Your Guide to a Healthy Weight by Patrick Firth

Your guide TO HEALTHY WEIGHT

STEPS YOU CAN TA K E T O M A N A G E YOUR WEIGHT

B R O U G H T T O Y O U B Y T H E O D S H E A LT H CO A C H I N G P R O G R A M

A N E W D AY Having a healthy weight offers many benefits, from higher selfesteem to more energy to enjoy life. It also reduces your risk for serious health conditions. You’ve probably already tried many diets, with successes and failures along the way. Following a strict diet alone is not the answer — nor is having more willpower. Along with guidance from your health coach, this workbook will help you change your approach to food and physical activity. You also will learn how to address anxiety and triggers associated with eating. Change is not an overnight process. It takes time and effort to replace unhealthy habits with healthier ones. By taking small steps and making changes to your lifestyle in ways that you’ll enjoy, you’ll find that a healthy weight is within your reach.

“

THINGS DO NOT CHANGE;

we change.

”

— H E N R Y D AV I D T H O R E A U

This workbook is meant to be a reference to help you live better. It is not meant to be used in place of consultation with your healthcare provider.

W H AT â&#x20AC;&#x2122; S I N S I D E Chapter 1: Goal-setting Chapter 2: The power of your mind Chapter 3: Healthy eating Chapter 4: Active living Chapter 5: Guidelines and risks Chapter 6: Your medical care Appendix A : Weight loss program details Appendix B: BMI calculator Food log Activity log Notes

4 7 12 18 20 22 26 27 28 42 50

CHAPTER 1: GOAL-SETTING

ASSESS YOUR HEALTH Before you get started, you may need to get a better picture of your current health. See Chapter 5 on page 20to assess your health risks. It’s also a good idea to calculate your current Body Mass Index (BMI) — see Appendix B on page 27. Knowing the state of your health and your BMI may help you better define your goals.

TARGET PRACTICE Where does an archer look when shooting? At the bull’s eye, of course! Goal-setting is important because it gives you a target.

is habit A N D N O T T O B E “ Habit FLUNG OUT OF THE WINDOW BY ANY MAN, BUT COAXED D O W N S TA I R S a step at a time.

”

— MARK TWAIN

On the next page, follow the step-by-step approach to achieving your goals.Then, remove the page from this workbook and post it where you can see it every day — perhaps on your refrigerator, near your computer or at your bedside.

GOAL-SETTING Use this step-by-step approach to help you achieve your goals.

Cut along dotted line and place this in a visible location to remind you of your goals.

1. Write down your goals. Post them where you can see them, and read them often.

2. Write down what it will take to reach your goals. Be specific â&#x20AC;&#x201D; what are your daily goals? Examples: daily exercise or eliminating junk food.

3. List what motivates you to achieve your goals. Emotions, such as love for your family or joy for a certain activity, can be great motivators. What emotional needs are fulfilled by meeting your goal? Example: I want to play with my grandchildren, or I want to ride in an airplane comfortably so I can experience the joy of travel.

GOAL-SETTING Use this step-by-step approach to help you achieve your goals.

5. List the unique strengths you can use to achieve your goals.Think about what has helped you succeed in the past.

6. List your unique challenges. What are the biggest barriers to your success?

Cut along dotted line and place this in a visible location to remind you of your goals.

4. List the qualities it will take to reach your goals. Examples: discipline or will power.

CHAPTER 2: THE POWER OF YOUR MIND

FOOD AND YOU

RELAX YOUR MIND AND BODY

Your first step toward change is to take a good look at your personal relationship with food and your eating habits. As you work your way through this guide, be ready to change your thinking as well as your habits.

Relaxing your body and mind will help you manage stress and make choices that get you closer to your goal.Try the following tips throughout the course of the day. Above all, trust yourself and your body when making decisions about food.

Emotions can trigger overeating or steer you toward unhealthy food choices. In this chapter, you’ll learn some techniques to help manage stress, encourage positive thinking and focus on your goals.

RETHINK STRESS Stress can act as a trigger to overeat. Identifying your stressors and avoiding them can be a powerful tool. When you can’t avoid stress, try to relax and accept the situation. For example, when you’re stuck in traffic, instead of getting frustrated, calm yourself by listening to some music and thinking about something positive. List a few situations that cause you stress. How can you avoid or accept these things?

• Body. Focus on each part of your body from head to toe, taking note of tense muscles and the sensations you feel in each body part. If you notice any tension, breathe in a long, slow breath and imagine your body relaxing every time you breathe out. • Breath. Count your breaths,“In, out, one; in, out, two …”Count to 10, and think about a gate swinging open and closed with each breath in and out, or use words, such as“stillness,”“calm” or“happy”to remind yourself to relax. • Mindful activity. Practice doing one thing at a time while paying close attention to what you’re doing. Do not rush through any activity, even chores. Use this practice especially when eating. • Concentration. Work in a garden, try an exercise class, or use your hands in any activity or craft that requires concentration and the use of your skills, creativity and senses. • Imagery. Start by using the breathing exercise above. Imagine the person you want to be and the things you will be doing when you have accomplished your goals. Hold on to the image and continue your deep breathing.

THE POWER OF THOUGHT

EMPHASIZE THE POSITIVE

The way you think about yourself sends a message to your body.Thoughts can come and go so quickly that we often don’t take the time to stop and examine them. Over time, thoughts become like habits, and negative thoughts lead to negative actions.Try changing bad habits by changing the thoughts behind them.

Are hopeless thoughts holding you back? If so, listen. What are they? Here are some examples of how to change negative thoughts into positive thoughts.

What actions do you think follow thoughts such as “I am fat”or“I am lazy”?

Observe your thinking throughout the day. Are there any undesirable thoughts that stand out?

Negative thinking

Postive thinking

I cannot control my eating.

I do not need to control my eating.

My body is naturally fat.

My weight is a perfect result of my past.

I am greedy and overindulgent.

All of my needs are met and my body is my guide.

It is hopeless.

I surrender to the new.

My goal is too far away.

I take one day at a time.

I don’t know what is good for me.

I trust pleasure and pain to guide me.

The changes I need to make are too big.

I do exactly what I am ready to do.

I am out of control.

I trust myself to make the right choices.

What's wrong with me?

I release my frustration.

I hate my body.

I accept myself.

AFFIRM YOUR SUCCESS

Think back to the goals you made in the last chapter. Do the thoughts you’ve just identified help you take action toward accomplishing your goals? If they don’t, then what thoughts would help you meet your goals?

Use a mantra or repeat a positive phrase to help you change your view of yourself. Be creative. Choose one that rings true for you. Say the mantra out loud or to yourself several times a day. Repeat your mantra with sincere belief. Eventually, you will commit these thoughts to your belief system and they will become second nature. Use the above phrases in the“positive” column or create your own. For example:“I feel beautiful.” List some positive phrases you can use as mantras:

BECOMING YOURSELF

REWARD YOURSELF

Weight loss goals can seem challenging and out of reach.Try visualizing the person you want to become. This exercise can bring you closer to your goals by creating an experience in your mind.

If you’ve gotten into the habit of treating yourself with food-related rewards, break the habit by doing other things that make you feel pampered. Make an appointment for a manicure or massage. Purchase new music, a new book or supplies for your favorite hobby. Go to a movie or show.Try to create new avenues for rewarding your successes.

Remember, you are retraining your brain. Always make positive affirmations instead of negative ones. For example, tell yourself,“I move with ease, my body feels light, I am smiling, and people tell me I look good.”

List ways you can reward yourself other than with food:

Visualize yourself accomplishing your goals. How do you look and feel? What do you hear, see and smell? Be specific.

FOOD ASSOCIATIONS

USING YOUR RESOURCES Your success takes planning. How will you organize yourself to accomplish your goals? You could use a day planner to schedule your workouts. Or perhaps make a consistent grocery list. Maybe you could prepare a healthy breakfast or lunch the night before so you avoid unhealthy food at work. Is sleep a factor? List some of the ways you can organize yourself, along with how it will help you reach your goals.

You may find that you associate a certain activity or environment with overeating.These situations are your cues. You may realize that you’re more likely to overeat when watchingTV, when treats are on display in the office break room or when coming home late from work to an empty fridge. • Separate the association of eating from the cue. Instead of eating in front of theTV, eat at the table while paying attention to your meal. • Avoid or eliminate the cue. Leave the break room immediately after pouring coffee. • Change the environment. Have a healthy meal ready to prepare when you get home from work. What are your cues that lead to overeating? List them here, and then write down some ideas for changing those cues.

MEASURE YOUR SUCCESS Weight loss can take time. If you are working hard and have stopped seeing results on the scale as quickly as you once were, consider other ways to measure your progress.

8. I sometimes wake up gasping for breath. True False 9. My bed partner says my snoring keeps her/him from sleeping. True False

• Energy. Do you have more to give your family or your work? Are you sleeping better?

10. I’ve fallen asleep driving. True False

• Fit of clothes. Are you using the next notch in your belt or finding that your clothes are looser?

If you checked true more than twice, talk to your healthcare provider, health coach or another member of your healthcare team.

• Feelings. Does eating well and exercising make you happy?

SLEEP BETTER

• Lab results. Do you see better cholesterol or blood sugar numbers? Remember to listen to your body. If you have reached a plateau, it’s okay. Your health coach and health team can help you continue to practice good habits and offer ideas to change your routine, if necessary.

Sleep is essential for a balanced body and mind. Sleep assists cellular renewal and hormone balance. Lack of sleep affects blood sugar, which can be high after a night of poor sleep. Over time, lack of sleep can wear you down, making your goals that much harder to reach.Try the following ways to improve your sleep. • Sleep in a dark room or wear a mask over your eyes.

SLEEP DISORDERS Sleeping problems, such as insomnia and excessive daytime sleepiness, can affect hormones, blood sugar and weight. Read the statements below and check true or false to identify whether you may have a sleep disorder. 1. I feel sleepy during the day, even when I get a good night’s sleep. True False 2. I get irritable when I can’t sleep. True False 3. I often wake up at night and have trouble falling back to sleep. True False 4. It usually takes me a long time to fall asleep. True False 5. I often wake up very early and can’t fall back to sleep. True False 6. I usually feel achy and stiff when I wake up in the morning. True False 7. I often seem to wake up because of dreams. True False 10

• Use clean, comfortable bedding. • Set a routine by rising and going to bed at the same time each day. • Avoid drinking caffeine and alcohol in the evening. • Drink herbal teas in the evening. Warm milk and some herbal teas have been shown to be effective for inducing sleep. • Avoid heavy meals before bedtime. • Avoid having aTV in your bedroom. • Use aromatic oils, such as lavender, in the bath or on your pillow. • Read, listen to soothing music, stretch, or practice mediation and deep breathing in the evening to relax. • Be physically active during the day to make your body more tired in the evening. • Remember that bed should be used for sleep and sex only.

YOUR SUPPORT NETWORK Write the names of the people in your life who help and support you from the inner to the outer circles.The inner circles are those closest to you; the outer circles contain acquaintances and casual friendships.

ACQUAINTANCES AND CASUAL FRIENDSHIPS

OTHER FRIENDS AND FAMILY

CLOSE FRIENDS AND FAMILY

MOST INTIMATE RELATIONSHIP(S)

CONSIDER ANY CHANGES YOU WOULD LIKE TO MAKE IN YOUR SOCIAL SUPPORT NETWORK.

> > > > >

In your circle of support, who is the most supportive? Who is not as supportive as you would like? Do you need to make a change? Are there relationships you would like to start? Or people in your network who you would like to be closer to? Are there any people in your support network who do not support your goals? 11

CHAPTER 3: H E A LT H Y E AT I N G

DON’T JUST LOSE WEIGHT — MAINTAIN IT

ROLL UP YOUR SLEEVES

In this chapter, you’ll learn how to start making small changes for the better. Over time, these changes will become routine and not only will you lose weight, but you’ll also keep it off.

Awaken your awareness of the foods you eat. Studies show that people who spend time preparing their food are at a healthier weight than those who eat out. Taking the time to shop, cook and eat at home adds value to your food experience.

Simply losing as little as 10percent of your current body weight can make a difference in your health, lowering your risk for heart disease and other conditions. A reasonable and safe weight loss is one half to two pounds per week. Remember that it’s better to lose a moderate amount of weight over time. A slow pace enables you to create habits that you can maintain.

A HEALTHY EATING PLAN To start losing weight, you’ll need to cut down the number of calories you get from food and beverages. One pound equals 3,500calories. For a weight loss of one to two pounds per week, reduce your daily intake by 500to 1,000calories. In general: • Eating plans containing 1,000 to 1,200calories will help most women lose weight safely. • Eating plans between 1,200 to 1,600calories are suitable for men and may also be appropriate for women who weigh 165 pounds or more, or who exercise regularly. If you don’t lose weight on a 1,600-calorie plan, you may want to try a 1,200-calorie plan. If you are hungry on either plan, try boosting your calories by 100to 200 per day. Do not follow plans of less than 800calories a day unless you are monitored by your doctor.

My daily intake goal is ________________ calories.

• Take the time to prepare your own food. • Sit at the table and remove all distractions. • Savor the aroma of your food. Smelling begins the digestive process. • Before eating, notice what makes you grateful. (The people at the table?The food? Your job?) • Enjoy.Taste your food and savor it! • Chew slowly.

CHOOSE VITAL FOODS FOR A VITAL YOU You receive energy from the food you eat. Processed foods contain mostly fat, salt and sugar and do not provide much nutrition. Instead, choose vital foods — whole foods with color, vibrancy and life. Your body naturally responds well to the following list of foods. Incorporate these fruits, vegetables, whole grains and good proteins into your diet for the energy you need to accomplish your goals. • Grains. Choose fiber-rich whole grains such as whole wheat bread, brown rice and oatmeal. Other grains include breads, pasta, cereals, grits, tortillas, couscous and crackers. • Vegetables .Vegetables are packed with vitamins. Eat them raw or cooked, fresh or frozen.Vary the type and colors. • Fruits. Fruits contain vitamins and fiber. Choose fresh, frozen, dried, whole, cut or pureed fruit, or drink an occasional glass of fruit juice. Eat a variety of fruits and go easy on juices, which increase blood sugar faster than whole fruit.

• Milk. Milk offers calcium, potassium, vitamin D and protein.Try soy, rice or almond milk for a change.They are usually fortified. • Protein. Protein consists of meat, poultry, fish and beans.These, along with peas, eggs, nuts and seeds, contain essential building blocks for the body, as well as vitamins and minerals. • Good oils and fats. Most of your fats should come from fish, nuts and vegetable oils. Butter is fine in limited amounts. Combine olive oil and butter to create a more nutritious spread. Canola and olive oils are heart healthy and can be used in moderate amounts. • Water. Water keeps you hydrated and helps your cells eliminate waste and perform other important functions. Water also creates healthier looking skin. Drink water between meals and have only a small amount of water with meals; too much water with meals interferes with digestion. Avoid ice and extremely cold water to help improve digestion as well.

are no secrets to success. “IT There IS THE RESULT OF PRE PA R AT I O N , hard work A N D

LEARNING FROM

FA I L U R E . — COLIN POWELL

MAKE YOUR LIST Spend time preparing a list before hitting the market. Shop around the perimeter (outside aisles) of the store, since packaged and processed foods tend to sit in the center. Not only are processed foods more expensive, but they also have less nutritional value. Stick with whole grain staples such as brown rice and oatmeal, nonprocessed meats and low-fat dairy products. Stop by the frozen section for vegetables that have a higher nutrient content and less salt than canned vegetables.

LIST FIVE HEALTHY ITEMS TO SHOP FOR:

SHOP AND CHOP If you have a busy lifestyle, follow the“shop and chop” method. Buy most of your vegetables for the week. Wash, dry and chop them all at once.Then place the prepared, raw vegetables in sealed plastic bags or airtight containers. Keep them in the crisper section of the refrigerator. When you come home from a busy day, your veggies are ready to be cooked.

FOOD PREPARATION You can bake, broil, grill, roast, microwave or steam your food to help keep the vitality of your food intact and the calories and fat low. You can also lightly stirfry or sauté food to keep your vegetables bright and colorful. Overcooking vegetables to the point where they’re too soft can deplete their nutritional value.

SPICE UP YOUR LIFE

“O RY OC UO MDPOLNI’CTATHEAVD EMTAOS TCEOROPKI EFAC ENSC Y — just good food from fresh ingredients.

”

— JULIA CHILD

It’s easier than you might think to prepare low-calorie, low-fat dishes.The way you cook food, as well as the addition of certain ingredients, can add flavor and pizzazz to your meal.Try to avoid butter or other added fats during preparation and at the table. Instead, add flavor with these low-fat ingredients: • Herbs, such as oregano, basil, cilantro, thyme, parsley, sage or rosemary • Spices, such as cinnamon, nutmeg, pepper or paprika • Mustard, ketchup or vinegar • Reduced sodium soy sauce • Salsa • Lemon or lime juice • Horseradish • Fresh ginger • Garlic • Red pepper flakes • Sprinkle of parmesan cheese • Sodium-free salt substitute • Jelly or fruit preserves on toast or bagels

REALITY CHECK

PORTION SIZE

Place a check mark next to the foods you purchase now.

A“portion”is the amount of each type of food on your plate. You decide whether it’s big or small. A“serving” is a measured amount of food or drink, such as one slice of bread or one cup of milk. Be careful that you’re not consuming multiple serving sizes without realizing it, especially when eating out. If portion control is an issue for you, try the following tips.

Processed meats Processed foods containing coconut and

palm oil Hard margarines, shortening and lard Commercially fried foods Foods containing partially hydrogenated oils

(including bakery goods packaged crackers, chips and tortillas) Canned fruit packed in syrup Soda and sweetened beverages

How do you feel after you eat these foods? How does eating these foods affect your mood or energy?

• Use a portion control plate designed with sections for each type of food. It will show you how to gauge portions and count calories. Eventually eyeballing the right portions will become second nature. • Dish up your plate in the kitchen and then take your food to the table. You will not be tempted to take second helpings that way. • Enjoy every bite and savor your food

DINING OUT? CELEBRATE!

BRAINSTORM ALTERNATIVES If you’re in the habit of eating foods from the list above, brainstorm with your health coach to identify ways to improve your diet. List the high-calorie, highfat items you currently use in food preparation, and then list lower-calorie, lower-fat replacements. Instead of using:

I can replace it with:

Just because you’re eating healthier doesn’t mean you have to stop dining out. When in doubt, ask your server how dishes are prepared and about substitutions.Try to reduce portion sizes by ordering appetizers as your main meal or sharing an entrée with a friend. You can ask for a takeout bag at the beginning of your meal and put half of it away before you begin eating. • Breakfast. Order whole grain cereal or oatmeal, multigrain pancakes or an omelet with vegetables. Have yogurt, fruit or a small glass of juice on the side. • Bread. Avoid the bread basket and wait for your meal instead. • Appetizers.Try steamed seafood, shrimp cocktail (limit cocktail sauce), fresh fruit, bean soups or salad with reduced-fat dressing. • Salads. Choose fresh greens, lettuce and spinach. Add vegetables, beans and chickpeas. Skip deli meats, bacon, egg, cheese and croutons. Dress with vinaigrette, or lemon juice.

• Entrée. Poultry, fish, shellfish and vegetable dishes are healthy choices.Trim the fat from poultry and meat. Ask for butter, gravy or sauces on the side and limit the amount of butter, margarine and salt you use. • Side dishes.Vegetables and starches (rice, potato and noodles) make good additions to meals. Ask for sides to be served without sour cream, butter or margarine, or request mustard, salsa or low-fat yogurt instead. • Dessert or coffee. Order fresh fruit, fat-free frozen yogurt or sorbet. Or, try sharing a dessert. Ask for low-fat milk for coffee instead of cream or half-and-half. • Beverages. Go with noncaloric options such as water with lemon, flavored sparkling water or iced tea.Try a juice spritzer (half fruit juice, half sparkling water) or reduced-sodium tomato juice. Using the tips above, think about a meal or two you can order from the menu the next time you eat at your favorite restaurant:

• A sandwich with lettuce, tomato, onion, mustard and ketchup instead of cheese, bacon, special sauces or butter • Pizza — light on the cheese, extra veggies

ALL ABOARD! Now that you’re taking steps toward better nutrition, it’s a great time to be a positive role model for your loved ones and improve the way your whole family eats. Sit down together for meals, and you’ll enjoy the benefits of family time as well as healthy eating habits. Remember that the habits your children are establishing now will help them avoid problems with weight later in life.

HEALTHY WORDS Look for these healthier terms when choosing a recipe or dining out: • Steamed in its own juice (au jus) • Garden fresh • Broiled • Baked • Roasted • Poached • Tomato juice • Dry boiled (in wine or lemon juice)

PUT ON THE BRAKES You don’t have to give up fast food completely. Just remember that fast food does not need to be eaten in a rush. Sit down, slow down and enjoy your food with care.Try ordering the following choices. • Roast beef, which is leaner than most burgers • A small hamburger • A baked potato instead of French fries (without sour cream, butter or cheese) • Grilled, broiled or baked fish and chicken • Skim or 1 percent milk, low-fat frozen yogurt or a low-fat milkshake • A salad with vinegar and oil or low-calorie dressing

• Lightly sautéed

FOOD AND ACTIVITY LOG Use the weekly food and activity log at the end of this workbook to keep track of your progress. You can review this log with your health coach to see how you are improving, as well as target areas to work on.

W A L K I N G I S T H E best possible “exercise . H A B I T U AT E Y O U R S E L F T O W A L K V E R Y FA R . — THOMAS JEFFERSON

CHAPTER 4: ACTIVE LIVING

GAIN THE BENEFITS OF EXERCISE Staying physically active is the most beneficial thing you can do to maintain a healthy weight. Plus, physical activity lowers your risk of chronic health problems, such as heart disease and diabetes. Regular activity offers plenty of other benefits. • Your weight is much easier to control. • Your joints feel better. • It’s good for your heart and circulatory system. • You’ll feel and look better and gain confidence. • You’ll have more energy. • It helps you burn off steam and beat stress or the blues. • You can be social by taking a class or joining a club.

• To manage body weight, aim for 60minutes of moderate to vigorous physical activity most days. • Change activities and explore new ways of moving your body to keep exercise interesting.

EVERYDAY ENERGIZERS Studies show that the more active you are in everyday life, the better your health.Take the stairs instead of the elevator, stretch or take a walk during breaks at work, and spend less time watching television and on the computer. Spend more time doing household chores, pushing someone you love in a stroller or wheelchair, doing yard work, ironing, cooking or playing a musical instrument. In parking lots, park as far as you can from the entrance. Bike or walk to work or to the store whenever possible. List some everyday activities you can do:

Speak to your doctor before starting a vigorous program if you are over40(men) or 50(women). Ask your doctor how excess weight, along with any of the following conditions, may affect your exercise program. • Heart disease, high blood pressure, diabetes, osteoporosis (bone loss) or asthma • A high risk for heart disease because of a family history of heart disease or stroke, a diet high in saturated fat and cholesterol, smoking, or an inactive lifestyle

WHAT TO AIM FOR Taking the time to discover what you enjoy doing will help make physical activity a regular part of your lifestyle. Exercise does not have to take place in the gym if you don’t like that environment. Find what you love and make the time to do it. • Aim for at least 30minutes of moderate physical activity most days.

INCREASING ACTIVITY Light to moderate physical activity includes activities you already do, such as walking, cleaning your house or gardening. After you’re comfortable at this level, try adding more challenging activities such as faster walking, weeding a garden, cycling, skiing, tennis or dancing.Vigorous activities include running, heavy manual digging, basketball, climbing, soccer or kickball.

ACTIVITY LOG Keep track of your exercise using the food and activity log at the end of this workbook. Remember that you don’t have to commit a full hour at a time. If you’d like, you can break up your exercise into shorter bouts — say, 15 minutes at a time.

FUN WAYS TO GET MOVING • Make up a walking course in your neighborhood. • Take up a hobby, such as carpentry or archery.

CALORIES BURNED DURING COMMON ACTIVITIES Activity

Approximate calories/hr for a 154 lb person

• Turn on some music and dance.

MODERATE PHYSICAL ACTIVITY

• Play a game of tag with your kids.

Hiking

370

Light gardening/yard work

330

Dancing

330

Golf (walking & carrying clubs)

330

Bicycling (less than 10mph)

290

Walking (3.5 mph)

280

Weight lifting (light workout)

220

Stretching

180

• Walk or play fetch with your dog. • Jump rope or spin a hula hoop. • Take dance classes. • Grab a friend and try something new! List some more fun activities that you’ll enjoy:

VIGOROUS PHYSICAL ACTIVITY Running/jogging (5 mph)

590

Bicycling (more than 10mph)

590

Swimming (freestyle)

510

Aerobics

480

• Hold your head up and keep your back straight.

Walking (4.5 mph)

460

• Bend your elbows as you swing your arms.

Heavy yard work (chopping wood)

440

Weight lifting (vigorous effort)

440

Basketball

440

GET THE MOST OUT OF YOUR WALKING ROUTINE To get the most out of your walking routine: • Breathe.

• Take long, easy strides.

From Dietary Guidelines for Americans 2005, Department of Health and Human Services and Department of Agriculture.

CHAPTER 5: GUIDELINES AND RISKS

According to guidelines from the National Heart Lung and Blood Institute, your health risk is assessed using three key factors: Body Mass Index, waist circumference and other certain health conditions. • Body Mass Index is a measure of your weight relative to your height. A high BMI suggests high body fat and an increased risk of disease. See appendix B to calculate your BMI. My BMI is: _______________ .

L E AV E A L L T H E A F T E R N O O N F O R “exercise and recreation, W H I C H ARE AS NECESSARY AS READING. I W I L L R AT H E R S AY more necessary B E C A U S E health is worth more than learning.

”

— THOMAS JEFFERSON

• Waist circumference is a good indicator of abdominal fat, which helps predict your risk for developing serious health conditions. Health risks increase with a waist measurement of more than40inches in men and more than 35 inches in women. Determine your waist circumference by placing a measuring tape snugly around your waist. My waist circumference is: _______________ . Note: If your BMI is greater than or equal to 35, then your waist circumference is not as important for your doctor to consider in determining your health status. • Other factors can increase your risk for serious health problems. Check the factors that apply to you: High blood pressure (hypertension) High LDL-cholesterol Low HDL-cholesterol (“good”cholesterol) High triglycerides Sleep apnea High blood glucose (sugar) Family history of heart disease Physical inactivity

Cigarette smoking

WEIGHT LOSS GUIDELINES Be safe about losing weight. Standard guidelines recommend weight loss for people who are considered obese or for those who are overweight and have two or more risk factors. Lose weight slowly, at about one half to two pounds a week. See your doctor or a nutritionist if you need help. Even a small weight loss ( just 10 percent of your current weight) will help lower your risk of developing diseases associated with obesity.

PREVENTION IS KEY Weight is often gained over a gradual period of time. Without awareness, weight can increase and so can the risks associated with being overweight: heart disease and diabetes. Often, problems such as high blood pressure, high cholesterol and high blood sugar can go unnoticed and cause damage to the body before they are discovered.This is why prevention is so important. While being overweight is not a disease, it can contribute greatly to the advancement of diseases that are life-threatening. You have goals and family. Think of them and put prevention first. You will not only be a happier person, but the cost of poor health to you and your family will be greatly reduced. If you are overweight, but do not have a high waist measurement or any risk factors, think about preventing future complications by preventing weight gain.

CHAPTER 6: YOUR MEDICAL CARE

YOUR HEALTHCARE TEAM

MY TEAM

You are not alone in struggling with your weight. Your weight management team is here to help you.These professionals will work closely with you and your family as you learn how to eat better, engage in physcial activity and find a renewed sense of yourself.

List the names and contact information of your healthcare providers below: Primary care provider: __________________________________________________ Phone number ___________________________________

Profession

Description

Primary care provider

This person may be an internist, nurse practitioner, doctor of osteopathy or naturopathic doctor. He or she manages your overall care and will provide referrals as needed.

Endocrinologist

This type of doctor is specially trained to work with people who have weight management problems because of hormone imbalances, including too much or too little insulin production.

Endocrinologist: __________________________________________________ Phone number ___________________________________

Psychologist

A psychologist helps obese people with psychological reasons for overeating. This may include post-traumatic stress (difficult events that have caused one to react by overeating), addiction and eating disorders. A psychologist also can help prepare and assess you for surgery if that is your plan.

Psychologist: __________________________________________________ Phone number ___________________________________

Nutritionist or dietician: __________________________________________________

Nutritionist or dietician

Physical therapist/ physiotherapist

A nutritionist or dietician may provide nutrition counseling and structure to the diet. He or she educates you on the types of foods to eat and why these foods will help you in your goals for good health and weight loss. A physiotherapist will help you develop an exercise routine. He or she also can help determine whether an obese person with injuries or certain physical limitations is ready to start an exercise program.

Phone number ____________________________________

Physical therapist/physiotherapist: __________________________________________________ Phone number ____________________________________

F L I E R : C O M M U N I C AT I O N WITH YOUR PROVIDERS

You will receive a flier in the mail suggesting questions to ask your provider about your care. Take it with you the next time you have an appointment. Itâ&#x20AC;&#x2122;s important to work with your healthcare provider to create a treatment plan that feels right for you.

DEPRESSION Feeling sad and hopeless for two weeks or more is a sign of serious depression. Depression and excess weight can go hand-in-hand. Depression can prevent you from taking good care of yourself. It can cause you to feel like you don’t have enough energy to perform regular activities or keep up with a good diet.This can keep you from losing the weight and being the person you were meant to be. By the same token, a serious side effect of dramatic weight loss can be depression. Being overweight can carry a lot of emotional attachments and associations. If these factors are not addressed and released (often with the help of counseling), it can be difficult for the weight to stay off. It is important that the“outside”you matches the“inside”you. A counselor can help you align how you think of yourself and help support the changes that are good but hard to manage at times. Take a look at the list of symptoms below to determine whether you might have depression. Recently, I have experienced: A loss of pleasure in the things I used to enjoy A change in my sleep patterns A change in my appetite Trouble concentrating A loss of energy Nervousness Guilt or a feeling of burden to others Morning sadness Suicidal thoughts

If you have three or more of these symptoms, or if you have just one or two but have been feeling bad for two

weeks or more, seek help.Talk with your healthcare provider to see if there’s a physical cause for your depression, such as thyroid problems or side effects from medications. Your healthcare provider may refer you to a mental health professional.

MEDICATIONS If you think you’re a candidate for weight loss medications, discuss this with your doctor. Patients on weight loss medications need to be monitored for side effects. Your doctor will schedule visits to monitor weight, blood pressure and pulse; discuss side effects; conduct laboratory tests; and answer your questions. Weight loss drugs approved by the Food and Drug Administration (FDA) should be used only as part of a program that includes diet, physical activity and behavioral changes.

TAKE AN ACTIVE ROLE Prevent problems with drug interactions and misuse by following these tips: • Fill all your prescriptions at the same pharmacy. • Make sure you understand how to take each medicine.Talk to the pharmacist. • Tell your doctor and pharmacist about all prescription and nonprescription medicines you take, including vitamins. • Tell your doctor and pharmacist if you have any medical conditions or allergies to any medicine or food, or if you are pregnant or breastfeeding. • Keep a list of all your medicines and their dosages and carry it with you.The list should include the name of the medicine, its purpose, when to take it and how to take it (i.e., with water or food, or on a full or empty stomach).

MEDICATION NAME

PURPOSE

DIRECTIONS

For example: Simvastatin

Cholesterol medication

40 mg once daily with dinner

YOUR LIPID PROFILE (OR PANEL) Your lipid profile helps determine your heart health and risk for stroke and cardiovascular disease. Lipids are checked during a“fasting”blood test (no food or drink other than water or coffee for 10to 12 hours before testing). The higher your total cholesterol, LDL (low-density lipoprotein) and triglycerides, the greater your risk for a heart attack or stroke. Most of the cholesterol we eat comes from animal-based foods. Eating the right foods and getting enough exercise can help keep your numbers in a safe range. Some people also need medication to control their cholesterol. Your healthcare provider can help you control your lipid levels.

GENERAL RANGES Your doctor will tell you the number he or she wants to see in your lipid profile. Note the general ranges and ask your doctor about your own goal.

cholesterol level is not a good prediction for your risk of heart disease. Nearly 75 percent of cholesterol is bound to LDL while nearly 25 percent is bound to high density lipoprotein (HDL). Most cholesterol comes from animal sources in the diet, but your liver can make it as well. A healthy cholesterol level is below 200mg/dL. My total cholesterol is: _______________ .

LDL LDL cholesterol is considered“bad”because it carries cholesterol out to your body through your blood vessels and it can build up on the walls of your arteries. LDL levels are most affected by what you eat. High levels of LDL can indicate a higher risk for heart disease. Depending on your doctor’s recommended target for you, keep this number below 100mg/dL. My LDL cholesterol is: _______________ .

CHOLESTEROL Cholesterol plays an important role in your body. It is required for the production of steroids, sex hormones, bile acids and cellular membranes. By itself, your 24

HDL HDL is considered“good”cholesterol because it carries cholesterol back to the liver to be eliminated from the body.This is good for keeping your blood

vessels clear. HDL levels are affected by diet and exercise. You want this number to be high, unlike the other numbers in your profile. Keeping this number greater than40mg/dL for men and greater than 50 mg/dL for women is ideal. My HDL cholesterol is: _______________ .

• To assist patients with cardiac disease in maintaining good physical fitness or to determine the limits to safe exercise during cardiac rehabilitation • To detect any blockages in the blood vessels of the legs • To see how effective heart medication or surgery was on the body

TRIGLYCERIDES Triglycerides, a form of fat in the bloodstream, are an important piece of the lipid profile.Triglycerides are transported by LDL cholesterol and very low density lipoprotein (VLDL) cholesterol in the blood. Triglycerides serve as storage for energy. When triglyceride levels are high in the blood, they get deposited in fatty tissue.Triglycerides make up most of the fat in your body. A healthy diet and medication (if necessary) can help lower your triglycerides. Limiting your consumption of simple sugars may help. Keeping this number below 150mg/dL is ideal. My triglyceride number is: _______________ .

CARDIAC STRESS TEST Stress testing provides information about a patient’s heart function.The heart is monitored for its reaction to certain stressors. Most commonly, your heart will be tested while you use a bicycle or treadmill. Chemical stressors are also sometimes used. During the exercise stress test, your electrocardiogram (ECG or EKG), heart rate and blood pressure are monitored. Your doctor will determine your target and maximum heart rates and see how well your heart reacts to the stress.This will help determine your exercise regimen as you work to lose weight. It also will determine your ability to handle weight loss medications as well as indicate any other precautions you should take if your heart is not managing stress well.This is also an important screen for bariatric surgery. Stress testing is used in the following situations: • To detect exercise-related hypertension (higher than normal blood pressure) • To evaluate chest pain in a patient suspected of having coronary disease

ELECTROCARDIOGRAM The electrocardiogram is a noninvasive test used to detect unseen heart conditions by measuring the electrical activity of your heart. Your doctor might order an EKG before you start a weight loss program to ensure that your heart is healthy enough for new physical challenges. Carrying excess weight over time could cause your heart to become strained and enlarged. An EKG is performed by attaching leads to your body while you lie flat on a bed or table. Leads are attached to your arms and legs and to six positions on the front of your chest. A small amount of gel is applied to your skin, which allows the electrical impulses of the heart to be more easily transmitted to the EKG leads.The test takes about five minutes and is painless. An EKG can detect: • The underlying rate and rhythm of your heart • The orientation of your heart in your chest cavity • Evidence of increased thickness (hypertrophy) of your heart muscle • Evidence of damage to the various parts of your heart muscle • Evidence of acutely impaired blood flow to your heart muscle • Patterns of abnormal electric activity that may predispose you to abnormal cardiac rhythm disturbances

HOW CHOLESTEROL AFFECTS YOUR BLOOD VESSELS • Blood flows easily when blood vessels are clear. • Less blood flows when cholesterol builds up in the walls of the blood vessels. 25

APPENDIX A: W E I G H T L O S S P R O G R A M D E TA I L S

YOUR WEIGHT LOSS PROGRAM

EXERCISE GOALS

If you are following a diet, what are your nutrition goals? What products are you using? It is helpful for your health coach to know what your diet plan is so that he or she can support it. Write down your diet specifics in the space below.

List the goals of your exercise program:

Starting weight: _______________ .

Goal weight: _______________ . ACTIVITY

Diet method (check one): Calories

Points

Carbs

Other:

Weight loss treatment program:

Supplements/products:

Method of measuring success (check all that apply): Weight

Inches

Other:

Healthy eating goals:

NOTES

MINUTES PER WEEK

APPENDIX B: B M I C A L C U L AT O R

HOW TO CALCULATE YOUR BMI

NOTES

BMI = (weight in pounds x 703) (height in inches)2 Example: For a person who is 5’10” (70 inches) tall and weighs 195 pounds:

BMI = (195 x 703) = 27.98 (70)2 WHAT DOES YOUR BMI MEAN? Underweight Normal Overweight Obese

less than 18.5 18.5 – 24.9 25 – 29.9 30 or higher

You also can use the BMI calculator or refer to the Body Mass Table at www.nhlbisupport.com/bmi.

FOOD LOG D A I LY I N TA K E Making dietary changes can be difficult. Keeping a food log can help you see the big picture of what you are eating so that you can work toward a more balanced diet. Keep track of your food intake for each meal over the course of a couple weeks, then share the information with your health coach or doctor.This log can be useful in creating a new diet plan.

DATE: Breakfast

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Grains Vegetables Fruits Dairy Protein Beverages Other Morning snack Lunch Grains Vegetables Fruits Dairy Protein Beverages Other Afternoon snack Dinner Grains Vegetables Fruits Dairy Protein Beverages Other Evening snack Total calories/carbs for the day

NOTES

DATE: Breakfast

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

NOTES

DATE: Breakfast

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

NOTES

DATE: Breakfast

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

NOTES

DATE: Breakfast

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

NOTES

DATE: Breakfast

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

NOTES

DATE: Breakfast

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

NOTES

DATE: Breakfast

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

NOTES

DATE: Breakfast

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

NOTES

DATE: Breakfast

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

NOTES

DATE: Breakfast

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

NOTES

DATE: Breakfast

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

NOTES

DATE: Breakfast

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

NOTES

DATE: Breakfast

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

Food name

Amount

Est. calories/carbs

ACTIVITY LOG W E E K LY P R O G R E S S Use the chart below to keep track of how much time you spend exercising each day. Have your chart handy when you talk with your health coach or visit your doctor. Work with your provider to find ways to keep your routine varied and enjoyable.

Date

Flexibility (stretching)

Endurance (walking, biking)

Strengthening (weights)

Other activities

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

Total time

NOTES

Date

Flexibility (stretching)

Endurance (walking, biking)

Strengthening (weights)

Other activities

Total time

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

NOTES

Date

Flexibility (stretching)

Endurance (walking, biking)

Strengthening (weights)

Other activities

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

Total time

NOTES

Date

Flexibility (stretching)

Endurance (walking, biking)

Strengthening (weights)

Other activities

Total time

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

NOTES

Date

Flexibility (stretching)

Endurance (walking, biking)

Strengthening (weights)

Other activities

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

Total time

NOTES

Date

Flexibility (stretching)

Endurance (walking, biking)

Strengthening (weights)

Other activities

Total time

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

NOTES

Date

Flexibility (stretching)

Endurance (walking, biking)

Strengthening (weights)

Other activities

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

Total time

NOTES

Date

Flexibility (stretching)

Endurance (walking, biking)

Strengthening (weights)

Other activities

Total time

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

SUN.

MON.

TUES.

WED.

THUR.

FRI.

SAT.

Weekly total:

NOTES Write down any thoughts, reminders or questions you have for your healthcare team

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