Weight Management and Body Image Information Sheet www.nhs.uk
Obesity Obesity is a term used to describe somebody who is very overweight, with a lot of body fat. It's a common problem, estimated to affect around one in every four adults and around one in every five children aged 10 to 11 in the UK. Defining obesity There are many ways in which a person's health in relation to their weight can be classified, but the most widely used method is body mass index (BMI). BMI is a measure of whether you're a healthy weight for your height. For most adults:
a BMI of 25 to 29.9 means you are considered overweight
a BMI of 30 to 39.9 means you are considered obese
a BMI of 40 or above means you are considered severely obese
BMI is not used to definitively diagnose obesity – as people who are very muscular sometimes have a high BMI, without excess fat – but for most people, it can be a useful indication of whether they may be overweight. A better measure of excess fat is waist circumference, and can be used as an additional measure in people who are overweight (with a BMI of 25 to 29.9) or moderately obese (with a BMI of 30 to 34.9). Generally, men with a waist circumference of 94cm or more and women with a waist circumference of 80cm or more are more likely to develop obesity-related health problems. Risks of obesity Taking steps to tackle obesity is important because, in addition to causing obvious physical changes, it can lead to a number of serious and potentially life-threatening conditions, such as:
type 2 diabetes
coronary heart disease some types of cancer, such as breast cancer and bowel cancer stroke
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Obesity can also affect your quality of life and lead to psychological problems, such as low selfesteem or depression.
Causes of obesity Obesity is generally caused by consuming more calories – particularly those in fatty and sugary foods – than you burn off through physical activity. The excess energy is then stored by the body as fat. Obesity is an increasingly common problem, because many modern lifestyles often promote eating excessive amounts of cheap, high-calorie food and spending a lot of time sitting at desks, on sofas or in cars. There are also some underlying health conditions that can occasionally contribute to weight gain, such as an underactive thyroid gland (hypothyroidism), although conditions such as this don’t usually cause weight problems if they are effectively controlled with medication. Read more about the causes of obesity. Treating obesity The best way to treat obesity is to eat a healthy, reduced-calorie diet and to exercise regularly. To do this you should:
eat a balanced, calorie-controlled diet as recommended by your GP or weight loss management health professional (such as a dietitian)
join a local weight loss group
take up activities such as fast walking, jogging, swimming or tennis for 150-300 minutes a week
eat slowly and avoid situations where you know you could be tempted to overeat
You may also benefit from psychological support from a trained healthcare professional, to help change the way you think about food and eating. If lifestyle changes alone don't help you lose weight, a medication called orlistat may be recommended. If taken correctly, this medication works by reducing the amount of the fat you absorb during digestion. Your GP will know whether orlistat is suitable for you. In rare cases, weight loss surgery may be recommended.
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Emaciation By Stefanie Lein http://www.eatingdisordersonline.com/medical/emaciation.php
Emaciation is a severe form of malnutrition in which most of the subcutaneous fat and muscle on a person has wasted away. Emaciated people are extremely thin and their bones are often visible beneath their skin, giving them a skeletal appearance. Although emaciation may be caused by a variety of medical conditions, in the context of eating disorders, it is a result of starvation as occurs in Anorexia Nervosa.
Early Stages of Emaciation In the early stages of emaciation a person may become irritable and engage in impulsive behavior as their body essentially eats itself, using muscle and fat tissue to maintain caloric requirements to stay alive. As the condition progresses, exhaustion, lethargy, depression and apathy set in. People who are emaciated are generally very passive in nature because they lack vital energy. Solving problems and reasoning becomes more difficult as mental function decreases.
Symptoms of Emaciation In addition, people who are emaciated not only lack essential nutrients, but tend to become dehydrated as well because both their hunger and thirst are blunted. This can lead to organ damage and result in a variety of variety of negative outcomes. Dry skin, thin skin, rashes, diarrhea, and muscle atrophy are some of the more mild symptoms. Anemia, pellagra, scurvy, edema, pain, heart failure, pleurisy, lymph system dysfunction, and kidney failure may also result. Metabolic and electrolyte disturbances are also possible such as hyponatremia (low blood sodium) and hypokalemia (low blood potassium). Such electrolyte imabalances and heart failure can be life-threatening.
Recovery from Emaciation Recovery from emaciation is possible but requires a very gradual introduction of nutrients and calories and may also involve psychological intervention and treatment. Generally for people who have been deprived of food for a long period of time, thin liquids and salty broth are first introduced. Over time more substantial liquids like milk are given. Then emaciated individual will be given up to eight small meals consisting of protein and nutrient rich foods daily two hours apart and much time will be spent sleeping, resting, and relaxing in order to increase body mass.
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Malnourishment (Malnutrition) www.nhs.uk Malnutrition is a serious condition that occurs when a person’s diet doesn't contain the right amount of nutrients. Malnutrition means "poor nutrition" and can refer to:
undernutrition – when you don't get enough nutrients
overnutrition – when you get more nutrients than you need
This topic focuses on undernutrition. Who's affected by malnutrition? Malnutrition is a common health problem. There are an estimated 3 million malnourished people in the UK at any time, with many more at risk of becoming malnourished. Around one in three people admitted to hospital or care homes in the UK are found to be malnourished or at risk of malnourishment. Malnutrition is caused by having an inadequate diet or a problem absorbing nutrients from food. There are many reasons why these might happen, including having reduced mobility, a long-term health condition, or a low income. Signs of malnutrition The most common symptom of undernutrition is unintentional weight loss (losing 5-10% or more of your body weight over three to six months). Other signs can include:
weak muscles
feeling tired all the time
low mood
an increase in illnesses or infections 4
The main sign of overnutrition is being overweight or obese. However, people with undernutrition can also be overweight if they eat a diet high in energy (calories), but low in other nutrients. Signs of malnutrition in children can include failure to grow at the expected rate and changes in behaviour, such as appearing unusually irritable, sluggish or anxious. Your child’s weight and physical development should be regularly assessed by your GP when your child is young. Speak to your GP or health visitor if you have any concerns about your child’s health or development.
When to see your GP See your GP if your body mass index (BMI) is lower than 18.5 or you notice the above symptoms. BMI is a measure of whether you're a healthy weight for your height. You can use the BMI healthy weight calculator to work out your BMI. You should visit your GP if you believe you or someone you care for is at risk of malnutrition. They can check for signs of malnourishment and any conditions that may cause malnutrition. Treating malnutrition Depending on what's caused a person to become malnourished and how severe it is, treatment may be carried out at home or in hospital. Dietary changes are the main treatment for malnutrition. If you're undernourished, you may need to increase the nutritional content of your food, with or without taking nutritional supplements. If you're unable to eat enough to meet your nutritional needs you may need:
a feeding tube to provide nutrients directly into your digestive system
a drip to provide nutrients and fluids directly into a vein
Preventing malnutrition The best way to prevent malnutrition is to eat a healthy, balanced diet. A healthy, balanced diet is vital for maintaining health and fitness. To stay healthy, you need to eat a variety of foods from the four main food groups including:
plenty of fruit and vegetables plenty of bread, rice, potatoes, pasta and other starchy foods some milk and dairy foods some meat, fish, eggs, beans and other non dairy sources of protein 5
The eatwell plate shows the different types of food you need to eat (and in what proportions) to maintain a well-balanced and healthy diet.
What is Body Image? https://www.nationaleatingdisorders.org/what-bodyimage Body image is how you see yourself when you look in the mirror or when you picture yourself in your mind. It encompasses:
What you believe about your own appearance (including your memories, assumptions, and generalizations).
How you feel about your body, including your height, shape, and weight.
How you sense and control your body as you move. How you feel in your body, not just about your body.
Negative Body Image
A distorted perception of your shape--you perceive parts of your body unlike they really are.
You are convinced that only other people are attractive and that your body size or shape is a sign of personal failure. 6
You feel ashamed, self-conscious, and anxious about your body.
You feel uncomfortable and awkward in your body.
Positive Body Image
A clear, true perception of your shape--you see the various parts of your body as they really are.
You celebrate and appreciate your natural body shape and you understand that a person’s physical appearance says very little about their character and value as a person.
You feel proud and accepting of your unique body and refuse to spend an unreasonable amount of time worrying about food, weight, and calories.
You feel comfortable and confident in your body.
Body Image and Eating Disorders People with negative body image have a greater likelihood of developing an eating disorder and are more likely to suffer from feelings of depression, isolation, low self-esteem, and obsessions with weight loss. We all may have our days when we feel awkward or uncomfortable in our bodies, but the key to developing positive body image is to recognize and respect our natural shape and learn to overpower those negative thoughts and feelings with positive, affirming, and accepting ones
Weight loss: Strategies for success Make your weightloss goals a reality. Follow these proven strategies. By Mayo Clinic Staff
Hundreds of fad diets, weightloss programs and outright scams promise quick and easy weight loss. However, the foundation of successful weight loss remains a healthy, caloriecontrolled diet combined with exercise. For successful, longterm weight loss, you must make permanent changes in your lifestyle and health habits. How do you make those permanent changes? Consider following these six strategies for weight loss success. 7
1. Make a commitment Permanent weight loss takes time and effort — and a lifelong commitment. Make sure that you're ready to make permanent changes and that you do so for the right reasons. To stay committed to your weight loss, you need to be focused. It takes a lot of mental and physical energy to change your habits. So as you're planning new weightlossrelated lifestyle changes, make a plan to address other stresses in your life first, such as financial problems or relationship conflicts. While these stresses may never go away completely, managing them better should improve your ability to focus on achieving a healthier lifestyle. Then, once you're ready to launch your weightloss plan, set a start date and then — start.
2. Find your inner motivation No one else can make you lose weight. You must undertake diet and exercise changes to please yourself. What's going to give you the burning drive to stick to your weightloss plan? Make a list of what's important to you to help stay motivated and focused, whether it's an upcoming beach vacation or better overall health. Then find a way to make sure that you can call on your motivational factors during moments of temptation. Perhaps you want to post an encouraging note to yourself on the pantry door, for instance. While you have to take responsibility for your own behavior for successful weight loss, it helps to have support — of the right kind. Pick people to support you who will encourage you in positive ways, without shame, embarrassment or sabotage. Ideally, find people who will listen to your concerns and feelings, spend time exercising with you or creating healthy menus, and who will share the priority you've placed on developing a healthier lifestyle. Your support group can also offer accountability, which can be a strong motivation to stick to your weightloss goals. If you prefer to keep your weightloss plans private, be accountable to yourself by having regular weighins and recording your diet and exercise progress in a journal.
3. Set realistic goals It may seem obvious to set realistic weightloss goals. But do you really know what's realistic? Over the long term, it's best to aim for losing 1 to 2 pounds (0.5 to 1 kilogram) a week. Generally to lose 1 to 2 pounds a week, you need to burn 500 to 1,000 calories more than you consume each day, through a lower calorie diet and regular exercise. When you're setting goals, think about both process and outcome goals. "Exercise every day" is an example of a process goal. "Lose 30 pounds" is an example of an outcome goal. It isn't essential that you have an outcome goal, but you should set process goals because changing your your habits is a key to weight loss.
4. Enjoy healthier foods 8
Adopting a new eating style that promotes weight loss must include lowering your total calorie intake. But decreasing calories need not mean giving up taste, satisfaction or even ease of meal preparation. One way you can lower your calorie intake is by eating more plantbased foods — fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without giving up taste or nutrition. In particular, get your weight loss started by eating a healthy breakfast every day; eating at least four servings of vegetables and three servings of fruits daily; eating whole instead of refined grains; and using healthy fats, such as olive oil, vegetable oils and nut butters. In addition, cut back on sugar, choose lowfat dairy products and keep meat consumption to a 3ounce portion (about the size of a deck of cards).
5. Get active, stay active While you can lose weight without exercise, exercise plus calorie restriction can help give you the weightloss edge. Exercise can help burn off the excess calories you can't cut through diet alone. Exercise also offers numerous health benefits, including boosting your mood, strengthening your cardiovascular system and reducing your blood pressure. Exercise can also help in maintaining weight loss. Studies show that people who maintain their weight loss over the long term get regular physical activity. How many calories you burn depends on the frequency, duration and intensity of your activities. One of the best ways to lose body fat is through steady aerobic exercise — such as brisk walking — for at least 30 minutes most days of the week. Any extra movement helps burn calories, though. Think about ways you can increase your physical activity throughout the day if you can't fit in formal exercise on a given day. For example, make several trips up and down stairs instead of using the elevator, or park at the far end of the lot when shopping.
6. Change your perspective It's not enough to eat healthy foods and exercise for only a few weeks or even months if you want longterm, successful weight loss. These habits must become a way of life. Lifestyle changes start with taking an honest look at your eating patterns and daily routine. After assessing your personal challenges to weight loss, try working out a strategy to gradually change habits and attitudes that have sabotaged your past efforts. And you have to move beyond simply recognizing your challenges — you have to plan for how you'll deal with them if you're going to succeed in losing weight once and for all.
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You likely will have an occasional setback. But instead of giving up entirely after a setback, simply start fresh the next day. Remember that you're planning to change your life. It won't happen all at once. Stick to your healthy lifestyle and the results will be worth it
Ten weight loss myths www.nhs.uk
FACT: 'Crash diets are unlikely to result in longterm weight loss. In fact, they can sometimes lead to longer term weight gain.
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'The main problem is that this type of diet is too hard to maintain. Your body will be low on energy, causing you to crave highfat and highsugar foods. 'When you finally give in and eat those foods, you will often eat more calories than you need, causing weight gain. Learn more about a healthy diet in the NHS' eight tips for healthy eating.'
FACT: 'Not true. Successful weight loss involves making small changes that you can stick to for a long time. That means building regular physical activity into your daily routine. 'Adults between 19 and 64 should get at least 150 minutes of physical activity – such as fast walking or cycling – every week, and those who are overweight are likely to need more than this to lose weight. 'To lose weight, you need to burn more calories than you consume. This can be achieved by eating less, moving more or, best of all, a combination of both.'
FACT: 'Slimming pills alone will not help you keep the weight off long term. They should only be used when prescribed by a doctor.'
FACT: 'Healthy foods are not necessarily more expensive than their unhealthy alternatives.
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'You'll typically pay more for a highfat, highsalt ready meal than you would if you had bought fresh ingredients and made the meal yourself.'
FACT: 'Foods labelled 'low fat' have to meet legal criteria to use that label. Labels such as 'reduced fat' do not have to meet the same criteria and can be misleading. 'A reducedfat snack should contain less fat than the fullfat version, but that doesn't automatically make it a healthy choice: it could still contain a lot more fat than, say, a portion of fruit. 'Lowfat foods also sometimes contain high levels of sugar.'
FACT: 'Margarine and butter contain different types of fat. Margarine is usually lower in saturated fat than butter. But it's more likely to contain hydrogenated fats. 'Hydrogenated fats, also called trans fats, may be more harmful to health than saturated fats. To lose weight, and for a healthy heart, reduce the amount of saturated and hydrogenated fats you eat. 'If oil in margarine has been hydrogenated, this has to be listed on the ingredient listing on packaging, so check labels carefully.'
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FACT: 'Eaten in the right quantities, carbohydrates will not cause weight gain. A 2003 study published in the New England Journal of Medicine concluded that dieters on the bestknown lowcarb diet, the Atkins diet, tended to lose weight not because they ate fewer carbohydrates, but simply because they ate less overall. 'Eat whole grain and wholemeal carbohydrates such as brown rice and wholemeal bread, and don't fry starchy foods when trying to lose weight.'
FACT: 'Snacking isn't the problem when trying to lose weight: it's the type of snack. Many people need a snack inbetween meals to maintain energy levels, especially if they have an active lifestyle. 'Choose fruit or vegetables instead of crisps, chocolate and other snacks that are high in sugar or saturated fat.'
FACT: 'Water does not cause you to lose weight, but it does keep you hydrated and might help you snack less. Water is essential for good health and wellbeing. 'Sometimes thirst can be mistaken for hunger – if you're thirsty you may snack more. The Department of Health recommends that we should drink about 1.2 litres of fluid every day.'
FACT: 'Skipping meals is not a good idea. To lose weight and keep it off, you have to reduce the amount of calories you consume or increase the calories you burn through exercise.
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'But skipping meals altogether can result in tiredness and poor nutrition. You will also be more likely to snack on highfat and highsugar foods, which could result in weight gain.
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