Antidepressants Blog

Hydrostatic Weighing TechniquesFrom a clinical perspective, the most accurate method of measuring body fat is through hydrostatic weighing techniques. This method measures the amount of water a person displaces when completely submerged. Because fat tissue has a lower density than muscle or bone tissue, a relatively accurate indication of actual body fat can be computed by comparing a person’s underwater and out-of-water weights. Although this method may be subject to errors, it is one of the most sophisticated techniques currently available.
Pinch and Skinfold MeasuresPerhaps the most commonly used method of determining body fat is the pinch test.Numerous studies have determined that the triceps area (located in the back of the upper arm) is one of the most reliable areas of the body for assessing the amount of fat in the subcutaneous (just under the surface) layer of the skin. In making this assessment, a person pinches a fold of skin just behind the triceps with the thumb and index finger. It is important to pinch only the fat layer and not the triceps muscle. After selecting a spot for measure, the person assesses the distance between the thumb and index finger. If the size of the pinch appears to be thicker than 1 inch, the person is generally considered over-fat.Another technique, the skinfold caliper test, resembles the pinch test but is much more accurate. In this procedure, a person pinches folds of skin at various points on the body with the thumb and index finger. This technique uses a specially calibrated instrument called a skinfold caliper to take a precise measurement of the fat layer. Besides the triceps area, the points most often used in these measurements are the biceps area (front of the arm), the subscapular area (upper back), and the iliac crest (hip). Once these data points are assessed, special formulas are employed to arrive at a combined prediction of total body fat.In the hands of trained technicians, the skinfold caliper test can be fairly accurate. If the person doing the test is inconsistent about the exact locations of the pinch or if there is difficulty in determining the difference between fat and muscle, the results may be inaccurate. In addition, the heavier a person is, the more prone this technique is to error. For obese people, difficulties in assessment are magnified because of problems in distinguishing between flaccid muscles and fat. Also, most currently available calipers do not expand far enough to obtain accurate measurements on the moderately obese (20 to 40 percent overweight) or the morbidly obese (more than 50 percent overweight). Additional errors in skinfold assessments may occur as a result of failure to account for certain age, sex, and ethnic differences in calibrations.
Girth and Circumference MeasuresAnother common method of body fat assessment is the use of girth and circumference measures. Diagnosticians use a measuring tape to take girth, or circumference, measurements at various body sites. These measurements are then converted into constants, and a formula is used to determine relative percentages of body fat. Although this technique is inexpensive, easy to use, and commonly performed, it is not as accurate as many of the other techniques listed here.
Soft-Tissue RoentgenogramA relatively new technique for determining body fat, the soft-tissue roentgenogram, involves injecting a radioactive substance into body and allowing this substance to penetrate muscle (lean) tissue so that distinctions between fat and lean tissue can be made by means of imaging.
Bioelectrical Impedance Analysis Another method of determining body fat levels, bioelectrical impedance analysis (BIA), involves sending a small electric current through the subject’s body. The amount of resistance to the current, along with the person’s age, sex, and other physical characteristics, is then fed into a computer that uses special formulas to determine the total amount of lean and fat tissue.
Total Body Electrical ConductivityOne of the newest (and most expensive) assessment techniques is total body electrical conductivity (TOBEC), which uses an electromagnetic force field to assess relative body fat. Although based on the same principle as impedance, this assessment requires much more elaborate, expensive equipment, and therefore is not practical for most people.Although all of these methods can be t they can also be inaccurate and even harmful unless the testers are skillful and well trained. Before agreeing to undergo any procedure, be sure you are aware of the expense, potential for accuracy, risks, and training of the tester.*7/277/5*

- Hypertension (High blood pressure)- Diabetes- Cardiovascular diseases- Cancer- Osteoarthritis- Gout- Depression- Respiratory Problems: Sleep apnea
HypertensionHigh blood pressure can lead to development of heart disease, kidney failure and stroke. Obese people are six times more prone to develop heart disease. Obese people generally have elevated blood lipids thus leading to atherosclerosis and cardiovascular problems.
Diabetes type IIObese people are ten times more likely to develop type II diabetes and obesity is the principal risk factor especially when it is central obesity (higher waist circumference) or (higher waist hip ratio).
Respiratory problemsObesity puts pressure on lungs thus reducing their size, chest wall is heavy and is difficult to lift, thus causing difficulty in breathing, sleep apnea is another disorder where subjects stop breathing in their sleep due to collapse of soft tissues in the throat. On long-term basis sleep apnea can cause hypertension, arrhythmia and sudden death.
Musculoskeletal problemsArthritis and low back pain are common. Joint replacements are also difficult to perform.
Gastroesophageal reflux disease (GERD)Increased stomach pressure results in high rate of reflux where acid from the stomach backs up into the oesophagus. Other problems include decreased or irregular menstrual cycle, infertility, ovarian cyst, etc. Obese women are also more prone to cancer of breast, uterus, cervix, ovaries or gall bladder.Psychological problems include negative image, shame, depression, rejection, etc. Studies have shown that each kg of weight loss is associated with 3- 4 months of prolonged survival; 10 kg weight loss is predicted to restore 35% of life expectancy; 10% of total body weight loss reduces HbAlC by 1.6%, reduces hypertension by 26%, reduces triglycerides, LDL (low density lipoprotein) and increases HDL (high density lipoprotein).
Weight ReductionMost recent WHO recommendation for dietary improvements and increased level of physical exercise provides the basis for the development of strategies to challenge rise in obesity. The more effective obesity therapies should prevent or delay the onset of chronic degenerative diseases like diabetes, hypertension and to maintain the weight loss.*2/356/5*

Summary of main points. Fat in food is a mixture of saturated, poly- and mono-unsaturated fatty adds, with different proportions in different foods.

• While saturated fats have the most detrimental effect on health, all fats and oils are currently thought to increase body fat.

• Reduction of fat should be the primary goal of any fat loss program, within a balanced diet.

• Client education should involve:

— assessment of dietary fat intake for obvious as well as hidden fats

— analysis of food choice and food preparation methods

— recommended food selection and preparation for dietary fat reduction

— information on how to read food labels and ingredient lists

— explanation of nutritional claims about fat in foods.

• Reducing fats in the diet is the single most important factor for fat loss.

The nutritional issues are intended to highlight the nutritional mediating component considered in the model of obesity (i.e. fat/energy intake).

As such, we will consider dietary fat and how to reduce it in detail in this chapter, then the alternative; increasing dietary carbohydrate and fibre. Reducing fat intake is regarded as an important part of a healthy eating pattern.

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The DSM-HI-R (Diagnostic and Statistical Manual of Mental Disorders) is more than just a psychiatric cookbook. No mere list of diagnostic criteria can describe the many ways a mental disorder affects people, while diagnosing by symptoms alone will not fully explain a condition. To enhance its usefulness, the manual describes some of the other features of anorexia nervosa.

For example, it notes the different ways weight loss can occur. One woman might rely on reduced food intake alone. Another might reduce intake but exercise excessively as well. Others use self-induced vomiting or laxatives or diuretics. The manual thus acknowledges that bulimia and anorexia may indeed coexist.

The compulsion to exercise is very common in anorexia. Even doctors a century ago recognized the symptom.

Many anorexics feel they have to run everywhere, that walking is just a missed opportunity to burn off more calories. Parents often tell me that their anorexic daughter “never stands still” or that she “always runs up the stairs” or that she “pedals her exercise bike until after midnight.”

Anorexics aren’t driven to exercise because they want to be physically fit. They simply want to burn off energy (and thus weight) in any way possible. Excessive exercise may also trigger some pleasurable changes in brain chemistry, producing effects such as the “runner’s high” that many joggers report. Thus anorexics may exercise to experience a neurochemical “reward.”

Besides exercise, other weight-loss methods include use of laxatives to stimulate bowel movements or diuretics to decrease water in the body. Anorexics frequently resort to such tricks to speed up the removal of food from the body.

The results can be disastrous. Many patients-some of whom use between thirty and a hundred laxative tablets a day-report cramps and abdominal pain. What’s more, the body, robbed of its ability to regulate elimination on its own, can become dependent on a laxative. I find that weaning patients from laxatives is one of the hardest tasks in treating eating disorders.

Laxatives and diuretics can produce severe dehydration and electrolyte imbalance. Electrolytes are chemicals such as sodium and potassium that help transmit electrical signals within the body. An insufficient supply of electrolytes puts tissues and organs, particularly the heart, at risk of failure. Patients who abuse laxatives and diuretics risk problems with their hearts and other organs, problems that in some cases lead to death. Ironically, laxatives don’t even help that much. A laxative abuser loses no more than 10 percent of available calories through this method, and most of the weight loss is merely “water weight” anyway, as I mentioned earlier.

Of course, the problem with starving yourself is that you’re always hungry. No matter how carefully you defend yourself against food, sooner or later you will have to eat something or die. Because the hunger can be overwhelming, eating even small amounts can trigger a binge.

For people with these disorders, eating anything, especially when it leads to a binge, represents loss of control. Vomiting restores control-at least until the next urge to eat comes along.

About half of all anorexics practice self-induced vomiting. I’ll have more to say about the physiological impact of vomiting in the discussion about bulimia in the next chapter.

By acknowledging these weight-loss practices, the DSM-III-R recognizes the differences between anorexics who attempt to starve themselves exclusively through reduced food intake (restricting anorexics) and those who reduce weight by extraordinary means (bulimic anorexics).

The manual goes on to describe some of the other common features of anorexia nervosa-for example, the “magic power” that food has over its victims.

Once I discovered that a patient named Debbie had stuffed whole packages of cookies, cheese, fruit, and candy into her underwear drawer in her hospital room. When I asked whether she was preparing for an eating binge, she replied, “Oh, no. I’m not going to eat that stuff. I just keep it there to show myself how much control I have over it. The more food I can lay my hands on, the greater the temptation to eat. And the more I can hold out and not eat, the stronger I feel.”

Like Debbie, many anorexics exhibit peculiar behavior connected to food. They imbue food with enormous, almost supernatural force. Some prepare elaborate meals for their families, but eat nothing themselves. Or they toy with the food on their plate, poking it around with their forks, and finally throwing the whole meal away.

Anorexics see their starvation not as a defect, but as something that makes them special. “Look at me,” they seem to say. “See how much control I have over my body.” Almost every one of my patients, at one time or another in the course of her illness, will feel something to the effect that “Not everyone can do this.”

Because they deny the problem, anorexics feel that therapy, or any attempt to intervene, constitutes a deadly threat, a plot to rob them of their “specialness.” Needless to say, such an attitude makes my job as their doctor much more difficult..

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Marlene Dropp was so out of shape that she couldn’t even walk around the block. Seven years later, at age 51, she walked a marathon.

A veteran dieter, Marlene had struggled with her weight all of her life. Sometimes she’d lose a few pounds, but they would always come back.

Then one day, as she looked in the mirror, Marlene realized how much she disliked the image that she saw. “I was a frumpy 200-pound matron,” says the mother of four. “My dress had stripes, a frilly collar, and fluffy sleeves, like something my mother would have worn. I couldn’t fit into more fashionable clothes. That’s when I started feeling like a blimp.”

That’s also when she decided to do something about it. Because of her weight, Marlene had always felt too self-conscious exercise in public. But this time, she was determined.

So one beautiful morning in 1989, with her husband at home to watch the kids, Marlene decided on impulse to take a walk around her Hibbing, Minnesota, neighborhood. To her surprise, she arrived home energized. “That’s when I decided to make walking part of my daily routine,” she says.

Immediately, Marlene set a goal for herself. She wanted to advance from walking around the block to walking 5 miles a day. Her neighborhood is laid out in half-mile circles, so she just kept adding circles to her route. Within 2 months, she achieved her goal. So she set her sights on a new objective: She wanted to cover a mile in 13 minutes. A year later, she could do it with ease.

Within 2 years of starting her exercise program and making some changes in her eating habits—primarily avoiding fats and sweets—Marlene lost 50 pounds. As she got faster, she began entering racewalking competitions—milers, 2-milers, and 5Ks. In 1996, she celebrated her 51st birthday by entering a marathon. She completed the 26-mile course in less than 6 hours.

Even though she continues to compete, Marlene credits those daily walks around the block with jump-starting her weight-loss efforts. Today, at age 55, she maintains a healthy weight of 150 pounds.

WINNING ACTION

Follow the 10 percent rule. Just as Rome wasn’t built in a day, neither is an exercise program. Whatever activity you choose—walking, running, cycling, swimming, or something else—start slow and easy. Gradually build to

your desired duration and intensity A good rule of thumb is to increase your level of activity by 10 percent a week. So if you’re able to walk for 10 minutes your first time out, stay at that level for 1 week. Then add 1 minute—10 percent—to your workout the next week. Continue until you’re walking for 30 minutes a day.

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