in the short term. The same holds true for St. John’s Wort. However, we only have people’s reports of the effectiveness of those two agents. There is no evidence of long-term benefit in managing obesity with those agents.

Hoodia grows in the Kalahari Desert. The San Bushmen eat Hoodia to keep hunger away during long hunts. The precise way that Hoodia works is not known, but like 5-HTP and St. John’s wort, it helps make you feel full sooner. Here’s what I tell my patients: if they walk as much as a San Bushman does when he is hunting, then Hoodia will probably help the weight-loss process!

THERMOGENIC (CALORIE -BURNING ) AGENTS
Wouldn’t it be nice if you could increase your metabolism [meh-TAB-o-liz-um] so you could burn more calories without having to be more physically active? That is what thermogenic agents are supposed to do. These are known as “fat-burning” agents. Have you heard of an “adrenaline [uh-DREN-uh-lin] rush”? This is what you get when you have to fight or run away. Adrenaline is a hormone and it gets your metabolism going. When you have an “adrenaline rush” your heart beats faster, you get shaky, you are more alert, and you release energy from your body stores. An “adrenaline rush” causes a thermogenic effect – it increases your body heat. Adrenaline is also called epinephrine [eh-pi-NEPHrin].
Norepinephrine [NOR-eh-pi-NEPH-rin], which is like epinephrine, decreases appetite.

Ephedrine [eh-FEH-drin] is a thermogenic agent. It is often combined with caffeine. Ephedrine decreases the breakdown of norepinephrine at the nerve endings. Neither ephedrine nor caffeine alone does much to help weight loss. However, when combined, ephedrine and caffeine do cause weight loss.

Ephedra [eh-FEH-druh], also known as ma huang [ma hwong], was often used in the past to help people with weight loss. The ephedra plant naturally contains ephedrine, pseudoephedrine [soo-doh-eh-FEH-drin], and phenylpropanolamine [fen-ul-pro-puh-NA-lameen], which are sold as medications. Ephedra is no longer a good option. In 2004, the US Food and Drug Administration (FDA) banned ephedra products because they were linked with serious or fatal side effects. Unfortunately, ephedra products are still around in the black market.

With ephedra gone, bitter orange is now popular. Bitter orange contains 1% to 6% synephrine [sih-NEF-reen]. Synephrine may cause weight loss because it is similar in its effects to ephedra. This means that bitter orange has the same potential for harm as ephedra. In fact, bitter orange supplements have been linked to stroke and heart damage, cardiac arrest, loss of consciousness, chest pain, and death.

Thermogenic products have chemicals that may seriously affect your health. If you have hypertension or known heart disease, stay away from them. Otherwise, make sure you are under the care of a doctor who may monitor your blood pressure and heart health.

One last word on thermogenic agents: caffeine sources include not just coffee, but also guarana [gwa-ra- NAH], cola nut, maté, and tea extract. Claims that these natural products cause significant weight loss are untrue. The very best way of increasing fat burning (thermogenesis) is to become more physically active on a regular basis.

DIGESTION INHIBITORS
Foods that contain fiber stretch the stomach and get digestion started. This causes fullness and may also cause the gut to absorb less of food. Psyllium [SILL-i-um] seeds, barley, and guar gum are some examples of natural products tried for weight loss. High-fiber foods decrease fat being absorbed by binding fats within he gut. Upping fiber intake lowers serum cholesterol [ko-LESS-tuh-roll] and triglyceride [try-GLIS-er-ide] levels. The effects on weight loss, however, vary.

The flip side of digestion inhibitors is that they may keep your prescription medications from being properly absorbed. If you use digestion inhibitors, be sure to take your medications one hour before or two hours after taking the high-fiber product.

OTHER AGENTS THAT MAY AID WEIGHT LOSS
There are several other natural products that are marketed for weight loss. These include:

Glucomannan [gloo-ko-MAN-nen], which is extracted from the konjac [KOHN-yak] plant.
Guggul [GOO-gul], which produces a gummy resin that is used in supplements.
Inulin, which is a sugar that comes from chicory.
Conjugated linoleic [lin-oh-LAY-ik] acid, which is found mainly in dairy products and beef.
Calcium in foods, because adults and children with low calcium intake are more likely to gain weight, have a higher body mass index (BMI), and be overweight or obese, compared with people with higher calcium intake.
7-keto-DHEA, which comes from the hormone DHEA and may boost basal metabolism and thermogenesis. As opposed to DHEA, 7-keto-DHEA is not converted to sex hormones, so it may be safer in this form.
Garcinia [gar-SIN-ee-uh] fruit and rind extracts, which contain up to 50% hydroxycitric [hy-drox-ee-SIH-trik] acid.
Chromium, which is an element found in nature that people use for high cholesterol, diabetes, and obesity.
Pyruvate [pie-ROO-vate], which taken in large amounts (22-44 grams) instead of carbs, may cause weight loss. The problem here is that pyruvate causes significant side effects in the gut, including diarrhea, bloating, and flatulence.
“African mango” or “bush mango,” which is a tree from Africa that produces a mango-like fruit. The seeds have high fiber content and function as a bulk-forming laxative.

MAKE IT COUNT!
When it comes to supplements, there is a lot of marketing, but little science. Here is the most natural way of losing weight that I know of, and what I tell my patients to do. There is actual science behind these recommendations. Counting is the key and these tips are brought to you courtesy of the numbers “2” and “10.”

“2”: Every hour on the hour during the waking hours of the day, get up and walk away for a minute. Then walk right back to what you were doing. These two minute walks add up to a 30-minute walk at the end of the day. When you are home at night, turn the TV on. At the beginning of every commercial break get up, and go up and down two flights of stairs. If you have the TV on two hours every night, then every night you will climb a 40-story tall building!
“10”: Aim for 10 servings of fresh fruits or vegetables every day. One serving is the size of a measuring cup. Eat two servings with breakfast, lunch, and supper. And eat one serving mid-morning, mid-afternoon and in the evening. You choose when to have the last serving. Increasing the amount of fresh fruits and vegetables in the meal plan does indeed help you lose weight! Just make sure these are fruits that have high fiber such as berries, apples, or cantaloupe, and if you have diabetes or prediabetes, check with your doctor to see what fruits and vegetables to avoid.

These recommendations help establish the building blocks to good health, which are healthy eating and physical activity.

Dr. J. Michael González-Campoy is an endocrinologist in private practice in Eagan, MN. He is a bariatric endocrinologist, and created this term to help the medical community understand that obesity is an endocrine disease. Dr. González-Campoy is a member of the American College of Endocrinology Board of Trustees.

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In the News: What Doctors Say about Obesity and Guidelines for your Health

In the News!

Doctors Say Obesity Is a Disease

In July 2011, the American Association of Clinical Endocrinologists [en-doh-krih-NOL-uh-jists] (AACE) declared obesity as a disease state. The Association believes that, by stating obesity is a disease, better treatments will be developed to help the 34% of Americans who have obesity. According to the Centers for Disease Control and Prevention (CDC), more than one-third of all Americans are obese, including 12.5 million children and teenagers, ages 2-19. Being obese means you have a body mass index over 30. Obesity is the second leading cause of death that can be prevented in the United States. Obesity costs the medical system around $147 billion dollars every year.

Guidelines for Your Health!

This just in: AACE has been hard at work developing management guidelines for a number of conditions. These include diabetes, hyperthyroidism [hye-per-THIGH-roi-diz-uhm], and acromegaly [a-kro-MEH-ga-lee]. Here’s what you need to know about these guidelines.

DIABETES CARE PLAN
In April 2011, AACE published guidelines for developing a comprehensive care plan for diabetes. These individual treatment plans are recommended and goals should be tailored to the patient based on how long they have had diabetes, what other diseases they have, how long they are expected to live, and how safe the treatment will be for them. The guidelines are written by leading diabetes experts. They answer a series of questions, which enables doctors and nurses to easily find the information they need. Many of the important topics are covered, including care for patients with type 1 and type 2 diabetes, prediabetes, diabetes in children, teenagers, and pregnant women, and inpatient care. Use of newer technologies like insulin pumps and continuous glucose monitoring (CGM) is also covered, as are less familiar topics such as sleep and breathing disturbances and depression.

HYPERTHYROIDISM AND OTHER CAUSES OF THYROTOXICOSIS [THIGH-RO-TOK-SI-KO-SIS]
In June 2011, AACE published new clinical guidelines for care of patients with hyperthyroidism, a condition when the thyroid gland produces more thyroid hormone than the body needs, which affects about 1% of Americans. The guidelines, developed jointly by AACE and the American Thyroid Association (ATA), include key updates, which involve the treatment of Graves’ disease. This condition, which may cause the eyes to bulge, is the most common form of hyperthyroidism. The guidelines also present new approaches to managing Graves’ eye disease; treating mild or early forms of hyperthyroidism; and preferred drugs for hyperthyroidism.

CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF ACROMEGALY [A-KRO-MEH-GA-LEE]
In August 2011, AACE released updated guidelines for the diagnosis and treatment of acromegaly, a condition often associated with gigantism [jy-GAN-tizm]. This is the result of an overactive pituitary [pi-TOO-i-ter-ee] gland producing excess growth hormone. The new guidelines offer the latest treatments for acromegaly, and a pathway for doctors to follow when designing a treatment plan.

For more information about these news stories and guidelines, visit www.aace.com. Stay tuned!

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Treatment for Nutrition Conditions

TREATMENT
The days of the four basic food groups - dairy, meat, vegetables and fruit - are long gone. Today, a healthy diet encompasses a far wider range of options and includes whole grains, legumes, seeds and nuts, fish and even plant oils such as olive oil. Add in ethnic, religious, cultural and personal preferences and there are more options than ever before when planning healthy meals and snacks.

A Healthy Eating Plan

A healthy eating plan can be illustrated in many ways, but guidelines for choosing foods are widely represented in various food pyramids. These pyramids reflect the general principles of healthy eating but allow for different food choices. The triangular shape of the pyramid helps to focus on selecting healthy foods. Most foods should be chosen from the lower half of the pyramid, and foods to eat in smaller amounts or less frequently are shown farther up the pyramid. A pyramid familiar to most Americans is the Food Guide Pyramid, established by the United States Department of Agriculture (USDA) and the Department of Health and Human Services in 1992. The Food Guide Pyramid has since been replaced with MyPyramid, a new symbol and interactive food guidance system that provides a more personalized eating plan based upon age, gender and daily physical activity. Many other pyramids exist, and include the Asian, Latin American and Mediterranean diet pyramids, the Mayo Clinic Healthy Weight Pyramid, and the Vegetarian Diet Pyramid. The lower number of servings in each food group is based on 1,200 calories and the higher number is based on 2,000 calories. If you exercise regularly and aren't overweight, you may need more calories. Diet Planning. Here are a few simple practices for a healthy diet plan.

Choose a variety of foods from each major food group to ensure intake of adequate amounts of calories, protein, vitamins, minerals and fiber. Choosing a wide range of foods also helps to make meals and snacks more interesting.
Adapt the meal plan to meet specific tastes and preferences. For example, a serving of grains doesn't only mean a slice of wheat bread. It can be wild rice, whole-wheat pasta, grits, bulgur, cornmeal muffins or even popcorn.
Combine foods from different major groups. For example, create a meal of (1) tortillas (grain group) and beans (meat and beans group), or (2) fish topped with fruit salsa served with steamed vegetables over pasta.
Select meals and snacks wisely and chose nutrient-rich foods within each group. For example, in the setting of lactose intolerance, choose foods from other groups that are good sources of the nutrients found in dairy products.

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When Sugar Management Goes Away

Digestible carbohydrates are broken down in the intestine into their simplest form, sugar, which then enters the bloodstream as glucose. Insulin is a hormone secreted from the pancreas in response to the rising blood glucose, and helps lower blood glucose by depositing it into body cells for energy or storage. In some people, this cycle doesn't work properly. People with type-1 diabetes do not make enough insulin to respond to the rising blood glucose. Individuals with type-2 diabetes have tissue cell insulin resistance, which prevents lowering of the blood glucose. Genetic makeup, a sedentary lifestyle, being overweight, and eating an unhealthy diet can all promote insulin resistance. Data from the Insulin Resistance Atherosclerosis Study suggests that substituting whole grains for refined grains in the diet can improve insulin sensitivity. Carbohydrates and the Glycemic Index. The glycemic index, measures how fast and how high blood sugar rises after eating food that contains carbohydrates. White bread, for example, is digested almost immediately to sugar and causes the blood glucose to rise rapidly, and thus is classified as having a high glycemic index. Brown rice is digested more slowly to sugar, has a low glycemic index, and results in a lower and more sustained rise in blood glucose. Diets rich in high-glycemic-index foods have been linked to an increased risk for both diabetes and heart disease. Conversely, lower glycemic index foods have been shown to help control type-2 diabetes.

High glycemic index foods include sugar, potatoes, and refined foods such as white bread, white rice, white spaghetti and cereals (i.e., Corn Flakes, Cheerios).
Low glycemic index foods include legumes, whole fruits, oats, bran, and whole-grain cereals.

One of the most important factors that determine a food's glycemic index is how highly processed its carbohydrates are. Processing carbohydrates removes the fiber-rich outer bran and the vitamin-rich and mineral-rich inner germ, leaving mostly the starchy endosperm. Finely ground grain is more rapidly digested, and has a higher glycemic index than coarsely ground grain. Other factors that influence how quickly the carbohydrates in food are digested, release sugar and raise glucose include:

Fiber content. Fiber protects the starchy carbohydrates in food from rapid digestion, slowing the release of carbohydrate sugar molecules into the bloodstream.
Ripeness. Ripe fruits and vegetables tend to have more sugar than unripe ones, and therefore tend to have a higher glycemic index.
Type of starch. Starch comes in many different (linear and branched) forms, and some release sugar molecules more easily than others. The starch in potatoes, for example, is digested and absorbed into the bloodstream relatively quickly.
Fat and acid content. The more fat or acid a food contains, the slower its carbohydrates are converted to sugar and absorbed into the bloodstream.

There is one important item that is not disclosed in a food's glycemic index: the relative amount of carbohydrate in a given food. For example; watermelon is a sweet-tasting fruit with a high glycemic index. However, a slice of watermelon has only a small amount of carbohydrate per serving and (as the name suggests) is made up mostly of water. Thus, the glycemic index alone may not tell us everything about a food's impact on blood sugar (glucose) levels. A new classification of food, called the glycemic load, takes into account both the amount of carbohydrate in the food and the impact that carbohydrate has on the blood glucose level. A food's glycemic load is determined by multiplying its glycemic index by the amount of carbohydrate it contains. Although seemingly complicated, the basic message is simple: whenever possible, replace highly processed grains, cereals and sugars with minimally processed whole-grain products. hide

Health Effects of Eating Fiber

Fiber appears to reduce the risk of developing various conditions, including heart disease, diabetes, colon diverticular disease and constipation. However, fiber may have little, if any, effect on preventing colon cancer.

Fiber and colon cancer. Well designed studies have failed to show a link between fiber and prevention of colon cancer. One of these - a Harvard study - followed over 80,000 female nurses for 16 years and found that dietary fiber was not strongly associated with a reduced risk for either colon cancer or colon polyps (a precursor to colon cancer).

Fiber and heart disease. Dietary fiber intake has been linked to a lower risk of heart disease in a number of large studies. In one study - a Harvard study of over 40,000 male health professionals - a high total dietary fiber intake was associated with a 40% lower risk of coronary heart disease. Cereal fiber seemed particularly beneficial. A related Harvard study of female nurses produced similar findings.

Fiber and type 2 diabetes. Type 2 diabetes is the most common form of diabetes. It is characterized by sustained high blood sugar (glucose) levels and resistance to the effects of insulin to lower glucose. Harvard studies of male health professionals and female nurses both found that a diet low in cereal fiber and rich in high glycemic index foods more than doubled the risk of type 2 diabetes compared to a diet high in cereal fiber and low in high glycemic index foods. Fiber intake has also been linked with the metabolic syndrome, a constellation of factors that increases the chances of developing heart disease and diabetes. Factors of the metabolic syndrome include high blood pressure, high insulin levels and elevated blood glucose, excess weight (especially around the abdomen), high levels of triglycerides and low levels of HDL cholesterol. Several studies suggest that consuming a higher intake of fiber may help prevent metabolic syndrome and the risk for diabetes.

Fiber and diverticular disease. Diverticulitis is an inflammation of the intestine and is one of the most common age-related disorders of the colon. In North America, this painful disease is estimated to occur in one-third of individuals over age 45 and in two-thirds of those over age 85. Among male health professionals in a long-term follow-up study, eating dietary fiber, particularly insoluble fiber, was associated with about a 40% lower risk of diverticular disease.

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Fruits, Vegetables, and Health

There is compelling evidence that a diet rich in fruits and vegetables can lower blood pressure and cholesterol, and decrease the risk of heart disease and stroke. There is also data to suggest that eating fruits and vegetables likely provides protection against certain types of cancer.

Fruits and Vegetables and Cardiovascular Disease. The largest and longest study to date, done as part of the Harvard-based Nurses' Health Study and Health Professionals Follow-up Study, found that the higher the average daily intake of fruits and vegetables, the lower the chances of developing cardiovascular disease. This study included almost 110,000 men and women whose health and dietary habits were followed for 14 years. Compared with those in the lowest category of fruit and vegetable intake ( 8 servings a day were 30% less likely to have had a heart attack or stroke.

Fruits and Vegetables, Blood Pressure and Cholesterol. Hypertension is a primary risk factor for developing heart disease or stroke. One of the most convincing associations between diet therapy and lower blood pressure was found in the Dietary Approaches to Stop Hypertension (DASH) study. The study diet was rich in fruits, vegetables and low-fat dairy products and also restricted the amount of saturated and total fat consumed. The upper (systolic) blood pressure fell by about 11 mm Hg and the (lower) diastolic blood pressure declined by almost 6 mm Hg with diet therapy; decreases similar to that achieved by medications.

In the National Heart, Lung, and Blood Institute's Family Heart Study of 4,466 men and women, those with the highest consumption (> 4 servings/day) of fruits and vegetables had significantly lower levels of LDL cholesterol. Eating more fruits and vegetables can help lower cholesterol, but how this occurs is still unknown. It is possible that eating more fruits and vegetables (1) results in eating less meat and dairy products, and thus less cholesterol and saturated fat, and (2) soluble fiber in fruits and vegetables may help block the absorption of cholesterol ingested.

Fruits and Vegetables and Cancer. Numerous early case-control studies revealed what appeared to be a strong link between eating fruits and vegetables and protection against cancer. However, it is possible that these results may have been skewed by problems such as recall bias and selection bias. Data from cohort studies that follow large groups of initially healthy individuals for many years have not consistently shown that diets rich in fruits and vegetables prevents cancer. For example, the 14-year Nurses' Health Study and Health Professionals Follow-up Study reported men and women with the highest intake of fruits and vegetables (> 8 servings/day) were just as likely to have developed cancer as those who ate only 1.5 servings daily.

It may be possible that fruits and vegetables protect against certain types of cancer. The International Agency for Research on Cancer, of the World Health Organization, recently reported that there is limited evidence for a cancer-preventive effect of total consumption of fruit and vegetables for cancers of the mouth and pharynx, esophagus, stomach, colon-rectum, larynx, lung, ovary, bladder and kidney. The International Agency for Research on Cancer acknowledges that specific fruits and vegetables may also protect against certain types of cancer. For example, lycopene (red pigment) in tomatoes may help protect men against prostate cancer (Health Professionals Follow-up Study).
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Supplements

Are dietary supplements necessary in otherwise healthy adults? The answer depends on eating patterns, lifestyle habits, and other factors such as age. A standard multivitamin supplement doesn't come close to making up for an unhealthy diet. A multivitamin provides a dozen or so of the vitamins known to maintain health, a mere shadow of what's available from eating a healthy diet. However, there's good evidence that taking a daily multi-purpose vitamin may be reasonable even in otherwise healthy adults. A standard multivitamin can ensure the Recommended Daily Intake (RDI) of vitamins and minerals needed for health. Vitamin supplementation should not exceed more than 100% of the RDI value. Dietary supplements may be appropriate if any of the following exist:

Poor dietary habits. Many people don't receive all of the nutrients they need from their diet because they either cannot (or do not) eat enough, or an adequate variety, of healthy foods. Eating less than five total servings of fruits and vegetables daily may not provide all of the vitamins and minerals the body needs. Also, eating only once or twice a day may limit the number and variety of servings from the various food groups.
Consuming less than 1,200 calories a day. Low-calorie diets limit the types and amounts of foods, and nutrients, consumed. Unless monitored by a doctor, a low-calorie diet isn't usually recommended.
Vegetarian diets. Vegetarians may not consume enough calcium, iron, zinc, vitamin B-12 or vitamin D. However, these nutrients are naturally present in non-meat sources, such as fortified soy products, green leafy vegetables, legumes, whole-grain products and nuts.
Medical conditions affecting nutrient absorption. Food allergies or intolerance (such as protein or dairy products) may limit nutrient intake. Diseases of the liver, gallbladder, intestines or pancreas may cause malabsorption or maldigestion of nutrients.
Postmenopausal women. After menopause, women are at an increased risk of bone loss due to estrogen deficiency. Postmenopausal women should ingest 1000-1500 milligrams elemental calcium in divided doses daily. Vitamin D guidelines are 400 international units (IU) for young postmenopausal women, 600 IU for women over 70 years, and 800 IU in the setting of osteoporosis.
Heavy menstrual bleeding. Additional iron may be needed to treat anemia and replace iron depleted by blood loss.
Pregnancy. Requirements for calcium, folate and iron all increase during pregnancy. Folate is needed very early in pregnancy to help protect the baby against neural tube birth defects, such as incomplete closure of the spine (spina bifida). Iron can help prevent fatigue by treating iron deficiency anemia. The National Academy of Sciences recommends 1000 mg/day elemental calcium for women 19-50 years and lactating women. It's important to take these supplements during planning of pregnancy, before becoming pregnant.
Smoking. Tobacco decreases the absorption of many vitamins and minerals, including vitamin C, folate, magnesium and calcium. Dietary supplements won't make up for the major health risks caused by smoking, and it is safest to avoid all tobacco products.
Excessive alcohol intake. Long-term excessive alcohol intake, as a substitute for food calories, may result in a diet lacking in essential nutrients. Excessive drinking is defined as more than two drinks a day for men and more than one drink a day for women. Taking dietary supplements will not make up for the major health risks caused by excessive alcohol consumption.
Choosing and using supplements. There are upper limits for intake of vitamins and minerals, and more is definitely not always better. Randomized trials of vitamin C, vitamin E, and beta-carotene have not revealed much in the way of protection from heart disease, cancer or age-related eye diseases. In addition, over consumption of one vitamin has the potential to mask a deficiency of another. For instance, (1) if excess folic acid is taken, it can mask a vitamin B12 deficiency, and (2) excess zinc supplementation can lead to a deficiency in copper and can cause problems with red or white blood cell production. When taking a vitamin or mineral supplement, consider these factors:
Look for “USP” on the label. This ensures that the supplement meets the standards for strength, purity, disintegration and dissolution established by the testing organization U.S. Pharmacopeia (USP).
Read labels carefully. Product labels list the serving size, and the active ingredients and nutrients per serving (for example, capsule, packet or teaspoonful).
Avoid supplements that provide “megadoses” of individual vitamins or minerals. In general, choose a brand name multivitamin-mineral supplement (i.e., Centrum, One-A-Day, or others) that provides about 100% of the Daily Value (DV) of all the vitamins and minerals. The exception to this is calcium as most calcium-containing vitamin supplements don't provide 100% of the DV for calcium.

Beware of gimmicks. Synthetic vitamins are usually the same as so-called "natural" vitamins, but "natural" vitamins usually cost more. Added herbs, enzymes or amino acids mostly add only cost, and some herbs can interact negatively with certain prescribed medications.

References
http://mayoclinic.com/health/HealthyLivingIndex/HealthyLivingIndex/ (mayo clinic)
http://www.hsph.harvard.edu/nutritionsource/index.html (harvard school of public health)
http://www.glycemicindex.com (glycemic index)
http://mypyamid.gov (government pyramid)
http://nccam.nih.gov (national center for complementary and alternative medicine)

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Nutrition Conditons

Conditions

There are a few prominent conditions related to having unbalanced nutrition, which are described in detail below.

Not Enough Fiber

Fiber refers to carbohydrates that cannot be completely digested. Fiber is present in all edible plants to include fruits, vegetables, grains and legumes. However, not all fiber is the same. One way to categorize fiber is by its source of origin. For example, fiber from grains is referred to as cereal fiber. Another way to categorize fiber is by how easily it dissolves in water. Soluble fiber partially dissolves in water whereas insoluble fiber does not dissolve in water. These differences are important in understanding fiber's effect on the risk of developing certain diseases.

Soluble Fiber

Insoluble Fiber

Oatmeal
Oatbran
Nuts and seeds
Legumes

Beans
Dried peas
Lentils

Fruit

Apples
Blueberries
Pears
Strawberries

Whole grains

Whole wheat breads
Barley
Brown rice
Couscous

Whole-grain breakfast cereals
Wheat bran
Vegetables

Carrots
Celery
Cucumbers
Tomatoes
Zucchini

Fiber adds bulk to the diet and creates a sense of satiety (feeling “full” faster) and helps to control body weight. Fiber also aides in digestion and helps prevent constipation. Current recommendations suggest that adults should consume 21-38 grams of dietary fiber daily, depending on age and gender. Children aged 1 and older should consume at least 19 grams of fiber daily. The average American adult eats only 15 grams of dietary fiber a day. The following ideas may help to increase dietary fiber:

Eat at least 4 to 5 cups of fruits and vegetables each day. Fruits that are high in fiber include apples, oranges, berries, pears, figs and prunes. Vegetables that are high in fiber include broccoli, cauliflower, brussel sprouts, green peas, carrots and beans
Replace white bread with whole-grain breads and cereals. Eat brown rice instead of white rice. Eat more bran muffins, oatmeal, multiple-grain cereals (cooked or dry), brown rice, 100% whole-wheat bread and popcorn.
Check labels on food packages for the amounts of dietary fiber, as some foods/brands may have less fiber than you think.

Fiber may cause abdominal bloating, cramping or flatus (gas). These symptoms can be prevented by making small changes in dietary fiber intake over a period of time. Start with one of the changes listed above, then wait several days to a week before making another. Drink more fluid (nine 8 ounce glasses daily for women, and twelve 8 ounce glasses daily for men) as liquids help to digest fiber.

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Too Much Salt (Sodium)

About 11% of the sodium in an average American diet comes from adding salt (or sodium-containing condiments) to foods while cooking or eating. However, 77% of sodium consumed comes from eating prepared or processed foods that contain salt.
The kidneys regulate the amount of sodium in the body. If the kidneys cannot eliminate excess sodium, it accumulates in the blood, attracts and holds water, and increases blood volume and blood pressure which increases the work on the heart. Certain diseases such as congestive heart failure, cirrhosis of the liver and chronic kidney disease can retain sodium in the body. Individuals older than 50 years of age, African-Americans, or those with a health condition such as hypertension, chronic kidney disease or diabetes may be more sensitive to the blood pressure effects of sodium. The National Academy of Sciences' Institute of Medicine has published recommendations for daily sodium intake between 1500 and 2400 milligrams (mg) daily for healthy adults. The following may also help to control sodium intake:

Eat more fresh foods and fewer processed foods. Most fresh fruits and vegetables are naturally low in sodium. Fresh meat is lower in sodium than luncheon meat, bacon, hot dogs, sausage and ham.
Read labels. Remove salt from recipes whenever possible. Leave out the salt in many recipes, including casseroles, stews and other main dishes. (Baked goods are an exception, as leaving out salt may affect the quality and taste of the food.)
Limit the use of condiments high in salt content. Salad dressings, sauces, dips, ketchup, mustard and relish all contain sodium.
Use herbs, spices and other flavorings to enhance foods. Use salt substitutes wisely. Some salt substitutes contain a mixture of sodium and other compounds, and using too much salt substitute may not reduce sodium intake. In addition, many salt substitutes contain potassium that may be harmful if one has kidney problems, heart failure or is taking medication that retains potassium.

The taste for salt is acquired, so it's also reversible. Decreasing salt intake gradually allows the taste buds to adjust to a lower salt diet.
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Pregnant with Diabetes

It is estimated that 8% of all pregnancies are complicated by diabetes. Approximately, 60% of these cases represent gestational diabetes (GDM), 30% type 2 diabetes and 10% type 1 diabetes. The estimated total number of pregnant women per year in the United States who have diabetes is up to 400,000 per year. Early diagnosis and maintenance of normoglycemia (normal blood sugar) during pregnancy dramatically reduces the risk of congenital birth defects, large for birth infants (macrosomia), birth related trauma and a host of other possible complications.

For these reasons, all pregnant patients should be tested for diabetes. Once the screening tests are completed, patients can then be educated in a proper balanced meal plan. The following guidelines are recommended for diabetes screening during pregnancy.

Positive family history (parents, siblings, and children)
Previous gestational diabetes
Previous premature infant or unexplained stillbirth
Prior large for birth ( ≥ infant with congenital anomaly
Prior infant >/ = 4000 grams or ≥ 9 lbs)
Poor reproductive history (infertility) or recurrent spontaneous abortions.
Overweight (BMI > 25) or obese (BMI > 30)
Elevated blood pressure or hypertension
Glucosuria

If the GCT test results are abnormal, (> 130 mg/dl) initiate the GDM diet and Home Glucose Monitoring (HGM) immediately.

Home Glucose Monitoring (HGM) and Diet can help manage glucose levels during antepartum, the time of pregnancy between conception and onset of labor. HGM is performed by checking a finger stick blood glucose at morning fasting, (before breakfast), before (AC) and one hour post (PC) every meal. Glucose goals for HGM are as follows:

Fasting and AC = 90 mg/dl
PC glucose, 1-hour after the first bite of meal, ≤ 120 mg/dl

The goals of nutrition therapy during GDM to promote fetal well-being are to achieve normoglycemia, prevent ketosis and provide adequate weigh gain. Seek counsel from a registered dietician or use the Nutrition Jump Start teaching tool. You will then be able to identify the food that should be avoided and those that can be eaten to satiety.

Also, keep in mind the following calorie and BMI ratios:

30 Kcal/kg of present pregnancy body weight if the women’s pregnancy BMI is 19 to 24
24 Kcal/kg if her BMI is 24-29
18 Kcal/kg if her BMI is greater than 30
40 Kcal/kg if her BMI is less than 12

Patients should eat three daily meals with calorie distribution as 30% protein, 40% fat. Snacking should be de-emphasized and used only to abate hunger. Snacks are advised if unexpected low blood sugars occur during daily administration of insulin, but planned daily snacking should never be used to compensate for poor insulin placed on consistency of diet, exercise, and monitoring of glucose to achieve blood glucose control and appropriate weight gain during pregnancy.

For women with, “Low-Risk Diet Controlled GDM,” defined as meeting the home glucose monitoring (HGM) goals outlined above, the following is recommended:

Diabetes diet and home glucose monitoring throughout pregnancy.
Doctor office visits in high-risk clinic 2 weeks until 34 weeks gestation; then weekly.
Begin antepartum surveillance at 39-40 weeks with biweekly nonstress testing of the fetus.
Consider delivery by 40 weeks gestation or sooner for macrosomia (estimated Birth Weight > 4000 grams) or other maternal or fetal indications.

If the patient is at “high risk GDM” during antepartum when HGM goals are not met, Insulin Requiring GDM/Type 1 or Type 2 Diabetes, the following insulin therapy should be initiated:

Gestational Age:
6 – 12 weeks 0.7 U/kg day
12 – 28 weeks 0.8 U/kg day
28 – 36 weeks 0.9 U/kg day
36 – 40 weeks 1.0 U/kg day

Insulin should be prescribed such that 50% of the total daily dose is the basal insulin dosage and 50% is meal-related insulin dosage. The insulin analogs aspart and lispro have clinical trials that prove they are safe in pregnancy. To date there are not clinical trials in pregnancy for the long acting insulin detemir and glargine. The basal insulin needs to be given either with a continuous infusion pump or as three doses of NPH spaced 8 hours apart.

High risk patients should also schedule weekly visits with their obstetrician, ensure co-management occurs with their endocrinologist, and schedule early ultrasound scans to establish dates. The upper level ultrasound scan should be conducted at 20-22 weeks gestation with fetal echocardiogram, growth scan at 4 weeks and scans for EFW as indicated. Antepartum surveillance should begin at 34 weeks and include biweekly NSTS and weekly AFIs. Earlier testing will be indicated by associated maternal and fetal conditions. Delivery should occur no later than 40 weeks. An earlier delivery should be considered if pulmonary maternity is established or maternal or fetal indications are present. If induction or scheduled Cesarian Section is needed, patients should take bedtime insulin the night before admission, fast in the morning, and do not take insulin the morning of admission.

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Nutrition: Micronutrients

What are Micronutrients?

Vitamins and minerals are substances the body needs in small but steady amounts for normal growth, function and health. Together, vitamins and minerals are called micronutrients. The body cannot make most micronutrients, so it must get them from foods or dietary supplements.

Vitamins

Vitamins must be absorbed from food because the body cannot make them. The body only needs small amounts of vitamins (that's why they are referred to as micronutrients) and uses them without breaking them down. Vitamins are needed for a variety of body functions to include muscle and skeletal health, food digestion and nerve function. Vitamins are involved in many bodily processes that use carbohydrates, fats and proteins for energy and repair.

There are thirteen compounds classified as vitamins. Vitamins A, D, E and K are fat-soluble vitamins. They accumulate in the body and have a long body retention time. Vitamin C and the eight B vitamins (biotin, folate, niacin, pantothenic acid, riboflavin, thiamin, vitamin B6, and vitamin B12) are water-soluble. They do not accumulate in the body because excess amounts consumed are readily excreted by the kidney. Vitamins are labeled by "letter" or name, and some common vitamins include:
Vitamin A = retinol, retinaldehyde, retinoic acid
Vitamin B1 = thiamin
Vitamin B2 = riboflavin
Vitamin B3 = niacin, nicotinic acid
Vitamin B12 = cobalamin
Vitamin C = ascorbic acid
Vitamin D = calciferol
Vitamin E = tocopherol, tocotrienol
Vitamin K = phylloquinone

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Minerals

These micronutrients include calcium, magnesium and phosphorus. They are the main components in teeth and bones and also serve as building blocks for all cells, help regulate body fluids, and are involved in nerve impulses and muscle function.

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Food labels

If you eat a healthy diet, do you need to take vitamins? Not long ago, the answer from most experts would have been a resounding "no.” The reason was that by eating a well balanced variety of foods one more than likely would consume all of the vitamins and minerals needed for health. Nutritious eating includes:
• Eating a variety of foods, including vegetables, fruits and whole-grain products.
• Eating lean meats, poultry, fish, beans and low-fat dairy products.
• Limiting consumption of salt, sugar, alcohol, saturated fats and trans fats.
• Reading food labels to ensure a healthy diet.
One model for a “balanced” and nutritious meal would be to use the "plate method" for planning food portions:
• 50 percent as assorted vegetables
• 25 percent as protein
• 25 percent as whole grains (e.g., brown rice)
• One fruit
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Vitamin deficiencies

Fat soluble vitamins may be deficient in diseases of malabsorption such as Celiac disease (sprue), cystic fibrosis, chronic pancreatitis, inflammatory bowel disease or short bowel from multiple bowel resections. Water soluble vitamin deficiencies are uncommon, but may be seen in wasting states (cancer, HIV, etc.), or after gastric bypass surgery during rapid weight loss and non-compliance with vitamin intake. Vitamin and mineral deficiencies may cause the following signs or symptoms:
Vitamin A = difficulty seeing at night, xerophthalmia (corneal erosions and scarring), dry skin
Vitamin B1 = double vision (nystagmus, ophthalmoplegia), impaired gait, confusion, memory loss
Vitamin B2 = anemia, dermatitis, sore throat-mouth-tongue
Vitamin B3 = vomiting, hyperpigmented rash, diarrhea, disorientation-delusions-dementia
Vitamin B12 = anemia, abnormal gait and balance, impaired memory and irritability, dementia
Vitamin C = scurvy (poor wound healing, bleeding gums, petechiae, arthralgias, hyperkeratosis)
Vitamin D = osteomalacia or rickets (in children), bone loss, muscle weakness or spasm
Vitamin E = abnormal gait and balance, muscle weakness, neurologic abnormalities
Vitamin K = poor blood clotting, skin bruising

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Nutrition: Macronutrients

What are Macronutrients?

Macronutrients are defined as proteins, carbohydrates and fats. As a group, they provide the body with energy and help to maintain and regulate normal body functions. The average person should consume approximately 50% to 60% of their total daily calories as carbohydrate, 15% to 20% as protein and 30% as fat.

Proteins

Amino acids are the basic building blocks of protein, and provide the raw material for all proteins. Protein is present in every living cell in the body. Our bodies use protein from the foods we eat to help build and maintain bone, muscle and skin. Around the world, millions of people don't eat enough protein. Protein malnutrition leads to a condition known as kwashiorkor. Lack of protein can cause growth failure, loss of muscle mass, decreased immunity, weakening of the heart and respiratory system and death. In the United States and other industrialized countries, eating the minimum daily requirement of protein is not difficult to do.

Protein is present in meat, dairy products, nuts and certain grains and beans. Protein from meat and other animal products are called “complete” proteins. This means that they supply all of the amino acids the body cannot make on its own. Plant proteins are “incomplete,” which means the body must ingest many different plant proteins to get all of the amino acids it needs to stay healthy. Because the body doesn't store amino acids, as it does for fat and carbohydrate, it needs a daily supply of amino acids to make new protein. It is important to eat enough dietary protein for bodily health. Healthy adults need a daily estimate of 0.8 grams of protein for every kilogram of body weight to keep from slowly breaking down organ tissues. That's just over 7 grams of protein for every 20 pounds of body weight, or 50-65 grams of protein each day. This is the amount of protein present in four ounces of meat plus a cup of cottage cheese.

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Carbohydrates

Carbohydrates come in a variety of forms, but the most common and abundant are sugars, starches and fibers. The basic building block of carbohydrates is the sugar molecule, a simple union of carbon, hydrogen and oxygen molecules. Starches and fibers are essentially chains of sugar molecules. Some of these chains are straight and contain only a few sugars, while others branch wildly and contain hundreds of sugars. Carbohydrates come from a wide variety of foods such as bread, beans, milk, popcorn, potatoes, cookies, spaghetti, corn and fruit. Carbohydrates were once grouped into two main categories as follows:

Simple carbohydrates include sugars such as fruit sugar (fructose), corn or grape sugar (dextrose or glucose), and table sugar (sucrose).

Complex carbohydrates include everything made of three or more linked sugars.
Simple sugars were once considered bad and complex carbohydrates good, but the picture is much more complex. The digestive system handles all carbohydrates in much the same way by breaking them down (or trying to break them down) into single sugar molecules small enough to enter the bloodstream. It also converts most digestible carbohydrates into glucose (blood sugar) because body cells are designed to use glucose as a universal energy source. Fiber is a carbohydrate exception. Fiber is put together in such a way that it cannot be broken down into simple sugar molecules, and passes through the body partially undigested.

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Fats

Fats are also referred to as lipids, and are made up of monounsaturated fats, polyunsaturated fats, saturated fats and cholesterol. Fats are a major source of energy and are important for proper growth and development, especially for infants and toddlers. Fat assists in the taste of food, is important to absorb fat-soluble vitamins (A, D, E and K) and provides satiety or a sense of feeling “full.” However, not all fats are the same as there are good and bad dietary fats. What is becoming clear is that bad fats increase the risk for certain diseases while good fats lower the risk.

Good Fats. Some fats, called unsaturated fats, are good or healthy fats. Unsaturated fats are found in plant products such as vegetable oils, nuts and seeds. There are two types of unsaturated fats:

Polyunsaturated fats are found in high concentrations in sunflower, corn and soybean oils.
Monounsaturated fats are found in high concentrations in canola, peanut and olive oils.

Unsaturated fats are commonly used in the Mediterranean diet. In studies in which polyunsaturated and monounsaturated fats were eaten in place of carbohydrates, these good fats decreased bad (LDL) cholesterol levels and increased good (HDL) cholesterol levels.

Bad Fats. Saturated fats and trans fatty acids are bad fats because they tend to worsen blood cholesterol levels.

Saturated fats are mainly animal fats. They are found in meat, seafood, high-fat dairy products (cheese, whole milk and ice cream), poultry skin and egg yolks. Some plant foods are also high in saturated fats and include coconut, coconut oil, palm oil and palm kernel oil. Saturated fats raise total blood cholesterol levels more than dietary cholesterol because they increase both HDL and LDL cholesterol. The net effect is negative, meaning it's important to limit saturated fats in the diet.
Trans fatty acids are fats produced by heating liquid vegetable oils in the presence of hydrogen, a process called hydrogenation. The more hydrogenated an oil is, the harder it will be at room temperature. For example, a tub of spread margarine is less hydrogenated and has fewer trans fats than stick margarine.

Most of the trans fats in the American diet are found in commercially prepared baked goods, stick margarines, snack foods and processed foods. Commercially prepared fried foods, like French fries and onion rings, also contain trans fat.

It is important to limit dietary intake of saturated fats, but it is very important to eliminate trans fats from the diet. Trans fats are the worst fats for health because they raise LDL and lower HDL levels (compared to saturated fats that raise both LDL and HDL cholesterol). Trans fats have been implicated in the vascular disease of heart attacks, stroke and diabetes.

Cholesterol content of the diet is important, especially if one has diabetes, but it is the cholesterol level in the bloodstream that is most important for health risk. High blood cholesterol levels greatly increase the risk for heart disease. The liver is responsible for 75% of blood cholesterol, while only 25% is absorbed from food. The biggest influence of the diet on the blood cholesterol is the mix of fats that is consumed. The key is to substitute good fats for bad fats in the diet.

DIETARY FATS
Type of Fat	Food Sources	Form at Room Temperature	Effect on Blood LDL and HDL Cholesterol Levels
Monounsaturated	Olives, olive oil, canola oil, peanut oil, cashews, almonds, peanuts and most other nuts, avocados	Liquid	Lowers LDL Raises HDL
Polyunsaturated	Corn, soybean, safflower, cottonseed oils, fish	Liquid	Lowers LDL Raises HDL
Saturated	Whole milk, butter, solid shortening, lard, fatback ,cheese, ice cream, red meat, chocolate, coconuts, coconut milk, coconut oil	Solid	Raises both LDL and HDL
Trans	Most margarines, vegetable shortening, partially hydrogenated vegetable oil, deep-fried chips, many fast foods, most baked goods	Solid or semi-solid	Raises LDL

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Treatment for Obesity

TREATMENT

Developing a healthier lifestyle will be part of any treatment program for overweight, obesity, and also for any long-term complications from them. Success is based on meeting three treatment goals:

You do not gain any more weight – we are happy.
You lose 1 percent of your body weight per year – we are happier.
You lose 5 to 10 percent of your body weight in 6-12 months – we are happiest!

Consider that losing 1 percent of your body weight can reduce your risk of developing complications, such as Type 2 diabetes, by 11 percent.

Improving your lifestyle, focusing on better nutrition and increased physical activity alone, is appropriate if your BMI is 25 to 29 and you have no complications from the excess weight (co-morbidities). Nutrition and increased physical activity should always be a part of your management because they improve cardiovascular conditioning, and lower cardiovascular risk.

Medications, in addition to improving lifestyle, are indicated for a BMI of 27 or more, with two or more complications from obesity. Medications are also indicated if your BMI is 30 or more, regardless of whether complications are present or not.

Surgery, in addition to improving lifestyle and using medications, is indicated for a BMI of 35 or more, with two or more complications from obesity. Surgery is also indicated for a BMI of 40 or more regardless of whether complications are present or not.

Click here to view useful guidelines for these intervention

BMI	18.5-24.9	25-29.9	30-34.9	35-39.9	>40
Risk of complications	Very low	Mild	Moderate	High	Extreme
Nutrition	X	X	X	X	X
Physical Activity	X	X	X	X	X
Behavioral Management	X	X	X	X	X
Medication		X	X	X	X
Surgery				X	X

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What You Need to Know

These are some numbers for you to track as you take charge of your health:

BMI
Weight
Minutes spent engaged in physical activity/day
Daily servings of fruits/vegetables, proteins, and carbohydrates
Nutritional content of what you eat (read all food labels)
Step count (get a pedometer, or step counter)

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Additional Resources

American Dietetic Association – www.eatright.org
Centers for Disease Control and Prevention – www.cdc.gov and click on "Health Promotion"
Action for Healthy Kids – www.actionforhealthykids.org
America on the Move – www.americaonthemove.com

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Prevention for Obesity

Prevention

Healthy eating combined with an active lifestyle is the best way to prevent obesity. This means eating more fresh fruits and vegetables, and whole grains. It also means finding physical activities that you enjoy. Note that “diet” and “exercise” are not needed. Rather good nutrition and physical activity throughout the day, every day, work best.

The key word for healthy eating is moderation. And it’s important to know portion sizes. A convenient way to balance your nutrition properly is to fill half of your plate with fruits and vegetables. In the other two quarters, put a source of protein and a carbohydrate. In addition, try using a salad plate rather than a full-size dinner plate.

Here are some other examples of portion equivalents:

3 oz. of lean meat = a deck of cards
1 oz. of cheese = 4 stacked dice
1 medium apple = a tennis ball
1 cup of pasta or rice = a clenched fist
1 serving of pie = 1/8 of the pie

Be sure to eat three well-balanced meals every day, with breakfast being the biggest. Skipping meals actually lowers your metabolism because your body thinks you’re trying to starve it.

Developing a healthy lifestyle is something you and your family can and should do together. Prepare favorite recipes using more healthful ingredients. Try fruits and vegetables you’ve never eaten before. Follow some of the physical activities that you and your family enjoy. Ask for more healthy eating ideas the next time you see your endocrinologist or personal physician. Remember, each meal is an opportunity to eat better and each day is an opportunity to be more physically active.

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Conditions related to Obesity

Related Conditions

Psychiatric Disease
Depression

Clinical depression or major depressive disorder is a state of intense sadness, melancholia or despair, that has advanced to the point of being disruptive to an individual's social functioning and/or activities of daily living

Skin
Skin tags

Skins tags are small benign tumors that form primarily in areas where the skin forms creases, such as the neck, armpits and groin. They may also occur on the face, usually on the eyelids. They range in size from rice to golf ball size, although larger ones have been seen. Skin tags are harmless, although they are sometimes irritated by clothing or jewelry and can interfere with shaving and other routine grooming. Why and how skin tags form is not entirely known, but there are correlations with age and obesity.

Acanthosis

Acanthosis is increased thickness of the prickle cell layer of the skin.

Pulmonary Disease

Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive airway disease (COAD), is a group of diseases characterized by limitation of airflow in the airway that is not fully reversible. COPD is the umbrella term for chronic bronchitis, emphysema and a range of other disorders. It occurs most often due to tobacco smoking, but can be due to other airborne irritants such as coal dust, asbestos or solvents, as well as preserved meats containing nitrites

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is not only much more frequent than Central Sleep Apnea, it is a common condition in many parts of the world. If studied carefully in a sleep lab by polysomnography, approximately 1 in 5 American adults has at least mild OSA. Since the muscle tone of the body ordinarily relaxes during sleep, and since, at the level of the throat, the human airway is composed of walls of soft tissue, which can collapse, it is easy to understand why breathing can be obstructed during sleep - particularly in the obese. Although many individuals experience episodes of obstructive sleep apnea at some point in life, a much smaller percentage of people are afflicted with chronic severe obstructive sleep apnea.

Hypoventilation Syndrome

Congenital Central Hypoventilation Syndrome or primary alveolar hypoventilation, is a respiratory disorder that is fatal if untreated. Persons afflicted with Ondine's Curse classically suffer from respiratory arrest during sleep.

Liver and biliary tree

Steatosis

In cellular pathology, steatosis (also called fatty change) is the process describing the abnormal retention of lipids within a cell. It reflects an impairment of the normal processes of synthesis and breakdown of triglyceride fat. Excess lipid accumulates in vesicles that displace the cytoplasm. When the vesicles are large enough to distort the nucleus, the condition is known as macrovesicular steatosis, otherwise the condition is known as microvesicular steatosis. Whilst not particularly detrimental to the cell in mild cases, large accumulations can disrupt cell constituents, and in severe cases the cell may even burst.

Steatohepatitis

Steatohepatitis is a type of liver disease, characterized by inflammation of the liver with concurrent fat accumulation in liver ("steato", meaning fat, "hepatitis", meaning inflammation of the liver). Classically seen in alcoholics, steatohepatitis also is frequently found in people with diabetes and obesity. When not associated with excessive alcohol intake, it's referred to as "non-alcoholic steatohepatitis," or NASH. Steatohepatitis of either etiology may progress to cirrhosis, and NASH is now believed to be a frequent cause of unexplained cirrhosis (at least in Western societies). Recent studies suggest that diet, exercise, and especially antiglycemic drugs may alter the course of the disease.

Cirrhosis

Cirrhosis of the liver is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrotic scar tissue as well as regenerative nodules, leading to progressive loss of liver function. Cirrhosis is most commonly caused by alcoholism and hepatitis C, but has many other possible causes.

Cholelithiasis, Cholecystitis

Cholecystitis is inflammation of the gall bladder. It is commonly due to impaction (sticking) of a gallstone within the neck of the gall bladder, leading to inspissation of bile, bile stasis, and infection by gut organisms. Cholecystitis may be a cause of right upper quadrant pain. The pain may actually manifest in the right flank or scapular region at first. In severe cases, the gall bladder can rupture and form an abscess or it may lead to a life-threatening infection of the liver called ascending cholangitis. In other cases, it may lead to a stable inflammatory state termed chronic cholecystitis.

Urinary Incontinence

Urinary Incontinence is an unintentional loss of urine control. Those with this condition are not able to hold urine in the bladder due to loss of voluntary control over the urinary sphincters resulting in the involuntary passage of urine. It is often temporary, and almost always results from an underlying medical condition.

Sexual Dysfunction

Hypogonadism

Hypogonadism is a medical term for a defect of the reproductive system which results in lack of function of the gonads (ovaries or testes). The gonads have two functions: to produce hormones (testosterone, estradiol, antimullerian hormone, progesterone, inhibin B), activin and to produce gametes (eggs or sperm). Deficiency of sex hormones can result in defective primary or secondary sexual development, or withdrawal effects (e.g., premature menopause) in adults. Defective egg or sperm development results in infertility.

Abnormal Menses - Infertility

Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some which may be bypassed with medical intervention.

Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS, also known clinically as Stein-Leventhal syndrome), is an endocrine disorder that affects approximately one in ten women. It occurs amongst all races and nationalities, is the most common hormonal disorder among women of reproductive age, and is a leading cause of infertility. The principal features are lack of regular ovulation and excessive amounts or effects of androgenic (masculinizing) hormones. The symptoms and severity of the syndrome vary greatly between women. While the causes are unknown, insulin resistance, diabetes, and obesity are all strongly correlated with PCOS.

Idiopathic intracranial hypertension

Idiopathic intracranial hypertension (IIH), sometimes called benign intracranial hypertension (BIH) or pseudotumor cerebri (PTC) is a neurological disorder that is characterized by increased intracranial pressure (ICP), in the absence of a tumor or other intracranial pathology.

Stroke

Stroke (or cerebrovascular accident or CVA) is the clinical designation for a rapidly developing loss of brain function due to an interruption in the blood supply to all or part of the brain. This phenomenon can be caused by thrombosis, embolism, or hemorrhage (haemorrhage).

Cataracts

A cataract is an opacity that develops in the crystalline lens of the eye or in its envelope. Early on in the development of age-related cataract the power of the crystalline lens may be increased, causing near-sightedness (myopia), and the gradual yellowing and opacification of the lens may reduce the perception of blue colors. Cataracts typically progress slowly to cause vision loss and are potentially blinding if untreated.

Coronary heart disease

Coronary heart disease (CHD), also called CAD, ischaemic heart disease, atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. While the symptoms and signs of coronary heart disease are noted in the advanced state of disease, most individuals with coronary heart disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arise.

GERD

Gastroesophageal Reflux Disease (GERD; or GORD when spelling œsophageal, the BrE form) is defined as chronic symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus. This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. This can be due to incompetence of the lower esophageal sphincter (LES), transient LES relaxation, impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia.

Severe Pancreatitis

Pancreatitis is defined as inflammation of the pancreas.

Cancer

A disease characterized by a population of cells that grow and divide without respect to normal limits, invade, and destroy adjacent tissues, and may spread to distant anatomic sites through a process called metastasis.

Breast Cancer

Cancer of the glandular breast tissue

Uterine Cancer

Uterine cancer may refer to one of several different types of cancer which occur in the uterus. These include endometrial cancers, cervical cancer, and sarcomas of the myometrium, or muscular layer of the uterus

Cervical Cancer

Malignant cancer of the cervix

Colon Cancer

Colorectal cancer, also called colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix.

Esophageal Cancer

Malignancy of the esophagus.

Pancreatic Cancer

Malignant tumor within the pancreatic gland.

Renal cell carcinoma

Renal cell carcinoma, also known as a gurnistical tumor, is the most common form of kidney cancer arising from the renal tubule.

Prostate Cancer

A disease in which cancer develops in the prostate, a gland in the male reproductive system. It occurs when cells of the prostate mutate and begin to multiply out of control.

Edema

Edema (American English), oedema or œdema (British English), formerly known as dropsy or hydropsy, is the increase of interstitial fluid in any organ — swelling. Generally, the amount of interstitial fluid is in the balance of homeostasis. Increased secretion of fluid into the interstitium or impaired removal of this fluid may cause edema.

Phlebitis

An inflammation of a vein, usually in the legs.

Venostatsis

The trapping of blood in an extremity by compression of veins, a method sometimes employed for reducing the amount of blood being returned to the heart.

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Obesity

In the News!

Doctors Say Obesity Is a Disease

Guidelines for Your Health!

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