CRE - CREATIVE LEARNING EXERCISE

CRE 61: OGR - OBESITY GENTLY RESOLVED … MIND & BODY REFRAMED!

DRAFT 25 – JANUARY 2014 – EXTENSIVE USA TESTING

IT’S SEEMS IMPOSSIBLE … SO LET’S DO IT ANYWAY!

NOTE: THE TEXT IS DELIBERATELY REPETITIVE TO FACILITATE LEARNING RETENTION

Copyright: RGAB23/2014 drbobboland@hotmail.comThree videos and two audios freely available on: www.crelearning.com

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DRAFT 23 – SEPTEMBER 2014 – EXTENSIVE USA TESTING

Section Page No.

1. INTRODUCTION 32. DANGERS 4

3. CAUSES 54. MEDITATE FOR SELF CONTROL 65. CONTROL HELGA - FREUD 66. LOVE FOOD 77. FEEL GOOD NOW - WITHOUT 88. CONCLUSIONS 99. REINFORCEMENT 10Exhibits:

A Meditation 12 B HELGA – FREUD NEGATIVE 14

C Food 16 D FGN – Without eating !!! 18 E Wikipedia & References 23

INSTRUCTIONS:

1. STUDY THE BASIC TEXT 1-92. STUDY THE EXHIBITS A - D3. PLAY AUDIOS WITH THE TEXT4. PRACTICE AND REINFORCE THE LEARNING WITH THREE VIDEOS!

This CRE/OGR is based on many research and published sources including the most inspiring work of Nicole Kellerman of The US Superior Weight Loss School (www.nicholekellerman.com).

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1. INTRODUCTION

First get rid of your illusions by reading the ¨NHS 10 Weight Loss Myths¨ which you will find on the last page of Exhibit E. Ready? Now recognize that in 2014, obesity is a leading preventable cause of worldwide death for both children and adults. Is it the most serious public health problem of the 21st century? Obesity is still a symbol of wealth and fertility, in some parts of the world (Wikipedia Exhibit E).

Obesity is a major health risk for Alzheimer – see the Harvard Medical School Report in Exhibit E. It is epidemic in both developed and developing countries. In the USA with such a powerful food industry, obesity is about 50%. It may add about 30% to health care costs, and it is much more dangerous to the world health population than cigarettes or drugs.

Perhaps obesity of a parent is unconscious ¨child abuse¨ ? No never!! Well, perhaps acceptance of obesity communicates an unhealthy lifestyle values to the children that we love? Not verbal communication, but through our powerful ¨body language”? Children follow so many parent values. Look around in other families … in 2014 obesity is epidemic!

Can we now take this OGR (Obesity Gently Resolved) opportunity to control our weight, and avoid both preventable sickness, abuse and disability? The key to success may be our ability to meditate, relax and laugh, so that our mind and body can be reframed. Perhaps our success can communicate hope to others, both children and adults?

Why bother? Why do it? At this time, we don’t care about diabetes, cardiac arrest or cancer. Well perhaps we do? Why not feel slim, active and energetic … and humorous? Not just for ourselves … but for someone else … for family or children or others who care about us. Doing it for others, motivates our success. The impossible becomes possible!

Obesity is often measured by BMI: weight kg/height cm² = normal 19 - 25

TABLEBelow 19 underweight19 - 25 normal range26 – 30 overweightOver 30 obese

But obesity can be more simply measured as: waist cm/height cm = normal .35 - .50. It only takes a minute. Do it now and record your score … and a target.

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TABLEBelow .35   underweight.35 - .50 normal range.51 - .58   overweightOver .58 obese

There are slightly different standards men/women.Are we ready to begin? OGR involves four steps:

a. Learn to meditate, relax and laughb. Control HELGA – Freud negative reactionc. Love our food.d. FGN - Feel good now – without eating!!!

We control our weight NOT for ourselves … but for our loved ones. If we are parents we control our ¨body language¨ to our children.

We need to recognize that so many solutions to obesity problems have only limited success. Diet systems work well for three months and then may fade away. Highly expensive complex surgery works well for a year and then so often fades away.

Hence our need for OGR without medication or surgery, which can achieve mind and body reframing, for a lifetime! Perhaps mind and body reframing, is also a powerful reinforcement of complex health care for chronic disease e.g. arthritis, depression, diabetes etc.?

Diet information is helpful but the key obesity issue is not information but motivation … long term lifetime motivation!! (Wikipedia, Spiegel & Proust in Exhibit E - later).

2. DANGERS OF OBESITY

Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis etc. etc. etc.!

So let us gently achieve a healthy lifestyle with fun now! Sometimes, we may fail a bit, but using our four steps well, we can soon recover control and achieve success!

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So we adopt OGR to control our weight NOT for ourselves … but for all the adults and children we come in contact with ….with our body language we can give them a good example to follow.

3. CAUSES OF OBESITYObesity is most commonly caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications or psychiatric illness-

Evidence to support the view that some obese people eat little yet gain weight due to a slow metabolism is limited; on average obese people have a greater energy expenditure than their thin counterparts due to the energy required to maintain an increased body mass. Carrying around 150 kg is not the best exercise for our mind and body.

But what causes overweight? Can we blame our parents? It must be both psychological and physical. Perhaps conscious and sub-conscious stress, stimulates our neuro-transmitters (Dopamine and Serotonin) and our hormones (Insulin). And all that gives us an overwhelming desire to eat as an escape. So we need an alternative!

We need to recognize real and pseudo hunger and thirst and to act accordingly. We must learn how ¨pseudo¨ hunger is induced by: stress, depression, thirst, exhaustion etc. We must identify ¨real¨ hunger and respond accordingly with food. Quite a challenge!

So for efficient and effective weight control, we need both conscious and sub-conscious care, humour, exercise and a healthy diet with enough fruit, vegetables, vitamins and oils etc. and reduced energy-dense food and drinks, high in fat and sugars. We need to be efficient (doing things right) and effective (doing the right things). Which is more important? You decide.

The thing is clear. The influence of obese parents on their children is so powerful. They don’t mean it, but is this unconscious child abuse? It Is all communicated not by words, but by body language? Are we doing the same harm to other children? Surely not … or perhaps we are?

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So perhaps we need to control our weight with OGR, not just for ourselves … but for others … ? Well here are the four steps: meditate, HELGA, food and FGN.

Diet information is helpful (Wikipedia Exhibit E), but the key obesity issue is not information but motivation … long term lifetime motivation!!

4. MEDITATE FOR SELF CONTROL

Step 1. – meditate and achieve control of mind and body.

To change in mind and body, we must be able to relax, laugh and feel free. Meditation can help us.

Sometimes we may feel a bit too stressed or lacking in confidence to relax and laugh. But laughter can give us strength to resolve impossible problems. So learning a simple meditation relaxation exercise can help us.

Relaxation helps us to laugh at the world and at ourselves, and gives us the strength to motivate our learning.

Relaxation so gently helps us to reframe (change) both mind and body. We begin to change those old old negatives (¨It’ impossible! I just can’t do it!! I tried before!! It did not last. I feel helpless. I am helpless!!! etc. etc.etc. ¨) … into new new positives (¨It may seem impossible … so let’s do it anyway!!!¨).

With meditation we take mind and body control. At first it takes about five minutes, but with practice, we can do it in one minute. (Study later Exhibit A).

Control our weight NOT for ourselves … but for others we care for and who care for us.

Diet information is helpful, but the key obesity issue is not information but motivation … long term lifetime motivation!! (Wikipedia, Spiegel & Proust in Exhibit E - later).

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5. CONTROL HELGA – FREUD NEGATIVE REACTION

Step 2. HELGA!

Deep inside, we all have a HELGA! A Freud negative reaction! A sub-conscious self-saboteur, who gives us negative reactions to our new ideas and problems. Perhaps she works for the greatly publicized food industry, selling energy-dense food and drinks, which are high in fat and sugars? She keeps telling us: ¨It’s impossible! We tried it before. We just can’t do it!¨

Our HELGA’s Freud negative reaction, comes from our own sub-conscious spirit which appears without warning to discourage us over and over, with lack of real confidence.

For OGR we must find a way to control HELGA and tell her to shut up, because! we don’t need her negative advice. We are in control! (Study later in Exhibit B).

We can control our weight NOT for ourselves … but for children and others.

6. LOVE AND RESPECT OUR FOOD

Step 3 Food!

We need some new habits. Study the food. Eat slowly and enjoy it. Remember what we taste. Try new things. Eliminate distractions while eating (reading, computer, portable, TV etc.). Get into the new habit of slow lovely eating in which we ENJOY every bit of it.

P.S. Bonus: we can laugh and give ourselves a glass of French wine … or a local alternative with the meal … if it helps us to change … OK?

We can eat out in places where they serve us small not huge portions, of increased fiber with fruit and vegetables, and reduced energy-dense food and drinks, with high in fat and sugars. We all know what to eat … and what NOT to eat!!!

We must release ourselves from the duty to ¨FINISH UP the whole plate¨ (It came from our Mother all those years ago, but is not needed any more!!!).

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We can at last be free … to leave it for Nature to consume. And with self-service we can take ONLY as much as we need. A new way of eating well and enjoying every bit. (Study later in Exhibit C).

Control our weight NOT for ourselves … but for others.

7. FGN – FEEL GOOD NOW … WITHOUT EATING!!!

Step 4 FGN

With OGR we need to plan FGN – Feel Good Now - without eating!! So often when we don’t FGN … we eat!!

So now with OGR, is the time to find new ways to FGN and be in food control. Say it now please … FGN – without eating!! … five times … !! Well done. Time to change.

The FGN concept was developed by Nicole Kellerman in The Superior Weight Loss School!

Now with OGR, we deliberately and instinctively, find other joys in life … without having to eat! We diagnose ¨pseudo hunger¨ and we don’t feed it. We recognize thirst and hunger separately and we don’t mix them up. We use 30 new alternatives to FGN without eating?

In the first trial with OGR, we use three alternatives each day in the next 28 days. (Study later in Exhibit D).

So we control our weight NOT for ourselves … but for our body language communication … and it’s powerful negative or positive effect … on the health of others.

8. CONCLUSIONS

That completes the structure of our OGR - Obesity Gently Resolved!. The practical OGR routines are explained in the Exhibits A – D which we study next.

What to conclude from this brief OGR introduction:

1. OGR can give us the power to achieve mind and body reframed. Let’s practice it for

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the first 28 days, to see how inspires us.

2. Today, let’s measure our waist and height. Let’s take a photograph now and at the end of 28 days, to record progress.

3. Adopt a brave new powerful routine. For just two minutes, each morning and night, we communicate with our mind and body in a very special way. Be brave. We look at

ourselves naked in the mirror. Move the body. We close our eyes and imagine what we want to look like. This communicates deeply into the subconscious mind, and helps to OGR work for us!! Take photo on day 1 and day 28!

4. For the 28 days of OGR, we practice the four steps regularly with the two audios. No diet/exercise restrictions needed. We act instinctively. And no more ¨finishing up¨ anything on the plate!! We leave it uneaten to Nature!!

5. We use the audios (on www.crelearning.com) with active mind and body (moving all the time) to reinforce our learning.

6. We meditate well to reinforce the practice of completing our four step program many times.

7. We put up ¨Reminder Sheets¨ around the house to reinforce us.

8. We keep a diary of progress and very personal feelings. We study the results at the end of 28 days.

9. We help someone else with our experience to achieve what they want.

10. We make a long term plan for the future. So please send us your new ideas which may help others.

11. When we feel really comfortable with OGR, we play the REINFORCEMENT videos described below. Thus we create a new low weight identity for ourselves! (Wikipedia, Spiegel & Proust in Exhibit E - later).

12. We control our weight NOT for ourselves … but for others … and we plan for reinforcement (below).

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10. REINFORCEMENT

a. When we feel confident with the four steps of OGR, we reinforce our learning with three inspiring videos.

b. Dr Phillips - Healing http://www.youtube.com/watch?v=8ZtsNoYDxrc&feature=player_embedded )

c. Nicole Kellman of the Superior Weight Loss School. Free trial (www.nicholekellerman.com) one inspiring fun video. Quality -Inspiring with enthusiasm!!! We can do it!

http://successfulweightlossschool.com/success-kit-secret-1/

d. Mind Body Interactions - Professor David Spiegel of Stanford University Medical School WONDERFUL VIDEO! THIS IS THEV KEY TO CRE!!!http://www.youtube.com/watch?v=PlFaIxTv1_w

Remember: Diet information is helpful (Wikipedia Exhibit E), but the key obesity issue is not information but motivation … instinctive lifetime motivation!!

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OVERALL

1. NOW WE CAN BEGIN TO PRACTICE OUR OGR EFFICIENTLY AND EFFECTIVELY … WE CAN FEEL FREE … FREE TO EAT WHATEVER WE WANT AND WHENEVER WANT TO … AS WE INSTINCTIVELY CONTROL OUR WEIGHT … NOT FOR OURSELVES … BUT FOR OTHERS …

2. FIRST WE STUDY EXHIBITS A- D

3. THEN WE USE THE AUDIOS AVAILABLE FROM (WWW.CRELEARNING.COM) AND THE VIDEOS (ON YOUTUBE).

4. TRIAL OF 28 DAYS … ON WE GO TOGETHER …

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EXHIBITS A – E

EXHIBIT A: MEDITATE FOR SELF CONTROL - THE KEY!!!

Step 1. Meditation

Now again get rid of your illusions by reading the ¨NHS 10 Weight Loss Myths¨ which you will find on the last page of Exhibit E. Ready? The mind builds and controls the body. Our body language reveals our personal values to our children and to others. Meditation with relaxation and laughter give us the power to change.

Sometimes we feel a bit too stressed or lacking in confidence to relax and laugh. But laughter will gives us strength to resolve impossible problems. So learning a simple meditation relaxation exercise can help us. It can give us strength and motivate new learning.

It can help us to reframe (change) both mind and body. Then we can learn to change those old old negatives into positives. It may seem impossible … but let’s do it anyway!

Meditation at first may takes about five minutes, but with practice, we can do it in one minute.

1. Sit down and relax the whole mind and body, as you gently count to three. At one, look up toward your eyebrows; at two, close your eyelids and take a deep breath in; and at three, breath out, and let your eyes relax, and let your body float upward.

2. As you feel yourself floating, permit one hand to float up just a little. It becomes your signal to enter a state of meditation in which you concentrate on the learning and achieving and what it means to you.

3. Begin slowly and mentally ... to count down from 10 to 0 … saying … deeper… deeper … 10 9 8 deeper 7 6 5 deeper … 4 3 2 deeper 1… 0

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4. Imagine a beautiful white light ... coming from above your head ... cleaning your brain and every part of you ... as it passes through your whole mind and body ... and out of your toes.

5. Imagine a beautiful soothing golden fluid ... coming in from your toes ... soothing and healing every part of your mind and body ... right up to the top of your head... you now relax …soothing and healing your brain…

6. Then RELAX … and repeat to yourself three times …I am going to make Obesity Gently Resolved … work well for me with the four steps … meditation, HELGA, Food and FGN – without eating!! Repeat one more time and relax deeply …

7. Tell yourself that you are going to do the impossible … and to laugh at your worries. Think about it deeply to find strengths within yourself that you did not know were there. Take your time …

8. Then when you are ready, bring yourself back out of this concentration, feeling well and very positive, by counting backwards this way.

9. Three, get ready. Two, with your eyelids closed, roll up your eyes (and do it now). And one let your eyelids open slowly.

10.Then, when your eyes are back in focus, slowly make a fist with the hand that is floating a little, open your fist slowly, and your usual sensation and control returns, with a happy feeling of floating.

By practicing the meditation every four hours for a day, you can learn to do it in just one minute … to float into this state of buoyant repose, in which you add extra-receptivity to re-imprint the critical learning for OGR, and give yourself confidence to laugh, deep in your mind.We practice meditation regularly and it becomes so easy. We achieve a control which leads to gentle positive reframing of mind and body for a successful OGR! On we go together…

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EXHIBIT B: CONTROL HELGA – FREUD NEGATIVE REACTION!

Step 2. HELGA!

Deep inside, we all have a HELGA! A Freud negative reaction! Find yours now … She is a self-saboteur! Perhaps working for the greatly publicized food industry!!! She tells us: It’s impossible! We tried before. We just can’t do it!

HELGA is our Freud negative sub-conscious spirit who appears without warning to discourage us over and over. For OGR we must find a way to control HELGA! So … what to do?

1. Exercise: a. Give your own very personal name to your inner very negative voice (or use HELGA?)

b. Observe your inner most thoughts … take a step back to get new ideas.

c. When HELGA suggests a negative reaction (It’s impossible!!!) to any new idea … you firmly say:

“ZIP IT HELGA !!! … I’m in control here!”

d. Then you give yourself a compliment (I really helped that friend last week!) And then you say: “I’m back!!!”

2. Practice. Make 3 copies of the exercise (a – e) above with your name on it. Put copies in places around the house to reinforce your control of HELGA … over and over as needed.

3. Get to know HELGA. Lose weight at the gym, without HELGA holding you ack. Weight loss & habitual change is 80% mental, 20% mechanics.

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4. Get to know HELGA and can change your life! Take control of what you want … not what HELGA thinks is impossible!! Don’t be fooled. She may say something good about her progress, then completely counter act it with a negative comment.

5. Get to know HELGA. Become an observer of your negative thoughts, and tell HELGA to shut up!

6. Really shine the light on HELGA. Who is she really? Fear? Does she work for the Food Publicity Industry? Figure out her “moods” e.g. Perfection (I’m not good enough), Achievement (I can’t do it), Love (I will never be really loved) etc. etc.

7. Help to make HELGA your ally instead of your enemy. This will take work, it’s like a muscle that needs to be strengthened. Action!!! NOW please… control HELGA!!!!

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EXHIBIT C: LOVE AND RESPECT OUR FOOD – INSTINCTIVELY!

Step 3 Food!

1. Exercise

As we eat: look at the food, remember the taste, try new things, eliminate distractions (reading, computer, portable, TV etc.). Eat slowly and enjoy it. Choose increased dietary fiber with fruit and vegetables, and less red meat and energy-dense food and less drinks, which are high in fat and sugars.

Rest our knife and fork as we eat and breathe - at EVERY mouthful … get into the new habit of … very slow lovely eating … in which we ENJOY every bit. A great new habit!!

P.S. Bonus: we can laugh and give ourselves a glass of French wine … or a local alternative with every meal … if it helps us to change … OK?

2. Practice

Choose to eat out in places where they serve you small not huge portions. Do not ¨FINISH UP¨ the whole plate!! We are free to leave it for Nature to consume.

Practice self-service with ONLY as much as you really need. Refuse excess very politely … blaming OGR!!!!!

Control your weight NOT for yourself … but for others.

3. Become a Food Lover! Give your body the chance to recognize it’s being loved and nourished. Don’t stuff your face out of guilt, and not really enjoy it. Enjoy the “Food Lover Effect”

4. Become a Food Lover! How you eat is a direct reflection of how you live. Do you woof your food down, with no respect for time? Do you sneak your food? (what else could you be sneaky about?) Do you eat standing up? (hard time for lovers!)

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5. Become a Food Lover! When you begin to eat without distractions (mental &

physical), your body relaxes, tastes the food, absorbs the mind and body nutrients! This leads to more satisfaction, no over eating, and a healthier mind and body!

We all know what we should eat … and … what we should NOT eat!!! Cabbage soup is great. Red meat … not so great!

With OGR feel free to instinctively eat what and when you like. No diet. Everything instinctive!! Control your weight NOT for yourself … but for others.

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EXHIBIT D: FGN – FEEL GOOD NOW – WITHOUT EATING!!!THE KEY MIND BODY REFRAMING!

Step 4 FGN

1. Exercise

FGN – Feel Good Now – without eating all the time!! Do something else!!! Get into your new habit of FGN. Say it now please … FGN – without eating!! … five times … !! Well done. Time to change. (See Wikipedia, Spiegel & Proust in Exhibit E - later).

Note: FGN is the great idea of Nicole Kellerman of The USA Superior Weight Loss School!

2. Practice

Now we must find … not just food… but other joys in life … without having to eat! We recognize thirst and hunger separately and we don’t mix them up.

3. So we control our weight NOT for ourselves … but for our NEW body language communication … and it’s powerful effect … on the health of others. And now we find so many other joys in life … without eating! Joys life … not just joys in food

4. We must seek 30 new alternatives to food …which can achieve FGN – without eating!!? We use them in the next 28 days to control our weight NOT for ourselves … but for others.

5. Alternatives to eating 1 – 10Take a shower

Read an inspiring book Take a walk in the country

Play with your dog Do a 10 minute body exercise Play with your Ipad (A great investment for life!!!)

Read the paper and have a small piece of chocolate. Make a list of everything going well Eat a healthy snack (fruit/veggies)

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Search the web for something to buy 6. Alternatives to eating 11 – 20 Drink some a gin and tonic

Play with your computer Listen to your favorite song

Watch the TV Do something nice for someone Find a new health care video on Youtube Look in the mirror and say I Love You! Telephone a friend Make some tea or coffee List all of your financial assets (be amazed !)

7. Alternatives to eating 21-30

Plan for tomorrow with a great healthy breakfast Get outside and enjoy nature (even if it’s cold, bundle up!) Say “I’m Back” and get back into this moment and into your life List all the things that went well this year.Write yourself a love letter.... just do it, its incredible Meditate for at least 5 minutes (just focus on your breath)

Get smartened up to go the grocery store (make-up, hair, nails) and feel like a million bucksCall a friend to thank for a kindnessTell someone you are grateful to have them in your life

Make love to your partner (or a good alternative …?)

Learn to do it all INSTINCTIVELY !!! Now print out the daily worksheet for the 28 day challenge … which follows. Record out of 10 our feelings before and after each meal.

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THE DAILY WORK SHEET 28 DAYS TO A HEALTHIER, SLIMMER LIFE

Day 3 FGN’s Did it help yes or no?

1 Take photo!2345

6789

10

1112131415

1617181920

2122232425

262728 Take photo

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8. Now we start the learning about ¨The Biology of Self Sabotage¨ which is a critical issue for success in OGR. It is discussed by experts in video secret 3

So much to learn, but here are some key points on sabotaging ourselves (with HELGA):

We tell stories to ourselves about what is possible and what is impossible in the outside world. They may have no reality! Emotional investments are the key to new achievement. Keep them positive. Emotions give both joy and frustration, especially when old old deeper beliefs are threatened, and we really must change. Ideals can be illusions. But so often the impossible is achieved so rapidly. We have a desperate need to associate highly conflicting values, which may seem to be incompatible. Can we find a new way? We need to justify why we are here and what we can and cannot do. And this can change so much, over time. The mind recreates the body under neuro bombardment of so many alternatives. Millions of nerves in our brain all fighting it out. Used neuro pathways tend wear out and disconnect easily. And so we forget some important memories too easily. Parental influence is powerful and deeply sub-conscious. Despite the best of intentions, it can be positive or highly negative.

We can change. But our old brain always seems to prefers ¨no change¨. (hence HELGA!).

New perceptions have to pass tough old barriers to get accepted. It may take years and then we wonder why it took so long. We are continually re-programming our lives with an attempt to avoid failure. But all every success seems to have a history of past failures that were overcome. Perhaps we learn more from failure than we do from success. See video

secret no. 3 and WIKIPEDIA in Exhibit E.

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9. Overall OGR: We need to create a life without old negative addictions, with changed neural pathways, and with new success which may seem impossible. Instinctively chose increased dietary fiber with fruit and vegetables, and reduced consumption red meat and energy-dense food and drinks, which are high in fat and sugars.

10. We must get emotions out … anger, frustration, sadness etc. to free our mind and body for positive change. Reframe mind and body!! They go together … !!!!!

11. OVERALL: The initial OGR challenge is 28 days to practice: meditation, control of HELGA, love for food and FGN.

With OGR … we are free … we eat instinctively … we eat what and when we like … without worry about diet … it will all be instinctive!

12. OVERALL: On we go together for 28 days … OGR … obesity gently controlled … with FGN!!!

(Wikipedia, Spiegel & Proust in Exhibit E - later).

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EXHIBIT E: WIKIPEDIA AND USEFUL REFERENCES

Harvard Medical School

Can you sidestep Alzheimer’s disease?A recent international survey identified Alzheimer’s as the second most feared disease, behind cancer. It’s no wonder.

Alzheimer’s disease is characterized by progressive damage to nerve cells and their connections. The result is devastating and includes memory loss, impaired thinking, difficulties with verbal communication, and even personality changes. A person with Alzheimer’s disease may live anywhere from two to 20 years after diagnosis. Those years are spent in an increasingly dependent state that exacts a staggering emotional, physical, and economic toll on families.

A number of factors influence the likelihood that you will develop Alzheimer’s disease. Some of these you can’t control, such as age, gender, and family history. But there are things you can do to help lower your risk. As it turns out, the mainstays of a healthy lifestyle — exercise, watching your weight, and eating right — appear to lower Alzheimer’s risk.

5 steps to lower Alzheimer’s risk

While there are no surefire ways to prevent Alzheimer’s, by following the five steps below you may lower your risk for this disease — and enhance your overall health as well.

1. Maintain a healthy weight. Cut back on calories and increase physical activity if you need to shed some pounds.

2. Check your waistline. To accurately measure your waistline, use a tape measure around the narrowest portion of your waist (usually at the height of the navel and lowest rib). A National Institutes of Health panel recommends waist measurements of no more than 35 inches for women and 40 inches for men. 

3. Eat mindfully. Emphasize colorful, vitamin-packed vegetables and fruits; whole grains; protein sources such as fish, lean poultry, tofu, and beans and other legumes; plus healthy fats. Cut down on unnecessary calories from sweets, sodas, refined grains like white bread

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More information

Get your copy of A Guide to Alzheimer's Disease

Have you noticed memory problems piling up in ways that affect daily life in yourself or someone you love? Do you find yourself struggling to follow a conversation or find the right word, becoming confused in new places, or botching tasks that once came easily? About 5.4 million Americans have Alzheimer’s disease, and estimates suggest it will affect 7.7 million by 2030. Already, it is the sixth leading cause of death in the United States. This Special Health Report includes in-depth information on diagnosing Alzheimer’s and treating its symptoms.

Click here to read more »

or white rice, unhealthy fats, fried and fast foods, and mindless snacking. Keep a close eye on portion sizes, too.

4. Exercise regularly. This simple step does great things for your body. Regular physical activity helps control weight, blood pressure, blood sugar, and cholesterol. Moderate to vigorous aerobic exercise (walking, swimming, biking, rowing), can also help chip away total body fat and abdominal fat over time. Aim for 2 1/2 to 5 hours weekly of brisk walking (at 4 mph). Or try a vigorous exercise like jogging (at 6 mph) for half that time.

5. Keep an eye on important health numbers. In addition to watching your weight and waistline, ask your doctor whether your cholesterol, triglycerides, blood pressure, and blood sugar are within healthy ranges. Exercise, weight loss if needed, and medications (if necessary) can help keep these numbers on target.

For more on ways to help prevent Alzheimer’s as well as information on diagnosing and treating it, buy A Guide to Alzheimer’s disease  by Harvard Medical School.

WIKIPEDIA – OBESITYObesity is a medical condition in which excess book fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems.[1][2] People are considered obese when their book mass index (BMI), a measurement obtained by dividing a person's weight in kilograms by the square of the person's height in metres, exceeds 30 kg/m2.[3]

Obesity increases the likelihoood of various diseases, particularly heart disease, type 2 diabetes,obstructive sleep apnea, certain types of cancer, and osteoarthritis.[2] Obesity is most commonly caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders endocrine disorders,medications or psychiatric illness.

Evidence to support the view that some obese people eat little yet gain weight due to a slow metabolism is limited; on average obese people have a greater energy expenditure than their thin counterparts due to the energy required to maintain an increased book mass.[4][5]

Dieting and physical exercise are the mainstays of treatment for obesity. Diet quality can be improved by reducing the consumption of energy-dense foods such as those high in fat and sugars, and by increasing the intake of dietary fiber. Anti-obesity drugs may be taken to reduce appetite or inhibit fat absorption together with a suitable diet. If diet, exercise and medication are not effective, a gastric balloon may assist with weight loss, or surgery may be performed to reduce stomach volume and/or bowel length, leading to earlier satiation and reduced ability to absorb nutrients from food.[6][7]

Obesity is a leading preventable cause of death worldwide, with increasing prevalence in adults and children, and authorities view it as one of the most serious public health problems of the 21st century.[8] Obesity is stigmatized in much of the modern world (particularly in the Western world), though it was widely perceived as a symbol of wealth and fertility at other times in history, and still is in some parts of the world.[2][9]

calculated as:

 

 

 †

24

† The conversion factor for UK/US units is more precisely 703.06957964, but that level of precision is not meaningful for this calculation.

The most commonly used definitions, established by the World Health Organization (WHO) in 1997 and published in 2000, provide the values listed in the table at right.[3]

Some modifications to the WHO definitions have been made by particular bodies. The surgical literature breaks down "class III" obesity into further categories whose exact values are still disputed.[15]

Any BMI ≥ 35 or 40 is severe obesity A BMI of ≥ 35 and experiencing obesity-related health conditions or ≥40–44.9 is morbid

obesity

A BMI of ≥ 45 or 50 is super obesity

As Asian populations develop negative health consequences at a lower BMI than Caucasians, some nations have redefined obesity; the Japanese have defined obesity as any BMI greater than 25[16] while China uses a BMI of greater than 28.[17]

Effects on healthExcessive book weight is associated with various diseases, particularly cardiovascular diseases, diabetes mellitus type 2, obstructive sleep apnea, certain types of cancer, osteoarthritis [2]  and asthma.[2][18] As a result, obesity has been found to reduce life expectancy.[2]

Mortality

Relative risk of death over 10 years for White men (left) and women (right) who have

never smoked in the United States by BMI.[19]

Obesity is one of the leading preventable causes of deathworldwide.[8][20][21] Large-scale American and European studies have found that mortality risk is lowest at a BMI of 20–25 kg/m2[19][22] in non-smokers and at 24–27 kg/m2 in current smokers, with risk increasing along with changes in either direction.[23][24] A BMI above 32 kg/m2 has been associated with a doubled mortality rate among women over a 16-year period.[25] In the United States obesity is estimated to cause 111,909 to 365,000 deaths per year,[2][21] while 1 million (7.7%) of deaths in Europe are attributed to excess weight.[26][27] On average, obesity reduces life expectancy by six to seven years,[2][28] a BMI of 30–35 kg/m2reduces life expectancy by two to four years,[22] while severe obesity (BMI > 40 kg/m2) reduces life expectancy by ten years.[22]

Morbidity

25

Main article: Obesity-associated morbidity

Obesity increases the risk of many physical and mental conditions. These comorbidities are most commonly shown in metabolic syndrome,[2]a combination of medical disorders which includes: diabetes mellitus type 2, high blood pressure, high blood cholesterol, and high triglyceride levels.[29]

Complications are either directly caused by obesity or indirectly related through mechanisms sharing a common cause such as a poor diet or a sedentary lifestyle. The strength of the link between obesity and specific conditions varies. One of the strongest is the link with type 2 diabetes. Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women.[30]

Health consequences fall into two broad categories: those attributable to the effects of increased fat mass (such as osteoarthritis, obstructive sleep apnea, social stigmatization) and those due to the increased number of fat cells (diabetes, cancer, cardiovascular disease, non-alcoholic fatty liver disease).[2][31] Increases in body fat alter the body's response to insulin, potentially leading to insulin resistance. Increased fat also creates a proinflammatory state,[32][33] and a prothrombotic state.[31][34]

Survival paradoxSee also: Obesity paradox

Although the negative health consequences of obesity in the general population are well supported by the available evidence, health outcomes in certain subgroups seem to be improved at an increased BMI, a phenomenon known as the obesity survival paradox.[56] The paradox was first described in 1999 in overweight and obese people undergoing hemodialysis,[56] and has subsequently been found in those with heart failureand peripheral artery disease (PAD).[57]

In people with heart failure, those with a BMI between 30.0 and 34.9 had lower mortality than those with a normal weight. This has been attributed to the fact that people often lose weight as they become progressively more ill.[58] Similar findings have been made in other types of heart disease. People with class I obesity and heart disease do not have greater rates of further heart problems than people of normal weight who also have heart disease. In people with greater degrees of obesity, however, the risk of further cardiovascular events is increased. [59][60]Even after cardiac bypass surgery, no increase in mortality is seen in the overweight and obese.[61] One study found that the improved survival could be explained by the more aggressive treatment obese people receive after a cardiac event. [62] Another found that if one takes into account chronic obstructive pulmonary disease (COPD) in those with PAD, the benefit of obesity no longer exists.[57]

Causes

At an individual level, a combination of excessive food energy intake and a lack of physical activity is thought to explain most cases of obesity.[63] A limited number of cases are due primarily to genetics, medical reasons, or psychiatric illness.[64] In contrast, increasing rates of obesity at a societal level are felt to be due to an easily accessible and palatable diet,[65] increased reliance on cars, and mechanized manufacturing.[66][67]

A 2006 review identified ten other possible contributors to the recent increase of obesity: (1) insufficient sleep, (2) endocrine disruptors(environmental pollutants that interfere with lipid metabolism), (3) decreased variability in ambient temperature, (4) decreased rates of smoking, because smoking suppresses appetite, (5) increased use of medications that can cause weight gain (e.g., atypical antipsychotics), (6) proportional increases in ethnic and age groups that tend to be heavier, (7) pregnancy at a later age (which may cause susceptibility to obesity in children), (8) epigenetic risk factors passed on generationally, (9) natural selection for higher BMI, and (10) assortative mating leading to increased concentration of obesity risk factors (this would increase the number of obese people by increasing population variance in weight).[68]While there is substantial evidence supporting the influence of these

26

mechanisms on the increased prevalence of obesity, the evidence is still inconclusive, and the authors state that these are probably less influential than the ones discussed in the previous paragraph.

DietMain article: Diet and obesity

Map of dietary energy availability per person per day in 1961 (left) and 2001–2003

(right) in kcal/person/day.[69]

   no data   <1600  1600–1800  1800–2000  2000–2200  2200–2400  2400–2600

  2600–2800  2800–3000  3000–3200  3200–3400  3400–3600  >3600

Average per capita energy consumption of the world from 1961 to 2002[69]

The per capita dietary energy supply varies markedly between different regions and countries. It has also changed significantly over time.[69] From the early 1970s to the late 1990s the average calories available per person per day (the amount of food bought) increased in all parts of the world except Eastern Europe. The United States had the highest availability with 3,654 calories per person in 1996.[69] This increased further in 2003 to 3,754.[69]During the late 1990s Europeans had 3,394 calories per person, in the developing areas of Asia there were 2,648 calories per person, and in sub-Saharan Africa people had 2,176 calories per person.[69][70] Total calorie consumption has been found to be related to obesity.[71]

The widespread availability of nutritional guidelines [72]  has done little to address the problems of overeating and poor dietary choice.[73] From 1971 to 2000, obesity rates in the United States increased from 14.5% to 30.9%. [74] During the same period, an increase occurred in the average amount of food energy consumed. For women, the average increase was 335 calories per day (1,542 calories in 1971 and 1,877 calories in 2004), while for men the average increase was 168 calories per day (2,450 calories in 1971 and 2,618 calories in 2004). Most of this extra food energy came from an increase in carbohydrate consumption rather than fat consumption.[75] The primary sources of these extra carbohydrates are sweetened beverages, which now account for almost 25 percent of daily food energy in young adults in America,[76] and potato chips.[77] Consumption of sweetened drinks is believed to be contributing to the rising rates of obesity.[78][79]

As societies become increasingly reliant on energy-dense, big-portions, and fast-food meals, the association between fast-food consumption and obesity becomes more concerning.[80] In the United States consumption of fast-food meals tripled and food energy intake from these meals quadrupled between 1977 and 1995.[81]

27

Agricultural policy and techniques in the United States and Europe have led to lower food prices. In the United States, subsidization of corn, soy, wheat, and rice through the U.S. farm bill has made the main sources of processed food cheap compared to fruits and vegetables.[82]

Obese people consistently under-report their food consumption as compared to people of normal weight. [83] This is supported both by tests of people carried out in a calorimeter room[84] and by direct observation.

Sedentary lifestyleSee also: Sedentary lifestyle and Exercise trends

A sedentary lifestyle plays a significant role in obesity.[85] Worldwide there has been a large shift towards less physically demanding work,[86][87][88] and currently at least 30% of the world's population gets insufficient exercise.[87] This is primarily due to increasing use of mechanized transportation and a greater prevalence of labor-saving technology in the home.[86][87][88] In children, there appear to be declines in levels of physical activity due to less walking and physical education.[89] World trends in active leisure time physical activity are less clear. TheWorld Health Organization indicates people worldwide are taking up less active recreational pursuits, while a study from Fnland[90] found an increase and a study from the United States found leisure-time physical activity has not changed significantly.[91]

In both children and adults, there is an association between television viewing time and the risk of obesity. [92][93][94] A review found 63 of 73 studies (86%) showed an increased rate of childhood obesity with increased media exposure, with rates increasing proportionally to time spent watching television.[95]

GeneticsMain article: Genetics of obesity

Like many other medical conditions, obesity is the result of an interplay between genetic and environmental factors. Polymorphisms in various genes controlling appetite and metabolism predispose to obesity when sufficient food energy present. As of 2006, more than 41 of these sites on the human genome have been linked to the development of obesity when a favorable environment is present.[97] People with two copies of the FTO gene (fat mass and obesity associated gene) have been found on average to weigh 3–4 kg more and have a 1.67-fold greater risk of obesity compared with those without the risk allele.[98] The percentage of obesity that can be attributed to genetics varies, depending on the population examined, from 6% to 85%.[99]

Obesity is a major feature in several syndromes, such as Prader-Willi syndrome, Bardet-Biedl syndrome,Cohen syndrome, and MOMO syndrome. (The term "non-syndromic obesity" is sometimes used to exclude these conditions.)[100] In people with early-onset severe obesity (defined by an onset before 10 years of age and body mass index over three standard deviations above normal), 7% harbor a single point DNA mutation.[101]

Studies that have focused on inheritance patterns rather than on specific genes have found that 80% of the offspring of two obese parents were also obese, in contrast to less than 10% of the offspring of two parents who were of normal weight.[102]

The thrifty gene hypothesis postulates that, due to dietary scarcity during human evolution, people are prone to obesity. Their ability to take advantage of rare periods of abundance by storing energy as fat would be advantageous during times of varying food availability, and individuals with greater adipose reserves would be more likely to survive famine. This tendency to store fat, however, would be maladaptive in societies with stable food supplies.[103] This theory has received various criticisms, and other evolutionarily-based theories such as the drifty gene hypothesis and the thrifty phenotype hypothesishave also been proposed.[104][105]

Other illnesses28

Certain physical and mental illnesses and the pharmaceutical substances used to treat them can increase risk of obesity. Medical illnesses that increase obesity risk include several rare genetic syndromes (listed above) as well as some congenital or acquired conditions:hypothyroidism, Cushing's syndrome, growth hormone deficiency,[106] and the eating disorders: binge eating disorder and night eating syndrome.[2] However, obesity is not regarded as a psychiatric disorder, and therefore is not listed in the DSM-IVR as a psychiatric illness.[107]The risk of overweight and obesity is higher in patients with psychiatric disorders than in persons without psychiatric disorders.[108]

Certain medications may cause weight gain or changes in body composition; these include insulin, sulfonylureas, thiazolidinediones, atypical antipsychotics, antidepressants, steroids, certain anticonvulsants (phenytoin and valproate), pizotifen, and some forms of hormonal contraception.[2]

Social determinantsMain article: Social determinants of obesity While genetic influences are important to understanding obesity, they cannot explain the current dramatic increase seen within specific countries or globally

.[109] Though it is accepted that energy consumption in excess of energy expenditure leads to obesity on an individual basis, the cause of the shifts in these two factors on the societal scale is much debated. There are a number of theories as to the cause but most believe it is a combination of various factors.

The correlation between social class and BMI varies globally. A review in 1989 found that in developed countries women of a high social class were less likely to be obese. No significant differences were seen among men of different social classes. In the developing world, women, men, and children from high social classes had greater rates of obesity.[110] An update of this review carried out in 2007 found the same relationships, but they were weaker. The decrease in strength of correlation was felt to be due to the effects of globalization.[111] Among developed countries, levels of adult obesity, and percentage of teenage children who are overweight, are correlated with income inequality. A similar relationship is seen among US states: more adults, even in higher social classes, are obese in more unequal states.[112]

Many explanations have been put forth for associations between BMI and social class. It is thought that in developed countries, the wealthy are able to afford more nutritious food, they are under greater social pressure to remain slim, and have more opportunities along with greater expectations for physical fitness. In undeveloped countries the ability to afford food, high energy expenditure with physical labor, and cultural values favoring a larger body size are believed to contribute to the observed patterns.[111] Attitudes toward body mass held by people in one's life may also play a role in obesity. A correlation in BMI changes over time has been found among friends, siblings, and spouses. [113] Stress and perceived low social status appear to increase risk of obesity.[112][114][115]

Smoking has a significant effect on an individual's weight. Those who quit smoking gain an average of 4.4 kilograms (9.7 lb) for men and 5.0 kilograms (11.0 lb) for women over ten years.[116] However, changing rates of smoking have had little effect on the overall rates of obesity.[117]

In the United States the number of children a person has is related to their risk of obesity. A woman's risk increases by 7% per child, while a man's risk increases by 4% per child.[118] This could be partly explained by the fact that having dependent children decreases physical activity in Western parents.[119]

In the developing world urbanization is playing a role in increasing rate of obesity. In China overall rates of obesity are below 5%; however, in some cities rates of obesity are greater than 20%. [120]

Malnutrition in early life is believed to play a role in the rising rates of obesity in the developing world.[121] Endocrine changes that occur during periods of malnutrition may promote the storage of fat once more food energy becomes available.[121]

Consistent with cognitive epidemiological data, numerous studies confirm that obesity is associated with cognitive deficits.[122] Whether obesity causes cognitive deficits, or vice versa is unclear at present.

29

Infectious agentsSee also: Infectobesity

The study of the effect of infectious agents on metabolism is still in its early stages. Gut flora has been shown to differ between lean and obese humans. There is an indication that gut flora in obese and lean individuals can affect the metabolic potential. This apparent alteration of the metabolic potential is believed to confer a greater capacity to harvest energy contributing to obesity. Whether these differences are the direct cause or the result of obesity has yet to be determined unequivocally.[123]

An association between viruses and obesity has been found in humans and several different animal species. The amount that these associations may have contributed to the rising rate of obesity is yet to be determined. [124]

Pathophysiology Flier summarizes the many possible pathophysiological mechanisms involved in the development and maintenance of obesity.[125] This field of research had been almost unapproached until leptinwas discovered in 1994. Since this discovery, many other hormonal mechanisms have been elucidated that participate in the regulation of appetite and food intake, storage patterns of adipose tissue, and development of insulin resistance. Since leptin's discovery, ghrelin, insulin, orexin, PYY 3-36, cholecystokinin, adiponectin, as well as many other mediators have been studied. Theadipokines are mediators produced by adipose tissue; their action is thought to modify many obesity-related diseases.

Leptin and ghrelin are considered to be complementary in their influence on appetite, with ghrelin produced by the stomach modulating short-term appetitive control (i.e. to eat when the stomach is empty and to stop when the stomach is stretched). Leptin is produced by adipose tissue to signal fat storage reserves in the body, and mediates long-term appetitive controls (i.e. to eat more when fat storages are low and less when fat storages are high). Although administration of leptin may be effective in a small subset of obese individuals who are leptin deficient, most obese individuals are thought to be leptin resistant and have been found to have high levels of leptin. [126] This resistance is thought to explain in part why administration of leptin has not been shown to be effective in suppressing appetite in most obese people.[125]

While leptin and ghrelin are produced peripherally, they control appetite through their actions on thecentral nervous

system. In particular, they and other appetite-related hormones act on thehypothalamus, a region of the brain central

to the regulation of food intake and energy expenditure. There are several circuits within the hypothalamus that

contribute to its role in integrating appetite, the melanocortin pathway being the most well understood.[125] The circuit

begins with an area of the hypothalamus, the arcuate nucleus, that has outputs to the lateral hypothalamus (LH)

andventromedial hypothalamus (VMH), the brain's feeding and satiety centers, respectively.[127]

The arcuate nucleus contains two distinct groups of neurons.[125] The first group coexpressesneuropeptide Y (NPY) and agouti-related peptide (AgRP) and has stimulatory inputs to the LH and inhibitory inputs to the VMH. The second group coexpresses pro-opiomelanocortin (POMC) andcocaine- and amphetamine-regulated transcript (CART) and has stimulatory inputs to the VMH and inhibitory inputs to the LH. Consequently, NPY/AgRP neurons stimulate feeding and inhibit satiety, while POMC/CART neurons stimulate satiety and inhibit feeding. Both groups of arcuate nucleus neurons are regulated in part by leptin. Leptin inhibits the NPY/AgRP group while stimulating the POMC/CART group. Thus a deficiency in leptin signaling, either via leptin deficiency or leptin resistance, leads to overfeeding and may account for some genetic and acquired forms of obesity.[125]

30

Public health

The World Health Organization (WHO) predicts that overweight and obesity may soon replace more traditional public health concerns such asundernutrition and infectious diseases as the most significant cause of poor health.[128] Obesity is a public health and policy problem because of its prevalence, costs, and health effects.[129] The United States Preventive Services Task Force recommends screening for all adults followed by behavioral interventions in those who are obese.[130] Public health efforts seek to understand and correct the environmental factors responsible for the increasing prevalence of obesity in the population. Solutions look at changing the factors that cause excess food energy consumption and inhibit physical activity. Efforts include federally reimbursed meal programs in schools, limiting direct junk food marketing to children,[131] and decreasing access to sugar-sweetened beverages in schools.[132] When constructing urban environments, efforts have been made to increase access to parks and to develop pedestrian routes.[133]

Many countries and groups have published reports pertaining to obesity. In 1998 the first US Federal guidelines were published, titled "Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report".[134] In 2006 theCanadian Obesity Network published the "Canadian Clinical Practice Guidelines (CPG) on the Management and Prevention of Obesity in Adults and Children". This is a comprehensive evidence-based guideline to address the management and prevention of overweight and obesity in adults and children.[135]

In 2004, the United Kingdom Royal College of Physicians, the Faculty of Public Health and the Royal College of Paediatrics and Child Healthreleased the report "Storing up Problems", which highlighted the growing problem of obesity in the UK.[136] The same year, the House of Commons Health Select Committee published its "most comprehensive inquiry [...] ever undertaken" into the impact of obesity on health and society in the UK and possible approaches to the problem.[137] In 2006, the National Institute for Health and Clinical Excellence (NICE) issued a guideline on the diagnosis and management of obesity, as well as policy implications for non-healthcare organizations such as local councils.[138] A 2007 report produced by Sir Derek Wanless for the King's Fund warned that unless further action was taken, obesity had the capacity to cripple the National Health Service financially.[139]

Comprehensive approaches are being looked at to address the rising rates of obesity. The Obesity Policy Action (OPA) framework divides measure into 'upstream' policies, 'midstream' policies, 'downstream' policies. 'Upstream' policies look at changing society, 'midstream' policies try to alter individuals' behavior to prevent obesity, and 'downstream' policies try to treat currently afflicted people.[140]

Management

Main article: Management of obesity

The main treatment for obesity consists of dieting and physical exercise.[63] Diet programs may produce weight loss over the short term,[141] but maintaining this weight loss is frequently difficult and often requires making exercise and a lower food energy diet a permanent part of a person's lifestyle. [142][143] Success rates of long-term weight loss maintenance with lifestyle changes are low, ranging from 2–20%.[144] Dietary and lifestyle changes are effective in limiting excessive weight gain in pregnancy and improve outcomes for both the mother and the child.[145]

One medication, orlistat (Xenical), is current widely available and approved for long term use. Weight loss however is modest with an average of 2.9 kg (6.4 lb) at 1 to 4 years and there is little information on how these drugs affect longer-term complications of obesity.[146] Its use is associated with high rates of gastrointestinal side effects[146] and concerns have been raised about negative effects on the kidneys.[147] Two other medications are also available. Lorcaserin (Belviq) results in an average 3.1 kg weight loss (3% of body mass) greater than placebo over a year.[148] A combination of phentermine and topiramate (Qsymia) is also somewhat effective.[149]

31

The most effective treatment for obesity is bariatric surgery.[150] Surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.[151] However, due to its cost and the risk of complications, researchers are searching for other effective yet less invasive treatments.

Epidemiology

Main article: Epidemiology of obesity

World obesity prevalence among males (left) and females (right).[152]

   <5%  5–10%  10–15%

  15–20%  20–25%  25–30%

  30–35%  35–40%  40–45%

  45–50%  50–55%  >55%

Before the 20th century, obesity was rare;[153] in 1997 the WHO formally recognized obesity as a global epidemic.[76] As of 2008 the WHO estimates that at least 500 million adults (greater than 10%) are obese, with higher rates among women than men.[154] The rate of obesity also increases with age at least up to 50 or 60 years old[155] and severe obesity in the United States, Australia, and Canada is increasing faster than the overall rate of obesity. [15][156][157]

Once considered a problem only of high-income countries, obesity rates are rising worldwide and affecting both the developed and developing world.[26] These increases have been felt most dramatically in urban settings.[154] The only remaining region of the world where obesity is not common is sub-Saharan Africa.[2]

History

EtymologyObesity is from the Latin obesitas, which means "stout, fat, or plump." Ēsus is the past participle of edere (to eat), with ob (over) added to it.[158] The Oxford English Dictionary documents its first usage in 1611 by Randle Cotgrave.[159]

Historical trends

32

During the Middle Ages and theRenaissance obesity was often seen as a sign of wealth, and was relatively common among the elite: The

Tuscan GeneralAlessandro del Borro, attributed to Charles Mellin, 1645[160]

Venus of Willendorf created 24,000–22,000 BC

The Greeks were the first to recognize obesity as a medical disorder.[153] Hippocrates wrote that "Corpulence is not only a disease itself, but the harbinger of others".[2] The Indian surgeon Sushruta (6th century BCE) related obesity to diabetes and heart disorders.[161] He recommended physical work to help cure it and its side effects.[161] For most of human history mankind struggled with food scarcity.[162] Obesity has thus historically been viewed as a sign of wealth and prosperity. It was common among high officials in Europe in the Middle Ages and the Renaissance [160]  as well as in Ancient East Asian civilizations.[163]

With the onset of the industrial revolution it was realized that the military and economic might of nations were dependent on both the body size and strength of their soldiers and workers.[76] Increasing the average body mass index from what is now considered underweight to what is now the normal range played a significant role in the development of industrialized societies.[76] Height and weight thus both increased through the 19th century in the developed world. During the 20th century, as populations reached their genetic potential for height, weight began increasing much more than height, resulting in obesity.[76] In the 1950s increasing wealth in the developed world decreased child mortality, but as body weight increased heart and kidney disease became more common. [76][164] During this time period insurance companies realized the connection between weight and life expectancy and increased premiums for the obese.[2]

Many cultures throughout history have viewed obesity as the result of a character flaw. The obesus or fat character in Greek comedy was a glutton and figure of mockery. During Christian times food was viewed as a gateway to the sins of sloth and lust.[9] In modern Western culture, excess weight is often regarded as unattractive, and obesity is commonly associated with various negative stereotypes. People of all ages can face social stigmatization, and may be targeted by bullies or shunned by their peers. Obesity is once again a reason for discrimination.[165]

Public perceptions in Western society regarding healthy body weight differ from those regarding the weight that is considered ideal  – and both have changed since the beginning of the 20th century. The weight that is viewed as an ideal has become lower since the 1920s. This is illustrated by the fact that the average height of Miss America pageant winners increased by 2% from 1922 to 1999, while their average weight decreased by 12%. [166] On the other hand, people's views concerning healthy weight have changed in the opposite direction. In Britain the weight at which people considered themselves to be overweight was significantly higher in 2007 than in 1999.[167] These changes are believed to be due to increasing rates of adiposity leading to increased acceptance of extra body fat as being normal.[167]

Obesity is still seen as a sign of wealth and well-being in many parts of Africa. This has become particularly common since the HIV epidemic began.[2]

The artsThe first sculptural representations of the human body 20,000–35,000 years ago depict obese females. Some attribute the Venus figurines to the tendency to emphasize fertility while others feel they represent "fatness" in the people of the time.[9] Corpulence is, however, absent in both Greek and Roman art, probably in keeping with their ideals regarding moderation. This continued through much of Christian European history, with only those of low socioeconomic status being depicted as obese.[9]

During the Renaissance some of the upper class began flaunting their large size, as can be seen in portraits of Henry VIII of England and Alessandro del Borro.[9] Rubens (1577–1640) regularly depicted full-bodied women in his pictures, from which derives the term Rubenesque. These women, however, still maintained the "hourglass" shape with its

33

relationship to fertility.[168] During the 19th century, views on obesity changed in the Western world. After centuries of obesity being synonymous with wealth and social status, slimness began to be seen as the desirable standard. [9]

Society and culture

Economic impactIn addition to its health impacts, obesity leads to many problems including disadvantages in employment [169][170] and increased business costs. These effects are felt by all levels of society from individuals, to corporations, to governments.

In 2005, the medical costs attributable to obesity in the US were an estimated $190.2 billion or 20.6% of all medical expenditures,[171][172][173]while the cost of obesity in Canada was estimated at CA$2 billion in 1997 (2.4% of total health costs).[63] The total annual direct cost of overweight and obesity in Australia in 2005 was A$21 billion. Overweight and obese Australians also received A$35.6 billion in government subsidies.[174] The estimate range for annual expenditures on diet products is $40 billion to $100 billion in the US alone.[175]

Obesity prevention programs have been found to reduce the cost of treating obesity-related disease. However, the longer people live, the more medical costs they incur. Researchers therefore conclude that reducing obesity may improve the public's health, but it is unlikely to reduce overall health spending.[176]

Obesity can lead to social stigmatization and disadvantages in employment.[169] When compared to their normal weight counterparts, obese workers on average have higher rates of absenteeism from work and take more disability leave, thus increasing costs for employers and decreasing productivity.[178] A study examining Duke University employees found that people with a BMI over 40 kg/m2 filed twice as many workers' compensation claims as those whose BMI was 18.5–24.9 kg/m2. They also had more than 12 times as many lost work days. The most common injuries in this group were due to falls and lifting, thus affecting the lower extremities, wrists or hands, and backs. [179] The Alabama State Employees' Insurance Board approved a controversial plan to charge obese workers $25 a month for health insurance that would otherwise be free unless they take steps to lose weight and improve their health. These measures started in January 2010 and apply to those state workers whose BMI exceeds 35 kg/m2 and who fail to make improvements in their health after one year.[180]

Some research shows that obese people are less likely to be hired for a job and are less likely to be promoted.[165] Obese people are also paid less than their non-obese counterparts for an equivalent job; obese women on average make 6% less and obese men make 3% less.[181]

Specific industries, such as the airline, healthcare and food industries, have special concerns. Due to rising rates of obesity, airlines face higher fuel costs and pressures to increase seating width. [182] In 2000, the extra weight of obese passengers cost airlines US$275 million.[183]The healthcare industry has had to invest in special facilities for handling severely obese patients, including special lifting equipment andbariatric ambulances.[184] Costs for restaurants are increased by litigation accusing them of causing obesity.[185] In 2005 the US Congress discussed legislation to prevent civil law suits against the food industry in relation to obesity; however, it did not become law. [185]

Size acceptance

34

United States PresidentWilliam Howard Taft was often ridiculed for being overweight

See also: Fat acceptance movement

The principal goal of the fat acceptance movement is to decrease discrimination against people who are overweight and obese.[186][187] However, some in the movement are also attempting to challenge the established relationship between obesity and negative health outcomes.[188]

A number of organizations exist that promote the acceptance of obesity. They have increased in prominence in the latter half of the 20th century.[189] The US-based National Association to Advance Fat Acceptance (NAAFA) was formed in 1969 and describes itself as a civil rights organization dedicated to ending size discrimination. [190] However, fat activism remains a marginal movement.[191]

The International Size Acceptance Association (ISAA) is a non-governmental organization (NGO) which was founded in 1997. It has more of a global orientation and describes its mission as promoting size acceptance and helping to end weight-based discrimination.[192] These groups often argue for the recognition of obesity as a disability under the US Americans With Disabilities Act (ADA). The American legal system, however, has decided that the potential public health costs exceed the benefits of extending this anti-discrimination law to cover obesity.[188]

Childhood obesity

Main article: Childhood obesity

The healthy BMI range varies with the age and sex of the child. Obesity in children and adolescents is defined as a BMI greater than the 95th percentile.[13] The reference data that these percentiles are based on is from 1963 to 1994 and thus has not been affected by the recent increases in rates of obesity.[14] Childhood obesity has reached epidemic proportions in 21st century, with rising rates in both the developed and developing world. Rates of obesity in Canadian boys have increased from 11% in 1980s to over 30% in 1990s, while during this same time period rates increased from 4 to 14% in Brazilian children.[193]

As with obesity in adults, many different factors contribute to the rising rates of childhood obesity. Changing diet and decreasing physical activity are believed to be the two most important in causing the recent increase in the rates.[194] Because childhood obesity often persists into adulthood and is associated with numerous chronic illnesses, children who are obese are often tested for hypertension, diabetes,hyperlipidemia, and fatty liver.[63] Treatments used in children are primarily lifestyle interventions and behavioral techniques, although efforts to increase activity in children have had little success.[195] In the United States, medications are not FDA approved for use in this age group.[193]

In other animals

Main article: Obesity in pets

Obesity in pets is common in many countries. Rates of overweight and obesity in dogs in the United States range from 23 to 41% with about 5.1% obese.[196] Rates of obesity in cats was slightly higher at 6.4%.[196] In Australia the rate of obesity among dogs in a veterinary setting has been found to be 7.6%.[197] The risk of obesity in dogs is related to whether or not their owners are obese; however, there is no similar correlation between cats and their owners. [198]

Notes

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Healthy dietLeafy green, allium, and cruciferous vegetables are key components of a healthy diet.

Common colorful fruitsl …

Apples,pears, strawberriesculinary, fruits. Apples,pears, strawberries oranges , bananas,grapes, canary melons, water

melon, cantaloupe, pineapple and mango.

A healthy diet is one that helps maintain or improve general health. It is thought to be important for lowering health

risks, such as obesity, heart disease, diabetes, hypertension and cancer- A healthy diet involves consuming primarily

fruits, vegetables, and whole grains to satisfy caloric requirements, provide the body withessential

nutrients, phytochemicals, and fibre, and provide adequate water intake. A healthy diet supports energy needs and

provides for human nutrition without exposure to toxicity or excessive weight gain from consuming excessive amounts.

Diet for Obesity

Weight control diets aim to maintain a controlled weight. In most cases dieting is used in combination with physical exercise to lose weight in those who are overweight or obese.

Diets to promote weight loss are generally divided into four categories: low-fat, low-carbohydrate, low-calorie, and very low calorie.

A meta-analysis of six randomized controlled trials found no difference between the main diet types (low calorie, low carbohydrate, and low fat), with a 2–4 kilogram weight loss in all studies.

At two years, all calorie-reduced diet types cause equal weight loss irrespective of the macronutrients emphasize ]

Unhealthy dietsAn unhealthy diet is a major risk factor for a number of chronic diseases including: high blood pressure, diabetes, abnormal blood lipids, overweight/obesity, cardiovascular diseases, and cancer.]

The WHO estimates that 2.7 million deaths are attributable to a diet low in fruit and vegetable every year.

Globally it is estimated to cause about 19% of gastrointestinal cancer, 31% of ischaemic heart disease, and 11% of strokes, thus making it one of the leading preventable causes of death worldwide.

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DIETARY RECOMMENDATIONS FROM VARIOUS ORGANIZATIONS

World Health OrganizationRecommendations for both populations and individuals:

Eat roughly the same amount of calories that your body is using.

A healthy weight is a balance between energy consumed and energy that is 'burnt off'.

Increase consumption of plant foods, particularly fruits, vegetables legumes, whole grains and nuts.

Limit intake of fats, namely saturated fats and trans fats and replace with healthier unsaturated fats.

Limit the intake of granulated sugar. A 2003 report recommends less than 10% simple sugars.

Limit salt / sodium consumption from all sources and ensure that salt is iodized .

Essential micronutrients such as vitamins and certain minerals.

Avoid directly poisonous (e.g. heavy metals) and carcinogenic (e.g. benzene) substances.

Avoid foods contaminated by human pathogens (e.g. E.coli, tapeworm eggs).

American Heart Association / World Cancer Research Fund / American Institute for Cancer Research

Diet that consists mostly of unprocessed plant foods, with emphasis a wide range of whole grains, legumes, and non-starchy vegetables and fruits.

This healthy diet is replete with a wide range of various non-starchy vegetables and fruits, that provide different colors including red, green, yellow, white, purple, and orange.

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The tomato cooked with oil, allium vegetables like garlic, and cruciferous vegetables like cauliflower, provide some protection against cancer.

This healthy diet is low in energy density, which may protect against weight gain and associated diseases.

Finally, limiting consumption of sugary drinks, limiting energy rich foods, including “fast foods” and red meat, and avoiding processed meats improves health and longevity.

Overall, researchers and medical policy conclude that this healthy diet can reduce the risk of chronic disease and cancer.

Harvard School of Public Health 

The Nutrition Source of Harvard School of Public Health makes the following recommendations:

Choose good carbohydrates: whole grains (the less processed the better), vegetables, fruits and beans.

Avoid white bread, white rice, and the like as well as pastries, sugared sodas, and other highly-processed food

Pay attention to the protein package: good choices include fish, poultry, nuts, and beans. Try to avoid red meat. Choose foods containing healthy fats. Plant oils, nuts, and fish are the best choices.

Limit consumption of saturated fats, and avoid foods with trans fat. Choose a fiber-filled diet which includes whole grains, vegetables, and fruits.

Eat more vegetables and fruits—the more colorful and varied, the better. Calcium is important, but milk is not its best source.

Good sources of calcium are collards, bok choy, fortified soy milk, baked beans, and supplements which contain calcium and vitamin D.

Water is the best source of liquid.

Avoid sugary drinks, and limit intake of juices and milk.

Coffee, tea, artificially-sweetened drinks, 100-percent fruit juices, low-fat milk and alcohol can fit into a healthy diet but are best consumed in moderation.

Sports drinks are recommended only for people who exercise more than an hour at a stretch to replace substances lost in sweat.

Limit salt intake. Choose more fresh foods, instead of processed ones

Moderate alcohol drinking has health benefits, but is not recommended for everyone.

Daily multivitamin and extra vitamin D intake has potential health benefits.

Other than nutrition, the guide recommends frequent physical activity (exercise) and maintaining a healthy body weight.

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Marcel Proust – ¨How power Can Change Your Life¨

¨How Proust Can Change Your Life¨ by Alain de Botton 1997

The book is worth reading. It combines literary-biography and self-help. in a hilarious and unexpectedly practical way.

Who would have thought that Marcel Proust, one of the most important writers of our century, could provide us with such a rich source of insight into how best to live life? Proust was severely sick with asthma all his life, and yet he understood that the essence and value of life was the sum of its everyday parts.

As relevant today as they were at the turn of the century, Proust's life and work are transformed here into a no-nonsense guide to, among other things, enjoying your vacation, reviving a relationship, achieving original and unclichéd articulation, being a good host, recognizing love, and understanding why you should never sleep with someone on a first date.

It took de Botton to find the inspirational in Proust's essays, letters and fiction and, perhaps even more surprising, to draw out a vivid and clarifying portrait of the master from between the lines of his work.

Here is Proust as we have never seen or read him before: witty, intelligent, pragmatic. He might well change your life.

Some challenging Proust quotes may help you to understand him:

1. Relating real life to books. In reality every reader, while he is reading a book, is the reader of his own self. The writer’s work is merely a kind of optical instrument, which he offers to the reader, to enable him to discern what, without this book, he would perhaps never have experienced in himself.

2. Unwilling to get up. Proust always sick, preferred to spend most of his time in bed, which he turned into an office.

3. Doctors. To believe in medicine would be the height of folly, if not to believe were not a greater folly.

4. Laughter. The lady was so overcome with humour and music, that on one occasion she dislocated her jaw by laughing too much.

5. Proust names. On his birth certificate he was: Valentin, Louis, Georges, Eugene, Marcel Proust. On death Marcel Proust (1971 – 1922).

6. Knowing people. There may be significant things to learn about people, by looking at what annoys them most.

7. True love. A girl may feel so much love for a boy friend, who shaves closely every daily. She adores a smooth skin. If he stopped shaving … ?

8. Generosity. If the dinner cost ten francs, Marcel would add twenty for the waiter.

9. Dinner time. Marcel’s conversation was dazzling and bewitching, But he always felt cold, he had to wear his overcoat for dinner.

10. Women. When you come to live with a woman, you will soon cease to see anything of what made you love her; although it is true that love elements can be re-united by jealousy.

11. Wisdom. When the wise Madame Leroi, was asked for her views on love, she replied: ¨Love? I make it often, but I never talk about it.¨

Professor David Spiegel of Stanford University

¨Complementary and Alternative Treatments in Mental Health Care¨ edited by James H. Lake, M.D., and David Spiegel, M.D .  Washington, DC:  American Psychiatric Publishing, Inc., 2007.

A book worth reading. The widespread use of nonconventional treatments, or complementary and alternative medicine (CAM), and the increasing evidence supporting their therapeutic benefits call for a concerted scientific effort to integrate treatments that work into mainstream medicines. 

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Answering that call is the groundbreaking Complementary and Alternative Treatments in Mental Health Care, a concise, practical reference that reviews the many CAM approaches used in North America and Europe to treat—or self-treat—mental health problems, and the history and rationale for a variety of CAM treatments, including the risks and benefits of their integration into mainstream mental health care.

And finally … the next page …

NHS - Ten Weight-loss MythsSo much is said about losing weight that it is hard to sort truth from fiction. Here's the truth:

1. Starving myself is the best way to lose weight

No!! Crash diets give no long-term weight loss. Too hard to maintain. Body becomes low on energy, with craving for high-fat and high-sugar foods. Result is eating more calories than needed and long term weight gain.

2. A radical exercise regime is the only way to lose weight

No!!! Need regular physical activity routine of 20 minutes daily such as fast walking or cycling etc. Lose 450g (1lb) a week, with a 500 calorie deficit per day. Eat less and move more.

3. Slimming pills are effective for long-term weight loss

No!! No help for long term. Only used as prescribed by a doctor.

4. Healthy foods are more expensive

No!! You may pay more for a high-fat, high-salt ready meal, than for fresh ingredients to make your own meal.

5. Foods labelled ‘low fat’ or ‘reduced fat’ are always a healthy choice

No!! Be cautious. Foods labelled 'low fat' meet legal label criteria. Labels such as 'reduced fat' do not!!!. A reduced-fat snack has less fat than the full-fat version, but may still be unhealthy. Low-fat foods may have high sugar levels.

6. Margarine contains less fat than butter

No!! Margarine contains different types of fat. Lower in saturated fat than butter, but has more hydrogenated (trans) fats, more harmful than saturated fats. Lose weight with less saturated fat food.

7. Carbohydrates makes you put on weight

No!! In the right quantities, carbohydrates do not cause weight gain. Eat less. Eat wholegrain and wholemeal carbohydrates (brown rice and wholemeal bread) not starchy foods.-

8. Cutting out all snacks can help you lose weight

No!! Snacking isn't the problem. It's the type of snack. Snacks between meals do maintain energy levels, for an active lifestyle. Choose fruit or vegetables, not crisps, chocolate and high sugar or saturated fat.

9. Drinking water helps you lose weight

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No! But it keeps you hydrated, and snacking less. Water ssential for good health. Do not mistake thirst for hunger!! Need two litres of fluid a day.

10. Skipping meals is a good way to lose weight

No! To lose weight, reduce calories consumed and burn off calories with exercise. Skipping meals gives tiredness and poor nutrition. Encourages excess high-fat and high-sugar snacks with weight gain.

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