Panel consisted of Dr Ehsan Assad,Dr Mehboob Ashraf,Dr Arshad Javaid Sh,
Dr Saleem A Rana.
| Weight reduction is important in many conditions and diseases.If it is dealt with properly and paid proper attention,success rate of patient’s compliance in my clinic is > 90 %.A separate consultation of ½ hour is required.Patient’s confidence is won over by properly educating him and giving him simple instructions. |
Some Definitions.
Obesity: Excess weight is > 20 % of desired weight.There is excessive fat.Body surface area is proportionately more increased than in overweight patients.BMR is slower than in normals.Physical activity has slowed down.Target of planned weight loss is to be 0.8 kg/Week.Slashing of calories in a big way is not advisable as this leads to rebound.
Overweight: Excess weight is < 20 % of desired weight.All other parameters mentioned above are nearer to the normals.BMR is normal.Target of planned weight loss will be 2 kgs/week. Here slashing of calories immediately is workable.Rebound is not a great problem
Glycaemic Index: Refers to the that quality of foods which indicates how soon calories will be available for body use.
Body Mass Index: ( Body weight in Kgs ) divided by (Square of Height in meters).It is a better indicator of excess weight and amount of fat.
Some General Prinicples.
q To loos one pound of weight, 2500 calories have to be removed from the present diet.
q Have a target of weight in your mind on first visit.It is better not to inform patient.Just monitor on each visist that weigt loss is as planned.
q Target one meal in one day.
q Lunch shall be the first target.Then snacks shall be targeted.
q Diet should never be oil free.
q Take proper drug history.Is he taking any medication which increases weight?Include that in your planning.Antidepressants,sleeping pills,antihistamines,contraceptives increase weight.
q When oil is restricted hair,nails and skin become dry.Give some emolient.Menstrual blood loss of ladies decreases.Do tell them.
Different Food Items and dialy Allowances.
Carbohydrates : These shall come from complex carbohydrate containing foods.Grains,vegetables,Potatoos,Banana,and fruits can be used.
Fats: Daily allowance is 3 teaspoons or 2 table spoons is the limit of daily fat intake.2/3rd should be from polysaturated types such as corn oil.One third should be from monopolysaturated oils such as olive oil.Best way is take one litre of corn oil (or other varieties) .Remove one third of this and replace it with Olive oil.
Proteins: Daily allowance is two ounces from animal sources.This can be fish,chicken or other poultery.1/2 leg piece is about one ounce.White of two egg whites and one glass of skimmed milk is also allowed.
Free Allowance: Subtract the calories mentioned above derived from fat and proteins from the total daily planned amount.Balance is known as free allowance.This should be filled from lentils.CHAPATI,Rice,bread are the usual sources.One fruit daily is also included.
Uric Acid Levels: A special word about uric acid levels.These may be raised.Be careful.If it is prolematic cut down on mutton,fish,chicken, and lentils.
Two types of exercises.
Cardios: This type burns calories for physical acitivity.Walking,Jogging,Cycling,Swimming,Tread mill and skipping over rope are the examples.
Physicals: These exercise utilize energy to build up different muscles.Weight lifting,body building are the examples.
Advice: 45 minutes of cardios and 15 minutes of physicals are advised to a patient who is loosing weight.
Measure what is the weight at present.Measure the height.Calculate how much BMI should be at this height and age.From here calculate how much weight is ideal.Now see how much weight has to be reduced.Is this patient obese? Or Overweight?This should give us idea how much weight we wish to remove in one week.( 0.8 kg or 2 kg/week).Multiply this 0.8 or 2 kg with 2500.This is the number of calories we wish to slash from the present diet in one week.How much has to be slashed in a day.First target lunch.One fourth of the total time planned for weight reduction,stick to lunch only.Then include snacks for slashing calories.
(Problem remained unsolved during interview:How much calories are contained in our day to day food items.We could not get chart. Please fill in this part.)