Healthy Weights Jump Start by aharvey

Jum mp Sttart A Prractical Program m For Weight W Lo oss, Dia abetes Preventio P on & H Heart Dis sease Prreventio on

HealtthyWeigh hts.ca (51 19) 772-05 563 RIM Park k Wate erloo, On ntario

Welcom me To The e Healthy y Weights Program m! I hope yoou are exciteed about the journey wee are beginniing togetherr. The fact that you are a reading this t indicatees you have already donne your hom me work in finding a safe, effecctive and sccientifically sound proggram. You should s be proud of your y work so far in choosing this prrogram as thhere are manny ‘quick’ fix optionns littering the weightt loss markket. We willl speak a lot about appreciatiing your thou ughts, actionns, decisionss and overalll self. This mannual is desig gned to be used u in conjjunction witth the Healthhy Weights Jump Startt program. Having a support sysstem of profe fessionals is very importtant for yourr progress annd your enjooyment of ofessionals can c help youu overcome barriers, turrn negative thoughts t intto positive the prograam. The pro thoughts and a answer questions thhat you are sure s to havee along the way. w There are 4 lessonns spanned over a fouur week prog gram. This manual m is not designed too be read coover to coverr in one evenning. Read each lessoon prior to the weekly meeting m and refer back to t the lessonn frequently throughout the week. There will be weeklly assignmeents and proojects that will w help yoou integratee new and wonderful w behaviourrs into your lifestyle. l Noow, let’s get to t work! Task 1: Separating S your y previouus failures frrom your fuuture successs. It is oftenn hard to im magine that ‘this time is different’’ but it trulyy is. Not becaause I have the t answer that t no one else e has, butt because I have com mpiled the con ncepts of huundreds of thhe world’s beest weight looss and healtth researcherrs into this program. That said, your y successs from this program p willl be yours and a yours allone. I simplly provide the ingreddients to the success reciipe, but you ultimately u d the bakingg! do

Learnin ng New Be ehaviourss Is Like L Learning How To G Golf If Tiger Woods W told you y how to swing s a golff club, wouldd you be an instant golff professionaal? Let me introduce the differen nce between ‘knowing’ and a ‘masteriing’. Knowinng how to golf is one thhing, being a bona-fidde expert is another. Noot only do prrofessional golfers g hit great g shots, more m importtantly they hit great shots one affter another. The same can be saidd for those who w are succcessful mainntaining a mber the ‘baad’. This is not n to say thhat Tiger Wooods never healthy boody weight. The ‘good’ days outnum hits a bad shot, but hee does seem to t quickly reegain his com mposure afteer a bad holee or two. What doees this have to do with healthy behhaviours? Trry doing thee same with the Healthyy Weights three pillaars of weigh ht loss: Diettary Therapyy, Exercise Therapy an nd Behaviou ur Modification. Start rating youur days as biirdies, pars and a the dreaaded double bogey. Takee it one day at a time annd aim for birdies annd be happy with w pars. Thhis is an impportant concept, we are going g to worrk together so s that you make bettter and health hier choices, most of thee time. Playing a new course? Shooting for f constant perfection can c be discouuraging. Som metimes boggey golf (1 over par) is the objecctive. Long weekends, w o overtime, hecctic family schedules, s sttressful situaations and t situations shoot foor par and be b happy witth the odd vacationinng are difficcult courses to play. In these bogey. It sure beats lo osing count of o your scoree and you’ll feel better with w every grreat round.

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Your Pathway To Success Will Be As Unique As Your Personality Like any journey, there are many different routes to travel, there are bumps in the road, and once in a while we make a wrong turn, but with a some planning, perseverance, willingness to ask for direction, and patience we can all reach our destination. Although there are similar underlying principles of weight loss and healthy living, no two people will choose the same techniques. Recognizing this fact will help you recognize that this manual and this program is not a bullet proof step by step plan for everyone as this would be impossible. What this program does do is allow you to develop your own bullet proof fully customized and modifiable plan. Thus Healthy Weights and this manual are not here to tell you exactly what you need to change, but help you determine areas for improvement and facilitate change. The sooner you can make this your own personal project, the sooner you will see results and the better you will feel. Thus many of the templates in this manual are just that; templates, that can be adjusted to suit your needs. Think back to when you were studying in school for exams and the techniques you developed for learning. Did you and your friend study in the exact same fashion? Did you make study notes or use q-cards, read out loud, recite passages, study alone or with partners, quiz each other and so on. You likely developed a strategy that suited you and your learning style. Take a similar approach with this program and you are bound to be successful! My Benefits List It is important to recognize that along with benefits of choosing a healthier lifestyle, there will ultimately be some sacrifices. Recognizing this is important particularly in times where our motivation is less than perfect. This list can be revisited and can thus serve as a reminder why we are working so diligently towards self improvement. Take some time and fill out the table below. Sample sacrifices could be: eating less fast food, time required for exercise means less television watching, and so on.

Benefits

Sacrifices

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Quality of Life Review

Today’s Date:__________________

I will spend a lot of time talking about the benefits of healthy living in addition to weight loss. Recognizing and tracking these benefits is motivational and an important part of your long term success. Please use the following scale to rate how satisfied you feel now about different aspects of your daily life. Choose any number from 1 to 9. Take some time and do this now.

1 = Extremely Dissatisfied 2 = Very Dissatisfied 3 = Moderately Dissatisfied 4 = Somewhat Dissatisfied 5 = Neutral 6 = Somewhat Satisfied 7 = Moderately Satisfied 8 = Very Satisfied 9 = Extremely Satisfied 1. ________ Mood (sadness, happiness) 2. ________ Self Esteem 3. ________ Energy and feeling healthy 4. ________ General Appearance 5. ________ Confidence in social situations 6. ________ Health Problems 7. ________ Leisure Activities 8. ________ Eating Habits 9. ________ Body Image 10. ________ Sleep Patterns 11. ________ Stress Level 12. ________ Overall Quality of Life 13._________ (________________) 14._________ (________________)

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Lesson 1

A Tune‐up or A Complete Overhaul?

Chances are that you that make a number of healthy choices each day. Truth is, even with the best intentions, there is a number of signals such as food advertisements, social gatherings and inactive jobs that can thwart even the best intentions. Together we will become experts in bridging the gap between good intentions and healthy actions. Separating Past Failures You may have tried other programs before and failed. However, you did not fail the program, the program failed you. Did it teach you the skills needed for long term success? Did it give you the necessary support? Yes, you have to take ownership of your own behaviours with the Healthy Weights program but rest assured, you are getting the best information science has to offer. Despite this, when you lose weight on the Healthy Weights program, only one person deserves credit− you. Diet Versus Lifestyle Change The term ‘diet’ conjures up different images for different people. Whether you envision bowls of salad with no dressing, an endless supply of cabbage soup or completely avoiding a single food group such as carbohydrates, there is a common theme. These are all means of self deprivation and suffering. Further, the term diet implies something that you go ‘on’ or ‘off’. Changing long term behaviour cannot occur while a person is ‘on’ a diet because it implies a short term fix to a lifelong problem. Maintenance of weight loss is just as difficult as losing weight, thus going ‘off’ a diet will ultimately result in regaining the lost weight. The cycling of weight up and down is not only harmful physically, but emotionally due to feelings of failure and discouragement. Permanent lifestyle change on the other hand means modifying behaviours and creating new habits that are sustainable. This involves establishing new habits and working hard to make them part of day-to-day life. Building Skills and Confidence. Lifestyle change requires a system or plan along with the skills and confidence to make the change happen. Skills enable you to make positive decisions with respect to your behaviour and confidence will prevent lapses in behaviour from turning in to relapses. Thinking positive about yourself and your abilities is one way to instill confidence. Group support is also effective for maintaining confidence and improving adherence to healthy habits. Goals and Expectations. A common mistake is setting unrealistic weight loss goals. Setting unrealistic goals results in perceived personal failure despite a number of positive health benefits that may have occurred. If your goal was to be active, eat healthy and fit into your favorite pair of bell bottomed jeans from high school, the latter is likely setting yourself up for failure. Despite losing a significant amount of weight and adopting a healthy lifestyle these constructive changes may be over looked because your favorite pair of jeans still does not fit. Discouraged with your apparent failure you abandon your healthy habits without recognizing the wealth of health benefits that have occurred. Realistic Goals and Long Term Results. Slow and gradual weight loss may not sound as exciting as losing “30 pounds in 30 days” or as flashy as some fad diets but it is ultimately more effective. Losing © Healthy Weights 2007

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more than 4 pounds per week of fat loss is physically impossible so a steady weight loss of 1-2 pounds per week is a good goal to aim for. Long term goals are essential, but it is just as important to have short term goals. These goals should be SMART. Specific, Measurable, Attainable, Rewarding and Time oriented. Set your short term goals accordingly and reward yourself for achieving them. Your short term success will provide you with the confidence to reach your long term goals and maintain your new healthy lifestyle in the future. Finally, think about what a reduction of as little as 10 pounds would do for you physically and emotionally. If you fail to lose more than ten pounds so be it, but the 10 pounds that you did lose is a significant achievement. Incorporate goals that do not involve the scale and concentrate on the things that really matter. Track your feelings, mood, sleep patterns, energy levels and overall feelings of health. You will find that these improve much quicker than the number on the bath room scale. After all, how you feel is what really matters. Remember, those closest to you love you for who you are, no matter what you weigh. Attitude Is Almost Everything Sometimes the discussions of confidence will sound like a pep talk, but pep talks can be helpful. One of the most important things you can do is to have your own internal pep talks. What you say to yourself when you succeed can have an important impact on your future. Moreover, what you tell yourself when you slip will be central to your success. I will talk often about the discussions you have with yourself. Knowing Versus Mastering These Principles You know the basics of nutrition. However, we will talk a lot about the difference between ‘knowing’ something and ‘mastering’ it. You can start by eating sensible meals regularly throughout the day, including breakfast. Try cutting your portion sizes down and increasing your intake of fruits and vegetables. As you'll learn, you can eat more than you think and still lose weight. Nevertheless, you have to be careful about what you choose. For instance, if you have a 3-oz portion (about the size of a deck of playing cards) of meat (like chicken) with seasonings, a salad (with two cups of lettuce, some cucumber and tomato, and two tablespoons of light salad dressing), one-half cup each of three vegetables, and some fruit, you will have a healthy and quite filling meal, with surprisingly few calories (about 500-600). Calorie Guide. You will need a calorie guide to record the number of calories in the foods you eat. For some foods, you can probably look at the food label on the package and find the calories. Other foods, like fruits and vegetables, do not come in packages, so the calorie count is not readily available. In addition, you may eat out and have foods served to you by friends or family and will need to know how to estimate calories. Calorie counting is a valuable tool for education. Although this task may seem arduous to start, we will develop an approach that is easy and fits into your daily regime. You may use a printed calorie guide or an online guide of your choice. © Healthy Weights 2007

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Physical Activity “I know that!” You can start being more physically active right away by doing two things. The first is to use every chance you get to be a bit more active. Try walking places, using stairs when possible− just making an effort to move around will help. Every time you are active is a reminder that you are making progress. The second thing you can do is to walk regularly− even in small amounts. Begin with short walks that are comfortable for you, then work your way up. Doing a series of short walks is as good as taking one long walk. You can use a watch to time the number of minutes that you walk each day. You also can use a step counter to count the number of steps you take each day. Throughout the program, I will discuss the advantages of using a step counter. Behaviour Change 101 It is important to recognize that regular behaviours or habits are not easy to break. Many of these behaviours go unnoticed and occur automatically. Making these behaviours a conscious decision is extremely important. First we must realize that INTENTIONS are not the same as ACTIONS. Intention ≠ Action How can we bridge the gap between intentions and actions so that the desired action occurs more frequently? I encourage you to draw your own version of this diagram and keep it somewhere visible.

Self-monitoring Goal Setting

Intention

Scheduling

Action

Overcoming Barriers Evaluation & Feedback Using Your Step Counter Wear your step counter every day, all day. This device gives you credit for all activity and reminds you to spend less time sitting whenever possible. This device also helps to debunk the myths about exercise intensity, duration, fat burning and so on. The truth is that any activity is good activity and the best activity is the one you enjoy. The pedometer does not discriminate between walking to work, pushing a lawn mower or performing an aerobics class. Be sure to jot down your daily step counts on your monitoring forms so you can enter these values on the Healthy Weights website. © Healthy Weights 2007

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The Mon nitoring Form Record everything nd the caloriies Record the food, the amount an Record immediatelyy after eating Carry it with you evverywhere

Weekly Destination D Plan I have proovided a cheeck list for each e lesson in the form of a “Destinnation Plan””. We chosee the name because you y are emb barking on a journey. Liike any jourrney, there are a many diifferent pathhs you can take, som me better than n others but ultimately arriving a at thhe right locaation is whatt matters. Off course, it is normall to ask for directions along a the way. w The weekly destinaation plans are a your roaad map to success. Post P them on n your fridgee door and reefer to it dailly. Check offf your progress as you go. The primaary goal this week is not to start a diet but to learn aboutt your eatingg, activity and a weight habits. Sppecific caloriie levels andd physical acctivity levelss will be disccussed later.. Make 7 coppies of the monitorinng form. Com mpleting theese forms is CRITICAL for your suuccess. As onne psychologgist put it, changing behaviour without w self monitoring is like tryinng to win the lottery witthout buyingg a ticket! The inform mation on th hese forms will w not only be helpful for fo you, but for f me as weell.

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Lesson 1 Expose

Self Monitoring – The Secret To Success (Adapted With Permission from: Gladden, 1997)

Suppose someone were to share a secret with you that would help you win the power-ball lottery. Would you be interested? Of course you would. Now, suppose someone were to share a secret with you that would help you lose weight and keep it off. Would you be interested? You would if you wanted to lose weight, right? A key component of a credible weight control program such as The Healthy Weights Program is selfmonitoring (i.e., record keeping). In fact, self-monitoring is one of the most important components of any behaviour-change or lifestyle-management program. For many, self-monitoring may be the secret to their weight management success. This should come as no surprise. Record keeping is an essential element of any successful endeavor. It’s hard to imagine successfully running a business, a household, or even playing a game of golf without good record keeping. The Science Common sense dictates that good record keeping is essential for successful weight control. Selfmonitoring is one subject where science and common sense go hand-in-hand. Research has shown over and over the vital role that self-monitoring plays in weight management. A recent study by Dr. Dan Kirschenbaum and his colleagues provides even more compelling evidence that self-monitoring is a key component of weight control. In this study, the researchers examined the self-monitoring practices of 59 overweight men and women. The participants in the study were in a long-term, cognitive-behavioural, weight control program. Three important findings emerged from the study: • • •

Self-monitoring is difficult Self-monitoring increases weight loss Self-monitoring is a learned behaviour

Let’s look at these findings a little closer. Self-Monitoring Is Difficult Roughly one fourth of the participants in Dr. Kirschenbaum’s study kept records of their food intake less than half the time over the duration of the study. This shows that even people actively enrolled in treatment programs (where counselors constantly repeat the importance of self-monitoring) have difficulty keeping records. This finding has been our experience as well. Many clients initially complain when the notion of self-monitoring comes up. “I didn’t do it in the past,” “It doesn’t work for me,” or “I don’t have time to do it,” are common responses from clients. Our stance is always consistent and unwavering—self-monitoring is a virtual requirement of success. We never compromise this issue because we feel so strongly about it. Collaboration between

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professionals and clients is important in order to discover a self-monitoring method that works best. The best self-monitoring system is the one that works for you. Self-Monitoring Increases Weight Loss The individuals in Dr. Kirschenbaum’s study who self-monitored lost more weight. This should come as no surprise. Many previous studies on weight control (and just about any other behaviour) have replicated this finding. With the overwhelming amount of evidence showing that those who selfmonitor are more successful at weight loss, why don’t more people do it? The answer is not clear. Success is, after all, what people are seeking. And self-monitoring may be the secret or key to that success. This is a compelling reason to work hard at self-monitoring− even if it seems difficult and burdensome at times. After all, aren’t most worthwhile things in life somewhat difficult? Consider the analogy to other forms of record keeping. If you have a checking account, do you keep a check register? How successful do you think you would be at managing your finances if you didn’t keep one? Think about what might happen to your bank balance if you went for an entire year without recording deposits that you make or checks that you write. Would you be more likely to over- or under-spend? And what might happen to your caloric intake if you went a whole year without recording what and how much you ate? Would you be more likely to over- or under-eat? If you are concerned about your finances, you wouldn’t think about not keeping records of your deposits and checks. Isn’t it reasonable to think of weight management in the same way? Self-Monitoring Is a Learned Behaviour Individuals differ over time in how much they self-monitor. The world is not divided into people who self-monitor and people who do not self-monitor. The ability to self-monitor is not a personality trait or characteristic, it is a learned behaviour. Similarly, financial record keeping is a learned behaviour. Perhaps the requirement for record keeping by the Internal Revenue Service is a motivating factor for many to adopt this behaviour. For years we’ve heard clients offer variations of “I’m not good at keeping records,” “I don’t do that,” and so forth. Dr. Kirschenbaum’s research suggests that individuals can turn this behaviour on and off over time. People who are successful weight managers don’t just happen to be good record keepers, but rather, good record keeping helps people to become better weight managers. The challenge becomes getting those who do not self-monitor to begin, and to get those who do self-monitor occasionally to become more consistent. Barriers to Self-Monitoring We have heard many reasons for not self-monitoring. These reasons include: •

They stop keeping records when they stop losing weight—the very time when self monitoring becomes even more important

•

Their motivation sometimes wanes and self-monitoring becomes difficult—maintaining and keeping records can become frustrating at times, especially for those who see self-monitoring as a major effort on their part

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•

They feel too embarrassed to do self-monitoring—people tend to ask questions when they see you writing. They stop self-monitoring when they are successful at weight loss—they achieve their goals.

In the arena of weight management, this is unfortunate. Weight management is not a simple outcome—it is a continuous process that involves ongoing lifestyle balance. If you had a goal of saving $1,000 for a specific purpose, would you stop keeping your check register when you reached this goal? Of course not. You want to continue to maintain financial balance and stability. The same principles apply in weight management. Changing habits requires three key ingredients. These include: •

Knowledge (what to do and why to do it)

•

Motivation (the desire to do it)

•

Skills (how to do it)

Hopefully, the discussion above will help convince you of the importance of record keeping. If not, accept our challenge and don’t keep any financial records for a year! Self-monitoring is a necessary component of weight management. Is it something you have to do the rest of your life? Perhaps. However, if self-monitoring is the secret to your success, wouldn’t it be worth the effort? Selfmonitoring behaviour can become as routine as monitoring your finances. Some people do it less frequently than others, but most keep track of their bank balance. When you find motivation starting to wane, remember the analogy of your checkbook. The third ingredient to lasting behaviour change also requires learning and mastering the necessary skills. Assess what you are doing now and what you should be doing. How well do you keep records and how consistent is your record keeping? How accurate and detail-oriented are you? It is important for you to identify your reasons for not keeping records. Think back on your history of selfmonitoring. Past experiences provide valuable clues for understanding current behaviours. Do you see any patterns? If so, what are they? Which of the three areas do you believe contribute to your lack of self-monitoring diligence—knowledge, motivation, or skills? For many clients, learning new skills about how to self-monitor can be a turning point in their weight management efforts. The Monitoring Form allows you to record amounts and calories of the foods you eat. Recording everything you eat and estimating calories may be hard to do initially, and when it becomes easy, you may find it repetitive. Conquering this resistance and keeping the records is important. Research has shown this to be one of the most, if not the most, important part of lifestyle change.

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Week 1 Destination Plan: Congratulations on starting the Healthy Weights lifestyle modification program! Your weekly destination maps will be your path to success. Like any journey, there are many different routes to travel, there are bumps in the road, and once in a while we make a wrong turn, but with a some planning, perseverance, willingness to ask for direction, and patience we can all reach our destination. Place your weekly road map on your fridge, share your journey with others, and refer to your map daily. Check the box next to each of your accomplishments. *The goal this week is not to start a diet, but to become familiar with your current habits. General Complete the Benefits and Sacrifices and the Quality of Life Review Visit the members section of the website (ask if you have not received your username and password) Behaviour Set goals, write them down and make them specific and realistic Strive to achieve the goals you set Nutrition Record each meal and snack on your monitoring forms (Circle Each Day 1 2 3 4 5 6 7) Physical Activity Wear your pedometer each day + record your daily steps (Circle Each Day 1 2 3 4 5 6 7) The Weekly Game Plan Smart Goal(s): Set them now! 1. To monitor each day to the best of my ability. I will do this by..? 2. 3. Action Plan(s): How will you achieve these goals? For example, make appointments to walk, not eat after 8pm? Schedule a grocery trip with a list in hand?)

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Monitoring Form - Lesson One (Make 7 copies or download from the members website) Time

Description

Place

Feelings

Calories

Sad? Happy?

Total Calories from breakfast

Total calories from lunch

Total calories from dinner

Total calories from snacks Total Number Of Steps Walked Today

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Lesson 2

A Toxic Weight Loss Environment

Welcome To Week 2! You may already be noticing a number of habits that you would like to change. Try not to be overwhelmed. Some of these habits have taken years to develop and will take time to change. Remember, slow and steady wins the race and start to prioritize your changes and make goals to reflect these prioritizations. You are likely doing a lot of things right, so think of this as ‘fine tuning’ rather than a complete ‘overhaul’. Why Are We Overweight? Why people are overweight is still somewhat of a mystery, although scientists have been working on the problem for years. Exciting discoveries occur frequently, yet we still have a long road to travel before we can unravel the complex causes of weight problems. Meanwhile, examining the popular reasons people use to explain overweight is helpful. I cover this information here because the reasons people use to explain weight problems create attitudes that can help or hinder efforts to lose weight. A person who feels genetics has determined his or her weight may be discouraged from attempting to lose weight. The information that follows may counter some misconceptions. The number 1 reason for weight gain is a decrease in daily energy expenditure also known as lifestyle physical activity. If we consider the daily energy expenditure of our parents, grandparents and so on, we realize that desk/computer jobs, work around the home and even yard work as become easier. The energy expenditure of an office worker is less than half that of a physical labourer. One problem is that we were taught how to eat, what to eat and how much to eat by our parents and grandparents who often needed to consume high fat high calorie foods to fuel their high energy expenditure. Grandma’s challenge was to keep ‘meat on the bones’ of grandpa who worked physical labour all day. This challenge has now reversed. Add to this the availability of high calorie, and readily available foods and we have a major crisis. This is why more than 2/3rds of North Americans are overweight or obese. When all is said and done, and all the reasons for overweight are debated, the fact remains that people gain weight because they consume more calories than their bodies use. Becoming overweight is usually a gradual process and may result from small errors in what we eat for a given level of physical activity. One business executive gained five pounds each year for 20 years. The five pounds each year were not too obvious, but he sure noticed the 100 pounds he accumulated over the 20-year period. This could have occurred from nothing more than two to three drinks per week. The solution to such a problem is a gradual change in eating and exercise habits so that long-term weight loss can occur. The Secret Of The Ever Counted Calorie The calorie is not only one of the most counted matters in existence; it is also a valuable tool for weight loss. The calorie is a measure of energy. Much like a centimeter is a measure of length. One calorie represents the amount of energy needed to raise the temperature of one gram of water one degree centigrade. What does this have to do with squeezing into your favorite pair of acid washed jeans from the 80’s? Everything. Food, specifically fat, carbohydrates and protein are sources of © Healthy Weights 2007

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energy. Without energy, we would not be able to carry out vital processes such as breathing and our muscles would not be able to convert food energy into movement energy. Let’s compare humans and automobiles to obtain a better understanding of energy and how it relates to body weight. A car requires energy, also called fuel, in the form of gasoline in order to operate. Similarly, humans need fuel in the form of food. A car stores energy in the gas tank and over fueling results in a costly spill on to the pavement. Humans store energy in the form of fat tissue. Over fueling causes fat tissue to grow. An idling car is comparable to a human sitting at rest. Similarly, in order to get from point A to B both require energy. The distance between point A and B will dictate the amount of fuel burned. Further, the faster the trip between point A to B the greater the rate that fuel is burned. Our bodies are unique in that they can simulate a small efficient car while doing delicate tasks such as knitting or a large gas guzzler while walking or biking. Consider muscles as engines, the larger the engine and the more engines running the greater the fuel consumption. The concept of energy balance is central to weight management. Daily energy or fuel intake is the total amount of calories you eat during the day. Similarly, daily energy expenditure represents how much energy you expended throughout the day. If your energy intake exceeds your expenditure the excess energy will be stored as fat. If energy intake is less than energy expenditure, previously stored fuel in the form of fat will be burned to make up for the deficit and weight loss occurs. Thus the focus should be on increasing daily energy expenditure, decreasing energy intake, or better yet, both. There are a few other important points to consider. Fat has 9 calories per gram, where protein and carbohydrates have 4. Therefore simply substituting fatty foods with leaner alternatives will reduce your energy intake. It should also be noted that weight loss through diet alone is both unhealthy and unsustainable. Keep in mind that energy is only one component of what we derive from food. We require vitamins, minerals, amino acids, essential fatty acids and water. Eating a balance diet and following Canada’s food guide is the simplest way to achieve an adequate level of nutrients. A calculation to estimate your daily energy expenditure is available on the Health Canada website. Use this estimate to guide your eating habits, record the foods that you eat and calculate your daily caloric intake. For safe and effective weight loss, strive for an energy deficit of 500 calories. This will result in a 3500 calorie per week energy deficit which happens to be the number of calories in a pound of fat. So that is the secret of the almighty calorie. As it turns out, the secret to the calorie is no secret at all.

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CHO 4 kcal/gram

F FAT 9

PRO

kcall/gram

4 kcal/gram

1 lb of Fatt = 3500 kcal k Eating a Sensible Meeal Making meals m count is i importantt. By this, I mean m you want w your meeals to be saatisfying, goood tasting, pleasing to t the eye, nutritious, n annd have a texture that iss pleasing too your palatee. Otherwisee, you will feel deprivved when th here is no need to, and yoou will keepp your body from gettingg the nutriennts it needs to stay heealthy. You do not havee to eat a spparse and booring "diet meal." m Yourr meals can be filling, nutritious, varied, dellicious, and still be low w in caloriess, sugar, andd fat. You may m have too do some advanced planning an nd make good food choicces, but this is not difficuult to do. A little practice can go a g and eating excellent meeals. long way to preparing k a lot aboutt eating "sennsible" mealls. I am a firrm believer that you shoould enjoy You will hear me talk bjective is for you to eat delicious, fiilling, and nutritious meeals− not a every bit of food you eat. The obj plate withh one stalk of o asparaguss and a beet. Keeping your y calories low, accom mplishing yoour dietary goals, andd being satisffied is quite possible− iff you make good g choicess. Some peoople like to feel f full wheen they eat. If I this soundds like you, a well-planned meal willl probably do the jobb. For exam mple, you miight eat a grreen salad, baked b chickeen breast, baaked potato garnished with butteer buds and dried chivees, grilled orr steamed sqquash and caarrots, and fresh f strawberries and melon forr dessert. Eatting a sensibble meal can mean eatingg a fun meal, a deliciouss meal, and a meal that makes youu feel virtuo ous. Exercise. I want you u to have a clear c understtanding of what w exercisee is and whatt it can and cannot c do for you. This T is an im mportant conncept, so readd carefully! The more realistic yourr expectationns and the more posiitive your ex xercise experriences the greater g your success will be. Regardlesss of weight loss, increasing physicaal activity will w improve your health.. This was shown in a recent stuudy in which h overweighht individuals who were physically active and fit f had a low wer risk of heart disease and prem mature deathh than peoplee who were thin but inacctive and unnfit. It is posssible to be fat but fit. © Healthy y Weights 2007 2

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Perhaps the best reason to exercise is that it makes you feel good about yourself. Even a quick twominute walk can help clear your mind and give you a boost. Over time, longer bouts of activity can make you feel more self-confident and more attuned to your body. Many of my clients tell me that simple activities such as stretching, dancing, and walking help them rediscover their bodies and enjoy movement for the sake of movement. In the next lesson, I discuss some more specific benefits of physical activity as they apply to weight management. Feeling good is the first step to having a ‘good day’ with respect to healthy living and healthy choices. Physical Activity and Weight Loss You have probably noticed that I have not emphasized the weight-reducing benefits of physical activity. I do this intentionally. Most people know that exercise burns calories, however, it takes a lot of exercise to lose one pound of fat. For most people, losing one pound of fat would require walking 25 to 30 miles or spending five to six hours a week in an intensive aerobics class. This is a lot of physical activity. Second, judging the benefits of exercise based on weight loss is bound to disappoint you some weeks. Your bathroom scale probably cannot reliably detect a weight loss of a half-pound or less. Sooner or later you will get on the scale and hear yourself say something like, "This isn't fair. I exercised five days this week and didn't lose anything! What's the point?" The way to keep from falling into this trap is to separate activity from weight loss. Increase your physical activity for the sake of the pleasure and improved health it brings. These payoffs alone are better than any pill or magic potion you can take. In addition, there are a host of long-term rewards. People who exercise regularly are far more likely to maintain their weight loss than those who are not physically active. Exercise can facilitate long-term weight management by improving mood, food choices, and self-control; in addition to burning calories. Most of my clients who are working to stabilize their weight tell me that they exercise because they love it. Keeping off lost weight is only one of many benefits. I hope you keep these points in mind as you increase your physical activity over the next few weeks. You may want to tag this page in some way so you can refer back to this discussion about exercise. Start to view physical activity as any walk that is longer than 2 minutes. Start to add two minute walks to nearly every hour during the day in addition to your planned walks or activities of longer duration. You will be amazed at how you great you feel, how much easier it is to eat healthy when you are feeling wonderful and how your personality will exude positivity. How does increasing physical activity manage to do all this? This is one of the wonders of physical activity that scientists haven’t put their finger on, but I promise you, try these short bouts of walking and before long, you’ll wonder why you weren’t more active sooner.

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Complex problems cannot c be fixxed with sim mple solutioons. What makes m weigh ht loss so com mplex?

Baarriers To Ph hysical Acctivity Time Effort Resourcces Injury Pain Fatigue

Eating is a Co omplex A Activity Upbrin nging Cultu ure Sociial Gatherrings Emotiions Distractions

Detectingg Eating Pattterns You may already kno ow some pattterns or habbits that you would like to t change. Write W these down d here and play detective wiith respect to t your eatinng habits. When W are youu most likelly to overeaat or make poor foodd choices? Co ould you chaange your beehaviour or the t environm ment around you?

P Pattern

Changess That Couuld Be Madde

Scale Dow wn We will describe d the advantages a a disadvanntages of weeighing yourrself, then yoou can experriment and and learn whaat works besst for you. The T primaryy disadvantaage is that ups u and dow wns unrelateed to your behaviourr can generaate strong feeelings, andd these feelinngs in turn can derail a program. You Y must decide whhat works beest for you.

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We encouraged you at the outset of the program to weigh yourself weekly and to record your weight change on the members section of the Healthy Weights website. Many people wonder how frequently they should weigh themselves. One popular self-help group, Overeaters Anonymous, does not have its members weigh themselves at all. The theory is that more frequent weighing gives "too much power to the scale." Other programs recommend that participants weigh regularly to get feedback on their progress. One problem with paying too much attention to the scale is that it can lead to undeserved euphoria or disappointment. An example would be a person who does not do well on his or her eating plan. The scale may show a weight loss anyway, perhaps due to water loss from a menstrual cycle. This person may think she can stray from the plan and still lose weight. The opposite side of the coin is the person who does well on the program and gains weight anyway. Again, this can happen for several reasons, many times each day. The average for people who enter weight loss programs is about once per day. Find out what works for you, but don’t let the number on the scale ruin a ‘good day’ or exacerbate a ‘bad’ day. The direction of your weight gain or loss is what is important. Sometimes not gaining weight is the objective. This Week Record activities and feelings associated with eating this week. Are you watching TV while eating or eating at your desk? Do you feel sad, happy, anxious, hurried, busy, tired or ‘average’ while eating? Scan your forms from last week for patterns and aim to increase your daily step count by 10%. Be sure to use the Healthy Weights website at least once this week and record your tracking information. Lesson 2 Expose

Avoiding Exercise Excuses

Everyone would agree that exercise is a vital component of any long-term weight-control program. Therefore, establishing an exercise routine that works for you is important. As humans, however, we can be very clever in devising reasons and excuses not to exercise. We compiled a list of excuses (see below) we've seen and heard in weekly food and exercise records collected from our clients at the Johns Hopkins Weight Management Center. Some reasons not to exercise are legitimate, such as a family emergency or a crisis. However, reasons for not exercising generally fall into the category of excuse-making. In this article, we discuss some of the reasons behind why people make excuses to avoid exercise, and we provide some strategies for conquering these exercise excuses. Excuses not to Exercise • • •

Traveling today Used the hot tub/sauna, and that's exercise isn't it? Too hot

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• • • • • • • • • • • • • • • • •

On vacation It was raining I feel wonderful when I exercise; I don't know why I don't do it Exercise equipment is in the basement, and I don't like it down there Exercise partner was away on vacation Will do it tomorrow The park where I walk closes at sundown Too cold outside Chain broke on bicycle, so I can't exercise Too sunny Was over at mother‐in‐law's party Too busy Had to run my son around all day and couldn't fit in exercise Have to take the kids along when I walk outside Have to drive son to class Could only do five minutes, so I figured it wasn't worth it I miss exercising and can't wait to get home and start exercising again

Source: The Hopkins Weight Management Center. Why Do We Make Excuses? Most of us make excuses at one time or another for our behaviour, and the reasons vary widely. In our busy and often stressful lives, we convince ourselves that there simply isn't time to be physically active. If we examine our days more carefully, however, they are most likely filled with all sorts of "unplanned time robbers." Phone calls, requests for assistance, deadlines, etc. are common time robbers. Before long, the needs of others begin to far outweigh our own needs− our need to be physically active. At times, small disruptions can derail our commitment to be more active. For example, tending to sick children or working late at the office can ruin a well-planned day. Unfortunately, many people view exercise as one of the first time-consuming activities to be abandoned during stressful or busy times. This is an unfortunate choice since exercise is one of nature's best remedies for stress. Excuses not to exercise appear more frequently when motivation begins to wane or boredom sets in. While one missed exercise session may feel insignificant, it may signal the beginning of an important motivational lapse. These excuses are the most dangerous− they signal a critical change in the individual's commitment to a healthier lifestyle. It's normal for commitment to be stronger at some times than at others. Changes in commitment, however, must always be taken seriously. When motivation begins to fall, your exercise program may be becoming too arduous, boring, or routine. It may be time to revamp your routine to keep it fresh and interesting.

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Countering Excuses If your interest and commitment to physical activity are less than they have been (or could be), don't despair. Motivation can return quickly once you address the primary culprit− the excuse. The first step is "recognizing the dangers of excuse making." Missing one day of exercise is not the end of the world. However, all lengthy breaks in exercise initially began with one missed session. What separates a single missed session from the "beginning of the end" is what happens on the next day. Examine all your excuses not to exercise carefully and counter them with a solid plan on how to get back on track IMMEDIATELY. As one of our clients says, "Someday is not a day of the week." Below are some of the things you can do to keep your exercise program on track. Remind Yourself of the Benefits of Exercise Exercise can be your best ally against weight gain and many diseases associated with overweight. Exercise increases and prolongs calorie burning and increases stamina, fitness, and muscle strength. Physical activity has also been shown to decrease appetite for many individuals and is directly associated with long-term weight control. Remind yourself regularly of the positive benefits you receive from physical activity. The mind can also benefit from exercise. Increases in overall well-being, mood, self-esteem, and the ability to cope with anxiety and stress have been found to be true of regular exercisers. Some people experience improvements in quality-of-life with regular exercise. Keep Your Program Varied Stale routines can cause even the most faithful exercisers to abandon their efforts. All muscles should be stimulated regularly. Doing the same exercises day-after-day does not optimize muscle stimulation. Repetitive exercises of certain muscle groups can also lead to injury from overuse. Change and update your routine every three or four months. Cross Training Cross training is another way to keep exercise varied and interesting. You can keep an exercise routine appealing by doing a variety of activities. For instance, you might dedicate Tuesdays and Thursdays to walking and low-impact aerobics. Swimming and riding the stationary bike may complete your exercise routine on Mondays and Wednesdays. Combining activities also reduces the likelihood of becoming bored with exercise.

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Interval Training Interval training is another option to help keep your exercise routine varied and interesting. Interval training consists of short bouts of exercise alternated with brief recovery sessions. For example, interval training in a walking program could involve walking briskly for the first one-half mile and then walking at a lighter intensity for the next one-quarter mile. Alternating intense activity with rest or recovery periods can increase your aerobic fitness. The length of the exercise and recovery intervals will depend on your individual goals. Resistance Training Resistance training can also add a much needed component to your exercise routine. Resistance training is now widely recommended for all weight-reduction programs to preserve lean body mass (i.e., muscle). Lean body mass is metabolically active (i.e., energy-demanding) and is directly related to a person's metabolic rate. Individuals who restrict their calories without exercising tend to have a more dramatic decrease in lean body mass than those individuals who do exercise. We have found that most of our clients enjoy both the feeling of strength and toning that occurs with resistance training. Anticipate Breaks in Your Exercise Routine Business travel, vacations, projects around the house, and special projects at work all require changes in our normal routine− they are all facts of life. Each week, sit down on Sunday night (or another convenient time that fits your schedule) and identify the days in the upcoming week that will be busiest for you. Next, schedule your exercise time on the less hectic days. Write down your scheduled exercise times just as you would an important meeting. We have often found our clients to be much more compliant with exercise with exercise when they actually block exercise times out in their calendar. Ultimately, you are the one who must regard exercise as an important appointment− an investment in your physical and emotional health. Vacations and business trips can derail even the most committed exerciser. Walking may feel uncomfortable in unfamiliar areas. Ask your travel agent to specifically look for accommodations that provide adequate onsite fitness centers. In some instances, the hotel itself may not have a good fitness facility but may offer vouchers to a fitness center within walking distance. Traveling can also provide unique opportunities to exercise by walking instead of using cabs whenever possible. Pedometers which are small (about the size of a matchbook) and typically cost as little as $25 are a great way to objectively measure distance walked. Establishing a Lasting Exercise Routine Like most things in life, we persist at activities we enjoy and abandon those we dislike. If you are having trouble sticking with your exercise program, ask yourself how you feel about what you are

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doing. Do you enjoy exercising or do you dislike it? The following questions are good markers of whether or not your exercise program is working for you: • • •

•

Do I enjoy my exercise program? Have I chosen activities that I like, or am I doing things only because I think I should do them or have been told they work best? Is my exercise facility convenient? Studies have shown that choosing a gym more than 10 miles from where you live or work significantly increases the likelihood you won't use it. Am I exercising at the right time of the day for me? The best time to exercise is the time that fits into your schedule. If you're not a morning person, how realistic is it to try and force yourself to get up an hour early to go for a walk? Do I have an exercise routine? Trying to "fit" exercise into a day is often a setup for a missed session. A better strategy is to develop a weekly exercise routine after looking at family and work responsibilities; then stick with it. Do I tell myself exercise doesn't count unless it makes me sweat?

Remember that doing something is better than doing nothing. When you truly are pressed for time, try fitting in a 15-minute walk rather than your normal 30 minutes of walking. Consider other ways to be physically active. Researchers have concluded that lifestyle physical activity offers an important alternative to traditional exercise while still providing health and weight-control benefits. The Surgeon General in conjunction with the Centers for Disease Control and Prevention and the American College of Sports Medicine now recommend that everyone accumulate 30 minutes of moderate physical activity each day. If blocking out chunks of time is difficult for you, this might be a welcome alternative to traditional exercise. Summary Unfortunately, exercise is one of the components of a weight-reduction program that most people abandon first. Time restraints and busy schedules make it hard to fit exercise into an already crowded day. Missing one day of exercise may not be the end of the world, but by saying this, you may be setting yourself up for failure by not getting back on track immediately. Excuses are quite common among people missing a series of days in their exercise program. Recognizing the "danger" signs of a stale or unenjoyable exercise program may be the first step to countering those threatening exercise excuses. Making excuses for "not" exercising may mean that it's time to plan better for exercise or that you may desire a more appropriate mode of exercise in order to keep your routine both enduring and enjoyable.

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Week 2 Destination Plan Week 1 is the most difficult adjustment so hang in there! If you faltered a little, felt overwhelmed, or have more questions now then when you started, you are on the right track! Staying mindful of your goals and why you are making these wonderful changes will pay huge dividends in the end! General Enter (online members section) your weight, caloric intake, steps and goals/action plan and daily steps. Choose a day of the week and enter the last 7 days (average). We will do this each week for the rest of the program. Enter 2 recipes on the recipe section and ask 1 ‘ask the experts’ question

Behaviour Strive to achieve the goals you set and assess your previous goals and achievements Nutrition Record each meal and snack on your monitoring forms (Circle Each Day 1 2 3 4 5 6 7) Become a food and mood detective (Is there a relationship?) Physical Activity Wear your pedometer daily + record your daily steps (Circle Each Day 1 2 3 4 5 6 7) Make a physical activity appointment with someone (Did you keep your appt? Y / N) Make a physical activity appointment to be done on your own (Did you keep your appt? Y / N) Flexibility 101 Flexibility 101 The Weekly Game Plan Smart Goal(s): 1. Steps: My goal is to walk _______ steps per day which is _______ more than last week. 2. Calories: My goal is to eat _______ kcal per day which is a deficit of ~_______kcal/day. 3. Action Plan(s): How will you achieve these goals?

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Monitoring Form-Lesson Two Time

Description

Place

Activity Calories Watching TV?

Total Calories from breakfast

Total calories from lunch

Total calories from dinner

Total calories from snacks Total Number Of Steps Walked Today

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Fabulou us Flexibillity 101

The Walkers W an nd Runnerrs Stretching Routin ne

Flexibilityy is an imporrtant yet ofteen neglectedd componentt of health. When W becom ming more acctive you may feel pain p or stiffn ness in your muscles andd joints. Thiis can be disccouraging, but b don’t let this dissuade you y from con ntinuing witth your new lifestyle chaanges becausse this is wheere flexibilitty and stretchingg come into play. p By streetching, youu help to relieeve the tighttness experieenced in variious muscles which w can caause the jointt pain. Modderate flexibiility is sufficcient and willl aid in dailyy activities such as bend ding to pick up somethinng off the flooor, and willl also help too maintain fuunctional a These are a few exxercises whicch can be doone in 5 minuutes either att home or independeence as one ages. while at work. w They are a also greatt for RELAX XATION! • Thhe best time to increase flexibility f is after exercise (while muuscles are warm). • Doo not bouncee. Go into a stretch slow wly and hold gently. Strettch to the pooint of feelingg a gentle puull, but neverr to the pointt of pain. Yoou should feeel a slight reelease after 10-15 1 secondds. • Hoold each streetch for 20 too 30 seconds. If you havve problems with a particcular area strretch that areea twice or more! m Get paaid to stretchh… stretch at a work! Should lder and Bacck: The first stretch focuuses on the siide of the shooulder and th he back of thhe upper arm m. Pull yourr elbow across your body towards t the opposite o shooulder. Hamm my Hamstriing: This streetch focusess on the backk of the leeg and the lower back annd calf. Thiss can be donee whilee sitting in a chair at worrk. Just exteend one leg inn front with your heeal resting on o the floor, and lean tow wards your leg. The oppposite leg caan be relaxedd. Pull back on t stretch thee calf. toes to A Optioon B Use a chair or tabble. Keep baack foot poinnted B forwaard. Calf Stretch h: Stand with h your handss against a wall. w With yoour back leg straight, your heel fllat on the flooor and your foot pointedd straight aheaad, lean slow wly forward,, bending thee front leg. You Y should feel the t stretch in n the middlee of your calff. Inner Thigh: T This stretch focuuses on the innner thigh annd groin. Spread d your stancee slightly andd lean towardds one side, therefore bending g the knee. Move oppossite hip downn towards thhe bent knee.

Hip ip flexor mu uscle stretch:: Kneel withh the left foott forward. Slo owly shift weight w forwarrd, keeping the t back straaight. Lift thee sto omach musclles and pushh the left butttock toward the floor, hoold forr 30 secondss. Relax and return to thee starting possition. © Healthy y Weights 2007 2

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Lesson 3

Willpower Versus Skill

The word willpower implies something in your psychological makeup that allows you to do hard jobs, overcome temptations, and stick to your goals. But willpower is merely a word or label. A better way of thinking about such strengths and weaknesses is to realize that they are tied to particular situations. In one situation you may succeed and others you may not, it is not your willpower but your skills in those particular situations. Some people who fail to stay on a diet blame their personalities or weak “willpower”, but in fact the blame usually lies in how they react to very specific situations.~ Watson, 1993 Some people speak as though willpower involves standing in the face of temptation, fists clenched, jaw tight, refusing to do what one shouldn't do, even though e wants to do it. After several decades of practicing chastity, for example, Mahatma Gandhi sometimes slept next to attractive young followers to demonstrate his ability to abstain from sex. But most people with effective self-direction simply avoid that kind of situation. It is far easier to remain chaste while sleeping alone. People use foresight and planning to avoid temptation. If you, like Gandhi, can resist temptation, then you don’t need the techniques of self direction and behaviour change. For the rest of us, the strategy is acting in advance to prevent behaviour we do not want – many of us use this nightly in the form of an alarm clock. The crucial element is making the desired choice when we are more likely to choose correctly.

Intentions

Actions

Reviewing Your Monitoring Forms This is your opportunity to play detective and analyze your behaviours. If humans are indeed creatures of habit, you will start to see patterns. Detect your desirable behaviours in addition to your undesired actions. Time. Did your eating cluster around certain times of the day? Your eating times may vary depending on the day of the week. Some people keep a strict schedule on weekdays and then have less control on weekends. If you find times when control is difficult, think about scheduling alternative activities, like exercise. © Healthy Weights 2007

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Feelings. Did you eat when you were bored, depressed, anxious, angry, or lonely? Other feelings may also be involved, like resentment, hostility, jealousy, or even joy. Seeing a pattern is a sure sign that you may want to develop more adaptive ways to cope with difficult feelings. Activity. What do you do while eating? Watching television is the main culprit, but reading a newspaper, listening. to a radio, or surfing the Internet also can signal problems. Doing two things at once insures that neither gets full attention. Eating Triggers Most people have well-defined eating triggers. What are yours? This is where the notion of high-risk situations becomes so important. Throughout this program, you will learn methods for avoiding or coping with situations that spell trouble. Identifying these situations, or triggers, is the first step. The knowledge you gain from studying your behaviour provides valuable information for later stages of the program. You can learn to predict the situations that increase your risk of overeating and plot your strategy accordingly. Triggers are typically a mixture of the factors included in your Expanded Monitoring Forms. Given the right time, feelings, and other circumstances, eating can be hard to resist. You may encounter positive pressure, like offers of food from friends, or negative pressure, such as feeling upset. Once the trigger loosens your restraint, stopping can be difficult. List your four main triggers in the "My Eating Triggers" worksheet on the right. Remember these; I will make many suggestions later about how to counter your particular eating triggers. My Eating Triggers 1

Physical Activity For The Long Haul Our concept of physical activity is not the typical exercise-prescription program of high-intensity exercise. Instead, this program promotes enjoyable activities. I gave you a brief overview of physical activity in Lesson Two. The objective of The Healthy Weights program is to make physical activity fun and to increase the number of activities you consider "exercise." The first example is walking and basic resistance training and more activities will be discussed shortly. Keeping calories low is one good way to help your body create an energy deficit. However, there is much, much more you can do. Now it is time to talk about the other side of the weight loss equation© Healthy Weights 2007

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increasing the number of calories you expend by increasing your physical activity. Are you ready? I cannot overstate the importance of increasing physical activity. Theoretically, you can eat less, exercise more, or do both. But there is much more to exercise than calorie burning it truly is a wonder drug. Wonder Drug and The Fountain of Youth Imagine for a moment that a new drug has been discovered and it has the ability to prevent many diseases. It causes fat loss and improved health. It will make you feel like you are years younger, improve your appearance and boost your self esteem. It will give you energy, reduce stress, fight depression and anxiety, and improve your mood. It will make you healthier, stronger and improve your ability to do everyday tasks. It will improve your golf game and help you keep up with your children or your grandchildren. This drug can be taken once or several times a day. In fact, you'll start seeing results with your first dose. What could this drug be?

You’ve guessed it! Old fashioned physical activity is probably the single most important thing you can do to age gracefully. Even in moderate amounts of walking, gardening, anything that gets your body moving can help you improve the quality of your life while preventing diseases such as heart disease and diabetes that are mistakenly presumed to be a usual part of aging. Scientists have also found that even small amounts of daily physical activity result in drastically improved eating patterns. Does a short walk cheer you up? Do you find you eat better when you are in a good mood? Maybe the mood enhancing benefits of physical activity are worth the sweat alone?

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Reversing The Trend – Some Suggestions By introducing a moderate amount of physical activity into your daily life, you can significantly improve your overall health, well-being and quality of life. These benefits can be achieved by virtually everyone, regardless of age, sex, race or physical ability. Whatever exercise you choose − and your activity of choice may vary from day to day − the key is to aim for 30 to 60 minutes of moderate-intensity physical activity on most days of the week. How you get it is up to you. Physical activity takes many forms, a number of which you may already enjoy, such as walking, gardening, dancing, swimming, playing basketball, biking, skating, shoveling snow, raking leaves and washing your car. Almost anything that gets your heart rate up qualifies. Here's some more good news. The more you exercise, the more you benefit. Even a modest increase in daily activity can help improve your health and quality of life. If you're already getting 30 minutes of physical activity a day, adding just one more mile to your evening walk or taking the stairs instead of the elevator at work can make your heart, muscles and lungs even healthier. Becoming physically fit doesn't require strenuous, high-intensity workouts, boring or monotonous routines or an expensive health club membership. You simply need some comfortable shoes a regular program of exercise and a healthy diet. You may believe that if you aren't active, you'll simply maintain your current health and wellness levels. That' s not true. If you don't exercise, you’ll lose muscle mass and flexibility, bone density, lung capacity, joint mobility − and many other factors of health − every day. Starting Your Walking / Exercise Program I cannot emphasize enough the importance of monitoring your physical activity. If you are using a step counter, put it on the first thing in the morning. At the end of each day, just before you go to bed, review your daily activity. Record the number of steps you walked during the day on your Monitoring Form in the space provided. Be sure to reset the step counter after you have recorded your steps. Your goal this week is to walk at least 4,000 steps each day. If you already walk more than this, keep up the good work. Maintain the level that you have been walking. Your goal will be to increase the number of steps by at least 200 steps per day each week, beginning next week. I have included a Walking Goals chart on page 44 to help guide your walking program. Remember, if you are currently walking more than 4,000 steps each day, use your current number as your starting point, and add at least 200 steps per day each week. If you can increase your number of steps more than the 200 I suggest, that's fine. However, make sure that your increases are gradual. For optimal health, some experts recommend an ultimate goal of 10,000 steps per day. This would be a great achievement, but for now, focus on near-term changes. There are many advantages to making © Healthy Weights 2007

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walking one of your primary activities. It can be done anywhere, it requires little equipment and can be performed on your own or with others. Be sure to have a good pair of walking shoes and keep your spare shoes in your car or at your workplace. Have a good jacket and an umbrella so you can conquer the weather excuse or think of places where walking can be performed in doors. Energy Balance We already discussed the importance of the energy balance equation. Much like our vehicles, if we drive them more than we fill the gas tank, the amount of fuel will decrease. Remember, our fuel is the food we eat and the fat stores on our body. Fat is our gas tank and our gas tank has the ability to change size. The goal for weight loss is to be in an energy deficit. In other words, consume fewer calories than we are burning in a day. Our energy expenditure consists of our basal metabolic rate, activity of daily living and exercise. Metabolic Rate 101 1. Basal Metabolic Rate (idling car, heart beat, breathing, digestion, etc.) 2. Daily Physical Activity (all activities, brushing teeth, searching for the remote) 3. Planned Exercise (darkened in diagram) The diagram on the right is a depiction of daily energy expenditure for a person who exercises daily. Notice that we can increase both activity of daily living and exercise energy expenditure. We can do this by simply spending less time sitting!

Canada’s Food Guide You will notice that fruits and vegetables are the cornerstone of the guide. In fact, fruits and veggies should be praised as much for what they are (full of vitamins, minerals and fiber) as what they aren’t (fatty, salty, calorie dense). Every time we increase our intake of fruit and veggies we displace higher calorie foods from our diet! Meal Planning. Meal planning doesn't have to take a lot of time! Do it once or twice a week when you write out your shopping list. The more you plan the easier it gets. A little planning goes a long way in helping you have healthy eating habits.

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Monitoring ‘More Than Calories’ It is a good idea to take a close look at the foods in your diet. Are you eating the appropriate amounts from each food group? Are you following Canada’s food guide? You may also be interested in the amount of salt, fat, cholesterol and so on. A good way to determine the detailed composition of your diet is to enter a week’s worth of eating into the Dietician’s of Canada ‘EAT tracker’ on their website. The EATracker can be accessed through the Healthy Weights member section under the resources link. Lesson 3 Expose

Anxiety, Eating, and Overweight (Adapted - Johnson et al., 2001)

Sarah is 5 feet, 5 inches tall and weighs 220 pounds. She is divorced, has two school-age children, and works full time as a high school biology teacher. Sarah’s ex-husband does not send his child-support payments consistently, which makes finances a source of anxiety for Sarah. To cope with this situation and decrease her resulting anxiety, Sarah turns to food. She often binge eats from 3:30 p.m. until dinner time. Sarah’s coping behaviour is strongly influenced and precipitated by emotions, particularly negative emotions. We call this type of coping behaviour emotional eating. Emotional eating is poorly understood for two important reasons. First, theories of weight and eating have either oversimplified the role of anxiety or downplayed the role of emotions in overeating. Second, few tools for measuring emotional eating are available. This article presents a brief overview of the theories and understanding about how anxiety and other emotions influence overeating. The Desire to Eat Scale (see chart below) is also provided to help individuals better understand their susceptibility to emotional eating. Review of Weight and Eating Theories Anxiety Reduction Theory. As early as the 1950s, researchers began investigating why people overeat to cope with their emotions or to reduce anxiety. Initially, they believed that overeating by obese individuals helped them reduce their anxiety, thus causing obesity. Today, we consider the theory of anxiety reduction to be overly simplistic and that emotion, particularly anxiety, interacts with other factors to influence eating. Other scientific theories of eating and overweight that followed the anxiety reduction theory also downplayed the role of emotional eating. The lack of consideration of emotional factors in weight and eating theories is one reason emotional eating is poorly understood today. Using Sarah as an example to illustrate the simplicity of this theory, her binge eating would be considered the result of her efforts to cope with her emotions or to reduce anxiety. Internal-External Theory. Schachter and his colleagues at Columbia University put forth one of the most influential theories in psychology. Their theory is called the internal-external theory of obesity. According to this theory, overweight individuals are more likely than normal-weight individuals to overeat in response to environmental (external) food cues. Emotional eating has a minor role in this theory. © Healthy Weights 2007

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This theory would focus on Sarah’s external cues to eat. For example, Sarah binge eats after work until dinner time because this is the only time of the day she is alone (i.e., after work and before her children come home from their after-school activities). Sarah's time alone in the house from 3:30 to 5:30 p.m. is an external cue to eat, as opposed to her internal cues of hunger. Set Point Theory. Influential during the 1970s, this theory suggests that peoples bodies are programmed to a particular weight. Any attempt to deviate from this set weight is met with resistance by the body's metabolism and other physiological mechanisms. This theory of overweight is primarily physiological, but also assigned a minor role to emotional eating. According to this theory, Sarah may participate in a weight loss program until she gets her weight down to 180 pounds. However, if her weight is set at 220 lbs, she will regain the 40 pounds she lost unless she continues to participate in the weight loss program and exercises. Restraint Theory. Since the 1980s, this has been the prevailing theory for eating disorders, specifically recurrent binge eating. The restraint theory maintains that chronic dieting is the primary factor in producing and maintaining overeating and overweight. Chronic dieting leads to feelings of deprivation and physical hunger, which eventually give way to binge eating episodes. Let’s look at how this theory applies to Sarah, who has been trying to lose weight for the past 20 years. She starts off each day by skipping breakfast and eating only yogurt for lunch. By the time she gets a break at 3:30 p.m. she is very hungry. She begins to eat, and her rapid eating soon becomes a binge eating episode. She has been deprived of food for most of the day and is hungry. Sarah then feels so guilty and depressed about overeating that she vows again to lose weight. The next day, she eats very little at breakfast and lunch, but inevitably finds herself binge eating after work—she is trapped in a vicious cycle. Traditionally, emotional eating has not been considered to be a factor in this theory, but more recently, the role of emotions is being reconsidered. The Role of Chronic Dieting As previously mentioned, the restraint theory maintains that chronic dieting is the primary factor in producing and maintaining binge eating. Therefore, individuals who regularly binge eat are likely to be chronic dieters and are often overweight or obese. Individuals who chronically diet and who are obese often increase their food intake when anxious. For example, Sarah’s binge eating behaviour increases when she is anxious about seeking legal assistance for collecting child support. On the other hand, individuals who do not diet and are normal weight often decrease their food intake when anxious. For example, Jill, who weighs 135 pounds and has never dieted, actually loses weight during periods of high anxiety. Newer research highlights the effects of chronic dieting on the relationships among anxiety, hunger, and eating. Chronic dieters who are hungry will overeat or binge eat when anxious. However, if they are not hungry, anxiety will have no effect on eating. Sarah is more likely to binge eat after work if she © Healthy Weights 2007

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has restricted her food intake all day and is anxious (e.g., because of worry about receiving a bill in the mail). In the same situation, Sarah will be less likely to binge eat after work if she had cereal and fruit for breakfast and a sandwich for lunch. On the other hand, when individuals who are not chronic dieters, are hungry, they will have suppressed eating behaviour when anxious. If they are not hungry, anxiety typically has no effect on eating. If Jill, who is not a chronic dieter, skips a meal during the day and then is feeling anxious (e.g., related to an argument with her husband), she likely will not eat very much the rest of the day. However, if Jill ate a good breakfast and lunch and then has an argument with her husband, she is more likely to eat a regular supper. The theories we discussed earlier have given us limited insight into the complex relationships among chronic dieting, anxiety, eating, and overweight. The recent development of a scale for measuring emotional eating may lead to an improved understanding of these relationships. Measuring Emotional Eating In 1995, Dr. Arnow and colleagues at Stanford University School of Medicine developed a scale to use as a tool to study emotional eating behaviour and to learn from people who struggle with overeating. The scale measures the relationship between emotions and urges to eat, but not emotions and actual eating behaviour. Take a moment now to complete the adapted version of this scale, called the Desire to Eat Scale, provided here. The Desire to Eat Scale does not have a numerical score, yet it can be an effective tool for evaluating your emotional eating behaviour. The first step is to complete the scale now. After you have completed the scale, try to maintain a regular pattern of eating three balanced meals and two to three snacks each day for the next week. The next step is to once again complete the Desire to Eat Scale and compare your responses. Notice whether your urges to eat have decreased in response to these emotions. The final step is to try to maintain this regular eating pattern for a month and, once again, complete the Desire to Eat Scale. Compare your responses with your earlier answers. If your urges to eat have decreased, this is evidence that reducing chronic dieting and hunger helps you to manage your emotional eating.

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Desire to Eat Scale We all respond in different ways to different emotions. Some types of feelings cause people to experience an urge to eat. Please indicate the extent to which the following emotions lead you to feel an urge to eat by checking the appropriate box.

Emotion(s)

No Desire to Small Desire to Eat

Moderate Desire to Eat

Strong to Overwhelming Desire to Eat

ANXIOUS Worried, Jittery Nervous SAD Blue Down Depressed LONELY Bored Discouraged Worthless TIRED Worn-out Fatigued ANGRY Upset Frustrated Furious HAPPY Good Joyous Excited

Anxiety and Eating Summary Overall, most scientific theories of eating and overweight have oversimplified or neglected emotional eating. Today, we know that emotions, particularly anxiety, influence urges to eat and eating behaviour. In particular, chronic dieters appear to be most susceptible to overeating when experiencing anxiety, especially when hungry. Individuals who are chronic dieters and who also have trouble with overeating may be able to prevent overeating in response to anxiety by not allowing themselves to become too hungry. Maintaining a regular pattern of eating three meals and two to three snacks that are spread evenly throughout the day may help these individuals avoid overeating when hunger and anxiety are high.

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Week 3 Destination Plan Week three is here and we will be turning the corner to create strategies to conquer our less desirable behaviours. Remember, you can’t simply remove a behaviour- you need to replace it with something enjoyable and accessible. General Complete the “Destination Plan”, Determine Your Eating Triggers Enter (online members section) your weight, caloric intake, steps and goals/action plan and daily steps. Choose a day of the week and enter the last 7 days (average). We will do this each week for the rest of the program. Enter 1 announcement/idea/find a buddy/etc. on the announcements section of the web Behaviour Strive to achieve the goals you set and assess your previous goals and achievements Nutrition Record each meal and snack on your monitoring forms (Circle Each Day 1 2 3 4 5 6 7) Become a food and mood detective (Is there a relationship?) Physical Activity Wear your pedometer each day + record your daily steps (Circle Each Day 1 2 3 4 5 6 7) Modify a sedentary activity by making it an ‘active’ activity (coffee meeting walking meeting) Make a physical activity appointment to be done on your own (Did you keep your appt? Y / N) Resistance Training X2 + Flexibility X2 (Schedule now ____________, ____________) The Weekly Game Plan Smart Goal(s): 1. Steps: My goal is to walk _______ steps per day 2. Calories: My goal is to eat _______ calories per day 3. ? 4. ? Action Plan(s): How will you achieve these goals?

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Monitoring Form-Lesson Three Time

Description

Place

Feelings Calories

Total Calories from breakfast

Total calories from lunch

Total calories from dinner

Total calories from snacks Total Number Of Steps Walked Today

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Muscle Toning T 101

Thee Watch TV V and Work kout Routinee

Muscular strength is important to overall health h and physical p fitnness. It enaables you too perform activities of daily living more eaasily and helps to mainttain functionnal independdence later on in life. Weight training is oftten seen as tiime-consum ming, confusiing, and an inconvenienc i ce, but it doesn’t have to be thatt way. The following 4 exercises can c be done right in youur own hom me, without needing n to purchase any a machinees and they only o take 100-15 minutess! The goal is i to be able to do 8-12 repetitions r of the exeercise, and peerform 2 sets each. 1) Squats • Leean back agaainst the wall, feet shouldder width appart and out in i front of yoour body. • Maintain M contact with the wall and sloowly bend knnees until yoour thigh is parallel p with the floor (N Note – don’t let your knees bend overr your anklee, keep it perp rpendicular to ground) • Hoold that posiition for 1 seecond then sllowly raise yourself y backk up • Bee sure to NO OT lock yourr knees and to t allow yourr body weighht to rest agaainst the walll 2) Wall Puush Ups • Faace the wall with w feet shooulder widthh apart and sttand far enough away thhat your palm ms can be pressed againsst it with youur arms extennded in fronnt of you, shooulder widthh apart • Slowly bend elbows e allow wing your boody to move towards the wall • Hoold for 1 seccond then exttend elbows and push boody away froom the wall slowly 3) Shouldder Press • Sitt upright in a chair with shoulders puushed back and a feet shouulder width apart • Hoolding 1 weiight in each hand h (can bee dumbbells or even 2 caans of soup), with elbow ws bent 90 deegrees, upperr arm paralleel with floor and lower arm a pointingg upwards • Puush arms up towards the ceiling and bring the 2 weights w togeether above the t head • Hoold for 1 seccond, then sloowly lower the t weights to the originnal position 4) Bicep Curl C • Sitt or stand wh hile holding 1 weight in each hand (dumbbells or o soup cans)) • Haave weights facing awayy from your body, b and sllowly bend elbow e • Brring weights up to your upper u arm, hold h for 1 seccond and low wer slowly

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Lesson 4

Embracing Your Healthy Lifestyle

People use programs like Healthy Weights because they want to lose weight, but there is much more at stake. Better health, living longer, being more vital and energetic, sleeping better, and having more confidence are just a few of the other reasons to change eating and physical activity habits. How much your weight changes is only one index of the success you have. Weighing The Benefits People often become too focused on the scale. This single-minded way of evaluating your progress can lead to disappointment when the scale moves less than you'd like and deprives you of opportunities to feel good about other changes. This is why I ask you to complete quality of life assessments throughout this program-to draw your attention to the total picture of how much your overall life is changing. The changes you make in diet and physical activity can improve your life in many ways, regardless of the impact they have on your weight. Your body will celebrate these changes, so it is important that your mind does the same. Pay attention to the changes you make, reward yourself for them, and make sure you consider changes in energy, sleep, vitality, and how you feel about yourself when you stop to size up your progress. There is much to be proud of. Weight Loss As A Side Effect Of Healthy Living Most of us have worried for years about "ideal weight." Height-weight tables are everywhere, and in many programs, a goal weight is given to program participants based on the ideals from these tables. The message is that you must lose to a magic level to benefit from weight loss. Far from being "ideal," these weight tables are a source of enormous frustration, given their unrealistic view that "one size fits all." The truth is that there is no magical number and any amount of weight loss is a great amount of weight loss. Moderate amounts of weight loss produce enormous benefits to health. Even in the absence of weight loss, improved eating habits and increased physical activity will no doubt improve your health and quality of life. Your vision of a ‘realistic amount of weight loss’ is as critical to your success as any other program factor. Unrealistic thoughts of appearance and the thought that ‘all of my probems will be solved with weight loss’ is a recipe for disaster. Think about what is realistic for you, realistic today, next week, next month and so on. What are you really after? Would you prefer to look great and feel lousy or feel great and let your appearance fall into to place. A wise person once told me that ‘people remember how you make them feel, far more than the jewelry you wear or the shape of your body and face. That is what true attraction is all about’.

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A note about staying positive. Did you know that a positive attitude is one of the best predictors of success with respect to a behaviour change program such as Healthy Weights? Are you in control of your mood? You and only you are ultimately responsible for your happiness and your outlook on life. Determining Your Target Calorie Level Over the next few lessons, you will have time to experiment with this beginning calorie level and to arrive at your target number. This number is important. I will ask you to enter your daily calorie target onto your Monitoring Forms for each week in future lessons. You will note your daily calorie target number on each daily Monitoring form. You will then have a record of whether you attained the goal each day of the program. The space for the precise calorie level in the Monitoring Form is left blank, so you can write in your personal number. Dropping your calorie level below 1,000 calories per day is not advisable. By eating fewer than 1,000 calories, you may be losing weight at the expense of good nutrition. A physician should supervise diets of less than 1,000 calories per day. Diets with few calories (800 calories per day or lower) are called very-low-calorie diets (VLCDs). Again, these diets should be used only under medical supervision, preferably in a program where a registered dietitian is available to provide expert nutritional input. The body goes through complicated changes when these diets are undertaken. If a person is not screened and monitored adequately, a potential for danger exists if the food or supplement to be eaten does not contain the right mix of nutrients. Before I share this with you, I want to emphasize that your Monitoring Form is an estimate of the calories you eat. Several studies have shown that individuals in weight management programs tend to underestimate their caloric intake and overestimate their energy expenditure-even when they are being as honest as they can. These studies have shown caloric intake to be underestimated by as much as 50 percent and energy expenditure to be overestimated by as much as 50 percent. The take-home message from these studies is that the more accurately you estimate your caloric intake, the more closely reflected these estimates will be on the bathroom scale. Carefully reading food labels, measuring the food and beverages you consume each day, and writing down everything that you eat and drink can go a long way to increasing the accuracy of your food intake. My target calorie level is _________________________ Barriers To Physical Activity A number of barriers stand in the way of many people being physically active. Extra weight can make exercise physically difficult. People who have been overweight all their lives may have little experience with vigorous exercise, and the experiences they do have may be unpleasant. They may have been teased or chosen last for sports teams. Put away your old feelings and develop new ones towards being active. You can decide to be an exerciser right now. In fact, carrying extra weight increases the work of every step you take and the calories burned.

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Your Walking Program Do your level best to walk every day. Making it part of your routine is important, like brushing your teeth, making your bed, or taking a shower. This is the only way you will integrate walking into your lifestyle. However, don't despair if you miss a day now and then. The long-term picture is more important than if you occasionally miss a day. Experiment with walking different places, at different times, and with different people (or try it alone). Find the way you like it best. Instead of going out for coffee with someone, go out for a walk with them. Invest in a music player or join a walking group. Accumulation Is The Key! According to the Canadian Society of Exercise Physiology (to which I am a member!), to reduce the risk of chronic disease, it is recommended that adults accumulate at least 60 minutes of moderateintensity physical activity on most, preferably all, days of the week. The key feature here is accumulation of physical activity. Contrary to popular belief, multiple short bouts of physical activity provide all the health benefits of a single long bout of physical activity. How can this be? If we separate the terms health and fitness this will make more sense. Health is defined as a total physical and psychological sense of wellbeing and not merely the absence of disease. Fitness on the other hand is tied much more closely to physical performance and sports such as the ability to run a marathon quickly. A regular walker or hiker can therefore be every bit as healthy as a marathon runner despite lacking the fitness attributes that allow the runner to complete a race quickly. A more concrete example of this would be comparing blood pressure and blood cholesterol between runners and walkers. Assuming that other lifestyle, diet and genetics are similar, the results of these tests would be equal. Howhow does one train for health or fitness? Different intensities and types of exercise confer different benefits. Vigorous physical activity (e.g., jogging or other aerobic exercise) provides greater benefits for physical fitness than does moderate physical activity and burns more calories per unit of time. Resistance exercise (such as weight training, using weight machines, and resistance band workouts) increases muscular strength and endurance and maintains or increases muscle mass. These benefits are seen in adolescents, adults, and older adults who perform resistance exercises on 2 or more days per week. Also, weight-bearing exercise has the potential to reduce the risk of osteoporosis by increasing peak bone mass during growth, maintaining peak bone mass during adulthood, and reducing the rate of bone loss during aging. In addition, regular exercise can help prevent falls, which is of particular importance for older adults. The barrier often given for a failure to be physically active is lack of time. Setting aside 60 consecutive minutes each day for planned exercise is one way to obtain physical activity, but it is not the only way. Physical activity may include short bouts (e.g., 10-minute bouts) of moderate-intensity activity. The accumulated total is what is important—both for health and for weight management. Physical activity can be accumulated through three to six 5-10 minute bouts over the course of a day. Consider incorporating both longer bouts and shorter accumulated bouts of activity into your day to increase your odds of achieving 60 minutes physical activity daily. © Healthy Weights 2007

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A great way that we already discussed is to monitor your daily activity is by using a step counter. Remember, accumulation of physical activity is the key to health. It does not matter if physical activity comes from house hold chores, a walk, a hike or a run. What matters is accumulation of physical activity and every step counts! Lesson 4 Expose

1-2-3 Energy and Portion Sizes

Consider snacks as mini meals. Like meals, snacks should be comprised of foods from different food groups. Use this outline in conjunction with Canada’s Food Guide for optimal daily energy (feeling energetic) and preventing hunger and subsequent over eating associated with hunger. For each snack (~1/2 portion) and meal (full portion) chose: 1. Fruit &/or Veggie (1 hr of energy) 2. Carbohydrate (2 hrs of energy) 3. Protein (3-4 hrs of energy)

Missed out on 1 while on the run? 2 out of three aint bad! Planning ahead is crucial!

Eat three meals a day and plan to snack in between them. Adjust portion sizes to suit your body size and activity level. Eat a variety of foods according to Canada’s Food Guide. Protein Favorites – large egg, yogurt, sliced turkey, chicken, peanut butter (it’s quite fatty – but ok in moderation), milk, brown beans, hummus, cottage cheese (objective is low fat proteins) Carbohydrate Favorites – choose whole wheat low fat carbohydrates when possible One Serving Looks Like...

Grain Products (5-12 servings)

Milk Products (2-4 servings)

Vegetables & Fruit (5-10 servings)

Meat & Alternatives (2-3 servings)

1/2 bagel = hockey puck

1 cup (250mL) milk = small measuring cup

one medium sized piece = tennis ball

50 to 100g meat, poultry or fish = deck of cards, computer mouse or palm of hand

1/2 cup (125mL) rice or pasta = light bulb or small fist

3/4 cup (175 mL) yogourt = small singleserve container

1/2 cup (125mL) fresh, frozen or canned = light bulb or small fist

1/2 cup to 1 cup (125mL - 250mL) beans or lentils = light bulb or small fist

3/4 cup (175mL) hot cereal = fist or cupped hand

50g cheese = size of two thumbs, or two processed cheese slices

1 cup (250mL) raw greens or salad = fist or cupped hand

2 tbsp. (30mL) peanut butter = ping pong ball

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Nutrition n Labeling For detailed informatiion on nutrittion labelingg visit www.hhc-sc.gc.ca/ffn-an/index__e.html

1. Serving siize 2. Calories 3. Percent Daily Value. i there is This scale tells you if l of a nutrient n a lot or a little 4. Get Less Of O These f per 5. Aim for 255-30 g of fibre day

2 4 3 5

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What Makes a Healthy Snack? Pick snacks that have lots of nutrients and fibre. The fibre will make you feel full, helping you to resist higher fat and higher calorie temptations. As a general rule of thumb, try to choose a snack that contains foods from at least two (aim for three 123 Energy) of the four food groups in Canada’s Food Guide to Healthy Eating. A few whole grain crackers (Grain Products) with lower-fat cheese (Milk Products) is a good example of a healthy snack. The carbohydrate in the crackers gives you immediate energy. By adding some lean protein and fat from the cheese, the snack takes longer to digest and gives you more sustained energy. And, as always, watch the portion size. A snack is meant to be a mini-meal to tide you over until the next time you eat. • • • • • • • • • • • •

Celery sticks dipped in peanut butter. A slice of leftover veggie pizza. Half a toasted whole grain bagel topped with lower-fat cottage cheese and sliced apples Grapes and a cheese stick Lean deli meats like roast turkey or ham on a whole grain bun with a glass of vegetable juice Cereal parfait: low-fat frozen yogurt, diced fruit and whole grain cereal in a cup Baked tortilla chips with lots of salsa A cup of orange juice with a handful of unsalted nuts Raw veggies with a low-fat yogurt or hummus dip

• • • • • • • • • • •

Bean dip or lower-fat cheese and whole grain crackers Fresh fruit with a vanilla yogurt dip Peanut butter and banana wrap in a whole wheat tortill Raisin toast with apple butter and a glass of milk A hard boiled egg and glass of tomato juice Low-fat cottage cheese with pineapple or peach slices A bowl of hot oatmeal cereal made with low-fat milk and topped with a sliced banana A whole wheat pita pocket stuffed with cold leftover chicken and grated carrots Canned tuna or salmon with light mayonnaise on high-fibre crispbreads

Mindful Eating ALONG WITH PHYSICAL ACTIVITY, being truly conscious of the food choices you make is the key to a healthy diet and to achieving and maintaining a healthy weight. And, although most diet books focus on the question of what you eat, we want you to understand that how you eat is just as important. It comes down to two basic ideas: pace and mindfulness. Pace means deliberately eating enough at regular intervals so that you have the fuel you need to function well and keep your blood sugar at a relatively consistent level. Mindfulness means paying attention to your food choices− and savoring every bite, instead of nibbling, inhaling your food without chewing enough, or just plain eating without much thought. What we want you to avoid is mindless "sleep-eating." Here's why. You're hungry or at least you think you are. You reach for food. The way to stay out of this loop is to remove hunger from the equation as much as you can. Eat three good meals a day, stay hydrated, and snack smartly in between if necessary, and you should seldom feel debilitating hunger. (A little edge of appetite, on the other hand, won't hurt you, and is to be expected from time to time, especially if you are on a weight-loss plan.) Avoid ravenous hunger, and chances are you'll avoid misusing or misinterpreting hunger as a cue.

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Week 4 Destination Plan Complex problems are rarely fixed with a simple solution. Rather, complex problems require understanding and a strategy to solve them. You will be making many plans and strategies throughout this program. Remember, there is no silver bullet but there are many ‘little’ things we can do each day that will make us successful. General Complete the “Destination Plan”, Visit the Dietitian’s Website of Canada Enter (online members section) your weight, caloric intake, steps and goals/action plan and daily steps. Choose a day of the week and enter the last 7 days (average). We will do this each week for the rest of the program. Behaviour Behaviour challenge – set daily physical activity goals for the next week and track your actual physical activity behaviour. Make a graphical comparison at the end of the week. Nutrition Record each meal and snack on your monitoring forms (1 2 3 4 5 6 7) Become a fat detective (Fat content and calorie content relationship?) Physical Activity Wear your pedometer each day + record your daily steps (1 2 3 4 5 6 7) Resistance Training X2 + Flexibility X2 (Schedule 2 days now ___________, __________) Set a “personal best” (Walk that route faster than you ever have before) The Weekly Game Plan Smart Goal(s): 1. Use a calendar to set daily physical activity goals 2. Calories: My goal is to eat _______ calories per day. 3. Action Plan(s): How will you achieve these goals?

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Monitoring Form-Lesson Four Time

Description

Place

Activity or Feelings

Calories

Total Calories from breakfast

Total calories from lunch

Total calories from dinner

Total calories from snacks Total Number Of Steps Walked Today

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R Resistanc ce Trainiing 102 Are you com A mfortable wiith the previious four exxercises you learned? It’’s normal too be concernned about p proper form and techniq que so pleasee ask for asssistance! Noow we’re gooing to add three more exercises e t you can use in your program. Like that L the last exercises, yoou want to be b able to doo 8-12 repetittions and d either 1 or do o 2 sets of eaach exercisee. Rememberr, stop at a “level “ 5” inteensity for thee first 3 or 4 exercise b bouts, and thhen work up to an 8-9 ouut of 10 intennsity. Most importantly, have fun wiith it! 1 Lunges 1) • Start with your feeet shoulder width apart,, facing forw wards • Step straight forw ward with yoour right foott while keepping left heall on the grouund • Loweer left knee to t the floor, while w keepinng your righht knee in line with your right heal • Raisee left knee baack off the floor f to original position & repeat wiith opposite side 2 Bent Overr Row 2) • Position your leftt hand and knee k on a bennch, and youur right foot on the floor.. h • Hold a weight in your right hand e towarrds the ceilinng (you shouuld feel the flexion fl in youur upper bacck) • Raisee your right elbow • Keepp your back parallel p withh the floor, while w raising the weight • Hold for one seco ond, then low wer arm back down to thhe floor • Repeat on the lefft side 3 Tricep Exxtensions 3) • This can be done either standding or sitting. • Hold the end of one o weight with w both hannds behind your y head • Both elbows shou uld be flexedd and pointinng towards the t ceiling ow, raising thhe weight tow wards the ceeiling • Extennd both elbo • Hold for one seco ond and low wer back dow wn

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Th he Core ‘Not So o’ Secrett IIn order to prevent back pain, injuryy and reduce the strain off day to day activities, perform the following f e exercises 3 times per week. w Stabillizers such as the abdoominals andd low back should be exercised e d differently thhan other mu uscles. Low loads held for f a longer period p of tim me (hold eacch exercise below b for 1 seconds to 10 t start and work w your way w up to 1 minute). Yoou may cyclee through thhe first 2 exeercises (3 p planks, frontt-left-right) one after another and repeat 3 tim mes). End with w the birddog and hold h each r repetition forr ~5 secondss. Alternate from f side to side and reppeat 4X to sttart and workk your way up u to 101 repetitionns per side. 12 Plank P L on your stomach Lie s and d place the ellbows below w the shouldeers. Flex the ankles so thhat you are on o your t tippy toes. Tighten your core musclees and raise the t hips off of o the ground. Keep the shoulders, hips, h and legs in a straaight alignmeent. **Do noot let the low w back arch*** Hold this position for up to 1 minuute.

Side Plank S L Lying on thee left side, pllace the elboow directly below b the shooulder. Tighhten your corre muscles annd raise t hips off of the o the ground d so that onlly the elbow and feet aree touching thhe floor. Keeep the shouldders, h hips, and kneees in a straiight alignment. Hold thiis position foor up to 1 miinute. Switchh sides and repeat. r

Birddog B G onto all 4-s Get 4 (hands and a knees) onn the floor. Straighten S onne arm out innfront of thee body. Takee the o opposite leg and straightt out backwaards. Balancee the body annd hold this position for 1 minute. Switch S the low bac s and repeeat. **Do no side ot arch (archh upward in this t picture) ck ** Do how wl like a birdddog☺

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Appendix A Quality of Life Review

Today’s Date:__________________

Please use the following scale to rate how satisfied you feel now about different aspects of your daily life. Choose any number from 1 to 9. 1 = Extremely Dissatisfied 2 = Very Dissatisfied 3 = Moderately Dissatisfied 4 = Somewhat Dissatisfied 5 = Neutral 6 = Somewhat Satisfied 7 = Moderately Satisfied 8 = Very Satisfied 9 = Extremely Satisfied 1. ________ Mood (sadness, happiness etc.) 2. ________ Self Esteem 3. ________ Energy and feeling healthy 4. ________ General Appearance 5. ________ Confidence in social situations 6. ________ Health Problems 7. ________ Leisure Activities 8. ________ Eating Habits 9. ________ Body Image 10. ________ Sleep Patterns 11. ________ Stress Level 12. ________ Overall Quality of Life 13._________ (________________) 14._________ (________________)

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Appendix B

Meal Planning: The Veggie Edition Breaking News- Fruits and veggies are good for you! Ok, so this isn’t exactly new information, but many of us struggle to eat the recommended daily amount of fruit and vegetables. Not only are fruits and vegetables packed with vitamins, minerals, antioxidants and fiber, it’s what they are ‘not’ that is even more important. They are not loaded with calories, saturated fat, salt and are rarely over consumed from ‘super sizing’ or extreme portion sizes. Why do we tend to choose other options even when the refrigerator is full of veggies? We have all heard or said at some point in time that vegetables and fruits are too much work. Indeed, they do take some work, so let’s examine some strategies to make preparing veggies a labor of love. Precook – Set aside a few days a month to shop for, prep, and precook a variety of veggies. Boil them until they are about half cooked, rinse with cold water and seal in a container or bad in the fridge till you are ready to eat them. When it’s time to eat, sauté the veggies in olive oil and garlic till warmed through. o Frozen is fine – Frozen veggies have all the goodness of fresh veggies. Freeze your own mix of vegetables or buy pre chopped veggies to be quickly thrown into a stir fry. o Karate Chop – Does the process of chopping and preparing veggies stand between you eating vegetables versus throwing them out after expiring? Here are some tips: Buy prepared veggies – prewashed salads, spinach, baby carrots, prepped broccoli Raid the salad bar – under the gun? Then grab a veggie tray or a premade salad Try roasting . Place veggies on a foil-lined baking sheet, drizzle with a little oil and balsamic vinegar, sprinkle with spices and roast at 425F until the veggies are soft and beginning to brown. Discover nut and seed oils. Buy a small amount and drizzle on for great flavor Consider the sauce. Dress your plain, steamed vegetables with an enticing but good for you sauce. Make Salad the Main Event Ditch the low fat dressings and make your own. Olive oil, balsamic vinegar and Dijon mustard. Add the right extras such as toasted nuts, feta, parmesan, flax seeds, or other cheese. Fruitful thinking. Present fruit in a pleasing manor. Slice or dice fruits, place them on a plate and enjoy them. Buy frozen mixes and add them to your morning cereal. Make fruit salad a regular dessert item and make extra so you can take it with you to work in a container. Additional Ideas ? Make veggie chopping a part of your grocery store routine. Chop your veggies as soon as you get home and place them in air tight containers. © Healthy Weights 2007

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Appendix C

Protein – The Basics and Then Some! The Basics Aim to have a protein with every meal and snack. Protein helps to slow digestion of carbohydrates (preventing spikes in blood sugar) and provides a feeling of fullness that will prevent subsequent hunger. And Then Some. All food contributes protein, however, we tend to over emphasize meat as the only protein source. We consume protein, break it down to its building block form (amino acids) then reassemble amino acids into body protein. Unlike carbohydrate (stored as muscle and liver glycogen) and fat (adipose or fat tissue), there is no storage form of protein. There are 20 amino acids used to make body protein, 9 of which are essential (required specifically through food, since the body can’t make these amino acids from other ingested amino acids). Each day adults create about 3 grams of new protein is made per kilogram of body weight to replace 3 g of old protein. This is the process of protein turnover (constant synthesis and degradation). Protein quality might be better understood as ‘protein completeness’. A complete protein supplies all the essential amino acids in adequate amounts. The required amount of protein is approximately 1 gram per kilogram body weight (or 0.5 grams per pound). This relates to approximately 15-20% of your daily caloric intake. With increased muscle mass and increased exercise, extra protein intake may be required but the reality is that most Canadian’s eat more than double the required amount of protein. Strict vegetarians actually have little problem with adequate dietary protein. Using a concept called complementary protein, eating items together such as grains nuts and seeds with legumes and vegetables compliment each other making a complete protein source. Typical eating patterns (they way or mom’s taught us!) tend to combine protein effectively. An example of this is a peanut butter sandwich or black beans and rice. Keep in mind that it is not necessary to consume complimentary proteins at the same meal as long as they are consumed over the course of the same day. Take some time and make a list of your favourite 1) dinner and 2) ‘on the go’ proteins.

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Appendix D

Physical Activity and Mathematics: Does 3 x 10 min = 1 x 30 min Regular physical activity has been shown to reduce the risk of certain chronic diseases, including high blood pressure, stroke, coronary artery disease, type 2 diabetes, colon cancer and osteoporosis. According to the Canadian Society of Exercise Physiology, to reduce the risk of chronic disease, it is recommended that adults accumulate at least 60 minutes of moderateintensity physical activity on most, preferably all, days of the week. The key feature here is accumulation of physical activity. Contrary to popular belief, multiple short bouts of physical activity provide all the health benefits of a single long bout of physical activity. How can this be? If we separate the terms health and fitness this will make more sense. Health is defined as a total physical and psychological sense of wellbeing and not merely the absence of disease. Fitness on the other hand is tied much more closely to physical performance and sports such as the ability to run a marathon quickly. A regular walker or hiker can therefore be every bit as healthy as a marathon runner despite lacking the fitness attributes that allow the runner to complete a race quickly. A more concrete example of this would be comparing blood pressure and blood cholesterol between runners and walkers. Assuming that other lifestyle, diet and genetics are similar, the results of these tests would be equal. How how does one train for health or fitness? Different intensities and types of exercise confer different benefits. Vigorous physical activity (e.g., jogging or other aerobic exercise) provides greater benefits for physical fitness than does moderate physical activity and burns more calories per unit of time. Resistance exercise (such as weight training, using weight machines, and resistance band workouts) increases muscular strength and endurance and maintains or increases muscle mass. These benefits are seen in adolescents, adults, and older adults who perform resistance exercises on 2 or more days per week. Also, weight-bearing exercise has the potential to reduce the risk of osteoporosis by increasing peak bone mass during growth, maintaining peak bone mass during adulthood, and reducing the rate of bone loss during aging. In addition, regular exercise can help prevent falls, which is of particular importance for older adults. The barrier often given for a failure to be physically active is lack of time. Setting aside 60 consecutive minutes each day for planned exercise is one way to obtain physical activity, but it is not the only way. Physical activity may include short bouts (e.g., 10-minute bouts) of moderateintensity activity. The accumulated total is what is important—both for health and for weight management. Physical activity can be accumulated through three to six 5-10 minute bouts over the course of a day. Consider incorporating both longer bouts and shorter accumulated bouts of activity into your day to increase your odds of achieving 60 minutes physical activity daily. © Healthy Weights 2007

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With colder weather approaching, 10 minute exercise bouts may be the trick to prevent inactivity on blustery days. Some ideas for staying active during the winter are to try something different such as snow shoeing or cross country skiing and having a good pair of boots to make your winter walks as comfortable as possible. The key is to break down barriers or ‘excuses’ for not being active. Exercise bikes and treadmills are a great option but can certainly be pricey. Keep in mind that a television in front of your treadmill will make the difference between walking on the treadmill versus hanging your laundry on it. A great way to monitor your daily activity is by using a step counter. Remember, accumulation of physical activity is the key to health. It does not matter if physical activity comes from house hold chores, a walk, a hike or a run. What matters is accumulation of physical activity and every step counts. Appendix E

Optimizing Optimism Understanding your WHY: the attribute of discovery Instructions: 1.Ask yourself: Why is this important to me? Why am I doing this? Why will this help me? 2. Repeat Step 1. Why Should You Put Yourself First? To be the best person you can be, you have to put yourself first. To be the best mom, or dad, or husband or wife, FIRST you must be the best person for yourself. Then you can be the best and do your best for others. The most important people in your life will benefit forever. Attitude Testers Every day we encounter attitude testers. It could be at work, at home, on the road or anywhere. It can be circumstances or people that test our attitude. But, how we react to these ‘tests’ is completely under our control. The 15 Minute Morning Attitude Drill 1. Create positive thoughts 2. Read positive thoughts 3. Write positive thoughts 4. Think and plan positive actions for the day 5. Speak positive words to yourself and others 6. Ignore all BS © Healthy Weights 2007

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Caloriie Guide

Appeendix F & G

b undersstand the calloric nutriennt values of many m This caloorie guide iss designed too help you better common food and beeverages. In a addition, it lists servinng sizes from m the five foood groups of o the Food Guuide Pyramid. You willl notice the Food Pyram mid (USA) differs from m Canada’s food guide in that it sepaarates fruits and vegetabbles into twoo categoriess. You do noot need to worry w about thee food guide categories at a this point. You mayy decide thatt you wouldd like a moree extensive guide g or a poocket size version. Thesse are availablee at most book stores. There T are also many webbsites that arre useful forr determininng the energy content c of food. fo Keep in i mind thaat you shoulld use the nutrition n infformation onn the packagess of the food d whenever possible. p There is a size conversion chart on thee last page of o this manual.

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