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Pregnancy – Wikipedia

08-01-2017 3:44 pm

Pregnancy, also known as gravidity or gestation, is the time during which one or more offspring develops inside a woman.[1] A multiple pregnancy involves more than one offspring, such as with twins.[2] Pregnancy can occur by sexual intercourse or assisted reproductive technology. It usually lasts around 40weeks from the last menstrual period (LMP) and ends in childbirth.[1][3] This is just over ninelunar months, where each month is about 29 days.[1][3] When measured from conception it is about 38 weeks. An embryo is the developing offspring during the first eight weeks following conception, after which, the term fetus is used until birth.[3] Symptoms of early pregnancy may include missed periods, tender breasts, nausea and vomiting, hunger, and frequent urination.[4] Pregnancy may be confirmed with a pregnancy test.[5]

Pregnancy is typically divided into three trimesters. The first trimester is from week one through 12 and includes conception. Conception is when the sperm fertilizes the egg. The fertilized egg then travels down the fallopian tube and attaches to the inside of the uterus, where it begins to form the fetus and placenta.[1] The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus).[6] The second trimester is from week 13 through 28. Around the middle of the second trimester, movement of the fetus may be felt. At 28 weeks, more than 90% of babies can survive outside of the uterus if provided high-quality medical care. The third trimester is from 29 weeks through 40 weeks.[1]

Prenatal care improves pregnancy outcomes.[7] Prenatal care may include taking extra folic acid, avoiding drugs and alcohol, regular exercise, blood tests, and regular physical examinations.[7]Complications of pregnancy may include high blood pressure of pregnancy, gestational diabetes, iron-deficiency anemia, and severe nausea and vomiting among others.[8] Term pregnancy is 37 to 41 weeks, with early term being 37 and 38 weeks, full term 39 and 40 weeks, and late term 41 weeks. After 41 weeks, it is known as post term. Babies born before 37 weeks are preterm and are at higher risk of health problems such as cerebral palsy.[1]Delivery before 39 weeks by labor induction or caesarean section is not recommended unless required for other medical reasons.[9]

About 213 million pregnancies occurred in 2012, of which, 190 million were in the developing world and 23 million were in the developed world. The number of pregnancies in women ages 15 to 44 is 133 per 1,000 women.[10] About 10% to 15% of recognized pregnancies end in miscarriage.[6] In 2013, complications of pregnancy resulted in 293,000 deaths, down from 377,000 deaths in 1990. Common causes include maternal bleeding, complications of abortion, high blood pressure of pregnancy, maternal sepsis, and obstructed labor.[11] Globally, 40% of pregnancies are unplanned. Half of unplanned pregnancies are aborted.[10] Among unintended pregnancies in the United States, 60% of the women used birth control to some extent during the month pregnancy occurred.[12]

One scientific term for the state of pregnancy is gravidity (adjective “gravid”), Latin for “heavy” and a pregnant female is sometimes referred to as a gravida.[13] Similarly, the term parity (abbreviated as “para”) is used for the number of times a female carries a pregnancy past 20 weeks of gestation. Twins and other multiple births are counted as one pregnancy and birth. A woman who has never been pregnant is referred to as a nulligravida. A woman who is (or has been only) pregnant for the first time is referred to as a primigravida,[14] and a woman in subsequent pregnancies as a multigravida or as multiparous.[13][15] Therefore, during a second pregnancy a woman would be described as gravida 2, para 1 and upon live delivery as gravida 2, para 2. In-progress pregnancies, abortions, miscarriages and/ or stillbirths account for parity values being less than the gravida number. In the case of twins, triplets, etc., gravida number and parity value are increased by one only. Women who have never carried a pregnancy achieving more than 20 weeks of gestation age are referred to as nulliparous.[16]

Recent medical literature prefers the terminology preterm and postterm to premature and postmature. Preterm and postterm are defined above, whereas premature and postmature have historical meaning and relate more to the infant’s size and state of development rather than to the stage of pregnancy.[17][18]

The symptoms and discomforts of pregnancy are those presentations and conditions that result from pregnancy but do not significantly interfere with activities of daily living or pose a threat to the health of the mother or baby. This is in contrast to pregnancy complications. Sometimes a symptom that is considered a discomfort can be considered a complication when it is more severe. For example, nausea can be a discomfort (morning sickness), but if, in combination with significant vomiting, it causes water-electrolyte imbalance it is a complication (hyperemesis gravidarum).

Common symptoms and discomforts of pregnancy include:

In addition, pregnancy may result in pregnancy complication such as deep vein thrombosis or worsening of an intercurrent disease in pregnancy.

There are multiple definitions of the beginning of a pregnancy.[22] Healthcare providers normally count the initiation of pregnancy from the first day of the woman’s last menstrual period. Using this date, the resulting fetal age is called the gestational age. This choice was a result of inability to discern the point in time when the actual conception happened. In in vitro fertilisation, gestational age is calculated by days from oocyte retrieval + 14 days (the 14 days before the known time of conception).[23]

Through an interplay of hormones that includes follicle stimulating hormone that stimulates folliculogenesis and oogenesis creates a mature egg cell, the female gamete. Fertilization is the event where the egg cell fuses with the male gamete, spermatozoon. After the point of fertilization, the fused product of the female and male gamete is referred to as a zygote or fertilized egg. The fusion of male and female gametes usually occurs following the act of sexual intercourse. Fertilization can also occur by assisted reproductive technology such as artificial insemination and in vitro fertilisation.

Fertilization (conception) is sometimes used as the initiation of pregnancy, with the derived age being termed fertilization age. Fertilization usually occurs about two weeks before the next expected menstrual period.

A third point in time is also considered by some people to be the true beginning of a pregnancy: This is time of implantation, when the future fetus attaches to the lining of the uterus. This is about a week to ten days after fertilization.[22] In this model, during the time between conception and implantation, the future fetus exists, but the woman is not considered pregnant.

The sperm and the egg cell, which has been released from one of the female’s two ovaries, unite in one of the two fallopian tubes. The fertilized egg, known as a zygote, then moves toward the uterus, a journey that can take up to a week to complete. Cell division begins approximately 24 to 36 hours after the male and female cells unite. Cell division continues at a rapid rate and the cells then develop into what is known as a blastocyst. The blastocyst arrives at the uterus and attaches to the uterine wall, a process known as implantation.

The development of the mass of cells that will become the infant is called embryogenesis during the first approximately ten weeks of gestation. During this time, cells begin to differentiate into the various body systems. The basic outlines of the organ, body, and nervous systems are established. By the end of the embryonic stage, the beginnings of features such as fingers, eyes, mouth, and ears become visible. Also during this time, there is development of structures important to the support of the embryo, including the placenta and umbilical cord. The placenta connects the developing embryo to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother’s blood supply. The umbilical cord is the connecting cord from the embryo or fetus to the placenta.

After about ten weeks of gestational age, the embryo becomes known as a fetus. At the beginning of the fetal stage, the risk of miscarriage decreases sharply.[24] At this stage, a fetus is about 30mm (1.2inches) in length, the heartbeat is seen via ultrasound, and the fetus makes involuntary motions.[25] During continued fetal development, the early body systems, and structures that were established in the embryonic stage continue to develop. Sex organs begin to appear during the third month of gestation. The fetus continues to grow in both weight and length, although the majority of the physical growth occurs in the last weeks of pregnancy.

Electrical brain activity is first detected between the fifth and sixth week of gestation. It is considered primitive neural activity rather than the beginning of conscious thought. Synapses begin forming at 17 weeks, and begin to multiply quickly at week 28 until 3 to 4 months after birth.[26]

Embryo at 4 weeks after fertilization. (Image from gestational age of 6 weeks). Retrieved 2007-08-28.

Fetus at 8 weeks after fertilization. (Image from gestational age of 10 weeks). Retrieved 2007-08-28.

Fetus at 18 weeks after fertilization. (Image from gestational age of 20 weeks). Retrieved 2007-08-28.

Fetus at 38 weeks after fertilization. (Image from gestational age of 40 weeks). Retrieved 2007-08-28.

Relative size in 1st month (simplified illustration)

Relative size in 3rd month (simplified illustration)

Relative size in 5th month (simplified illustration)

Relative size in 9th month (simplified illustration)

During pregnancy, the woman undergoes many physiological changes, which are entirely normal, including cardiovascular, hematologic, metabolic, renal, and respiratory changes. Increases in blood sugar, breathing, and cardiac output are all required. Levels of progesterone and oestrogens rise continually throughout pregnancy, suppressing the hypothalamic axis and therefore also the menstrual cycle.

The fetus is genetically different from the woman and can be viewed as an unusually successful allograft.[27] The main reason for this success is increased immune tolerance during pregnancy.[28] Immune tolerance is the concept that the body is able to not mount an immune system response against certain triggers.[27]

Pregnancy is typically broken into three periods, or trimesters, each of about three months.[29][30] Each trimester is defined as 14 weeks, for a total duration of 42 weeks, although the average duration of pregnancy is 40 weeks.[31] While there are no hard and fast rules, these distinctions are useful in describing the changes that take place over time.

Minute ventilation increases by 40% in the first trimester.[32] The womb will grow to the size of a lemon by eight weeks. Many symptoms and discomforts of pregnancy like nausea and tender breasts appear in the first trimester.[33]

Weeks 13 to 28 of the pregnancy are called the second trimester. Most women feel more energized in this period, and begin to put on weight as the symptoms of morning sickness subside and eventually fade away. The uterus, the muscular organ that holds the developing fetus, can expand up to 20 times its normal size during pregnancy.

Although the fetus begins to move during the first trimester, it is not until the second trimester that movement, often referred to as “quickening”, can be felt. This typically happens in the fourth month, more specifically in the 20th to 21st week, or by the 19th week if the woman has been pregnant before. It is common for some women not to feel the fetus move until much later. During the second trimester, most women begin to wear maternity clothes.

Final weight gain takes place, which is the most weight gain throughout the pregnancy. The woman’s abdomen will transform in shape as it drops due to the fetus turning in a downward position ready for birth. During the second trimester, the woman’s abdomen would have been upright, whereas in the third trimester it will drop down low. The fetus moves regularly, and is felt by the woman. Fetal movement can become strong and be disruptive to the woman. The woman’s navel will sometimes become convex, “popping” out, due to the expanding abdomen.

Head engagement, where the fetal head descends into cephalic presentation, relieves pressure on the upper abdomen with renewed ease in breathing. It also severely reduces bladder capacity, and increases pressure on the pelvic floor and the rectum.

It is also during the third trimester that maternal activity and sleep positions may affect fetal development due to restricted blood flow. For instance, the enlarged uterus may impede blood flow by compressing the vena cava when lying flat, which is relieved by lying on the left side.[34]

The mean pregnancy length has been estimated to be 283.4 days of gestational age as timed from the first day of the last menstrual period and 280.6 days when retrospectively estimated by obstetric ultrasound measurement of the fetal biparietal diameter (BPD) in the second trimester.[35] Other algorithms take into account other variables, such as whether this is the first or subsequent child, the mother’s race, age, length of menstrual cycle, and menstrual regularity. In order to have a standard reference point, the normal pregnancy duration is assumed by medical professionals to be 280 days (or 40 weeks) of gestational age.

The best method of determining gestational age is ultrasound during the first trimester of pregnancy. This is typically accurate within seven days.[36] This means that fewer than 5 percent of births occur on the day of being 40 weeks of gestational age; 50 percent of births are within a week of this duration, and about 80 percent are within 2 weeks.[35] For the estimation of due date, mobile apps essentially always give consistent estimations compared to each other and correct for leap year, while pregnancy wheels made of paper can differ from each other by 7 days and generally do not correct for leap year.[37] Once the estimated due date (EDD) is established, it should rarely be changed, as the determination of gestational age is most accurate earlier in the pregnancy.[38]

The most common system used among healthcare professionals is Naegele’s rule, which was developed in the early 19th century. This calculates the expected due date from the first day of the last normal menstrual period (LMP or LNMP) regardless of factors known to make this inaccurate, such as a shorter or longer menstrual cycle length. Pregnancy most commonly lasts for 40 weeks according to this LNMP-based method, assuming that the woman has a predictable menstrual cycle length of close to 28 days and conceives on the 14th day of that cycle.

The average time to birth has been estimated to be 268 days (38 weeks and two days) from ovulation, with a standard deviation of 10 days or coefficient of variation of 3.7%.[39]

Accurate dating of pregnancy is important, because it is used in calculating the results of various prenatal tests, (for example, in the triple test). A decision may be made to induce labour if a fetus is perceived to be overdue. Furthermore, if ultrasound dating predicts a later due date than LMP, this might indicate slowed fetal growth and require closer review.

The stage of pregnancy defined as the beginning of legal fetal viability varies around the world. It sometimes incorporates weight as well as gestational age.[40] It ranges from 16 weeks in Norway, to 20 weeks in the US and Australia, 24 weeks in the UK and 26 weeks in Italy and Spain.[40][41][42]

In the ideal childbirth labor begins on its own when a woman is “at term”.[45] Pregnancy is considered at term when gestation has lasted between 37 and 42 weeks.[44]

Events before completion of 37 weeks are considered preterm.[43]Preterm birth is associated with a range of complications and should be avoided if possible.[46]

Sometimes if a woman’s water breaks or she has contractions before 39 weeks, birth is unavoidable.[44] However, spontaneous birth after 37 weeks is considered term and is not associated with the same risks of a pre-term birth.[47] Planned birth before 39 weeks by Caesarean section or labor induction, although “at term”, results in an increased risk of complications.[48] This is from factors including underdeveloped lungs of newborns, infection due to underdeveloped immune system, feeding problems due to underdeveloped brain, and jaundice from underdeveloped liver.[49]

Babies born between 39 and 41 weeks gestation have better outcomes than babies born either before or after this range.[44] This special time period is called “full term”.[44] Whenever possible, waiting for labor to begin on its own in this time period is best for the health of the mother and baby.[45] The decision to perform an induction must be made after weighing the risks and benefits, but is safer after 39 weeks.[45]

Events after 42 weeks are considered postterm.[44] When a pregnancy exceeds 42 weeks, the risk of complications for both the woman and the fetus increases significantly.[50][51] Therefore, in an otherwise uncomplicated pregnancy, obstetricians usually prefer to induce labour at some stage between 41 and 42 weeks.[52]

Childbirth, referred to as labor and delivery in the medical field, is the process whereby an infant is born.[47]

A woman is considered to be in labour when she begins experiencing regular uterine contractions, accompanied by changes of her cervix primarily effacement and dilation. While childbirth is widely experienced as painful, some women do report painless labours, while others find that concentrating on the birth helps to quicken labour and lessen the sensations. Most births are successful vaginal births, but sometimes complications arise and a woman may undergo a cesarean section.

During the time immediately after birth, both the mother and the baby are hormonally cued to bond, the mother through the release of oxytocin, a hormone also released during breastfeeding. Studies show that skin-to-skin contact between a mother and her newborn immediately after birth is beneficial for both the mother and baby. A review done by the World Health Organization found that skin-to-skin contact between mothers and babies after birth reduces crying, improves motherinfant interaction, and helps mothers to breastfeed successfully. They recommend that neonates be allowed to bond with the mother during their first two hours after birth, the period that they tend to be more alert than in the following hours of early life.[53]

The postnatal period, also referred to as the puerperium, begins immediately after delivery and extends for about six weeks.[47] During this period, the mother’s body begins the return to pre-pregnancy conditions that includes changes in hormone levels and uterus size.[47]

The beginning of pregnancy may be detected either based on symptoms by the pregnant woman herself, or by using a medical test(s). However, an important condition with serious health implications that is more common than expected is denial of pregnancy by the pregnant woman. It has rate at 20 weeks gestation of approximately 1 in 475 pregnant women. The proportion of cases persisting until delivery is about 1 in 2500 refusing to acknowledge that they are pregnant (denial of pregnancy)).[54] Conversely, some non-pregnant women have a very strong belief that they are pregnant along with some of the physical changes. This condition is known as pseudocyesis or false pregnancy.[55]

Most pregnant women experience a number of symptoms,[56] which can signify pregnancy. A number of early medical signs are associated with pregnancy.[57][58] These signs include:

Pregnancy detection can be accomplished using one or more various pregnancy tests,[60] which detect hormones generated by the newly formed placenta, serving as biomarkers of pregnancy.[61] Blood and urine tests can detect pregnancy 12 days after implantation.[62] Blood pregnancy tests are more sensitive than urine tests (giving fewer false negatives).[63] Home pregnancy tests are urine tests, and normally detect a pregnancy 12 to 15 days after fertilization.[64] A quantitative blood test can determine approximately the date the embryo was conceived because HCG doubles every 36 to 48 hours.[47] A single test of progesterone levels can also help determine how likely a fetus will survive in those with a threatened miscarriage (bleeding in early pregnancy).[65]

Obstetric ultrasonography can detect some congenital diseases at an early stage, estimate the due date, and detect multiple pregnancies.[66][needs update] The resultant estimated gestational age and due date of the fetus are slightly more accurate than methods based on last menstrual period.[67] Ultrasound is used to measure the nuchal fold in order to screen for Downs syndrome.[68]

Pre-conception counseling is care that is provided to a woman and/ or couple to discuss conception, pregnancy, current health issues and recommendations for the period before pregnancy.[69]

Prenatal medical care is the medical and nursing care recommended for women during pregnancy, time intervals and exact goals of each visit differ by country.[70] Women who are high risk have better outcomes if they are seen regularly and frequently by a medical professional than women who are low risk.[71] A woman can be labeled as high risk for different reasons including previous complications in pregnancy, complications in the current pregnancy, current medical diseases, or social issues.[72][73]

The aim of good prenatal care is prevention, early identification, and treatment of any medical complications.[74] A basic prenatal visit consists of measurement of blood pressure, fundal height, weight and fetal heart rate, checking for symptoms of labor, and guidance for what to expect next.[69]

Nutrition during pregnancy is important to ensure healthy growth of the fetus.[75] Nutrition during pregnancy is different from the non-pregnant state.[75] There are increased energy requirements and specific micronutrient requirements.[75] Women benefit from education to encourage a balanced energy and protein intake during pregnancy.[76] Some women may need professional medical advice if their diet is affected by medical conditions, food allergies, or specific religious/ ethical beliefs.[77]

Adequate periconceptional (time before and right after conception) folic acid (also called folate or Vitamin B9) intake has been shown to decrease the risk of fetal neural tube defects, such as spina bifida.[78] The neural tube develops during the first 28 days of pregnancy, a urine pregnancy test is not usually positive until 14 days post-conception, explaining the necessity to guarantee adequate folate intake before conception.[64][79] Folate is abundant in green leafy vegetables, legumes, and citrus.[80] In the United States and Canada, most wheat products (flour, noodles) are fortified with folic acid.[81]

DHA omega-3 is a major structural fatty acid in the brain and retina, and is naturally found in breast milk.[82] It is important for the woman to consume adequate amounts of DHA during pregnancy and while nursing to support her well-being and the health of her infant.[82] Developing infants cannot produce DHA efficiently, and must receive this vital nutrient from the woman through the placenta during pregnancy and in breast milk after birth.[83]

Several micronutrients are important for the health of the developing fetus, especially in areas of the world where insufficient nutrition is common.[84] Whereas micronutrient supplementation for the mother has been found to reduce the risk of low birth weight, several studies reported variable effects on mortality in the newborn in developing countries.[84][needs update][85] In developed areas, such as Western Europe and the United States, certain nutrients such as Vitamin D and calcium, required for bone development, may require supplementation.[86][87][88] Vitamin E supplementation has not been shown to improve birth outcomes.[89] Zinc supplementation has been associated with a decrease in preterm birth, but it is unclear whether it is causative.[90] Daily iron supplementation reduces the risk of maternal anemia.[91] Studies of routine daily iron supplementation for all pregnant women in developed countries found improvement in blood iron levels, without a clear clinical benefit.[92]

Women are counseled to avoid certain foods, because of the possibility of contamination with bacteria or parasites that can cause illness.[93] Careful washing of fruits and raw vegetables may remove these pathogens, as may thoroughly cooking leftovers, meat, or processed meat.[94] Unpasteurized dairy and deli meats may contain Listeria, which can cause neonatal meningitis, stillbirth and miscarriage.[95] Pregnant women are also more prone to Salmonella infections, can be in eggs and poultry, which should be thoroughly cooked.[96] Cat feces and undercooked meats may contain the parasite Toxoplasma gondii and can cause toxoplasmosis.[94] Practicing good hygiene in the kitchen can reduce these risks.[97]

Women are also counseled to eat seafood in moderation and to eliminate seafood known to be high in mercury because of the risk of birth defects.[96] Pregnant women are counseled to consume caffeine in moderation, because large amounts of caffeine are associated with miscarriage.[47] However, the relationship between caffeine, birthweight, and preterm birth is unclear.[98]

The amount of healthy weight gain during a pregnancy varies.[99] Weight gain is related to the weight of the baby, the placenta, extra circulatory fluid, larger tissues, and fat and protein stores.[75] Most needed weight gain occurs later in pregnancy.[100]

The Institute of Medicine recommends an overall pregnancy weight gain for those of normal weight (body mass index of 18.524.9), of 11.315.9kg (2535 pounds) having a singleton pregnancy.[101] Women who are underweight (BMI of less than 18.5), should gain between 12.718kg (2840lbs), while those who are overweight (BMI of 2529.9) are advised to gain between 6.811.3kg (1525lbs) and those who are obese (BMI>30) should gain between 59kg (1120lbs).[102]

During pregnancy, insufficient or excessive weight gain can compromise the health of the mother and fetus.[100] The most effective intervention for weight gain in underweight women is not clear.[100] Being or becoming overweight in pregnancy increases the risk of complications for mother and fetus, including cesarean section, gestational hypertension, pre-eclampsia, macrosomia and shoulder dystocia.[99] Excessive weight gain can make losing weight after the pregnancy difficult.[99][103]

Around 50% of women of childbearing age in developed countries like the United Kingdom are overweight or obese before pregnancy.[103] Diet modification is the most effective way to reduce weight gain and associated risks in pregnancy.[103] A diet that has foods with a low glycemic index may help prevent the onset of gestational diabetes.[104]

Drugs used during pregnancy can have temporary or permanent effects on the fetus.[105] Anything (including drugs) that can cause permanent deformities in the fetus are labeled as teratogens.[106] In the U.S., drugs were classified into categories A,B,C,D and X based on the Food and Drug Administration (FDA) rating system to provide therapeutic guidance based on potential benefits and fetal risks.[107] Drugs, including some multivitamins, that have demonstrated no fetal risks after controlled studies in humans are classified as Category A.[105] On the other hand, drugs like thalidomide with proven fetal risks that outweigh all benefits are classified as Category X.[105]

The use of recreational drugs in pregnancy can cause various pregnancy complications.[47]

Intrauterine exposure to environmental toxins in pregnancy has the potential to cause adverse effects on the development of the embryo/fetus and to cause pregnancy complications.[47] Air pollution has been associated with low birth weight infants.[114] Conditions of particular severity in pregnancy include mercury poisoning and lead poisoning.[47] To minimize exposure to environmental toxins, the American College of Nurse-Midwives recommends: checking whether the home has lead paint, washing all fresh fruits and vegetables thoroughly and buying organic produce, and avoiding cleaning products labeled “toxic” or any product with a warning on the label.[115]

Pregnant women can also be exposed to toxins in the workplace, including airborne particles. The effects of wearing N95 filtering facepiece respirators are similar for pregnant women as non-pregnant women, and wearing a respirator for one hour does not affect the fetal heart rate.[116]

Most women can continue to engage in sexual activity throughout pregnancy.[117] Most research suggests that during pregnancy both sexual desire and frequency of sexual relations decrease.[118][119] In context of this overall decrease in desire, some studies indicate a second-trimester increase, preceding a decrease during the third trimester.[120][121]

Sex during pregnancy is a low-risk behavior except when the healthcare provider advises that sexual intercourse be avoided for particular medical reasons.[117] For a healthy pregnant woman, there is no safe or right way to have sex during pregnancy.[117] Pregnancy alters the vaginal flora with a reduction in microscopic species/genus diversity.[122]

Regular aerobic exercise during pregnancy appears to improve (or maintain) physical fitness.[123]Physical exercise during pregnancy does appear to decrease the risk of C-section.[124]

The Clinical Practice Obstetrics Committee of Canada recommends that “All women without contraindications should be encouraged to participate in aerobic and strength-conditioning exercises as part of a healthy lifestyle during their pregnancy”.[125] Although an upper level of safe exercise intensity has not been established, women who were regular exercisers before pregnancy and who have uncomplicated pregnancies should be able to engage in high intensity exercise programs.[125] In general, participation in a wide range of recreational activities appears to be safe, with the avoidance of those with a high risk of falling such as horseback riding or skiing or those that carry a risk of abdominal trauma, such as soccer or hockey.[126]

The American College of Obstetricians and Gynecologists reports that in the past, the main concerns of exercise in pregnancy were focused on the fetus and any potential maternal benefit was thought to be offset by potential risks to the fetus. However, they write that more recent information suggests that in the uncomplicated pregnancy, fetal injuries are highly unlikely.[126] They do, however, list several circumstances when a woman should contact her health care provider before continuing with an exercise program: vaginal bleeding, dyspnea before exertion, dizziness, headache, chest pain, muscle weakness, preterm labor, decreased fetal movement, amniotic fluid leakage, and calf pain or swelling (to rule out thrombophlebitis).[126]

It has been suggested that shift work and exposure to bright light at night should be avoided at least during the last trimester of pregnancy to decrease the risk of psychological and behavioral problems in the newborn.[127]

Each year, ill health as a result of pregnancy is experienced (sometimes permanently) by more than 20 million women around the world.[128] In 2013 complications of pregnancy resulted in 293,000 deaths down from 377,000 deaths in 1990. Common causes include maternal bleeding (44,000), complications of abortion (44,000), high blood pressure of pregnancy (29,000), maternal sepsis (24,000), and obstructed labor (19,000).[11]

The following are some examples of pregnancy complications:

There is also an increased susceptibility and severity of certain infections in pregnancy.

A pregnant woman may have intercurrent diseases, defined as disease not directly caused by the pregnancy, but that may become worse or be a potential risk to the pregnancy.

About 213 million pregnancies occurred in 2012 of which 190 million were in the developing world and 23 million were in the developed world. This is about 133 pregnancies per 1,000 women between the ages of 15 and 44.[10] About 10% to 15% of recognized pregnancies end in miscarriage.[6] Globally 40% of pregnancies are unplanned. Half of unplanned pregnancies are aborted.[10]

Of pregnancies in 2012 120 million occurred in Asia, 54 million in Africa, 19 million in Europe, 18 million in Latin America and the Caribbean, 7 million in North America, and 1 million in Oceania.[10] Pregnancy rates are 140 per 1000 women of childbearing age in the developing world and 94 per 1000 in the developed world.[10]

The rate of pregnancy, as well as the ages at which it occurs, differ by country and region. It is influenced by a number of factors, such as cultural, social and religious norms; access to contraception; and rates of education. The total fertility rate (TFR) in 2013 was estimated to be highest in Niger (7.03 children/woman) and lowest in Singapore (0.79 children/woman).[133]

In Europe, the average childbearing age has been rising continuously for some time. In Western, Northern, and Southern Europe, first-time mothers are on average 26 to 29 years old, up from 23 to 25 years at the start of the 1970s. In a number of European countries (Spain), the mean age of women at first childbirth has crossed the 30-year threshold.

This process is not restricted to Europe. Asia, Japan and the United States are all seeing average age at first birth on the rise, and increasingly the process is spreading to countries in the developing world like China, Turkey and Iran. In the US, the average age of first childbirth was 25.4 in 2010.[134]

In the United States and United Kingdom, 40% of pregnancies are unplanned, and between a quarter and half of those unplanned pregnancies were unwanted pregnancies.[135][136]

Globally, an estimated 270,000 women die from pregnancy-related complications each year.[137]

In most cultures, pregnant women have a special status in society and receive particularly gentle care.[138] At the same time, they are subject to expectations that may exert great psychological pressure, such as having to produce a son and heir. In many traditional societies, pregnancy must be preceded by marriage, on pain of ostracism of mother and (illegitimate) child.

Overall, pregnancy is accompanied by numerous customs that are often subject to ethnological research, often rooted in traditional medicine or religion. The baby shower is an example of a modern custom.

Pregnancy is an important topic in sociology of the family. The prospective child may preliminarily be placed into numerous social roles. The parents’ relationship and the relation between parents and their surroundings are also affected.

A belly cast may be made during pregnancy as a keepsake.

Due to the important role of the Mother of God in Christianity, the Western visual arts have a long tradition of depictions of pregnancy.[139]

Pregnancy, and especially pregnancy of unmarried women, is also an important motif in literature. Notable examples include Hardy’s Tess of the d’Urbervilles and Goethe’s Faust.

Modern reproductive medicine offers many forms of assisted reproductive technology for couples who stay childless against their will, such as fertility medication, artificial insemination, in vitro fertilization and surrogacy.

An abortion is the termination of an embryo or fetus, either naturally or via medical methods.[140] When done electively, it is more often done within the first trimester than the second, and rarely in the third.[24] Not using contraception, contraceptive failure, poor family planning or rape can lead to undesired pregnancies. Legality of socially indicated abortions varies widely both internationally and through time. In most countries of Western Europe, abortions during the first trimester were a criminal offense a few decades ago[when?] but have since been legalized, sometimes subject to mandatory consultations. In Germany, for example, as of 2009 less than 3% of abortions had a medical indication.

Many countries have various legal regulations in place to protect pregnant women and their children. Maternity Protection Convention ensures that pregnant women are exempt from activities such as night shifts or carrying heavy stocks. Maternity leave typically provides paid leave from work during roughly the last trimester of pregnancy and for some time after birth. Notable extreme cases include Norway (8 months with full pay) and the United States (no paid leave at all except in some states). Moreover, many countries have laws against pregnancy discrimination.

In 2014, the American state of Kentucky passed a law which allows prosecutors to charge a woman with criminal assault if she uses illegal drugs during her pregnancy and her fetus or newborn is considered harmed as a result.[141]

In the United States, laws make some actions that result in miscarriage or stillbirth crimes. One such law is the federal Unborn Victims of Violence Act.

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Pregnancy – Wikipedia

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07-01-2017 12:44 pm

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Among Ashburn gyms, the Gold’s Ashburn Broadlands health club near you is renowned for its heated indoor swimming pool. While at the Gold’s Gym Broadlands family fitness center, you can tackle a few laps in this four-lane pool or dive into an aqua fitness class that builds muscle with water-resistance exercises. Our up-to-date Gold’s Gym Ashburn VA fitness club is open extensive Gold’s Gym hours, so you can grab a workout when its convenient for you. Several Gold’s local gyms, including the Gold’s Gym health club near Ashburn, also feature a sauna, the perfect place to unwind and help muscles recover before the next fun and challenging round of exercises.

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Ashburn Gyms, Broadland Gyms, Group Exercise Classes …

Management of obesity – Wikipedia

06-01-2017 11:44 am

Management of obesity can include lifestyle changes, medications, or surgery. The main treatment for obesity consists of dieting and physical exercise.[1] Diet programs may produce weight loss over the short term,[2] but maintaining this weight loss is frequently difficult and often requires making exercise and a lower calorie diet a permanent part of an individual’s lifestyle.[3][4] Success rates of long-term weight loss maintenance with lifestyle changes are low, ranging from 2 to 20%.[5] Dietary and lifestyle changes are effective in limiting excessive weight gain in pregnancy and improve outcomes for both the mother and the child.[6] The National Institutes of Health recommend a weight loss goal of 5% to 10% of the person’s current weight over six months.[7]

One medication, orlistat, is current widely available and approved for long term use. Weight loss however is modest with an average of 2.9kg (6.4lb) at 1 to 4years and there is little information on how these drugs affect longer-term complications of obesity.[8] Its use is associated with high rates of gastrointestinal side effects.[8]

The most effective treatment for obesity is bariatric surgery.[9] Surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.[10] However, due to its cost and the risk of complications, researchers are searching for other effective yet less invasive treatments.

A 2007 review concluded that certain subgroups such as those with type 2 diabetes and women show long term benefits in all cause mortality, while outcomes for men do not seem to be improved with weight loss.[11] A subsequent study found benefits in mortality from intentional weight loss in those who have severe obesity.[12]

Diets to promote weight loss are generally divided into four categories: low-fat, low-carbohydrate, low-calorie, and very low calorie.[2] A meta-analysis of six randomized controlled trials found no difference between three of the main diet types (low calorie, low carbohydrate, and low fat), with a 24kilogram (4.48.8lb) weight loss in all studies.[2] At two years these three methods resulted in similar weight loss irrespective of the macronutrients emphasized.[13] High protein diets do not appear to make any difference.[14] A diet high in simple sugars such as those in soft drinks increases weight.[15]

Very low calorie diets provide 200800kcal/day, maintaining protein intake but limiting calories from both fat and carbohydrates. They subject the body to starvation and produce an average weekly weight loss of 1.52.5kilograms (3.35.5lb). These diets are not recommended for general use as they are associated with adverse side effects such as loss of lean muscle mass, increased risks of gout, and electrolyte imbalances. People attempting these diets must be monitored closely by a physician to prevent complications.[2]

With use, muscles consume energy derived from both fat and glycogen. Due to the large size of leg muscles, walking, running, and cycling are the most effective means of exercise to reduce body fat.[16] Exercise affects macronutrient balance. During moderate exercise, equivalent to a brisk walk, there is a shift to greater use of fat as a fuel.[17][18] To maintain health, the American Heart Association recommends a minimum of 30 minutes of moderate exercise at least 5 days a week.[18]

The Cochrane Collaboration found that exercising alone led to limited weight loss. In combination with diet, however, it resulted in a 1kilogram weight loss over dieting alone. A 1.5kilogram (3.3lb) loss was observed with a greater degree of exercise.[19] Even though exercise as carried out in the general population has only modest effects, a dose response curve is found, and very intense exercise can lead to substantial weight loss. During 20weeks of basic military training with no dietary restriction, obese military recruits lost 12.5kg (27.6lb).[20] High levels of physical activity seem to be necessary to maintain weight loss.[21] A pedometer appears useful for motivation. Over an average of 18-weeks of use physical activity increased by 27% resulting in a 0.38 decreased in BMI.[22]

Signs that encourage the use of stairs as well as community campaigns have been shown to be effective in increasing exercise in a population.[23] The city of Bogota, Colombia for example blocks off 113 kilometers (70mi) of roads every Sunday and on holidays to make it easier for its citizens to get exercise. These pedestrian zones are part of an effort to combat chronic diseases, including obesity.[24]

In an effort to combat the issue, a primary school in Australia instituted a standing classroom in 2013.[25]

Weight loss programs often promote lifestyle changes and diet modification. This may involve eating smaller meals, cutting down on certain types of food, and making a conscious effort to exercise more. These programs also enable people to connect with a group of others who are attempting to lose weight, in the hopes that participants will form mutually motivating and encouraging relationships.[26]

A number of popular programs exist, including Weight Watchers, Overeaters Anonymous, and Jenny Craig. These appear to provide modest weight loss (2.9kg, 6.4lb) over dieting on one’s own (0.2kg, 0.4lb) over a twoyear period.[27] Internet-based programs appear to be ineffective.[28] The Chinese government has introduced a number of “fat farms” where obese children go for reinforced exercise, and has passed a law which requires students to exercise or play sports for an hour a day at school (see Obesity in China).[29][30]

In a structured setting, 67% of people who lost greater than 10% of their body mass maintained or continued to lose weight one year later.[31] An average maintained weight loss of more than 3kg (6.6lb) or 3% of total body mass could be sustained for five years.[32]

Several anti-obesity medications are currently approved by the FDA for long term use.[33][34][35] Orlistat reduces intestinal fat absorption by inhibiting pancreatic lipase.

Lorcaserin has been found to be effective in the treatment of obesity with a weight loss of 5.8kg at one year as opposed to 2.2kg with placebo[36][37] and it is approved by the Food and Drug Administration for use in the treatment of obesity.[38] Side effects may include serotonin syndrome.[33]

The combination drug phentermine/topiramate (Qsymia) is approved by the FDA as an addition to a reduced-calorie diet and exercise for chronic weight management.[39]

Rimonabant (Acomplia), another drug, had been withdrawn from the market. It worked via a specific blockade of the endocannabinoid system. It has been developed from the knowledge that cannabis smokers often experience hunger, which is often referred to as “the munchies”. It had been approved in Europe for the treatment of obesity but has not received approval in the United States or Canada due to safety concerns.[40][41]European Medicines Agency in October 2008 recommended the suspension of the sale of rimonabant as the risk seem to be greater than the benefits.[42]Sibutramine (Meridia), which acts in the brain to inhibit deactivation of the neurotransmitters, thereby decreasing appetite was withdrawn from the UK market in January 2010 and United States and Canadian markets in October 2010 due to cardiovascular concerns.[35][43][44]

Weight loss with these drugs is modest. Over the longer term, average weight loss on orlistat is 2.9kg (6.4lb), sibutramine is 4.2kg (9.3lb) and rimonabant is 4.7kg (10.4lb). Orlistat and rimonabant lead to a reduced incidence of diabetes, and all three drugs have some effect on cholesterol. However, there is little information on how these drugs affect the longer-term complications or outcomes of obesity.[8] In 2010 it was found that sibutramine increases the risk of heart attacks and strokes in people with a history of cardiovascular disease.[45][46]

There are a number of less commonly used medications. Some are only approved for short term use, others are used off-label, and still others are used illegally. Most are appetite suppressants that act on one or more neurotransmitters.[47]Phendimetrazine (Bontril), diethylpropion (Tenuate), and phentermine (Adipex-P) are approved by the FDA for short term use, while bupropion (Wellbutrin), topiramate (Topamax), and zonisamide (Zonegran) are sometimes used off-label.[34]Recombinant human leptin is very effective in those with obesity due to congenital complete leptin deficiency via decreasing energy intake and possibly increases energy expenditure. This condition is, however, rare and this treatment is not effective for inducing weight loss in the majority of people with obesity. It is being investigated to determine whether or not it helps with weight loss maintenance.[48]

The usefulness of certain drugs depends upon the comorbidities present. Metformin (Glucophage) is preferred in overweight diabetics, as it may lead to mild weight loss in comparison to sulfonylureas or insulin.[49] The thiazolidinediones, on the other hand, may cause weight gain, but decrease central obesity.[50] Diabetics also achieve modest weight loss with fluoxetine (Prozac), orlistat and sibutramine over 1257weeks. Preliminary evidence has however found higher number of cardiovascular events in people taking sibutramine verses control (11.4% vs. 10.0%).[51] The long-term health benefits of these treatments remain unclear.[52]

Fenfluramine and dexfenfluramine were withdrawn from the market in 1997,[34] while ephedrine (found in the traditional Chinese herbal medicine m hung made from the Ephedra sinica) was removed from the market in 2004.[53]Racemic amphetamine is FDA-approved for the treatment of obesity.[54]

Though hypothesized that supplementation of vitamin D may be an effective treatment for obesity, studies do not support this.[55]

Bariatric surgery (“weight loss surgery”) is the use of surgical intervention in the treatment of obesity. As every operation may have complications, surgery is only recommended for severely obese people (BMI>40) who have failed to lose weight following dietary modification and pharmacological treatment. Weight loss surgery relies on various principles: the two most common approaches are reducing the volume of the stomach (e.g. by adjustable gastric banding and vertical banded gastroplasty), which produces an earlier sense of satiation, and reducing the length of bowel that comes into contact with food (e.g. by gastric bypass surgery or endoscopic duodenal-jejunal bypass surgery[56][57]), which directly reduces absorption. Band surgery is reversible, while bowel shortening operations are not. Some procedures can be performed laparoscopically. Complications from weight loss surgery are frequent.[58]

Surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.[10] A marked decrease in the risk of diabetes mellitus, cardiovascular disease and cancer has also been found after bariatric surgery.[59][60] Marked weight loss occurs during the first few months after surgery, and the loss is sustained in the long term. In one study there was an unexplained increase in deaths from accidents and suicide, but this did not outweigh the benefit in terms of disease prevention.[60] When the two main techniques are compared, gastric bypass procedures are found to lead to 30% more weight loss than banding procedures one year after surgery.[61]

Ileojejunal bypass, in which the digestive tract is rerouted to bypass the small intestine, was an experimental surgery designed as a remedy for morbid obesity.

The effects of liposuction on obesity are less well determined. Some small studies show benefits[62] while others show none.[63] A treatment involving the placement of an intragastric balloon via gastroscopy has shown promise. One type of balloon led to a weight loss of 5.7BMI units over 6months or 14.7kg (32.4lb). Regaining lost weight is common after removal, however, and 4.2% of people were intolerant of the device.[64]

An implantable nerve simulator which improves the feeling of fullness was approved by the FDA in 2015.[65]

In 2016 the FDA approved an aspiration therapy device that siphons food from the stomach to the outside and decreases caloric intake.[66] As of 2015 one trial shows promising results.[67]

Much of the Western world has created clinical practice guidelines in an attempt to address rising rates of obesity. Australia,[68] Canada,[1] the European Union,[69] and the United States[70] have all published statements since 2004.

In a clinical practice guideline by the American College of Physicians, the following five recommendations are made:[70]

A clinical practice guideline by the US Preventive Services Task Force (USPSTF) concluded that the evidence is insufficient to recommend for or against routine behavioral counseling to promote a healthy diet in unselected people in primary care settings, but that intensive behavioral dietary counseling is recommended in those with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians.[71][72]

Canada developed and published evidence-based practice guidelines in 2006. The guidelines attempt to address the prevention and management of obesity at both the individual and population levels in both children and adults.[1] The European Union published clinical practice guidelines in 2008 in an effort to address the rising rates of obesity in Europe.[69] Australia came out with practice guidelines in 2004.[68]

Temporary, controllable gastric pseudo-bezoars (swallowable, swellable foreign bodies in the stomach meant to reduce gastric volume from inside the organ) are being tested.[73] Treatment with naltrexone plus bupropion in a phase three trial resulted in a weight lose of 56% versus 1% for a placebo.[74]

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Management of obesity – Wikipedia

Weight Management | HealthyWomen

05-01-2017 6:46 am

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What Is It? Your dietthe way you eatis ingrained in your lifestyle. To change your weightwhether you want to lose a few pounds, or more, and keep them offor to ensure you don’t succumb to the expanding-waistline syndrome, you must permanently adopt a healthy lifestyle.

Americans are obsessed with both food and dieting. As a nation, we love to eat. We eat out often, when meals are often higher in fat and calories than meals eaten at home; we eat larger portions; and we indulge in dozens of delicious “new” food products found on our grocery store shelves every year.

But we also spend billions of dollars a year on commercial weight-loss products and services hoping for a quick fix to our weight problem. And what a problem: with all that eating, the Centers for Disease Control and Prevention (CDC) reports that 68 percent of the nation is overweight or obese. What’s more, dieting is failure-prone, and the statistics are even worse when it comes to those who can keep the weight off.

The answer to this weight loss/weight gain cycle lies in how you manage your weight on a day-in, day-out basis. Your dietthe way you eatis ingrained in your lifestyle. To change your weightwhether you want to lose a few pounds, or more, and keep them offor to ensure you don’t succumb to the expanding-waistline syndrome, you must permanently adopt a healthy lifestyle.

Unfortunately, it’s not just all that tempting food that stands in the way of your efforts to achieve or maintain a healthy weight. Technology has altered Americans’ lifestyle. Most of us, most of the time can be found sittingin front of a computer or TV, in a car, at a restaurant. About a quarter of adultsand an even greater percentage of womenreport they are sedentary and engage in no physical activity during leisure time, and less than half exercise regularly. And as women age, their tendency to be sedentary steadily increases.

Being overweight increases your risk for many diseases. If you are overweight, you are more likely to develop heart disease and stroke, the leading causes of death for both men and women in the United States.

Overweight people are more likely to have high blood pressure, a major risk factor for heart disease and stroke, and high cholesterol, also a risk factor. They’re twice as likely to develop type 2 diabetesa major cause of death, heart disease, kidney disease, stroke, amputation and blindnessas those not overweight.

Additionally, several types of cancer are associated with being overweight. In women, these include cancer of the uterus, gallbladder, cervix, ovary, breast and colon. Being overweight can also cause problems such as gout (a joint disease caused by excess uric acid), gallbladder disease or gallstones, sleep apnea (interrupted breathing during sleep), and osteoarthritis, or wearing away of the joints. Anyone with risk factors for health problems must be concerned about extra weight.

It all seems so simple: eat less, exercise, lose weight. But few people succeed in losing more than a few pounds on diets and even fewer succeed in maintaining that weight loss. An estimated 90 percent of dieters regain the weight in five years. One reason is that many factors other than overeating can play a part in weight, including your genetic makeup, cultural influences and natural hormonal and neurologic regulators.

Extreme dieting programs can sometimes be harmful and are rarely successful over the long term. Thus, weight loss should not be your only or even your primary goal if you are concerned about your health. Instead, the success of your weight-management efforts should be evaluated not just by the number of pounds you lose, but by improvements in your chronic disease risk factors, such as reduced blood pressure, cholesterol and blood sugar levels, as well as by new, healthy lifestyle habits. In fact, some experts believe that weight is not the sole cause of the diseases associated with being overweight, but that the accompanying unhealthy foods and sedentary lifestyles also contribute to these diseases.

On the flip side, some women are underweight, despite having tried to achieve or maintain a “normal” weight. Having a metabolism that burns too many calories can be as dangerous as being overweight. Underweight women are susceptible to vitamin and mineral deficiencies, resulting in a loss of bone density and muscle tissue.

A Word About Teens

Teenage girls today feel a lot of pressure from the media, friends and sometimes their own parents to be very slim. This pressure can create a distorted body image, making them see themselves as fat when they are not fat, or they see themselves as fatter than they really are.

According to the National Eating Disorders Association (NEDA), 40 percent of newly identified cases of anorexia are in girls ages 15 to 19, and over half of teenage girls use unhealthy weight-control behaviors, such as skipping meals, fasting, smoking cigarettes, taking laxatives and vomiting.

Fad dieting can keep teenagers from getting the calories and nutrients they need to grow properly. Stringent dieting may cause girls to stop menstruating and prevent girls from developing adequate muscle tone. If the diet doesn’t provide enough calcium or vitamin D, bones may not lay down enough calcium, which may increase the risk of osteoporosis later in life.

The flip side to teenagers feeling pressured to be thin is that some may have legitimate concerns about their weight that adults dismiss. Adolescent obesity can carry serious lifelong health consequences. The best advice to teenage girls: Instead of dieting because everyone is doing it or because you are not as thin as you want to be, first find out from a health care professional or dietitian whether you carry too much body fat for your age and height. If you need to lose weight, follow the sensible guidelines laid out here. Depending on your age, your health care professional may recommend you eat more low-fat dairy products than is recommended for adults because of your heightened need for calcium.


The weight management techniques discussed here are straightforward. But if you are over 40, have been inactive for some time, suffer from shortness of breath or weakness that interferes with daily activities or suffer from a chronic condition, consult a health care professional before beginning any effort to reduce your weight or increase your activity level.

If you are healthy, you may not need to consult a health care professional before launching a weight management program but you might want to talk to a professional who specializes in this area. These include:

Nutritionist. There is no accepted national definition for the title “nutritionist.” Some states have a statutory definition of nutritionist saying that the RD credential is not required for certification as a nutritionist, but is required for licensing as a dietitian. In general, the license or certification as a dietitian can be obtained with a bachelor’s degree, a related supervised practice experience component and an exam (or proof of RD status with the Commission on Dietetic Registration), while the nutritionist licensure or certification typically requires a master’s degree or higher.

Make sure any nutritionist you see is licensed by a state agency. Nutritionists and dietitians evaluate the diets and nutritional habits of clients and help structure more healthful eating patterns and weight management strategies based on their patients’ health needs, food selection and calorie goals. Nutritionists do not usually advise patients with chronic illnesses, disorders and other disease conditions.

Registered dietitians (RD). An RD after someone’s name indicates a dietitian who has completed academic and practice requirements established by the American Dietetic Association, including a bachelor’s degree, an accredited pre-professional experience program, successful completion of a national credentialing exam and ongoing continuing professional development. A registered dietician may have a master’s degree and advanced training in certain subspecialties, such as diabetes education.

Endocrinologist. Endocrinology is the field of medicine involving the body’s chemical messengers, or hormones, and its biochemical control mechanisms, or metabolism. Endocrinologists are physicians who care for patients with complex hormonal disorders and metabolic conditions, including obesity as well as diabetes, thyroid disorders, metabolic bone disease, pituitary and adrenal conditions and growth and gonadal disorders.

Personal trainer. Trainers provide one-on-one exercise-related goal-setting help, motivation, professional expertise and personalized attentionall key components of reaching your personal health and fitness goals. A personal trainer should be certified by an accredited professional organization such as the American Council on Exercise, the American College of Sports Medicine or the American Aerobics and Fitness Association. Keep in mind that personal trainers vary greatly, not only in educational background and cost, but also in personal philosophy, training and consulting practices.

Lose, Maintain or Gain?

To determine if you are overweight, of normal weight or underweight, you or your health care professional can calculate your body mass index (BMI), which describes body weight relative to height and is strongly correlated with total body fat content in adults. Your BMI equals your weight in kilograms divided by your height in meters squared. Or you can divide your weight in pounds by your height in inches squared and then multiply by 703.

The following chart shows body mass indices for people of various heights and weights. To determine your BMI, find the row that most closely approximates your weight. Read across the row until it crosses the column closest to your height.

A BMI between 18.5 and 24.9 is considered within the normal, healthy range; 25 to 29.9 is considered overweight; 30 or more is considered obese; and 40 or greater is considered extremely obesity. An exception is athletes, who have more muscle mass and less body fat than normal. They might have a BMI as high as 30 and yet not be obese. BMI is also adjusted for age and gender in people under age 18.

If your BMI falls under 18.5, you may be underweight; if so, you may want to ask your health care professional to assess your health.

For more information on calculating your BMI and how to achieve and maintain a healthy weight, visit the National Heart, Lung, and Blood Institute’s Aim for a Healthy Weight program.

Your health care professional might also measure your body composition, which is the percentage of lean muscle and fat. The most common test is the use of a caliper-like device to measure skinfold thickness and subcutaneous fat, which lies just under the skin at targeted sites such as the back of your upper arm, waist or thigh. The accuracy of skinfold thickness measurements depend on the skill of the examiner and may vary widely.

Or, your health care professional may conduct a bioelectrical impedance analysis (BIA) test. There are two forms of BIA. Using one form, the patient stands on a special scale with footpads and a harmless amount of electrical current is sent through her body to calculate the percentage body fat. The second type of BIA involves the use of a portable instrument called an impedance analyzer to transmit a noninvasive, low-frequency electrical current through electrodes placed on the patient’s hand and foot with a gel. The change in voltage between electrodes is measured, and the patient’s body fat percentage is calculated.

In addition, because abdominal fat is an independent predictor of disease risk, you or your health care professional should measure your waist. Women with a waist circumference over 35 inches (and men over 40 inches) have the greatest risk of developing insulin resistance, diabetes, high blood pressure and cardiovascular disease (heart disease and strokes).

Your health care professional may also ask you about chest pain, faintness or dizziness, bone or joint pain and any medications you may be taking. He or she will probably check the health of your heart and joints, measure your blood pressure and determine if you have a hernia or diabetes. These issues may affect how vigorously you should exercise or what types of exercises you should avoid.

If you have heart disease or cardiovascular risk factors, you may be asked to take an exercise stress test. During this test, you walk on a treadmill while a health care professional monitors your heart’s activity.

In some cases, your health care professional may suggest you start a weight management program. You may receive this recommendation if you have high blood pressure, blood sugar or cholesterol, and/or are overweight or have a high percentage of body fat.

Your health care professional can advise you about a weight-loss program suited to your weight and health goals. He or she also may refer you to a nutritionist or registered dietician and/or fitness professional or to a hospital-based weight-management or fitness class to provide guidance while you’re getting started.


The key to weight management is incorporating three strategies into lifelong practiceseating healthfully, exercising regularly and, for some women, changing your relationship with food. Unfortunately, of the millions of American women who are trying to lose weight, a minority use this method.

The most important key to success is to approach any changes in diet and exercise not as punishment, but as a plan to implement pleasurable healthy substitutes for unhealthy overeating and sedentary behavior.

Eating for Weight Management

Keeping in mind the biological reason we eatto provide our bodies the energy and nutrients it needs to carry out the tasks we ask of itis a good way to think about food.

Since an estimated 90 percent of dieters who lose weight regain all or part of it within five years indicates that “dieting” is not the answer to weight management. The best “diet” is a way of life that you can follow for the rest of your life. Therefore, it should consist of a balance of a variety of foods.

You can ask a nutritionist or registered dietitian for guidance on the number of calories you should eat to reach and maintain your goal weight. But as a rule of thumb, you should take in about 250 calories per day less than is needed to maintain your current weight and add an exercise regime that burns an additional 250 calories a day if you want to lose weight. This regimen should help you safely lose about a pound per week.

Your basal metabolic rate (BMR) is the number of calories your body needs to maintain its basic functions. Several factors go into the calculation of your BMR, including your height, weight and age. To get an idea of your BMR, go to You need additional calories to provide energy for daily activities; the more active you are, the more calories you need.

A more accurate method is to keep a detailed food diary over a few days to a week during which you maintain your weight. Determine exactly how many calories you eat on an average dayseveral books and websites provide calorie counts for thousands of foodsand use that figure as a starting place for weight maintenance or weight loss.

After you’ve determined how many calories per day you should eat, plan daily menus. A registered dietitian or nutritionist can help you plan menus that include the types and amounts of food you should eat which, in most cases, should be based on the sensible guidelines set forth by the federal government in its 2010 Dietary Guidelines for Americans. The guidelines, available at, aim to help Americans lose weight in an effort to reduce the risk of obesity-related chronic diseases. The guidelines recommend balancing calories with physical activity and encourage Americans to eat more healthful foods, such as vegetables, fruits, whole grains, fat-free and low-fat dairy products and seafood, and to consume less sodium, saturated fats, trans fats, added sugars and refined grains.

The easiest advice to follow is to divide your plate into sections. Half your plate at main meals should consist of colorful vegetables, one quarter of grain products such as whole-grain bread, pasta, whole-grain rice and cereals, and one quarter of lean meat, fish or poultry. Several times a week, you should substitute dishes made from dried beans or peas as your main course. You should also eat plenty of fruits and get three cups of low-fat milk products like yogurt or cheese daily.

These guidelines will help reduce your calories and fat and increase the fiber in your diet, all of which have been shown to decrease the risk for heart disease. While you should try to cut back on fats and sugars, allow for an occasional treat. As soon as you label a food as “off limits,” chances are you will crave and perhaps even binge on it. A few simple ways to cut back on calories include:

Hold the sauce. Dishes that include high-fat sauces, mayonnaise and regular salad dressings should be consumed only occasionally and only in small portions.

Drink more water. And steer clear of calories hidden in drinks like juice drinks, alcoholic beverages, fancy coffee concoctions and smoothies. Avoid excessive fruit juice consumption.

Eat high-volume foods. High-volume, low-calorie foods, like most fruits and vegetables, are high in water and fiber, helping you feel fuller longer. Up your intake of vegetables and cut back on fats and sweets.

Focus on nutrient-dense foods. The 2010 Dietary Guidelines suggest replacing foods that contain sodium, solid fats, added sugars and refined grains with nutrient-dense foods and beverages. These foods include vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats, poultry, eggs, beans and nuts and seeds.

Health care professionals recommend women have moderate fat consumption, between 20 to 35 percent or less of your total calorie intake. Most fats should come from polyunsaturated fats and monounsaturated fats, which are found in vegetable sources. The Dietary Guidelines for Americans 2010 recommend consuming less than 10 percent of calories from saturated fats and restricting trans fats (also known as trans fatty acids) as much as possible. The guidelines also recommend limiting cholesterol to less than 300 milligrams per day.

Strategies for reducing saturated fat and cholesterol include:

Get 10 percent of less of your fat from saturated fat sources such as red meats, processed meats, organ meats or high-fat dairy products.

Choose low saturated-fat protein sources, such as fish, turkey, chicken, legumes (dried peas and beans), nuts and seeds.

Use lean cuts of meat and trim excess fat.

Substitute skim and low-fat milk for high-fat dairy foods.

Broil, bake or boil foods instead of frying.

Increase your consumption of fruits, vegetables and whole grains.

You’ve probably heard of “good” fats and “bad” fats. These labels refer to the effects various types of fat have on your body and health. Saturated fats are commonly found in animal-based food products, as well as in palm and coconut oils. They are solid at room temperature. Excess amounts of saturated fat are considered unhealthy because they can contribute to fatty deposits in the arteries, clogging them and leading to heart disease. Unsaturated fats are liquid at room temperature and are known as oil. Two types of unsaturated fats are monounsaturated and polyunsaturated, both of which are thought to help lower cholesterol. Examples of these fats are olive and canola oils. Monounsaturated fats also are found in avocados, nuts and olives.

Trans fats are actually unsaturated fats that have been chemically modified. Manufacturers add hydrogen to vegetable oil in a process called hydrogenation. This increases the shelf life and the flavor stability of foods containing these fats. Trans fats can be found in vegetable shortenings, some margarines, crackers, cookies, snack foods and other foods made with or fried in partially hydrogenated oils. Like saturated fat and dietary cholesterol, they raise LDL cholesterol and increase your risk for cardiovascular disease.

Essential fatty acids are a category of fatty acids found in polyunsaturated fats your body needs but cannot manufacture itself. Good sources of polyunsaturated fatty acids include soybean, corn and cottonseed oils.

When an unsaturated fat is solidifiedinto margarine, for examplethe process turns it into partially hydrogenated oils, which contains trans fatty acids.

The Skinny On Fad Diets

Despite the ads that claim miracle weight-loss for some products, there simply is no magic formula for losing weight. Fad diets, like those based on cabbage soup, grapefruit or protein, may help you lose some pounds in the short run, but they don’t work in the long term because they’re impossible and unhealthy to maintain. The truth is permanent weight loss takes time and requires a permanent change in eating and exercise habits.

Extreme diets of less than 1,000 calories per day carry health risks and could trigger excessive overeating following the period of extreme caloric restriction. Such diets usually provide insufficient vitamins and minerals as well. Severe dieting also has unpleasant side effects, including fatigue, intolerance to cold, hair loss, gallstone formation and menstrual irregularities. Most of the initial weight loss is in fluids; later, fat is lost, but so is muscle.

It is very dangerous to be on severe diets longer than 16 weeks or to fast for more than two or three days. There have been rare reports of death from heart arrhythmia when liquid formulas didn’t have sufficient nutrients.

High-protein, low-carbohydrate diets are still used by some people for weight loss. Although a high-protein diet will lead to quick weight loss, its long-term health and safety benefits are uncertain. One byproduct of this type of diet is the release of substances called ketone bodies, which can lead to a condition called ketosis and cause nausea and lightheadedness because you are restricting your body’s source of fuel. Such high-protein diets may also be high in saturated fat and low in fiber-rich and healthful whole grains, fresh fruits and vegetables.

Carbohydrates provide your body with its main source of fuel and energy, namely, a form of glucose called glycogen. This complex carbohydrate is stored in liver and skeletal muscle. Simple carbohydrates (sucrose) offer quick energy boosts, while complex carbohydrates provide the body with fuel for several hours.

Examples of simple carbohydrates include fruit sugars (fructose) found in fruits, milk sugars (lactose) found in milk products, and other forms of sugar (sucrose) found in sweeteners such as corn syrup, honey, dextrose, high-fructose corn syrup and fruit juice concentrates. Complex carbohydrates are found in whole grains, rice, peas and dried beans, such as lentils and black, kidney and pinto beans.

Carbohydrates stored in the body are packed with water. That’s why introducing a low-carbohydrate diet leads to rapid weight loss as the body turns to stored carbohydrates for energy, eliminating large amounts of fluid from your body. After the stored carbohydrates are gone, your body turns to fat and lean body tissue for fuel, inducing further weight loss.

Many people on low-carbohydrate diets eat less but feel fuller due to the high-protein, high-fat foods they consume. However, this creates more work for your kidneys, which have to process the high amounts of protein. This is especially dangerous for people with diabetes. Additionally, excess protein excretion can cause valuable calcium to be excreted.

Many health care professionals believe that rather than adhere to a low-carbohydrate diet, it’s healthier to consume healthy carbohydrates in reasonable amounts. This means focusing on complex carbohydrates like beans, whole grains and vegetables, as well as simple carbohydrates that pack plenty of fiber, such as fruits.

Choosing A Diet Plan

With all of the fad diets circulating these days, you need to do your homework before embarking on a new weight-loss plan. The following questions will help you determine if a diet is healthy and legitimate or just a scam:

Does the plan promise dramatic and rapid weight loss? If a program is promising results that sound too good to be true, they probably are. A 10-pound loss in two weeks is unrealistic and may harm your overall health. A weight-loss goal of one to two pounds per week is a safe and effective rate for long-lasting results.

Does the plan exclude entire groups of foods? If a weight-loss plan excludes an entire group of foods such as grains, fruits, vegetables, dairy or protein, you risk missing out on essential vitamins and minerals.

Does the plan require extremely low calorie levels? Most experts agree that we need to consume at least 1,200 calories each day to maintain a healthy body. This is a minimum; most people actually need more. If a weight-loss plan restricts calories below this level, it’s not nutritionally adequate, and you’ll be in danger of nutrient deficiencies.

Are you required to buy special foods or supplements to follow the program? Weight-loss programs that rely on special foods or supplements tend to be money-making schemes to benefit the seller. These types of programs will drain your wallet without teaching you about nutrition and healthy eating habits.

Does the plan address lifestyle changes, such as increased exercise and improved eating habits? Realistic weight-loss plans should focus on the causes of your weight gain and on long-term lifestyle changes, not just on short-term losses.

Can you continue this way of eating for the rest of your life? Weight loss is difficult, but maintaining that weight loss is even harder. Any plan that allows you to lose weight should also be a plan you can continue indefinitely to maintain that weight.

The following claims and promotions should alert you to the probability of a bogus weight-loss scheme:

The plan is touted as requiring no sacrificeno exercise or no change in your eating habits.

No reliable evidence or scientific proof is offered to back up claims that the plan is safe and effective.

Testimonialsand case histories of people who have supposedly been successful on the plan are offered as “proof” of its effectiveness. A few successes don’t prove the plan will work for everyone.

The plan is described in sensational articles, or worse, advertisements made to look like articles, in tabloids and weight-loss magazines.

The plan is promoted as “cleansing” the body of “toxins” to let the body’s “natural” curative powers help in your weight loss efforts.

Today’s most popular weight-loss programs vary greatly. No single diet is appropriate for everyone, so you’ll want to weigh factors that vary by plan, such as types of food you can eat, reliance on supplements or drugs, calorie levels allotted and support offered.

Popular Weight-Loss Plans

Mediterranean-Style Diet

The Mediterranean diet is really a way of eating, rather than a particular diet. Some large studies point to the Mediterranean style of eating as a good alternative to low-fat dietary approaches as a way to reduce weight and, consequently, reduce your risk of heart disease and diabetes. Like the low-fat diets, the Mediterranean eating pattern focuses on fruits, vegetables, whole grains, nuts and seeds, but it also includes olive oil as a significant source of monounsaturated fat and wine in low to moderate amounts. The major protein sources are dairy, fish and poultry, with minimal red meat.

The Mediterranean eating style allows a higher percentage of calories from fat than the low-fat diets typically endorsed by health organizations, but several recent major studies have shown that the diet is an alternative to low-fat diets, especially for lowering risk of diabetes and heart attacks, often related to weight.

Weight Watchers

This diet program, one of the most popular among health care professionals, has helped millions of people worldwide lose unwanted pounds since it was founded in 1963. In general, the plan is healthylong on fruits and vegetables and short on fat, protein and sugar. Weight Watchers provides two optionsweekly in-person meetings or Weight Watchers Online. Weight Watchers meetings offer member support. (Your weight is kept private.) Meeting leaders have achieved their own weight loss goals with Weight Watchers and have been able to maintain their goal weight. The discussions can be helpful because they focus on the common challenges you face when trying to lose weightwhat to do about eating in restaurants or at a wedding, for example. They also let members exchange dietary advice on tasty alternatives or ideas for trimming calories. Weight Watchers Online offers members comprehensive guides to help them learn how to follow the Weight Watchers approach and food plan, including interactive tools and customized sites for men and women. Exercise is stressed as part of the program.

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Weight Management | HealthyWomen

Weight Management | Cigna

05-01-2017 6:46 am

Topic Overview What is a healthy weight?

A healthy weight is a weight that lowers your risk for health problems. For most people, body mass index (BMI) and waist size are good ways to tell if they are at a healthy weight.

But reaching a healthy weight isn’t just about reaching a certain number on the scale or a certain BMI. Having healthy eating and exercise habits is very important.

If you want to get to a healthy weight and stay there, healthy lifestyle changes will work better than dieting. Reaching a certain number on the scale is not as important as having a healthy lifestyle.

Staying at a healthy weight is one of the best things you can do for your health. It can help prevent serious health problems, including:

But weight is only one part of your health. Even if you carry some extra weight, eating healthy foods and being more active can help you feel better, have more energy, and lower your risk for disease.

In today’s society, there is a lot of pressure to be thin. But being thin has very little to do with good health. Many of us long to be thin, even though we’re already at a healthy weight. So we get desperate, and we turn to diets for help.

If you decide that you do need to make some changes, here are the three steps to reaching a healthy weight:

One Woman’s Story:

“The biggest key to my success is knowing that this is a process. It’s not ‘all or nothing at all.’ It’s a matter of making choices every day. One day I might decide to eat more than another day, and that’s okay, as long as I’m paying attention. I finally realized it wasn’t a time-limited thing. It became much more of a lifestyle change than a temporary diet. The idea that somehow I could go back to my old ways was just not there anymore.” Maggie

Read more about how Maggie changed her life and lost 50 pounds .

Your first step to find out if you are at a healthy weight is to find out what your BMI , or body mass index, is and what your waist size is. For most people, these are good clues to whether they are at a healthy weight.

A healthy weight is one that is right for your body type and height and is based on your body mass index (BMI) and the size of your waist ( waist circumference ). If you are age 20 or older, use the Interactive Tool: Is Your BMI Increasing Your Health Risks? to check your BMI when you know your height in feet, weight in pounds, and waist circumference.

If you are Asian, your recommended weight range may be lower. Talk to your doctor.

It’s important to remember that your BMI is only one measure of your health. A person who is not at a “normal” weight according to BMI charts may be healthy if he or she has healthy eating habits and exercises regularly. People who are thin but don’t exercise or eat nutritious foods aren’t necessarily healthy just because they are thin.

After you know your BMI, it’s time to look at your waist size.

Measuring your waist can help you find out how much fat you have stored around your belly. People who are “apple-shaped” and store fat around their belly are more likely to develop weight-related diseases than people who are “pear-shaped” and store most of their fat around their hips. Diseases that are related to weight include type 2 diabetes, heart disease, and high blood pressure.

Measure your waist size with a tape measure. The tape should fit snugly but not press into your skin.

For most people, the goal for a healthy waist is: footnote 1

If you are Asian, the goal for a healthy waist is:

In the underweight range on the BMI chart:

See your doctor to find out if you have a medical problem that is causing your low weight.

Within the recommended BMI range and your waist size is within the recommendations:

Your weight is not a problem for your health.

At or above the recommended BMI range and your waist size is higher than recommended:

See your doctor to find out if you have health problems that might be related to your weight.

You may need to change your eating habits and get more active.

In the overweight category on the BMI chart but your waist size is within the recommendations:

Your weight may be right for you. But you need to see your doctor to find out if you have health problems that might be related to your weight.

In the obese category on the BMI chart, no matter what your waist measurement is:

You may need to lose weight to be healthier, as well as change your eating and activity habits.

Your doctor may want to take another measurement, called a waist-to-hip ratio. This measurement is a comparison of your waist size to your hip size. A higher waist-to-hip ratio means that you are more “apple-shaped” than “pear-shaped” and therefore at a higher risk for weight-related disease.

Body fat testing is sometimes used to help find out if a person has a healthy percentage of body fat.

If you are in the overweight or obese category and your waist size is too high, it’s important to talk to your doctor about weight-related health problems you may have, including:

If you have two or more of these health problems, your doctor may advise you to make some lifestyle changes and/or lose weight. He or she may also refer you to a dietitian , an expert in healthy eating.

If you’re at a healthy weight but are still unhappy with your weight, you’re not alone. Lots of people are.

It can be hard to be satisfied with how you look when TV and magazines show unrealistic images of what it means to be thin. Here are some things to think about:

When we say “genetic makeup,” we’re talking about everything you inherited from your ancestors, from the color of your eyes or the shape of your toes to the way your brain works and the way your body stores fat.

Your genetic makeup has a very big effect on your weight. It affects:

The average American meal contains too many calories. It also contains too much saturated fat, animal protein, salt, alcohol, and sugar.

It can be hard to make healthy food choices:

For more information, see the topic Quick Tips: Cutting Calories .

Being physically active is an important part of staying at a healthy weight.

A healthy lifestyle means:

Becoming more active and improving your eating habits are the two main ways to reach a healthy weight.

One Woman’s Story:

“I see it as a whole life change. I actually get mad at people when they say, ‘You’ve been on a diet.’ I’m not on a diet. I’ve never been on a diet. I just changed the way I eat. I changed the way I live.” Jaci

Read more about how Jaci lost 65 pounds .

If you need to make some lifestyle changes to get to a healthy weight, you’ll have more success if you first change the way you think about certain things:

For more on how positive thinking can help you, see:

One Woman’s Story:

“I finally realized it wasn’t a time-limited thing. It wasn’t like, ‘Well, I’m going to be really good and stay on this food plan now until I get the weight off.’ It was more a realization that, ‘You know, at 62, if I want to weigh 130 to 135 pounds, then I have to do these things.’ I can’t stop doing them just because I lose the weight. So it became much more of a lifestyle change than a temporary diet. The idea that somehow I could go back to my old ways was just not there anymore.” Maggie

Read more about how Maggie changed her life and lost 50 pounds .

Making any kind of change in the way you live your daily life is like being on a path. The path leads to success. Here are the first steps on that path :

Before you make lifestyle changes, ask your doctor to check your cholesterol levels, blood pressure, and blood sugar. Your doctor can help you know your risk for heart attack and stroke.

Keep track of your weight.

Have your cholesterol, blood pressure, and blood sugar checked again after you have lost 5% to 10% of your weight or in 3 to 6 months. You can also check your blood pressure and blood sugar at home.

Another way to measure improvements is to look for changes in your fitness level. For example, are you able to walk longer and on more days than when you started? Can you climb a flight of stairs without getting as tired or out of breath? Do you have better strength and muscle tone? Do you have more energy?

Here’s one person’s list of barriers to taking a brisk 30-minute walk every day, along with some possible solutions.



I might be too busy.

I might get bored.

It might rain.

You can use a personal action plan (What is a PDF document?) to write down your goals and organize your support system.

Eating a healthy, balanced variety of foods is far more satisfying than following a strict weight-loss diet that leaves you feeling deprived and hungry. And healthy eating paired with increased activity is more likely to get you to a healthy weightand keep you therethan dieting is.

Dieting may make you feel like a failure if you can’t lose weight or stay on your diet. Instead of blaming the diets, people who are overweight tend to blame themselves. You may think, “If I could just stay on that diet, I would be thin.” This doesn’t take into account that your body has powerful regulators that affect your weightthings you can’t do anything about. And if you’ve dieted again and again without success, you can get into a cycle of negative thinkingand even gain more weight.

When you go on a diet, you deprive yourself of food. For many people, that means being hungry most of the time and not having enough energy. It also can lead you to think about food all the time. So you’re much more likely to overeat when you finally give yourself permission to eat. It’s important to make healthy eating changes that you can keep doing , instead of dieting.

Many different diets and programs promise rapid weight loss but rarely work for the long term. Some might even be dangerous.

But what does healthy eating mean? Everywhere we turn, we get conflicting advice on what foods are good for our health. It can be hard to know where to start after you’ve decided to make a change.

Young children are good at paying attention to their body signals . They eat when they’re hungry. They stop when they’re full.

But as we grow older, and fast food, huge portions, and delicious snacks are everywhere, many of us start to ignore our body signals. We eat for other reasonsor sometimes without thinking at all.

You can ignore those body signals for a while, but they are powerful. And if you ignore them for a long time (by dieting, for example) you lose your ability to pay attention to them. You get out of practice.

Common triggers to eating when you’re not really hungry are:

Identify your eating triggers by keeping an eating journal for a week or two. Write down everything you eat, plus the time of day and what you were feeling right before you ate.

After you understand why and how you eat, it’s time to look at what and how much you eat.

Many people classify foods as “good” or “bad” based on their calorie or fat content and, sometimes, on how nutritious they are. But a healthy diet has room for all kinds of foods.

A healthy, balanced diet means getting the right amounts of:

Keep a food diary (What is a PDF document?) , writing down everything you eat for a week or two. It will help you see which foods you need to eat more of and which foods you’re eating too much of.

Just cutting back on the size of your portions can be a great way to get to or stay at a healthy weightwithout giving up any of your favorite foods.

One Woman’s Story:

“Before I gained the weight, I wish someone said, ‘portion sizes.’ If you’re not thinking about it, you go to a restaurant, you think you’re getting a portion size. You’re not thinking they’re serving you six plates of food.” Jaci

Read more about how Jaci lost 65 pounds .

Physical activity is key to improving your health and preventing serious illness. Experts say to do either of these things to get and stay healthy:

Physical activity for weight loss means burning more calories. Experts say more than 5 hours a week (aim for 60 to 90 minutes a day) of moderate activity can help.

Being active in several blocks of 10-minutes or more throughout the day can count toward these recommendations. You can choose to do one or both types of activity.

If you’re not active right now, you don’t have to start out at this level. Instead, start small and build up over time. Moderate activity is safe for most people. But it’s always a good idea to talk to your doctor before you start an exercise program.

Regular moderate-intensity physical activity lowers your risk of:

Brushing your teeth and getting dressed are regular parts of your day, right? You hardly think about it.

It can be that way with physical activity too. With practice and repetition, you can make activitywhether it’s formal exercise or an activity like gardening or walking the dogso routine that it becomes something you just do because it’s part of your day and you enjoy it.

Like any lifestyle change, changing your activity level may be easier if you have a plan. Set small goals. Be creative. For more information, see Getting to a Healthy Weight: Making Lifestyle Changes .

Don’t wait until you are “thin” to do the activities you want to do. Just make sure to start slowly. If you aren’t active at all, talk to your doctor first.

No matter what you do, the key is making physical activity a regular, fun part of your life. And as soon as you start seeing the results, you’ll be even more motivated to keep doing it.

It’s best to get some moderate physical activity for at least 2 hours a week. Brisk walking is one kind of moderate activity.

But if you’re not active at all, work up to it. For example, you may want to start by walking around the block every morning, or walking for just 10 minutes. Over time, you can make your walks longer or walk more often throughout your day and week.

Here’s how you can tell if an activity or exercise is making you work hard enough:

You can also use the rating of perceived exertion scale.

Walking is one of the easiest and cheapest ways to get moving for most people. Keep track of the number of steps you take each day with a phone app or pedometer. Using it may motivate you to walk more in order to increase your total steps.

There are lots of reasons why you may have trouble getting more active. These are called barriers .

These barriers can range from “I don’t have time” to “I’m too embarrassed.”

Excerpt from:
Weight Management | Cigna

Weight Management

05-01-2017 6:46 am

Home Prebiotin Academy Diets Weight Management Prebiotin WM (Weight Management) is designed to be used with every weight loss or obesity treatment program. To get the full benefit of Prebiotin WM it is important that you understand exactly how it fits into your overall digestive health. Gut Bacteria or the Microbiome

A remarkable finding of modern science is the fact that the lower bowel or colon is really a health organ. We have known for a long time that a huge number of bacteria live there, actually ten times the number of the total cells in the human body. The remarkable new findings indicate that this bacteria factory has many health benefits. But only if the mix of bacteria is favorable, meaning many more good bacteria than bad ones.

A startling recent discovery has been that most overweight people have a bad mix of colon bacteria. This bad mix technically is called dysbiosis. What causes this type of bad bacterial mix to occur? It is the type of diet, often high meat and saturated fat that overweight people have eaten over many years. There is still much that is not known but here is what we do know:

Prebiotics are not probiotics. A probiotic is a live bacteria that you take by mouth as in yogurt or a pill, in the hope that it will make a beneficial change in the digestive track. A prebiotic, on the other hand, is a plant fiber, a specialized form of soluble fiber that has distinct actions within the colon. Simply put, these fibers are the fuel that drive the very best bacteria already in the colon to vigorously multiply. We know these good bacteria can and do grow and divide every 20 minutes if there is enough nourishment around. Keeping a rich supply of the best prebiotics in the colon is simply the healthiest thing you can do in order to prevent dysbiosis in the colon.

It is quite surprising that so much medical research has occurred so quickly in this area. So, here is what we know:

Prebiotin WM (Weight Management) is our specially formulated composition which is the premium prebiotic available. It consists of 2 prebiotics, oligofructose and inulin. Oligofructose is not fructose. Different health benefits occur in different parts of the colon. Each of the 2 prebiotics acts in a separate part of the colon to give you the complete total coverage that others do not provide. It is why we call Prebiotin the Full Spectrum Prebiotic. The imagesbelow show where they work.

Weight loss and management must be a complete package. Changing the bacterial makeup of the colon will add a significant impact to the food program you are following. This program can and should be one that makes sense for you and your own situation. It could be a dietary program at a hospital, doctors office, a book like South Beach Diet, or an established program like Weight Watchers or NutriSystem. Whichever one you are following, it will be significantly more effective when your own microbiome, your very bacterial makeup within your gut, works together with your own dietary weight loss program.

Week 1: scoop or 1packet (2 grams) once a day

Week 2: scoop or 1 packet (2 grams) in the morning, scoop or 1 packet (2 grams) in the mid-afternoon

Week 3: 1 level scoop or 2 packets in the morning. scoop or 1 packet (2 grams) in the mid-afternoon

Week 4: 1 level scoop or 2 packets in the morning. 1 scoop or 2 packets in the mid afternoon

Thereafter, adjust the dosage to your own response. Remember, you cannot seriously overdose. In general you can never get too much fiber. If mild bloating should occur, simply wait a day and proceed with a reduced dose. Prebiotin WM will tend to encourage an acidity within the colon. This is very healthy. When this occurs, smelly rectal gas or flatus does not develop. When rectal gas no longer has a bad smell, you know you are at the right dosage level.Try Prebiotin WM Today

There is now an enormous amount of research that has occurred on the gut microbiome. The forefront of this research has been looking directly at the microbiome and bacterial makeup and its relationship to the development of obesity and overweight. As with every thing we say on our web site, there must be good science behind it first. Medical credibility is our foremost goal. That is our promise. Please go to our science/obesity page to review the medical articles you may have an interest in. Keep in touch with us and send us any questions you may have.

Antibiotics are wonder drugs when you have a severe infection. However, they should not be used indiscriminately such as for the virus induced common cold where they have no effect. Further, it is possible that low levels of antibiotics that farmers use to fatten animals before processing may still be present in the meats, poultry and even milk that you buy. Antibiotics generally are very destructive to the good colon bacteria make up. Avoid them and question your physician on their use. Ask for antibiotic free foods at your store. Your food store will respond to these requests. Buy natural or organic milk that is labeled no antibiotics.

Prebiotics are natural plant fibers. As such they should be part of your diet program since almost all of them can be part of a weight loss program. As such there are no serious side effects. Some societies can eat up to 50 grams or more per day of fiber without problems. If excessive fiber is ingested it is possible that excess and completely harmless gas and bloating might occur. Simply reduce the dose and continue on your program.

Should you want to learn how much fiber, both insoluble and soluble, you are eating each day, go to our Fiber Content of Food section and find out for yourself.

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Weight Management

Weight Management | IU Health

05-01-2017 6:46 am

Maintaining a healthy weight reduces the risk of conditions such as type 2 diabetes, heart disease and even cancer. By maintaining a healthy weight, you also ease stress on your joints, heart and lungs. At IU Health, our primary care physicians help you meet your weight loss goals through high quality, personalized care.

A body mass index (BMI) between 18 and 25 describes a healthy weight for the average person. For example, an adult who is 5 foot 5 inches tall can weigh between 111 and 150 pounds to have a healthy BMI. To calculate your BMI, take your height in inches and square it. Divide your weight in pounds by that number, then multiply by 703 to find out your BMI.

For an easier way to compute your BMI, use our BMI calculator.

Maintaining a healthy weight requires eating a nutritious diet that contains the recommended number of calories and participating in regular physical activity. The number of calories you should eat each day varies depending on your sex, age and activity level, but most adults can eat between 1600 and 2400 calories per day. Adults should also get at least 150 minutes (2.5 hours) of moderate physical activity each week.

Many conditions, such as diabetes, polycystic ovary syndrome and hypothyroidism can make maintaining a healthy weight difficult. If you suffer from these conditions you should work with your primary care physician to manage symptoms so you can achieve a healthy weight. Certain medications, along with diet and exercise, may help manage weight gain caused by these conditions.

Before starting any diet or exercise program, you should consult with your primary care physician. Many diets include unsafe weight loss solutions that may do more harm than good. By working with your physicians you can ensure that you lose weight safely.

IU Health Primary Care physicians serve as your support team. We understand the difficulties of losing weight and will assist you in making a comprehensive plan for weight loss. As part of the states only nationally ranked health system, we have access to expert resources on nutrition and exercise. Our primary care physicians will ensure you remain healthy throughout your weight loss journey through regular appointments and monitoring of existing conditions. By providing high-quality care and coordination of weight loss, we help you live a healthier, more active lifestyle.

Originally posted here:
Weight Management | IU Health

Pounds and Inches – hCG Protocol | hCG Weight Loss

21-12-2016 1:52 pm

POUNDS AND INCHES A New Approach to Obesity


This is a complete rendering of the original document, with slight formatting changes to make the paragraphs look nice. You can download a PDF version of the document here.

A summary of the 500 calorie diet in this manuscript is available here. Search the site and manuscript using the search menu above, or to answer some of the most common questions, view our FAQ.

This book discusses a new interpretation of the nature of obesity, and while it does not advocate yet another fancy slimming diet it does describe a method of treatment which has grown out of theoretical considerations based on clinical observation.

What I have to say is an essence of views distilled out of forty years of grappling with the fundamental problems of obesity, its causes, its symptoms, and its very nature. In these many years of specialized work thousands of cases have passed through my hands and were carefully studied. Every new theory, every new method, every promising lead was considered, experimentally screened and critically evaluated as soon as it became known. But invariably the results were disappointing and lacking in uniformity.

I felt that we were merely nibbling at the fringe of a great problem, as, indeed, do most serious students of overweight. We have grown pretty sure that the tendency to accumulate abnormal fat is a very definite metabolic disorder, much as is, for instance, diabetes. Yet the localization and the nature of this disorder remained a mystery. Every new approach seemed to lead into a blind alley, and though patients were told that they are fat because they eat too much, we believed that this is neither the whole truth nor the last word in the matter.

Refusing to be side-tracked by an all too facile interpretation of obesity, I have always held that overeating is the result of the disorder, not its cause, and that we can make little

headway until we can build for ourselves some sort of theoretical structure with which to explain the condition. Whether such a structure represents the truth is not important at this moment. What it must do is to give us an intellectually satisfying interpretation of what is happening in the obese body. It must also be able to withstand the onslaught of all hitherto known clinical facts and furnish a hard background against which the results of treatment can be accurately assessed.

To me this requirement seems basic, and it has always been the center of my interest. In dealing with obese patients it became a habit to register and order every clinical experience as if it were an odd looking piece of a jig-saw puzzle. And then, as in a jig saw puzzle, little clusters of fragments began to form, though they seemed to fit in nowhere. As the years passed these clusters grew bigger and started to amalgamate until, about sixteen years ago, a complete picture became dimly discernible. This picture was, and still is, dotted with gaps for which I cannot find the pieces, but I do now feel that a theoretical structure is visible as a whole.

With mounting experience, more and more facts seemed to fit snugly into the new framework, and when then a treatment based on such speculations showed consistently satisfactory results, I was sure that some practical advance had been made, regardless of whether the theoretical interpretation of these results is correct or not.

The clinical results of the new treatment have been published in scientific journal and these reports have been generally well received by the profession, but the very nature of a scientific article does not permit the full presentation of new theoretical concepts nor is there room to discuss the finer points of technique and the reasons for observing them.

During the 16 years that have elapsed since I first published my findings, I have had many hundreds of inquiries from research institutes, doctors and patients. Hitherto I could only refer those interested to my scientific papers, though I realized that these did not contain sufficient information to enable doctors to conduct the new treatment satisfactorily. Those who tried were obliged to gain their own experience through the many trials and errors which I have long since overcome.

Doctors from all over the world have come to Italy to study the method, first hand in my clinic in the Salvator Mundi International Hospital in Rome. For some of them the time they could spare has been too short to get a full grasp of the technique, and in any case the number of those whom I have been able to meet personally is small compared with the many requests for further detailed information which keep coming in. I have tried to keep up with these demands by correspondence, but the volume of this work has become unmanageable and that is one excuse for writing this book.

In dealing with a disorder in which the patient must take an active part in the treatment, it is, I believe, essential that he or she have an understanding of what is being done and why. Only then can there be intelligent cooperation between physician and patient. In order to avoid writing two books, one for the physician and another for the patient a prospect which would probably have resulted in no book at all I have tried to meet the requirements of both in a single book. This is a rather difficult enterprise in which I may not have succeeded. The expert will grumble about long-windedness while the lay-reader may occasionally have to look up an unfamiliar word in the glossary provided for him.

To make the text more readable I shall be unashamedly authoritative and avoid all the hedging and tentativeness with which it is customary to express new scientific concepts grown out of clinical experience and not as yet confirmed by clear-cut laboratory experiments. Thus, when I make what reads like a factual statement, the professional reader may have to translate into: clinical experience seems to suggest that such and such an observation might be tentatively explained by such and such a working hypothesis, requiring a vast amount of further research before the hypothesis can be considered a valid theory. If we can from the outset establish this as a mutually accepted convention, I hope to avoid being accused of speculative exuberance.

As a basis for our discussion we postulate that obesity in all its many forms is due to an abnormal functioning of some part of the body and that every ounce of abnormally accumulated fat is always the result of the same disorder of certain regulatory mechanisms. Persons suffering from this particular disorder will get fat regardless of whether they eat excessively, normally or less than normal. A person who is free of the disorder will never get fat, even if he frequently overeats.

Those in whom the disorder is severe will accumulate fat very rapidly, those in whom it is moderate will gradually increase in weight and those in whom it is mild may be able to keep their excess weight stationary for long periods. In all these cases a loss of weight brought about by dieting, treatments with thyroid, appetite-reducing drugs, laxatives, violent exercise, massage, baths, etc., is only temporary and will be rapidly regained as soon as the reducing regimen is relaxed. The reason is simply that none of these measures corrects the basic disorder.

While there are great variations in the severity of obesity, we shall consider all the different forms in both sexes and at all ages as always being due to the same disorder. Variations in form would then be partly a matter of degree, partly an inherited bodily constitution and partly the result of a secondary involvement of endocrine glands such as the pituitary, the thyroid, the adrenals or the sex glands. On the other hand, we postulate that no deficiency of any of these glands can ever directly produce the common disorder known as obesity.

If this reasoning is correct, it follows that a treatment aimed at curing the disorder must be equally effective in both sexes, at all ages and in all forms of obesity. Unless this is so, we are entitled to harbor grave doubts as to whether a given treatment corrects the underlying disorder. Moreover, any claim that the disorder has been corrected must be substantiated by the ability of the patient to eat normally of any food he pleases without regaining abnormal fat after treatment. Only if these conditions are fulfilled can we legitimately speak of curing obesity rather than of reducing weight.

Our problem thus presents itself as an enquiry into the localization and the nature of the disorder which leads to obesity. The history of this enquiry is a long series of high hopes and bitter disappointments.

There was a time, not so long ago, when obesity was considered a sign of health and prosperity in man and of beauty, amorousness and fecundity in women. This attitude probably dates back to Neolithic times, about 8000 years ago; when for the first time in the history of culture, man began to own property, domestic animals, arable land, houses, pottery and metal tools. Before that, with the possible exception of some races such as the Hottentots, obesity was almost non-existent, as it still is in all wild animals and most primitive races.

Today obesity is extremely common among all civilized races, because a disposition to the disorder can be inherited. Wherever abnormal fat was regarded as an asset, sexual selection tended to propagate the trait. It is only in very recent times that manifest obesity has lost some of its allure, though the cult of the outsize bust always a sign of latent obesity shows that the trend still lingers on.

In the early Neolithic times another change took place which may well account for the fact that today nearly all inherited dispositions sooner or later develop into manifest obesity. This change was the institution of regular meals. In pre-Neolithic times, man ate only when he was hungry and on1y as much as he required to still the pangs of hunger. Moreover, much of his food was raw and all of it was unrefined. He roasted his meat, but he did not boil it, as he had no pots, and what little he may have grubbed from the Earth and picked from the trees, he ate as he went along.

The whole structure of mans omnivorous digestive tract is, like that of an ape, rat or pig, adjusted to the continual nibbling of tidbits. It is not suited to occasional gorging as is, for instance, the intestine of the carnivorous cat family. Thus the institution of regular meals, particularly of food rendered rapidly assimilable, placed a great burden on modern mans ability to cope with large quantities of food suddenly pouring into his system from the intestinal tract.

The institution of regular meals meant that man had to eat more than his body required at the moment of eating so as to tide him over until the next meal. Food rendered easily digestible suddenly flooded his body with nourishment of which he was in no need at the moment. Somehow, somewhere this surplus had to be stored.

In the human body we can distinguish three kinds of fat. The first is the structural fat which fills the gaps between various organs, a sort of packing material. Structural fat also performs such important functions as bedding the kidneys in soft elastic tissue, protecting the coronary arteries and keeping the skin smooth and taut. It also provides the springy cushion of hard fat under the bones of the feet, without which we would be unable to walk.

The second type of fat is a normal reserve of fuel upon which the body can freely draw when the nutritional income from the intestinal tract is insufficient to meet the demand. Such normal reserves are localized all over the body. Fat is a substance which packs the highest caloric value into the smallest space so that normal reserves of fuel for muscular activity and the maintenance of body temperature can be most economically stored in this form. Both these types of fat, structural and reserve, are normal, and even if the body stocks them to capacity this can never be called obesity.

But there is a third type of fat which is entirely abnormal. It is the accumulation of such fat, and of such fat only, from which the overweight patient suffers. This abnormal fat is also a potential reserve of fuel, but unlike the normal reserves it is not available to the body in a nutritional emergency. It is, so to speak, locked away in a fixed deposit and is not kept in a current account, as are the normal reserves.

When an obese patient tries to reduce by starving himself, he will first lose his normal fat reserves. When these are exhausted he begins to burn up structural fat, and only as a last resort will the body yield its abnormal reserves, though by that time the patient usually feels so weak and hungry that the diet is abandoned. It is just for this reason that obese patients complain that when they diet they lose the wrong fat. They feel famished and tired and their face becomes drawn and haggard, but their belly, hips, thighs and upper arms show little improvement. The fat they have come to detest stays on and the fat they need to cover their bones gets less and less. Their skin wrinkles and they look old and miserable. And that is one of the most frustrating and depressing experiences a human being can have.

When then obese patients are accused of cheating, gluttony, lack of will power, greed and sexual complexes, the strong become indignant and decide that modern medicine is a fraud and its representatives fools, while the weak just give up the struggle in despair. In either case the result is the same: a further gain in weight, resignation to an abominable fate and the resolution at least to live tolerably the short span allotted to them a fig for doctors and insurance companies.

Obese patients only feel physically well as long as they are stationary or gaining weight. They may feel guilty, owing to the lethargy and indolence always associated with obesity. They may feel ashamed of what they have been led to believe is a lack of control. They may feel horrified by the appearance of their nude body and the tightness of their clothes. But they have a primitive feeling of animal content which turns to misery and suffering as soon as they make a resolute attempt to reduce. For this there are sound reasons.

In the first place, more caloric energy is required to keep a large body at a certain temperature than to heat a small body. Secondly the muscular effort of moving a heavy body is greater than in the case of a light body. The muscular effort consumes Calories which must be provided by food. Thus, all other factors being equal, a fat person requires more food than a lean one. One might therefore reason that if a fat person eats only the additional food his body requires he should be able to keep his weight stationary. Yet every physician who has studied obese patients under rigorously controlled conditions knows that this is not true.

Many obese patients actually gain weight on a diet which is calorically deficient for their basic needs. There must thus be some other mechanism at work.

At one time it was thought that this mechanism might be concerned with the sex glands. Such a connection was suggested by the fact that many juvenile obese patients show an under-development of the sex organs. The middle-age spread in men and the tendency of many women to put on weight in the menopause seemed to indicate a causal connection between diminishing sex function and overweight. Yet, when highly active sex hormones became available, it was found that their administration had no effect whatsoever on obesity. The sex glands could therefore not be the seat of the disorder.

When it was discovered that the thyroid gland controls the rate at which body-fuel is consumed, it was thought that by administering thyroid gland to obese patients their abnormal fat deposits could be burned up more rapidly. This too proved to be entirely disappointing, because as we now know, these abnormal deposits take no part in the bodys energy-turnover they are inaccessibly locked away. Thyroid medication merely forces the body to consume its normal fat reserves, which are already depleted in obese patients, and then to break down structurally essential fat without touching the abnormal deposits. In this way a patient may be brought to the brink of starvation in spite of having a hundred pounds of fat to spare. Thus any weight loss brought about by thyroid medication is always at the expense of fat of which the body is in dire need.

While the majority of obese patients have a perfectly normal thyroid gland and some even have an overactive thyroid, one also occasionally sees a case with a real thyroid deficiency. In such cases, treatment with thyroid brings about a small loss of weight, but this is not due to the loss of any abnormal fat. It is entirely the result of the elimination of a mucoid substance, called myxedema, which the body accumulates when there is a marked primary thyroid deficiency. Moreover, patients suffering only from a severe lack of thyroid hormone never become obese in the true sense. Possibly also the observation that normal persons though not the obese lose weight rapidly when their thyroid becomes overactive may have contributed to the false notion that thyroid deficiency and obesity are connected. Much misunderstanding about the supposed role of the thyroid gland in obesity is still met with, and it is now really high time that thyroid preparations be once and for all struck off the list of remedies for obesity. This is particularly so because giving thyroid gland to an obese patient whose thyroid is either normal or overactive, besides being useless, is decidedly dangerous.

The next gland to be falsely incriminated was the anterior lobe of the pituitary, or hypophysis. This most important gland lies well protected in a bony capsule at the base of the skull. It has a vast number of functions in the body, among which is the regulation of all the other important endocrine glands. The fact that various signs of anterior pituitary deficiency are often associated with obesity raised the hope that the seat of the disorder might be in this gland. But although a large number of pituitary hormones have been isolated and many extracts of the gland prepared, not a single one or any combination of such factors proved to be of any value in the treatment of obesity. Quite recently, however, a fat-mobilizing factor has been found in pituitary glands, but it is still too early to say whether this factor is destined to play a role in the treatment of obesity.

Recently, a long series of brilliant discoveries concerning the working of the adrenal or suprarenal glands, small bodies which sit atop the kidneys, have created tremendous interest. This interest also turned to the problem of obesity when it was discovered that a condition which in some respects resembles a severe case of obesity the so called Cushings Syndrome was caused by a glandular new-growth of the adrenals or by their excessive stimulation with ACTH, which is the pituitary hormone governing the activity of the outer rind or cortex of the adrenals.

When we learned that an abnormal stimulation of the adrenal cortex could produce signs that resemble true obesity, this knowledge furnished no practical means of treating obesity by decreasing the activity of the adrenal cortex. There is no evidence to suggest that in obesity there is any excess of adrenocortical activity; in fact, all the evidence points to the contrary. There seems to be rather a lack of adrenocortical function and a decrease in the secretion of ACTH from the anterior pituitary lobe.

So here again our search for the mechanism which produces obesity led us into a blind alley. Recently, many students of obesity have reverted to the nihilistic attitude that obesity is caused simply by overeating and that it can only be cured by under eating.

For those of us who refused to be discouraged there remained one slight hope. Buried deep down in the massive human brain there is a part which we have in common with all vertebrate animals the so-called diencephalon. It is a very primitive part of the brain and has in man been almost smothered by the huge masses of nervous tissue with which we think, reason and voluntarily move our body. The diencephalon is the part from which the central nervous system controls all the automatic animal functions of the body, such as breathing, the heart beat, digestion, sleep, sex, the urinary system, the autonomous or vegetative nervous system and via the pituitary the whole interplay of the endocrine glands.

It was therefore not unreasonable to suppose that the complex operation of storing and issuing fuel to the body might also be controlled by the diencephalon. It has long been known that the content of sugar another form of fuel in the blood depends on a certain nervous center in the diencephalon. When this center is destroyed in laboratory animals, they develop a condition rather similar to human stable diabetes. It has also long been known that the destruction of another diencephalic center produces a voracious appetite and a rapid gain in weight in animals which never get fat spontaneously.

Assuming that in man such a center controlling the movement of fat does exist, its function would have to be much like that of a bank. When the body assimilates from the intestinal tract more fuel than it needs at the moment, this surplus is deposited in what may be compared with a current account. Out of this account it can always be withdrawn as required. All normal fat reserves are in such a current account, and it is probable that a diencephalic center manages the deposits and withdrawals.

When now, for reasons which will be discussed later, the deposits grow rapidly while small withdrawals become more frequent, a point may be reached which goes beyond the diencephalons banking capacity. Just as a banker might suggest to a wealthy client that instead of accumulating a large and unmanageable current account he should invest his surplus capital, the body appears to establish a fixed deposit into which all surplus funds go but from which they can no longer be withdrawn by the procedure used in a current account. In this way the diencephalic fat-bank frees itself from all work which goes beyond its normal banking capacity. The onset of obesity dates from the moment the diencephalon adopts this labor-saving ruse. Once a fixed deposit has been established the normal fat reserves are held at a minimum, while every available surplus is locked away in the fixed deposit and is therefore taken out of normal circulation.

Assuming that there is a limit to the diencephalons fat banking capacity, it follows that there are three basic ways in which obesity can become manifest. The first is that the fat-banking capacity is abnormally low from birth. Such a congenitally low diencephalic capacity would then represent the inherited factor in obesity. When this abnormal trait is markedly present, obesity will develop at an early age in spite of normal feeding; this could explain why among brothers and sisters eating the same food at the same table some become obese and others do not.

The second way in which obesity can become established is the lowering of a previously normal fat-banking capacity owing to some other diencephalic disorder. It seems to be a general rule that when one of the many diencephalic centers is particularly overtaxed; it tries to increase its capacity at the expense of other centers.

In the menopause and after castration the hormones previously produced in the sex-glands no longer circulate in the body. In the presence of normally functioning sex-glands their hormones act as a brake on the secretion of the sex-gland stimulating hormones of the anterior pituitary. When this brake is removed the anterior pituitary enormously increases its output of these sex-gland stimulating hormones, though they are now no longer effective. In the absence of any response from the non-functioning or missing sex glands, there is nothing to stop the anterior pituitary from producing more and more of these hormones. This situation causes an excessive strain on the diencephalic center which controls the function of the anterior pituitary. In order to cope with this additional burden the center appears to draw more and more energy away from other centers, such as those concerned with emotional stability, the blood circulation (hot flushes) and other autonomous nervous regulations, particularly also from the not so vitally important fat-bank.

The so-called stable type of diabetes heavily involves the diencephalic blood sugar regulating center. The diencephalon tries to meet this abnormal load by switching energy destined for the fat bank over to the sugar-regulating center, with the result that the fat-banking capacity is reduced to the point at which it is forced to establish a fixed deposit and thus initiate the disorder we call obesity. In this case one would have to consider the diabetes the primary cause of the obesity, but it is also possible that the process is reversed in the sense that a deficient or overworked fat-center draws energy from the sugar-center, in which case the obesity would be the cause of that type of diabetes in which the pancreas is not primarily involved. Finally, it is conceivable that in Cushings syndrome those symptoms which resemble obesity are entirely due to the withdrawal of energy from the diencephalic fat-bank in order to make it available to the highly disturbed center which governs the anterior pituitary adrenocortical system.

Whether obesity is caused by a marked inherited deficiency of the fat-center or by some entirely different diencephalic regulatory disorder, its insurgence obviously has nothing to do with overeating and in either case obesity is certain to develop regardless of dietary restrictions. In these cases any enforced food deficit is made up from essential fat reserves and normal structural fat, much to the disadvantage of the patients general health.

But there is still a third way in which obesity can become established, and that is when a presumably normal fat-center is suddenly the emphasis is on suddenly called upon to deal with an enormous influx of food far in excess of momentary requirements. At first glance it does seem that here we have a straight-forward case of overeating being responsible for obesity, but on further analysis it soon becomes clear that the relation of cause and effect is not so simple. In the first place we are merely assuming that the capacity of the fat center is normal while it is possible and even probable that only persons who have some inherited trait in this direction can become obese merely by overeating.

Secondly, in many of these cases the amount of food eaten remains the same and it is only the consumption of fuel which is suddenly decreased, as when an athlete is confined to bed for many weeks with a broken bone or when a man leading a highly active life is suddenly tied to his desk in an office and to television at home. Similarly, when a person, grown up in a cold climate, is transferred to a tropical country and continues to eat as before, he may develop obesity because in the heat far less fuel is required to maintain the normal body temperature.

When a person suffers a long period of privation, be it due to chronic illness, poverty, famine or the exigencies of war, his diencephalic regulations adjust themselves to some extent to the low food intake. When then suddenly these conditions change and he is free to eat all the food he wants, this is liable to overwhelm his fat-regulating center. During the last war about 6000 grossly underfed Polish refugees who had spent harrowing years in Russia were transferred to a camp in India where they were well housed, given normal British army rations and some cash to buy a few extras. Within about three months, 85% were suffering from obesity.

In a person eating coarse and unrefined food, the digestion is slow and only a little nourishment at a time is assimilated from the intestinal tract. When such a person is suddenly able to obtain highly refined foods such as sugar, white flour, butter and oil these are so rapidly digested and assimilated that the rush of incoming fuel which occurs at every meal may eventually overpower the diecenphalic regulatory mechanisms and thus lead to obesity. This is commonly seen in the poor man who suddenly becomes rich enough to buy the more expensive refined foods, though his total caloric intake remains the same or is even less than before.

Much has been written about the psychological aspects of obesity. Among its many functions the diencephalon is also the seat of our primitive animal instincts, and just as in an emergency it can switch energy from one center to another, so it seems to be able to transfer pressure from one instinct to another. Thus, a lonely and unhappy person deprived of all emotional comfort and of all instinct gratification except the stilling of hunger and thirst can use these as outlets for pent up instinct pressure and so develop obesity. Yet once that has happened, no amount of psychotherapy or analysis, happiness, company or the gratification of other instincts will correct the condition.

No end of injustice is done to obese patients by accusing them of compulsive eating, which is a form of diverted sex gratification. Most obese patients do not suffer from compulsive eating; they suffer genuine hunger real, gnawing, torturing hunger which has nothing whatever to do with compulsive eating. Even their sudden desire for sweets is merely the result of the experience that sweets, pastries and alcohol will most rapidly of all foods allay the pangs of hunger. This has nothing to do with diverted instincts.

On the other hand, compulsive eating does occur in some obese patients, particularly in girls in their late teens or early twenties. Compulsive eating differs fundamentally from the obese patients greater need for food. It comes on in attacks and is never associated with real hunger, a fact which is readily admitted by the patients. They only feel a feral desire to stuff. Two pounds of chocolates may be devoured in a few minutes; cold, greasy food from the refrigerator, stale bread, leftovers on stacked plates, almost anything edible is crammed down with terrifying speed and ferocity.

I have occasionally been able to watch such an attack without the patients knowledge, and it is a frightening, ugly spectacle to behold, even if one does realize that mechanisms entirely beyond the patients control are at work. A careful enquiry into what may have brought on such an attack almost invariably reveals that it is preceded by a strong unresolved sex-stimulation, the higher centers of the brain having blocked primitive diencephalic instinct gratification. The pressure is then let off through another primitive channel, which is oral gratification. In my experience the only thing that will cure this condition is uninhibited sex, a therapeutic procedure which is hardly ever feasible, for if it were, the patient would have adopted it without professional prompting, nor would this in any way correct the associated obesity. It would only raise new and often greater problems if used as a therapeutic measure.

Patients suffering from real compulsive eating are comparatively rare. In my practice they constitute about 1-2%. Treating them for obesity is a heartrending job. They do perfectly well between attacks, but a single bout occurring while under treatment may annul several weeks of therapy. Little wonder that such patients become discouraged. In these cases I have found that psychotherapy may make the patient fully understand the mechanism, but it does nothing to stop it. Perhaps societys growing sexual permissiveness will make compulsive eating even rarer.

Whether a patient is really suffering from compulsive eating or not is hard to decide before treatment because many obese patients think that their desire for food to them unmotivated is due to compulsive eating, while all the time it is merely a greater need for food. The only way to find out is to treat such patients. Those that suffer from real compulsive eating continue to have such attacks, while those who are not compulsive eaters never get an attack during treatment.

Some patients are deeply attached to their fat and cannot bear the thought of losing it. If they are intelligent, popular and successful in spite of their handicap, this is a source of pride. Some fat girls look upon their condition as a safeguard against erotic involvements, of which they are afraid. They work out a pattern of life in which their obesity plays a determining role and then become reluctant to upset this pattern and face a new kind of life which will be entirely different after their figure has become normal and often very attractive. They fear that people will like them or be jealous on account of their figure rather than be attracted by their intelligence or character only. Some have a feeling that reducing means giving up an almost cherished and intimate part of themselves. In many of these cases psychotherapy can be helpful, as it enables these patients to see the whole situation in the full light of consciousness. An affectionate attachment to abnormal fat is usually seen in patients who became obese in childhood, but this is not necessarily so.

In all other cases the best psychotherapy can do in the usual treatment of obesity is to render the burden of hunger and never-ending dietary restrictions slightly more tolerable. Patients who have successfully established an erotic transfer to their psychiatrist are often better able to bear their suffering as a secret labor of love.

There are thus a large number of ways in which obesity can be initiated, though the disorder itself is always due to the same mechanism, an inadequacy of the diencephalic fat-center and the laying down of abnormally fixed fat deposits in abnormal places. This means that once obesity has become established, it can no more be cured by eliminating those factors which brought it on than a fire can be extinguished by removing the cause of the conflagration. Thus a discussion of the various ways in which obesity can become established is useful from a preventative point of view, but it has no bearing on the treatment of the established condition. The elimination of factors which are clearly hastening the course of the disorder may slow down its progress or even halt it, but they can never correct it.

Weight alone is not a satisfactory criterion by which to judge whether a person is suffering from the disorder we call obesity or not. Every physician is familiar with the sylphlike lady who enters the consulting room and declares emphatically that she is getting horribly fat and wishes to reduce. Many an honest and sympathetic physician at once concludes that he is dealing with a nut. If he is busy he will give her short shrift, but if he has time he will weigh her and show her tables to prove that she is actually underweight.

I have never yet seen or heard of such a lady being convinced by either procedure. The reason is that in my experience the lady is nearly always right and the doctor wrong. When such a patient is carefully examined one finds many signs of potential obesity, which is just about to become manifest as overweight. The patient distinctly feels that something is wrong with her, that a subtle change is taking place in her body, and this alarms her.

There are a number of signs and symptoms which are characteristic of obesity. In manifest obesity many and often all these signs and symptoms are present. In latent or just beginning cases some are always found, and it should be a rule that if two or more of the bodily signs are present, the case must be regarded as one that needs immediate help.

The bodily signs may be divided into such as have developed before puberty, indicating a strong inherited factor, and those which develop at the onset of manifest disorder. Early signs are a disproportionately large size of the two upper front teeth, the first incisor, or a dimple on both sides of the sacral bone just above the buttocks. When the arms are outstretched with the palms upward, the forearms appear sharply angled outward from the upper arms. The same applies to the lower extremities. The patient cannot bring his feet together without the knees overlapping; he is, in fact, knock-kneed.

The beginning accumulation of abnormal fat shows as a little pad just below the nape of the neck, colloquially known as the Duchess Hump. There is a triangular fatty bulge in front of the armpit when the arm is held against the body. When the skin is stretched by fat rapidly accumulating under it, it may split in the lower layers. When large and fresh, such tears are purple, but later they are transformed into white scar-tissue. Such striation, as it is called, commonly occurs on the abdomen of women during pregnancy, but in obesity it is frequently found on the breasts, the hips and occasionally on the shoulders. In many cases striation is so fine that the small white lines are only just visible. They are always a sure sign of obesity, and though this may be slight at the time of examination such patients can usually remember a period in their childhood when they were excessively chubby.

Another typical sign is a pad of fat on the insides of the knees, a spot where normal fat reserves are never stored. There may be a fold of skin over the pubic area and another fold may stretch round both sides of the chest, where a loose roll of fat can be picked up between two fingers. In the male an excessive accumulation of fat in the breasts is always indicative, while in the female the breast is usually, but not necessarily, large. Obviously excessive fat on the abdomen, the hips, thighs, upper arms, chin and shoulders are characteristic, and it is important to remember that any number of these signs may be present in persons whose weight is statistically normal; particularly if they are dieting on their own with iron determination.

Common clinical symptoms which are indicative only in their association and in the frame of the whole clinical picture are: frequent headaches, rheumatic pains without detectable bony abnormality; a feeling of laziness and lethargy, often both physical and mental and frequently associated with insomnia, the patients saying that all they want is to rest; the frightening feeling of being famished and sometimes weak with hunger two to three hours after a hearty meal and an irresistible yearning for sweets and starchy food which often overcomes the patient quite suddenly and is sometimes substituted by a desire for alcohol; constipation and a spastic or irritable colon are unusually common among the obese, and so are menstrual disorders.

Returning once more to our sylphlike lady, we can say that a combination of some of these symptoms with a few of the typical bodily signs is sufficient evidence to take her case seriously. A human figure, male or female, can only be judged in the nude; any opinion based on the dressed appearance can be quite fantastically wide off the mark, and I feel myself driven to the conclusion that apart from frankly psychotic patients such as cases of anorexia nervosa; a morbid weight fixation does not exist. I have yet to see a patient who continues to complain after the figure has been rendered normal by adequate treatment.

I remember the case of a lady who was escorted into my consulting room while I was telephoning. She sat down in front of my desk, and when I looked up to greet her I saw the typical picture of advanced emaciation. Her dry skin hung loosely over the bones of her face, her neck was scrawny and collarbones and ribs stuck out from deep hollows. I immediately thought of cancer and decided to which of my colleagues at the hospital I would refer her. Indeed, I felt a little annoyed that my assistant had not explained to her that her case did not fall under my specialty. In answer to my query as to what I could do for her, she replied that she wanted to reduce. I tried to hide my surprise, but she must have noted a fleeting expression, for she smiled and said I know that you think Im mad, but just wait. With that she rose and came round to my side of the desk. Jutting out from a tiny waist she had enormous hips and thighs.

By using a technique which will presently be described, the abnormal fat on her hips was transferred to the rest of her body which had been emaciated by months of very severe dieting. At the end of a treatment lasting five weeks, she, a small woman, had lost 8 inches round her hips, while her face looked fresh and florid, the ribs were no longer visible and her weight was the same to the ounce as it had been at the first consultation.

While a person who is statistically underweight may still be suffering from the disorder which causes obesity, it is also possible for a person to be statistically overweight without suffering from obesity. For such persons weight is no problem, as they can gain or lose at will and experience no difficulty in reducing their caloric intake. They are masters of their weight, which the obese are not. Moreover, their excess fat shows no preference for certain typical regions of the body, as does the fat in all cases of obesity. Thus, the decision whether a borderline case is really suffering from obesity or not cannot be made merely by consulting weight tables.

If obesity is always due to one very specific diencephalic deficiency, it follows that the only way to cure it is to correct this deficiency. At first this seemed an utterly hopeless undertaking. The greatest obstacle was that one could hardly hope to correct an inherited trait localized deep inside the brain, and while we did possess a number of drugs whose point of action was believed to be in the diencephalon, none of them had the slightest effect on the fat-center. There was not even a pointer showing a direction in which pharmacological research could move to find a drug that had such a specific action. The closest approach were the appetite-reducing drugs the amphetamines but these cured nothing.

Mulling over this depressing situation, I remembered a rather curious observation made many years ago in India. At that time we knew very little about the function of the diencephalon, and my interest centered round the pituitary gland. Froehlich had described cases of extreme obesity and sexual underdevelopment in youths suffering from a new growth of the anterior pituitary lobe, producing what then became known as Froehlichs disease. However, it was very soon discovered that the identical syndrome, though running a less fulminating course, was quite common in patients whose pituitary gland was perfectly normal. These are the so-called fat boys with long, slender hands, breasts any flat-chested maiden would be proud to posses, large hips, buttocks and thighs with striation, knock-knees and underdeveloped genitals, often with undescended testicles.

It also became known that in these cases the sex organs could he developed by giving the patients injections of a substance extracted from the urine of pregnant women, it having been shown that when this substance was injected into sexually immature rats it made them precociously mature. The amount of substance which produced this effect in one rat was called one International Unit, and the purified extract was accordingly called Human Chorionic Gonadotrophin whereby chorionic signifies that it is produced in the placenta and gonadotropin that its action is sex gland directed.

The usual way of treating fat boys with underdeveloped genitals is to inject several hundred International Units twice a week. Human Chorionic Gonadotrophin which we shall henceforth simply call HCG is expensive and as fat boys are fairly common among Indians I tried to establish the smallest effective dose. In the course of this study three interesting things emerged. The first was that when fresh pregnancy-urine from the female ward was given in quantities of about 300 cc. by retention enema, as good results could be obtained as by injecting the pure substance. The second was that small daily doses appeared to be just as effective as much larger ones given twice a week. Thirdly, and that is the observation that concerns us here, when such patients were given small daily doses they seemed to lose their ravenous appetite though they neither gained nor lost weight. Strangely enough however, their shape did change. Though they were not restricted in diet, there was a distinct decrease in the circumference of their hips.

Remembering this, it occurred to me that the change in shape could only be explained by a movement of fat away from abnormal deposits on the hips, and if that were so there was just a chance that while such fat was in transition it might be available to the body as fuel. This was easy to find out, as in that case, fat on the move would be able to replace food. It should then he possible to keep a fat boy on a severely restricted diet without a feeling of hunger, in spite of a rapid loss of weight. When I tried this in typical cases of Froehlichs syndrome, I found that as long as such patients were given small daily doses of HCG they could comfortably go about their usual occupations on a diet of only 500 Calories daily and lose an average of about one pound per day. It was also perfectly evident that only abnormal fat was being consumed, as there were no signs of any depletion of normal fat. Their skin remained fresh and turgid, and gradually their figures became entirely normal, nor did the daily administration of HCG appear to have any side-effects other than beneficial.

From this point it was a small step to try the same method in all other forms of obesity. It took a few hundred cases to establish beyond reasonable doubt that the mechanism operates in exactly the same way and seemingly without exception in every case of obesity. I found that, though most patients were treated in the outpatients department, gross dietary errors rarely occurred. On the contrary, most patients complained that the two meals of 250 Calories each were more than they could manage, as they continually had a feeling of just having had a large meal.

Once this trail was opened, further observations seemed to fall into line. It is, for instance, well known that during pregnancy an obese woman can very easily lose weight. She can drastically reduce her diet without feeling hunger or discomfort and lose weight without in any way harming the child in her womb. It is also surprising to what extent a woman can suffer from pregnancy-vomiting without coming to any real harm.

Pregnancy is an obese womans one great chance to reduce her excess weight. That she so rarely makes use of this opportunity is due to the erroneous notion, usually fostered by her elder relations, that she now has two mouths to feed and must keep up her strength for the coming event. All modern obstetricians know that this is nonsense and that the more superfluous fat is lost the less difficult will be the confinement, though some still hesitate to prescribe a diet sufficiently low in Calories to bring about a drastic reduction.

A woman may gain weight during pregnancy, but she never becomes obese in the strict sense of the word. Under the influence of the HCG which circulates in enormous quantities in her body during pregnancy, her diencephalic banking capacity seems to be unlimited, and abnormal fixed deposits are never formed. At confinement she is suddenly deprived of HCG, and her diencephalic fat-center reverts to its normal capacity. It is only then that the abnormally accumulated fat is locked away again in a fixed deposit. From that moment on she is suffering from obesity and is subject to all its consequences.

Pregnancy seems to be the only normal human condition in which the diencephalic fat-banking capacity is unlimited. It is only during pregnancy that fixed fat deposits can be transferred back into the normal current account and freely drawn upon to make up for any nutritional deficit. During pregnancy, every ounce of reserve fat is placed at the disposal of the growing fetus. Were this not so, an obese woman, whose normal reserves are already depleted, would have the greatest difficulties in bringing her pregnancy to full term. There is considerable evidence to suggest that it is the HCG produced in large quantities in the placenta which brings about this diencephalic change.

Though we may be able to increase the dieneephalic fat banking capacity by injecting HCG, this does not in itself affect the weight, just as transferring monetary funds from a fixed deposit into a current account does not make a man any poorer; to become poorer it is also necessary that he freely spends the money which thus becomes available. In pregnancy the needs of the growing embryo take care of this to some extent, but in the treatment of obesity there is no embryo, and so a very severe dietary restriction must take its place for the duration of treatment.

Only when the fat which is in transit under the effect of HCG is actually consumed can more fat be withdrawn from the fixed deposits. In pregnancy it would be most undesirable if the fetus were offered ample food only when there is a high influx from the intestinal tract. Ideal nutritional conditions for the fetus can only be achieved when the mothers blood is continually saturated with food, regardless of whether she eats or not, as otherwise a period of starvation might hamper the steady growth of the embryo. It seems that HCG brings about this continual saturation of the blood, which is the reason why obese patients under treatment with HCG never feel hungry in spite of their drastically reduced food intake.

HCG is never found in the human body except during pregnancy and in those rare cases in which a residue of placental tissue continues to grow in the womb in what is known as a chorionic epithelioma. It is never found in the male. The human type of chorionic gonadotrophin is found only during the pregnancy of women and the great apes. It is produced in enormous quantities, so that during certain phases of her pregnancy a woman may excrete as much as one million International Units per day in her urine enough to render a million infantile rats precociously mature. Other mammals make use of a different hormone, which can be extracted from their blood serum but not from their urine. Their placenta differs in this and other respects from that of man and the great apes. This animal chorionic gonadotrophin is much less rapidly broken down in the human body than HCG, and it is also less suitable for the treatment of obesity.

As often happens in medicine, much confusion has been caused by giving HCG its name before its true mode of action was understood. It has been explained that gonadotrophin literally means a sex-gland directed substance or hormone, and this is quite misleading. It dates from the early days when it was first found that HCG is able to render infantile sex glands mature, whereby it was entirely overlooked that it has no stimulating effect whatsoever on normally developed and normally functioning sex-glands. No amount of HCG is ever able to increase a normal sex function; it can only improve an abnormal one and in the young hasten the onset of puberty. However, this is no direct effect. HCG acts exclusively at a diencephalic level and there brings about a considerable increase in the functional capacity of all those centers which are working at maximum capacity.

Two hormones known in the female as follicle stimulating hormone (FSH) and corpus luteum stimulating hormone (LSH) are secreted by the anterior lobe of the pituitary gland. These hormones are real gonadotrophins because they directly govern the function of the ovaries. The anterior pituitary is in turn governed by the diencephalon, and so when there is an ovarian deficiency the diencephalic center concerned is hard put to correct matters by increasing the secretion from the anterior pituitary of FSH or LSH, as the case may be. When sexual deficiency is clinically present, this is a sign that the diencephalic center concerned is unable, in spite of maximal exertion, to cope with the demand for anterior pituitary stimulation. When then the administration of HCG increases the functional capacity of the diencephalon, all demands can be fully satisfied and the sex deficiency is corrected.

That this is the true mechanism underlying the presumed gonadotrophic action of HCG is confirmed by the fact that when the pituitary gland of infantile rats is removed before they are given HCG, the latter has no effect on their sex-glands. HCG cannot therefore have a direct sex gland stimulating action like that of the anterior pituitary gonadotrophins, as FSH and LSH are justly called. The latter are entirely different substances from that which can be extracted from pregnancy urine and which, unfortunately, is called chorionic gonadotrophin. It would be no more clumsy, and certainly far more appropriate, if HCG were henceforth called chorionic diencephalotrophin.

It cannot he sufficiently emphasized that HCG is not sex-hormone, that its action is identical in men, women, children and in those cases in which the sex-glands no longer function owing to old age or their surgical removal. The only sexual change it can bring about after puberty is an improvement of a pre-existing deficiency, but never a stimulation beyond the normal. In an indirect way via the anterior pituitary, HCG regulates menstruation and facilitates conception, but it never virilizes a woman or feminizes a man. It neither makes men grow breasts nor does it interfere with their virility, though where this was deficient it may improve it. It never makes women grow a beard or develop a gruff voice. I have stressed this point only for the sake of my lay readers, because, it is our daily experience that when patients hear the word hormone they immediately jump to the conclusion that this must have something to do with the sex- sphere. They are not accustomed as we are, to think thyroid, insulin, cortisone, adrenalin etc, as hormones.

Owing to the fact that HCG has no direct action on any endocrine gland, its enormous importance in pregnancy has been overlooked and its potency underestimated. Though a pregnant woman can produce as much as one million units per day, we find that the injection of only 125 units per day is ample to reduce weight at the rate of roughly one pound per day, even in a colossus weighing 400 pounds, when associated with a 500- Calorie diet. It is no exaggeration to say that the flooding of the female body with HCG is by far the most spectacular hormonal event in pregnancy. It has an enormous protective importance for mother and child, and I even go so far as to say that no woman, and certainly not an obese one, could carry her pregnancy to term without it.

If I can be forgiven for comparing my fellow-endocrinologists with wicked Godmothers, HCG has certainly been their Cinderella, and I can only romantically hope that its extraordinary effect on abnormal fat will prove to be its Fairy Godmother.

HCG has been known for over half a century. It is the substance which Aschheim and Zondek so brilliantly used to diagnose early pregnancy out of the urine. Apart from that, the only thing it did in the experimental laboratory was to produce precocious rats, and that was not particularly stimulating to further research at a time when much more thrilling endocrinological discoveries were pouring in from all sides, sweeping, HCG into the stiller back waters.

Some complicating disorders are often associated with obesity, and these we must briefly discuss. The most important associated disorders and the ones in which obesity seems to play a precipitating or at least an aggravating role are the following: the stable type of diabetes, gout, rheumatism and arthritis, high blood pressure and hardening of the arteries, coronary disease and cerebral hemorrhage.

Apart from the fact that they are often though not necessarily associated with obesity, these disorders have two things in common. In all of them, modern research is becoming more and more inclined to believe that diencephalic regulations play a dominant role in their causation. The other common factor is that they either improve or do not occur during pregnancy. In the latter respect they are joined by many other disorders not necessarily associated with obesity. Such disorders are, for instance, colitis, duodenal or gastric ulcers, certain allergies, psoriasis, loss of hair, brittle fingernails, migraine, etc.

If HCG + diet does in the obese bring about those diencephalic changes which are characteristic of pregnancy, one would expect to see an improvement in all these conditions comparable to that seen in real pregnancy. The administration of HCG does in fact do this in a remarkable way.

In an obese patient suffering from a fairly advanced case of stable diabetes of many years duration in which the blood sugar may range from 3-400 mg%, it is often possible to stop all antidiabetic medication after the first few days of treatment. The blood sugar continues to drop from day to day and often reaches normal values in 2-3 weeks. As in pregnancy, this phenomenon is not observed in the brittle type of diabetes, and as some cases that are predominantly stable may have a small brittle factor in their clinical makeup, all obese diabetics have to be kept under a very careful and expert watch.

A brittle case of diabetes is primarily due to the inability of the pancreas to produce sufficient insulin, while in the stable type, diencephalic regulations seem to be of greater importance. That is possibly the reason why the stable form responds so well to the HCG method of treating obesity, whereas the brittle type does not. Obese patients are generally suffering from the stable type, but a stable type may gradually change into a brittle one, which is usually associated with a loss of weight. Thus, when an obese diabetic finds that he is losing weight without diet or treatment, he should at once have his diabetes expertly attended to. There is some evidence to suggest that the change from stable to brittle is more liable to occur in patients who are taking insulin for their stable diabetes.

All rheumatic pains, even those associated with demonstrable bony lesions, improve subjectively within a few days of treatment, and often require neither cortisone nor salicylates. Again this is a well known phenomenon in pregnancy, and while under treatment with HCG + diet the effect is no less dramatic. As it does after pregnancy, the pain of deformed joints returns after treatment, but smaller doses of pain-relieving drugs seem able to control it satisfactorily after weight reduction. In any case, the HCG method makes it possible in obese arthritic patients to interrupt prolonged cortisone treatment without a recurrence of pain. This in itself is most welcome, but there is the added advantage that the treatment stimulates the secretion of ACTH in a physiological manner and that this regenerates the adrenal cortex, which is apt to suffer under prolonged cortisone treatment.

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HCG Diet: 10 Ways to Cheat and Get Away With It

21-12-2016 1:52 pm

Are you feeling confined or bored with the restricted food list on the HCG diet? Are you going to scream if you have to eat chicken or fish for ONE MORE MEAL??? Are your taste buds crying for mercy?

Sometimes all you need is just a little more variety! Something to help you get past another day on the HCG diet. If only you could cheat . . . just once . . . just a little! Isn’t there a way?

Yesthere is! Especially if you’re careful about it. Anybody can cheat on the HCG dietbut there’s a secret to cheating successfullywithout overly jeopardizing your weight loss.

The most important thing about cheating on the HCG diet is to pick the right food. Don’t go off the deep end and eat a giant piece of cheesecake or a super-sized burger combo meal. There’s a better way to cheat and give your taste buds a little vacation while still playing it safe. Some people have discovered HCG diet cheats that don’t stall their weight loss at allespecially if they follow the secret method described below this list.

Please note that these items are not in Dr. Simeons’ original HCG diet protocol, and so we are NOT approving them as a safe part of the HCG diet. We take Dr. Simeons’ protocol seriously and try to stay true to his research. But if you’re going to cheat anyway, this list will help you do it responsibly!

The top 10 thingsin no particular orderthat successful cheaters have used while on the HCG diet are:

1. Watermelon

Some HCG diet clinics allow watermelon anytime. While we aren’t so careless about modifying the core protocol, we do know that watermelon makes a good HCG diet cheat because it’s low in sugar and high in water contentboth good things. Plus it’s so refreshing on a hot day!

2. Mixed vegetables

Dr. Simeons advised that the chemical makeup of certain foods caused problems with weight loss on the HCG diet, especially when combined with other foods. Yet everybody’s chemical makeup is a little different. You might not have trouble with mixed vegetables.

3. Cottage cheese

Cottage cheese is an often overlooked alternative to your standard meat portion on the HCG diet. Get a fat-free variety and eat it alone or use a serving to add extra flavor to your fruit or starch selection.

4. Whole wheat crackers

There’s a chance this might actually be better for you than your standard bread stick or Melba toast. Wheat grain doesn’t stick to your intestinal tract like processed white flour, and a few people actually report better weight loss using wheat crackers. Be sure to pick a brand and portion size with the same calorie count and other nutrition as the usual bread stick or Melba toast.

5. Truvia

Even though it’s based on stevia, we don’t normally recommend Truvia for the HCG diet, because it contains erythritol, a form of sugar. But we have heard reports from people who are still successful while using Truvia.

6. American beef

Dr. Simeons outlawed American beef from the HCG diet due to its extra calories and fat content, yet many people have found that they still lose weight after eating a lean beef steak or even ground beef.

7. Green beans

This is probably the most asked-after vegetable that’s not on the HCG diet food list. If you’re going to try them, remember to skip the butter. If you can get them fresh out of the garden, you won’t need it anywaythey’ll be fresh and bursting with flavor already! Add a little salt if you want to enhance the flavor.

8. Turkey

A four ounce serving of ground turkey breast is almost identical to a three-and-a-half ounce rib-eye steak. Because of this, we think that the “other white meat” was most likely tested by Dr. Simeons and found to be not as effective as chicken for the HCG diet. Yet as with many of these foods, there’s a decent chance you’ll be just fine with turkey.

9. Lotion

OK, it’s not a food, but as you probably know lotions containing fats and oils aren’t allowed on the HCG diet due to the way it’s absorbed into the skin and metabolized just as if eaten. But for some mysterious reason, certain people have no problem with lotion. (Be very careful with this one!)

10. Chicken stock, chicken broth, beef broth, and bouillon cubes

Four in one! These items often contain small amounts of sugar, fat, and oil. But the amount is so tiny, and the gain in flavor is so huge, it might just be worth a try.

Now, remember how I said there’s a secret to cheating successfully? Keep reading to learn the true technique of cheating.

The True Key to Successful Cheating

Choosing the right food to cheat on your HCG diet with is only the first part. To minimize your risk of gaining or stalling, you also need to make sure you’re in a regular pattern of weight loss.

What does that mean? It means you’ve been losing weight for at least the first two weeks of the 500-calorie HCG dietlong enough to know what your particular pattern is. Everybody loses weight in different patterns. Some people lose the same amount of weight every day on the HCG diet. Others lose in a stair-step fashiontwo days of weight loss followed by two days without, and so on.

Above all, make sure you’re not in a plateau already. Cheating during a plateau will only make it worse!

Once you know your own weight loss pattern, you can try a cheat. Then pay attention to your weight loss the next few of days. If you continue to lose weight according to your regular patternyou may have just found a food that you can cheat the HCG diet with consistently! But if your weight loss stalls, be strict the next week or so until you can establish your regular weight loss pattern again. You can try the same cheat one more time if you really want to confirm the testor you can try a new cheat.

Just don’t do it too often, or you may continue to stall too much, and you may have wasted your chance to lose weight, not to mention your HCG drops. Don’t take too many risks and end up disappointed. Remember, the HCG diet is your one big chance to achieve your weight loss goals.

One last piece of advice: don’t start cheating on the HCG diet with more than one food at the same time. Otherwise if you stall, you won’t know which food caused the problem.

Good luck, and happy cheating!

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HCG Diet: 10 Ways to Cheat and Get Away With It

Chris Kresser Let’s take back your health – Starting Now.

21-12-2016 1:50 pm

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Chris Kresser Let’s take back your health – Starting Now.