Ameena was in tears, “but honestly I try very hard, I go without food for days and have been trying to exercise.” I felt very sorry for the young medical student who had been struggling without overweight for the last few years. “What do you avoid?” I asked her. “I swear I do not eat anything, I starve myself but some times I have to eat something…” and purposely she did not elaborate on ‘something’. All along I believed in her and appreciated her determination and efforts but it is that ‘something’ which makes the difference and determines the eventual outcome.
“Bibi, for years, you have been slipping ‘prohibitive’ amounts of ‘proscribed’ food through this ‘silt’ (pointing to mouth) to please only a small part of your tongue. Do you realize that taste buds are only confined to the front one third of tongue? You have held the whole body hostage to the demands of a small part of tongue. All the illnesses you are inviting are the consequences of this imbalance of food and priorities of life,” I deliver an impromptu sermon. Many people have their mouth and eyes wide open as they grapple with the new ‘revelations’. “So, from now onwards, look after the rest of your body and deny the ‘extraordinary luxuries’ you are bestowing upon the ‘twittering tongue’,” I advise while concluding my oration.
The concept of bank account works well with some people. Weight is like an account, the more you put in and the lesser you take out, the amount increases. The sum will naturally decrease, if less money is put in and more is siphoned out. When one is consuming food, one is in fact putting more money in and when one is exercising that is like spending money. The interest rate may be different in different type of accounts but the basic philosophy remains the same. This is how I can explain, the much argued, different rates of metabolism in different people.
Different types of food are like different types of currency. Where as fats are like pounds, carbohydrates are like dollars and proteins are equivalent to the local currency. So if people consume fats, they are putting in more pounds and the account will increase proportionally. Similarly excessive consumption of sweets and carbohydrates contributes to the account (weight). Spending patterns mimic same analogy. Strenuous aerobic exercise like running, swimming, climbing stairs, playing competitive games – squash, football or hockey are like spending in pounds. Moderate aerobic exercises like brisk walking and playing indoor games, will be like spending in dollars. Leisure walking, playing golf and cycling are like spending money in local currency. As long as some money is being spent, the account cannot stay static and is bound to go down. Therefore some type of exercise has to be encouraged as it is bound to reflect in reducing the account/weight.
This concept of storing and spending works well with most people. Saving and spending in different currencies clicks with a little more enlightened person. The resolve to avoid ‘pound foods’ at all costs, refuse ‘dollar foods’ most of the time and prefer ‘local currency food’ has to be inculcated forcefully. The concept may take some time to be swallowed but it is worth the effort. Similarly, classifying spending as pounds, dollar and rupees generates interest in intelligent persons. The emphasis on ‘pound exercises’ pays dividend and many patients refer to it in a light vein on their next visit.
“If you continue like this, I will be obliged to order a new tougher and bigger chair and a larger door for your next visit; on the contrary, you might surprise me by losing a lot of weight with a slim figure and an enviable waist line,” are the final words before the patient leaves the clinic. It contains both messages – admonition and encouragement. The approach has to be based on ‘carrot and stick’ theory. Many patients shuffle restlessly to get their weight checked on subsequent visits to register their success.
What are the goals? Goals have to be realistic and achievable. For moderately obese person an ideal target will be to lose 10% of weight in six months. So, if someone is weighing 100 kg, the aim will be to lose 10 kg over six months. This translates roughly to 2 kg every month. Of paramount importance is to emphasize that perseverance is the key to success. Initial enthusiasm can die very quickly. Encouragement from the family is most important. And comments like, “Oh, you look very smart,” or “you look a lot slimmer and healthier,” can go a long way.
What to eat and what not eat, is the crux of all bickering. Every fat man recognizes the fact, that the extra folds of fat are consequences of his overindulgence in food. But what to avoid and what to consume remains the most important question. What types of foods doctors ban, holds the key to compliance. This is more like introduction of ‘emergency’ where the person is instructed to avoid a few ‘calorie bombs’ and reduce ‘calorie missiles’. Talking in vague terms of ‘percentage of reduction’ in carbohydrate, fats and proteins is difficult to comprehend and implement by a majority of semi literate and even otherwise literate persons. The emphasis should not be on offering a ‘short course’ on nutrition and calories rather a list of ‘dos and don’ts’ while explaining the rationale in simple and comprehensible terms.
I have made the ‘lesson on food’ very easy to understand in theory, how ever it needs determination and conviction for ‘gluttons’ to put it to practice. I employ Urdu alphabet ‘chai’ to elaborate my theory. My single one liner message is to avoid edibles starting with ‘chai’ to lead a ‘happy, smart and enviable life’. Most of the food items bubbling with calories contain – cheeney, chawal and chiknai – all start with ‘chey’.
Cheeney (sugar) implies all sweet things including ‘sugar and gur’ in any form and combination; be it hot drinks – like tea, coffee, qehwa, lemon tea or cold drinks like fizzy drinks and sweetened drinks like sweet juices. Many women will fervently deny taking sugar in any form, just to concede a little later, of using tea prepared for the family containing sugar, using ‘gur’ in tea or adding honey to yogurt. Bakery items are loaded with calories as they contain sugar and fats. All exotics like alluring cakes, tempting pastries, appealing rolls and other must be avoided all together. Finger licking and ‘calories dipping’ sweets of the ‘halwai’ – like khoya, barfai, gulab jaman, rubric, laddu, balushahi have to be kept away from at all cost. Desserts – the better half of a meal – are usually encumbered with calories and may contain more ‘ingredients for obesity’ than the main course itself. Many of us find ice cream and local version – ‘Kulfi’ very alluring and hard to resist, but then, so are most of the sins. The luring combination of scoops of ice cream topped with cream may be very appealing but as they contain not one but at least two ‘cheys’ – sweet and fats they have to be from a weight reducing diet. Beware of these tempting snares of ‘tummy busters’, they come in different tantalizing forms and hues but the eventual effect on health and waist line is the same!
Chawal – rice has to be totally avoided as it is difficult to ascertain the quantity. A platful may mean different things to different people. Many of the accompaniments of ‘rice’ have a tremendous fattening effect. Chiknai – fats have to be avoided and extra effort has to be put in to avoid getting ‘pounds’ in account. Fats include gheeand oil besides butter, cheese and cream. Many overweight people will flatly refuse consuming fats believing that they do not drink oil and eat ghee. Most of our patients feverishly deny taking fats, only to realize that their last meal was cooked in fat and this is how most of the people consume fat. Many assume that oil is better than ghee; that may be true from cholesterol point of view but as far as they weight and calories are concerned, both are equally bad. The advice to take boiled, broiled, baked without fat, grilled or barbecued food is not swallowed very well. The traditional concept of gravy and rot (roties here) is a major impediment.
Another ‘chey’ – chapati needs special mention, though one would like to ban it all together yet a midway will be to reduce it by half. Here again many people will enter into argument regarding the number of ‘roties’ being consumed. The simple answer to this is the advice to reduce the number by half, regardless of what the person is consuming.
Exercise is like a medicine, the dose and frequency has to be prescribed by the doctor. By and large, fit persons should exercise for twenty to thirty minutes five times a week. Any aerobic exercise will serve the purpose, for example aerobic exercise, walking, jogging, swimming, competitive games or structured exercises. Walking, perhaps is an excellent form of exercise as it employs most of the muscles of the body and does not entail heavy expenses. It can be performed anywhere and does not require any special dress code or membership. Walking briskly five days a week will satisfy most of the demands of body. Walk has to be taken seriously like prayers.
Before undertaking walk, one has to determine how much to walk and for what length of time, more like ‘Niat’ of prayers. And after asking for Divine help, one should embark upon walking on a pre-specified route without resorting to engage in talking. “Tasbeehat’ enhance the utility of walk and confer sanctity to it. One has to concentrate to maintain the desired speed and achieve the goal in pre-specified time.
Every woman thinks that performing daily chores in the house is the most rigorous form of exercise and to ask for more will be against the norms of decency and natural justice. Men are convinced tht duties they perform in the office should be classified as exercise. And to expect them to exercise before or after working hours is asking for too much. Many of them will refuse point blank, and say, “I am so busy that I cannot afford to have time off.” “Oh, I am sorry, am I conversing with the president of Pakistan?” I ask, while purposely keeping my eyes down and add, “If a person as busy as him can find time for exercise, why can’t you?” Another trick up in our sleeves is to ask, “Do you offer your prayers regularly?” If reply is in affirmative then I add, “Isha prayers normally take 20 to 30 minutes; you have to be convinced that exercise is important for you, then you will have no problem finding similar time for exercise as well.”
After initial hesitation many would agree and some will try as well. But, not all will persist for a long time, as we all believe in quick results. They weigh themselves after every walk and if weight does not drop drastically, they are disappointed and give up walking and restrictions. At this time they have learnt all the theory, but they need active encouragement from their family and friends to persist to achieve the goals. Good habits have to be positively reinforced, like appreciating their determination, encouraging exercise and understanding difficulties in following restrictions.
What shall be the next step if dieting and exercising are not enough? Are there any drugs to help to reduce weight? Drugs can be helpful to decrease weight but dietary restrictions have to be followed and exercises have to be performed. There are drugs that work on satiety centre in the brain and suppress appetite and others that work on decreasing absorption of food. Previously, drugs used to reduce weight have been associated with serious side effects and have been withdrawn from the market. Recently introduced drugs are supposed to be safe and effective but none of them are supposed to perform wonders. Drugs like Orlistat have been used to reduce absorption hence it is administered with food. The experience has been rewarding and many persons have been able to reduce their weight significantly. Drugs that suppress the appetite have resulted in appreciable loss of weight in many patients At one time all these drugs were beyond the reach of common man but now they are available at reasonable price.
Surgery is an option in a limited number of persons who are grossly obese, cannot diet and find it difficult to exercise and are at high risk for obesity related diseases and death. It is reserved for patients in whom all other efforts have failed. The best option in such persons is wiring of jaws where they are denied food and fed through a tube via nose. Second form of surgery is gastro intestinal surgery with stomach restriction or stomach by pass.
The concept of a bank account has to be reinforced again and again. Food going in has to be regulated versus energy spent to lose weight. A balance has to be struck and a person has to be conscious of ‘income’ and ‘expenditure’ all the time. This calculator has to be followed in letter and spirit and excuses like ‘one meal will not make a difference, today is my birthday and why ‘perhaiz’ on Eid and Ramazan’ should not be entertained.
In the fight against obesity, the plan has to be well conceived and executed meticulously. It is not a one time affair, it needs life long commitment and hard work. But the benefits and joys are unlimited and perhaps not quantifiable. It is all worth it!
“Bibi, for years, you have been slipping ‘prohibitive’ amounts of ‘proscribed’ food through this ‘silt’ (pointing to mouth) to please only a small part of your tongue. Do you realize that taste buds are only confined to the front one third of tongue? You have held the whole body hostage to the demands of a small part of tongue. All the illnesses you are inviting are the consequences of this imbalance of food and priorities of life,” I deliver an impromptu sermon. Many people have their mouth and eyes wide open as they grapple with the new ‘revelations’. “So, from now onwards, look after the rest of your body and deny the ‘extraordinary luxuries’ you are bestowing upon the ‘twittering tongue’,” I advise while concluding my oration.
The concept of bank account works well with some people. Weight is like an account, the more you put in and the lesser you take out, the amount increases. The sum will naturally decrease, if less money is put in and more is siphoned out. When one is consuming food, one is in fact putting more money in and when one is exercising that is like spending money. The interest rate may be different in different type of accounts but the basic philosophy remains the same. This is how I can explain, the much argued, different rates of metabolism in different people.
Different types of food are like different types of currency. Where as fats are like pounds, carbohydrates are like dollars and proteins are equivalent to the local currency. So if people consume fats, they are putting in more pounds and the account will increase proportionally. Similarly excessive consumption of sweets and carbohydrates contributes to the account (weight). Spending patterns mimic same analogy. Strenuous aerobic exercise like running, swimming, climbing stairs, playing competitive games – squash, football or hockey are like spending in pounds. Moderate aerobic exercises like brisk walking and playing indoor games, will be like spending in dollars. Leisure walking, playing golf and cycling are like spending money in local currency. As long as some money is being spent, the account cannot stay static and is bound to go down. Therefore some type of exercise has to be encouraged as it is bound to reflect in reducing the account/weight.
This concept of storing and spending works well with most people. Saving and spending in different currencies clicks with a little more enlightened person. The resolve to avoid ‘pound foods’ at all costs, refuse ‘dollar foods’ most of the time and prefer ‘local currency food’ has to be inculcated forcefully. The concept may take some time to be swallowed but it is worth the effort. Similarly, classifying spending as pounds, dollar and rupees generates interest in intelligent persons. The emphasis on ‘pound exercises’ pays dividend and many patients refer to it in a light vein on their next visit.
“If you continue like this, I will be obliged to order a new tougher and bigger chair and a larger door for your next visit; on the contrary, you might surprise me by losing a lot of weight with a slim figure and an enviable waist line,” are the final words before the patient leaves the clinic. It contains both messages – admonition and encouragement. The approach has to be based on ‘carrot and stick’ theory. Many patients shuffle restlessly to get their weight checked on subsequent visits to register their success.
What are the goals? Goals have to be realistic and achievable. For moderately obese person an ideal target will be to lose 10% of weight in six months. So, if someone is weighing 100 kg, the aim will be to lose 10 kg over six months. This translates roughly to 2 kg every month. Of paramount importance is to emphasize that perseverance is the key to success. Initial enthusiasm can die very quickly. Encouragement from the family is most important. And comments like, “Oh, you look very smart,” or “you look a lot slimmer and healthier,” can go a long way.
What to eat and what not eat, is the crux of all bickering. Every fat man recognizes the fact, that the extra folds of fat are consequences of his overindulgence in food. But what to avoid and what to consume remains the most important question. What types of foods doctors ban, holds the key to compliance. This is more like introduction of ‘emergency’ where the person is instructed to avoid a few ‘calorie bombs’ and reduce ‘calorie missiles’. Talking in vague terms of ‘percentage of reduction’ in carbohydrate, fats and proteins is difficult to comprehend and implement by a majority of semi literate and even otherwise literate persons. The emphasis should not be on offering a ‘short course’ on nutrition and calories rather a list of ‘dos and don’ts’ while explaining the rationale in simple and comprehensible terms.
I have made the ‘lesson on food’ very easy to understand in theory, how ever it needs determination and conviction for ‘gluttons’ to put it to practice. I employ Urdu alphabet ‘chai’ to elaborate my theory. My single one liner message is to avoid edibles starting with ‘chai’ to lead a ‘happy, smart and enviable life’. Most of the food items bubbling with calories contain – cheeney, chawal and chiknai – all start with ‘chey’.
Cheeney (sugar) implies all sweet things including ‘sugar and gur’ in any form and combination; be it hot drinks – like tea, coffee, qehwa, lemon tea or cold drinks like fizzy drinks and sweetened drinks like sweet juices. Many women will fervently deny taking sugar in any form, just to concede a little later, of using tea prepared for the family containing sugar, using ‘gur’ in tea or adding honey to yogurt. Bakery items are loaded with calories as they contain sugar and fats. All exotics like alluring cakes, tempting pastries, appealing rolls and other must be avoided all together. Finger licking and ‘calories dipping’ sweets of the ‘halwai’ – like khoya, barfai, gulab jaman, rubric, laddu, balushahi have to be kept away from at all cost. Desserts – the better half of a meal – are usually encumbered with calories and may contain more ‘ingredients for obesity’ than the main course itself. Many of us find ice cream and local version – ‘Kulfi’ very alluring and hard to resist, but then, so are most of the sins. The luring combination of scoops of ice cream topped with cream may be very appealing but as they contain not one but at least two ‘cheys’ – sweet and fats they have to be from a weight reducing diet. Beware of these tempting snares of ‘tummy busters’, they come in different tantalizing forms and hues but the eventual effect on health and waist line is the same!
Chawal – rice has to be totally avoided as it is difficult to ascertain the quantity. A platful may mean different things to different people. Many of the accompaniments of ‘rice’ have a tremendous fattening effect. Chiknai – fats have to be avoided and extra effort has to be put in to avoid getting ‘pounds’ in account. Fats include gheeand oil besides butter, cheese and cream. Many overweight people will flatly refuse consuming fats believing that they do not drink oil and eat ghee. Most of our patients feverishly deny taking fats, only to realize that their last meal was cooked in fat and this is how most of the people consume fat. Many assume that oil is better than ghee; that may be true from cholesterol point of view but as far as they weight and calories are concerned, both are equally bad. The advice to take boiled, broiled, baked without fat, grilled or barbecued food is not swallowed very well. The traditional concept of gravy and rot (roties here) is a major impediment.
Another ‘chey’ – chapati needs special mention, though one would like to ban it all together yet a midway will be to reduce it by half. Here again many people will enter into argument regarding the number of ‘roties’ being consumed. The simple answer to this is the advice to reduce the number by half, regardless of what the person is consuming.
Exercise is like a medicine, the dose and frequency has to be prescribed by the doctor. By and large, fit persons should exercise for twenty to thirty minutes five times a week. Any aerobic exercise will serve the purpose, for example aerobic exercise, walking, jogging, swimming, competitive games or structured exercises. Walking, perhaps is an excellent form of exercise as it employs most of the muscles of the body and does not entail heavy expenses. It can be performed anywhere and does not require any special dress code or membership. Walking briskly five days a week will satisfy most of the demands of body. Walk has to be taken seriously like prayers.
Before undertaking walk, one has to determine how much to walk and for what length of time, more like ‘Niat’ of prayers. And after asking for Divine help, one should embark upon walking on a pre-specified route without resorting to engage in talking. “Tasbeehat’ enhance the utility of walk and confer sanctity to it. One has to concentrate to maintain the desired speed and achieve the goal in pre-specified time.
Every woman thinks that performing daily chores in the house is the most rigorous form of exercise and to ask for more will be against the norms of decency and natural justice. Men are convinced tht duties they perform in the office should be classified as exercise. And to expect them to exercise before or after working hours is asking for too much. Many of them will refuse point blank, and say, “I am so busy that I cannot afford to have time off.” “Oh, I am sorry, am I conversing with the president of Pakistan?” I ask, while purposely keeping my eyes down and add, “If a person as busy as him can find time for exercise, why can’t you?” Another trick up in our sleeves is to ask, “Do you offer your prayers regularly?” If reply is in affirmative then I add, “Isha prayers normally take 20 to 30 minutes; you have to be convinced that exercise is important for you, then you will have no problem finding similar time for exercise as well.”
After initial hesitation many would agree and some will try as well. But, not all will persist for a long time, as we all believe in quick results. They weigh themselves after every walk and if weight does not drop drastically, they are disappointed and give up walking and restrictions. At this time they have learnt all the theory, but they need active encouragement from their family and friends to persist to achieve the goals. Good habits have to be positively reinforced, like appreciating their determination, encouraging exercise and understanding difficulties in following restrictions.
What shall be the next step if dieting and exercising are not enough? Are there any drugs to help to reduce weight? Drugs can be helpful to decrease weight but dietary restrictions have to be followed and exercises have to be performed. There are drugs that work on satiety centre in the brain and suppress appetite and others that work on decreasing absorption of food. Previously, drugs used to reduce weight have been associated with serious side effects and have been withdrawn from the market. Recently introduced drugs are supposed to be safe and effective but none of them are supposed to perform wonders. Drugs like Orlistat have been used to reduce absorption hence it is administered with food. The experience has been rewarding and many persons have been able to reduce their weight significantly. Drugs that suppress the appetite have resulted in appreciable loss of weight in many patients At one time all these drugs were beyond the reach of common man but now they are available at reasonable price.
Surgery is an option in a limited number of persons who are grossly obese, cannot diet and find it difficult to exercise and are at high risk for obesity related diseases and death. It is reserved for patients in whom all other efforts have failed. The best option in such persons is wiring of jaws where they are denied food and fed through a tube via nose. Second form of surgery is gastro intestinal surgery with stomach restriction or stomach by pass.
The concept of a bank account has to be reinforced again and again. Food going in has to be regulated versus energy spent to lose weight. A balance has to be struck and a person has to be conscious of ‘income’ and ‘expenditure’ all the time. This calculator has to be followed in letter and spirit and excuses like ‘one meal will not make a difference, today is my birthday and why ‘perhaiz’ on Eid and Ramazan’ should not be entertained.
In the fight against obesity, the plan has to be well conceived and executed meticulously. It is not a one time affair, it needs life long commitment and hard work. But the benefits and joys are unlimited and perhaps not quantifiable. It is all worth it!
___________________________________________________
Ref: Heal Thy Heart written by Prof: Dr. Muhammad Hafizullah
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