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Meal replacements (MRs) for weight loss
Do they work, and are they safe?
to not only provide nutritional balance, VWXG\VKRZVWKLVVWD\VORZIRUXSWRÀYH DUHIRUWLÀHGZLWKYLWDPLQVPLQHUDOVDQG viable in some cases of extreme obesity, RYHUGLDEHWLFVXEMHFWV7KHÀUVW results from this, expected at the World German scientists have shown that in metabolic rate. If a full weight loss from MRs without apparent side effects.
a high level of greenery are three program is not built around this, it can times more likely to be active and products as a tool in the weight loss battle. 40% less likely to be obese. Those For reference:
who live with lots of graffiti, litter Research evidence
and dog poo are 50% less likely to (Who says science is not creative?) strategy: meta and pooling analysis from six studies. International Journal of Reasons for past concern
be made up of rather bland ‘milkshape’ in this issue
type powders with little concern for total nutritional balance. They have also been are not found in a low calorie diet. MRs meals during the day. Finally, there has – or even a diet meal – and hence can been little emphasis put on supervision, hence often leading to a ‘bounce back’ Which MRs?
Getting the best from
There are really only three MR versions recommended by the Professor (none of your meal replacements which he has any commercial interest in).
Dr McCloud’s is the brand name given to a
Here are some suggestions for optimizing the weight loss effects of meal product produced by a Queensland GP, and replacements:• Use once or twice a day instead of meals that are most easy to replace; only available through doctors. It has a large • Mix shakes with low fat or skim milk, if not satisfying with water; number of flavours and types – perhaps too • Use quality products that are properly nutritionally balanced (see table); • Use fruit and low calorie foods as snacks; Optifast, is the oldest of the commercial
• Use 2 replacements per day more often for weight loss, then 1/day MRs, but is suffering by not having changed its formulation for years. It’s also a bit bland, • When full meals are taken, make sure these are still low energy and not but does have different flavours, and has Examples from the Frontline:
KicStart is produced by a Sydney-based
Ted Anderson from Mona Vale NSW who has lost over 15kg in 6 months pharmacy product development team. It is says meal replacements have been the big breakthrough for him: “They’re well balanced, perhaps the most tasty, and FRQYHQLHQWEXWDOVRÀOOLQJµKHVD\V´6XUSULVLQJO\P\ZLIHZKRWKRXJKW, has extra ingredients like omega 3/omega 6 ZDVMXVWJRLQJWKURXJKDQRWKHUIDGQRZXVHVWKHPUHJXODUO\KHUVHOIµ fats in a healthy ratio. There is currently only Greg Nielsen from Epping says meal replacements help keep him on one flavour, but flavour sachets are soon to track; “It’s easy to just take in too much in this day and age. With meal be added to ‘custom make’ your own taste.
replacements, you know you’re not pigging out, but you’re also not craving sachet or meal, and these generally come John Mesites from Manly says MRs now make weight loss easier: “These in boxes (except Dr McCloud’s) of around weren’t around when I did GutBusters years ago, but they make it a hell of a ORWHDVLHUQRZ<RXGRQ·WIHHOOLNH\RX·UHJLYLQJXSDQ\WKLQJµ Obesity and the Metabolic Syndrome
The bad news is that being overweight can cause disease. Testing for the Metabolic Syndrome
Now the even more bad news is that there is a group of Diabetes scientists meeting in Brussells recently have pulled these diseases that occur more commonly together in WRJHWKHUDQXPEHURIGHÀQLWLRQVRIWKHPHWDEROLFV\QGURPH overweight people, which can lead to even bigger problems.
to come up with one universal description and cut-offs. The 7KH0HWDEROLF6\QGURPHZDVÀUVWPHQWLRQHGLQD QHZGHÀQLWLRQGHÀQHVDQ\RQHZKRKDVWKHIROORZLQJDV seminal medical presentation in the 1980s. It was thought to be a cluster of disease risks like blood •&HQWUDO2EHVLW\ GHÀQHGDVDZDLVWFLUFXPIHUHQFHJUHDWHU than or equal to 94 for Europid men and greater than or  HTXDOWRFPIRU(XURSLGZRPHQZLWKHWKQLFLW\VSHFLÀF • raised serum triglyceride levels (>1.7mmol/L) • reduced serum HDL cholesterol (<1.03 mmol/L in males • raised blood pressure (systolic >130mmHg or diastolic >85mmHg) or treatment of previously diagnosed • impaired fasting blood sugars 9>5.6mmol/L) or previously Take home message:
Metabolic syndrome, which consists of a pot belly and 2 other risks, is a cause for concern.
categorization linking obesity with diabetes, and variously Zimmet PZ and others. Mainstreaming the metabolic called ‘diabesity’ (as most, but not all type 2 diabetes is V\QGURPH$GHÀQLWLYHGHÀQLWLRQMedical Journal of Australia, 2005;183(4):175-176.
Being active to go
Coffee consumption may
help diabetes
been adopted but just about all cultures – hence the interests in its effects.
10 points for both systolic and diastolic VKRZQQRVLJQLÀFDQWDGYHUVHEHQHÀWVLI blood pressure after the dark chocolate, but not after the white. The ‘bad’ (LDL) best, controlled studies of caffeine and insulin resistance, which is a pre-cursor with diabetes. They found there was a 35% less risk of getting the disease Cholesterol lowering
margarines do work
day. The results were consistent across several countries.
existed, it was only in over 60 year-olds, Also it didn’t occur with instant coffee, claims this is not an excuse for pigging doesn’t have to be taken off the list for LGHQWLI\LQJVSHFLÀFÁDYRQRLGVWKDWFDQ slight positive effect on weight loss, it Take home message:
chocolate is also bitter sweet and is not Caffeine could be helpful for diabetics.
likely to be eaten in large amounts. It’s For reference:
weight loss – at least unless other foods gram per serving of plant sterols, and risk of type 2 diabetes: a systematic Take home message:
for a daily total intake of at least in saturated fat and cholesterol, … and dark chocolate
For reference:
could also help with blood
disease.” What they haven’t said pressure
,QDVHFRQGVXUSULVHÀQGLQJUHVHDUFKHUV at Tufts University in the US have found Hypertension, 2005; 46: 398-405.
Factors influencing body
Don’t be afraid to pump a
fat levels
bit of iron as you get older
of weight training (WT) in body fat loss. like walking, because it helps maintain, another. Some of this may be genetically (because muscle is ‘active’), and thus, things that can’t be changed – at least theoretically at least, burn more energy.
2WKHUVÀQGDQHIIHFWEXWRQO\LQFHUWDLQ PRUHDSSUHFLDWHGDWWKHVFLHQWLÀFOHYHO It gives a hint to people that they’re not always to blame for their own excess fat.
Accept some increases in
body fat with age
It’s natural to add a little fat to the Accept (and understand)
your physical limitations
effects have been less obvious, but this • a decreased sensitivity of fat cells ‘weight control’ programs. Everybody • decrease of a muscle protein that helps these – including being comfortable at a higher than normal, but healthy, level of Change the things you can,
but accept the things you
• increased eating (although this is often can’t change
gains with aging don’t appear to be as dangerous as those in the young. They can LQÁXHQFHVRQERG\IDWOHYHOVWKRVHWKDW be worse though if the gains are too much (i.e. more than 20lbs over the weight at These are listed in the table below.
age 20), so some caution is still needed.
Calculate your required daily TRIM’S TRIVIA
Being overweight can
food intake
change your stature
It’s probably just common sense,
You can estimate the amount of food you need daily to stay at the same weight but researchers in Brazil (Clinical by detailed and complicated laboratory analyses, or it can be estimated through Biomechanics, July 62005) have found formulae, such as those below for males and females. that being overweight is likely to lead to stature changes that can cause a Resting Metabolic Rate (RMR):
Males: 66 + (6.22 x wt(lbs)) + (12.7x ht(inches)) - (6.8 x age) Females: 655 + (4.36 x wt(lbs)) + (4.32 x ht(inches)) - (4.7 x age) From the estimated metabolic rate, you can see that even a 50kg woman requires around 1200kcals per day to balance metabolism in the resting state. So In measuring intervertebral disc height, any diet of less than 1200kcals is likely to lead to weight loss.
Special calculations are then needed to estimate the extra requirements for carrying the load, but the obese men’s physical activity carried out throughout the day. Again, the general consensus is that for even a sedentary person, the RMR should be multiplied by about 1.2, when they weren’t carry an extra load. whereas an extremely vigorous person may require a multiplier of more. A table showing the energy required at different levels of exertion is shown below: Nicotine replacements
Seated with no option of moving and little exercise lead to less weight gain
Seated work with requirement to move around when quitting
Standing work (e,g, housework, shop assistant) Indeed evidence suggests this is true because of (a) a decrease in metabolism 7KHÀQDOÀJXUHKHUHLVWKHQXPEHURIFDORULHVSHUGD\\RXQHHGWRVWD\DWWKHVDPH weight. Consuming less will lead to weight loss.
Check your genetic limitations quitting. But some help comes from
a study of post menopausal female quitters in Minneapolis who were given Although not a guaranteed measure of heritability, the following test can give you DQLQGLFDWLRQRIZKHWKHUJHQHVLQÁXHQFH\RXUZHLJKWOHYHODQGZK\ZHLJKWORVV for two week after quitting (Addictive Behaviour, 2005 Aug;30(7):1273-80.). The nicotine patch group gained 1. As far as you know, were either or both of your parents VLJQLÀFDQWO\RYHUZHLJKWIRUPRVWRIWKHLUOLYHV" Surprisingly, the nicotine group actually ate more than the others, suggesting that 2. Do you have any brothers or sisters who have been VLJQLÀFDQWO\RYHUZHLJKWIRUPRVWRIWKHLUOLYHV" Aging means losing
fitness quicker
:KHQGLG\RXÀUVWEHFRPHRYHUZHLJKW" older and younger men, researchers in the UK have found that the effects of aerobic +RZGLIÀFXOWGR\RXÀQGLWWRWDNHRIIZHLJKW" younger men (British Journal of Sports Medicine, 2005 Aug;39(8):561-4.). suggests a similar phenomenon in gaining 5. Where do you mainly get fat when you put on weight? ÀWQHVV European Journal of Applied Physiology, 2005 Jul 20). The positive EHQHÀWVRIDHURELFH[HUFLVHDUHVKRZQLQ reduced insulin resistance (a pre-cursor Scores: 0-4: No apparent genetic involvement. 5-7: Moderate hereditary component. 8-10: There
of diabetes) for up to 72 hours in young DSSHDUVWREHDVLJQLÀFDQWKHUHGLWDU\FRPSRQHQWWR\RXUZHLJKWSUREOHP7KLVPHDQV\RXPD\QHHG women, but this is not the case in older special help for effective weight loss.
women. Unfortunately age is one of those risk factors that just can’t be changed.
Maintenance the best way to keep kilos off
The importance of maintenance has been accentuated in program, having lost an average of 44 lb — about 20% of a new American Study to Prevent Regain (STOP Regain) their total body weight — in a variety of ways. The most developed by Dr Rena Wing, one of that country’s leading common methods were Weight Watchers, their own diets, weight control experts. Preliminary results from the study, which offers counselling and face-to-face contact as well as Take home message:
Internet support, show that 42% of people given little help $OOZHLJKWORVVSURJUDPVVKRXOGLQYROYHVLJQLÀFDQW other than a newsletter in the maintenance stage, regain 2.2kg (5lbs) or more, 6 months after starting a program. Of those given counselling, only 26% regained that amount, For reference:
as did 32% of those given ongoing advice over the Internet. Wing R. North American Association for the Study of Participants were highly motivated upon entering the 2EHVLW\$QQXDO6FLHQWLÀF0HHWLQJ$EVWUDFW25 …and the best advice for keeping it off
He’s said it in these pages before, but the Professor’s statement is worth repeating: ‘Anyone can lose weight. It’s Third, you will need a lifetime commitment to long-term keeping it off that’s the problem’. So how is this best done? physical activity. As the risk of regain is greater for anyone And is it different to the initial stage of losing? who has been overweight, the ex-obese need more of this The best evidence comes from the study of those who than someone who has never had a weight problem. Sixty have done it successfully over the long-term. Entrants in a to 90 minutes of accumulated activity is the amount now US Weight Loss registry, comprised of over 5,000 people considered essential to prevent regain.
ZKRKDYHORVWDWOHDVWNJDQGNHSWWKLVRIIIRUDWOHDVWÀYH Fourth, and perhaps paradoxically, those who eat breakfast keep their lost weight off better than those who ,QWKHÀUVWSODFHLWVHHPVWKDWZHLJKWUHJDLQLVOHVVOLNHO\ don’t. This is probably because they eat less for the rest of the longer this is kept off. After 2 years, the game gets easier, but before this, the risks of regain are great as the Fifth, self-monitoring, by measuring and recording what body tends to want to get back to the weight it once new, you do, like steps per day etc., seems to have a positive and which it thinks is best for long term survival (in case of HIIHFWRQORQJWHUPORVVHV$QGÀQDOO\KDYLQJWHFKQLTXHV for dealing with stress, that reduce the risk of compensatory Secondly, a diet low in energy density (particularly fat) eating in these situations seems to help.
DFKLHYHVWKHEHVWEHQHÀWV$OWKRXJKLWLVSRVVLEOHWRORVH Once you have lost the weight, putting these six things through any combination of nutrients that reduce volume together should help you keep it off longer – hopefully, until (ie. low carbohydrate, low protein), over 95% of the registry that fateful day when weight loss becomes automatic! OLots of different species live longer when fed less food (calories). Some, like the fruit fly, live longer when fed less of different types of calories, SWEET CHILLI AND ONION DIP
like sugar vs yeast (PloS Medicine, (Makes approximately 3 cup servings) 2005;2(8):721-723). This begs the question whether certain nutrients may be more important for longevity in humans – a question now being put to the test in the U.S. Stand by for the ‘Fruit Fly Diet Plan’. 2 tbs sweet chilli relish½ tsp onion powder OThe state of Oregon was the only state in the US not to increase its 1. Mix together onion and water in a microwave safe container levels of obesity in the last year. 2. Cook on high for 3 minutes, or until onion is tender. Rinse onion in cold water to cool.
urban design and the fact that many 3. Meanwhile, process the cottage cheese until to work than in other states. Could 4. Place in chilli relish, onion powder and it also be that Oregon is about as  SURFHVVXQWLOÀQHO\FKRSSHG EXWQRWVPRRWK  you can get, while still being in the 5. Serve chilled with crudites or rice crackers.
the band. Hence it’s thought that tactile year or two – so don’t go crazy on the were carried out suggest that although it … where the Professor takes the bit Q. How much should I
you’ll continue to gain. Ultimately then, realistically expect to lose if I
Q. As a diabetic I can
go serious on a weight loss
understand how glycaemic
program like yours?
index is important for diabetes,
but I notice you’re now
much as you want’. But that would also concentrating on this for weight
because it won’t necessarily happen, but loss. How does this work?
A. Good question. In fact it’s one where
very low levels of internal or ‘visceral’ fat – which is one of the most dangerous quite like the taste of this by the way!). of factors, like genetics, how long they rate in this group. For all these reasons do to try to lose it. The average weight active is necessary, but don’t sweat on enough to get a big increase in health (in Q. I’ve been told about a new
about a 30% decrease in disease risk).
type of surgery for weight loss
however (Journal of Internal Medicine, which is very non intrusive
and somehow uses small
shocks on the stomach. Can
you tell me something about
only predictor of success at the start of lead to a greater feeling of satiety. This because it’s still very early days for expected to lose less at the start, actually related to blood sugar levels (as well as other factors) and when this drops below left inserted just below the skin. Every from high GI foods), there is a tendency to want to eat more. Simple, isn’t it? Q. I’m a big bloke. Always
have been. But my doctor tells
me I’m perfectly healthy. So is
is all it takes – leads to a reduction in you ‘burn off’ more fat. There’s less there any real reason for me to
evidence for this, but it’s a distinct lose weight?
this is probably also the way laproscopic weight control experts (yes, it’s true, to think that this just reduced the size of suggests a genetic cause for your obesity. What types of exercise help?
OMNIs and NOMOI’s:
“Any exercise which increases his Proof that fat doesn’t always
cardiac output, the ability of his heart to mean unhealthy, and lean
pump blood, will be extremely helpful. doesn’t always mean healthy
If he does exercises that involve the lower part of his body, involving the quadriceps and hamstrings and lower back, you’re going to promote blood weight is not a health problem, and another group who suffer the problems On drug use (Viagra, Cialis etc)
A lot of men don’t appreciate that you actually need sexual stimulation for these drugs to work. Taking the medicine (For men only)
is not going to induce an erection. What Does hard = healthy?
the medicines do is facilitate an erection in an appropriate setting, so stimulation It’s well known that one of the adverse is absolutely necessary in order for the erection to occur. As men get older erectile dysfunction (ED). This is often they actually need more sensory and physical stimulation in order to achieve On the ‘hardness’ diet
First thing is reduce your portions damaging than the weight they carry.
– start having less to eat. Let’s reduce author of a new book called Sexual the fat in your diet. When you eat fat, Fitness for Men: The Hardness Factor what you’re basically doing is stunning your blood vessels. If you stun the blood vessels, they can’t open and close and they can’t be as elastic as they would be under normal circumstances. If you draw blood on somebody who has had a Once men understand the connection big meal, the blood is milky, it’s opaque. between health and virility, they will That’s due to the triglycerides that are circulating. You want to try to reduce the VXSHUÀFLDOOHYHOVRIERG\IDWEXWKLJKHU total amount of fat and sugar in the diet. internal, or ‘visceral’ fat which is …On the other hand, if you enrich your diet with foods of color — green, orange, fat around the organs, like liver, kidneys UHGIUXLWVYHJHWDEOHVÀEHU³,WKLQN you are actually going to enhance the pushed into the blood stream in response quality of your health and subsequently, It’s not clear what proportions of the On why ED occurs with age
“Erections change over time, they On other supplements
change with every decade of a man’s You want to start to use some of the life, as every other organ changes. That antioxidants, the Pycnogenol, the organ has to age and be affected by arginine, the omega-3s. And niacin is illness and vascular disease and stress a fantastic substance that raises your good cholesterol and lowers your bad On the value of lifestyle change
cholesterol. Have some green tea, “If he is able to exercise and lose weight probably the healthiest drink I know ofµ at the same time, he’s going to free On sex and longevity
up some testosterone which will now It appears as though the men who have enhance his sexual performance and his relax until you’ve had everything tested. more regular sex seem to be healthier and seem to live longer. There’s the On how often
good news -- good sex may actually “…every man (should) have an erection cause good health. And the reverse may every day of his life. This is not intended to mean that he needs to be having sex For more information:
For reference:
every day, it means that he should be Lamm S.
biologically healthy enough to have an or
erection every day because that would imply the integrity of his blood vessels, The Professor’s Comment:
Karelis AD and others. Diabetes and his nerves, his hormones and his brain.”


Tp 2005 205x275

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56 | EDGE INTERNATIONAL REVIEW EDGE INTERNATIONAL REVIEW | 57 By Ger y Riskin the problem lies with the ways in which thecompensation process plays out, including expecta-tions of partner behavior and the communicationof the process by which a figure is reached. e result is that if you ask any individual partner to describe the compensation system,you will get a unique interpretat

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