Saturday, 5 August 2017

Weight Management

Americans are obsessed with both food and dieting. As a nation, we love to eat. We eat out often, when meals are often higher in fat and calories than meals eaten at home; we eat larger portions; and we indulge in dozens of delicious “new” food products found on our grocery store shelves every year.
But we also spend billions of dollars a year on commercial weight-loss products and services hoping for a quick fix to our weight problem. And what a problem: with all that eating, the Centers for Disease Control and Prevention (CDC) reports that 68 percent of the nation is overweight or obese. What’s more, dieting is failure-prone, and the statistics are even worse when it comes to those who can keep the weight off.
The answer to this weight loss/weight gain cycle lies in how you manage your weight on a day-in, day-out basis. Your diet—the way you eat—is ingrained in your lifestyle. To change your weight—whether you want to lose a few pounds, or more, and keep them off—or to ensure you don’t succumb to the expanding-waistline syndrome, you must permanently adopt a healthy lifestyle.
Unfortunately, it’s not just all that tempting food that stands in the way of your efforts to achieve or maintain a healthy weight. Technology has altered Americans’ lifestyle. Most of us, most of the time can be found sitting—in front of a computer or TV, in a car, at a restaurant. About a quarter of adults—and an even greater percentage of women—report they are sedentary and engage in no physical activity during leisure time, and less than half exercise regularly. And as women age, their tendency to be sedentary steadily increases.
Being overweight increases your risk for many diseases. If you are overweight, you are more likely to develop heart disease and stroke, the leading causes of death for both men and women in the United States.
Overweight people are more likely to have high blood pressure, a major risk factor for heart disease and stroke, and high cholesterol, also a risk factor. They’re twice as likely to develop type 2 diabetes—a major cause of death, heart disease, kidney disease, stroke, amputation and blindness—as those not overweight.
Additionally, several types of cancer are associated with being overweight. In women, these include cancer of the uterus, gallbladder, cervix, ovary, breast and colon. Being overweight can also cause problems such as gout (a joint disease caused by excessuric acid), gallbladder disease or gallstones, sleep apnea (interrupted breathing during sleep), and osteoarthritis, or wearing away of the joints. Anyone with risk factors for health problems must be concerned about extra weight.
It all seems so simple: eat less, exercise, lose weight. But few people succeed in losing more than a few pounds on diets and even fewer succeed in maintaining that weight loss. An estimated 90 percent of dieters regain the weight in five years. One reason is that many factors other than overeating can play a part in weight, including your genetic makeup, cultural influences and natural hormonal and neurologic regulators.
Extreme dieting programs can sometimes be harmful and are rarely successful over the long term. Thus, weight loss should not be your only or even your primary goal if you are concerned about your health. Instead, the success of your weight-management efforts should be evaluated not just by the number of pounds you lose, but by improvements in your chronic disease risk factors, such as reduced blood pressure, cholesterol and blood sugar levels, as well as by new, healthy lifestyle habits. In fact, some experts believe that weight is not the sole cause of the diseases associated with being overweight, but that the accompanying unhealthy foods and sedentary lifestyles also contribute to these diseases.
On the flip side, some women are underweight, despite having tried to achieve or maintain a “normal” weight. Having a metabolism that burns too many calories can be as dangerous as being overweight. Underweight women are susceptible to vitamin and mineral deficiencies, resulting in a loss of bone density and muscle tissue.
A Word About Teens
Teenage girls today feel a lot of pressure from the media, friends and sometimes their own parents to be very slim. This pressure can create a distorted body image, making them see themselves as fat when they are not fat, or they see themselves as fatter than they really are.
According to the National Eating Disorders Association (NEDA), 40 percent of newly identified cases of anorexia are in girls ages 15 to 19, and over half of teenage girls use unhealthy weight-control behaviors, such as skipping meals, fasting, smoking cigarettes, taking laxatives and vomiting.
Fad dieting can keep teenagers from getting the calories and nutrients they need to grow properly. Stringent dieting may cause girls to stop menstruating and prevent girls from developing adequate muscle tone. If the diet doesn’t provide enough calcium or vitamin D, bones may not lay down enough calcium, which may increase the risk ofosteoporosis later in life.
The flip side to teenagers feeling pressured to be thin is that some may have legitimate concerns about their weight that adults dismiss. Adolescent obesity can carry serious lifelong health consequences. The best advice to teenage girls: Instead of dieting because everyone is doing it or because you are not as thin as you want to be, first find out from a health care professional or dietitian whether you carry too much body fat for your age and height. If you need to lose weight, follow the sensible guidelines laid out here. Depending on your age, your health care professional may recommend you eat more low-fat dairy products than is recommended for adults because of your heightened need for calcium.

Treatment

The key to weight management is incorporating three strategies into lifelong practices—eating healthfully, exercising regularly and, for some women, changing your relationship with food. Unfortunately, of the millions of American women who are trying to lose weight, a minority use this method.
The most important key to success is to approach any changes in diet and exercise not as punishment, but as a plan to implement pleasurable healthy substitutes for unhealthy overeating and sedentary behavior.
Eating for Weight Management
Keeping in mind the biological reason we eat—to provide our bodies the energy and nutrients it needs to carry out the tasks we ask of it—is a good way to think about food.
Since an estimated 90 percent of dieters who lose weight regain all or part of it within five years indicates that “dieting” is not the answer to weight management. The best “diet” is a way of life that you can follow for the rest of your life. Therefore, it should consist of a balance of a variety of foods.
You can ask a nutritionist or registered dietitian for guidance on the number of calories you should eat to reach and maintain your goal weight. But as a rule of thumb, you should take in about 250 calories per day less than is needed to maintain your current weight and add an exercise regime that burns an additional 250 calories a day if you want to lose weight. This regimen should help you safely lose about a pound per week.
Your basal metabolic rate (BMR) is the number of calories your body needs to maintain its basic functions. Several factors go into the calculation of your BMR, including your height, weight and age. To get an idea of your BMR, go to www.bmi-calculator.net/bmr-calculator. You need additional calories to provide energy for daily activities; the more active you are, the more calories you need.
A more accurate method is to keep a detailed food diary over a few days to a week during which you maintain your weight. Determine exactly how many calories you eat on an average day—several books and websites provide calorie counts for thousands of foods—and use that figure as a starting place for weight maintenance or weight loss.
After you’ve determined how many calories per day you should eat, plan daily menus. A registered dietitian or nutritionist can help you plan menus that include the types and amounts of food you should eat which, in most cases, should be based on the sensible guidelines set forth by the federal government in its 2010 Dietary Guidelines for Americans. The guidelines, available at www.healthierus.gov/dietaryguidelines, aim to help Americans lose weight in an effort to reduce the risk of obesity-related chronic diseases. The guidelines recommend balancing calories with physical activity and encourage Americans to eat more healthful foods, such as vegetables, fruits, whole grains, fat-free and low-fat dairy products and seafood, and to consume less sodium, saturated fats, trans fats, added sugars and refined grains.
The easiest advice to follow is to divide your plate into sections. Half your plate at main meals should consist of colorful vegetables, one quarter of grain products such as whole-grain bread, pasta, whole-grain rice and cereals, and one quarter of lean meat, fish or poultry. Several times a week, you should substitute dishes made from dried beans or peas as your main course. You should also eat plenty of fruits and get three cups of low-fat milk products like yogurt or cheese daily.
These guidelines will help reduce your calories and fat and increase the fiber in your diet, all of which have been shown to decrease the risk for heart disease. While you should try to cut back on fats and sugars, allow for an occasional treat. As soon as you label a food as “off limits,” chances are you will crave and perhaps even binge on it. A few simple ways to cut back on calories include:
Hold the sauce. Dishes that include high-fat sauces, mayonnaise and regular salad dressings should be consumed only occasionally and only in small portions.
Drink more water. And steer clear of calories hidden in drinks like juice drinks, alcoholic beverages, fancy coffee concoctions and smoothies. Avoid excessive fruit juice consumption.
Eat high-volume foods. High-volume, low-calorie foods, like most fruits and vegetables, are high in water and fiber, helping you feel fuller longer. Up your intake of vegetables and cut back on fats and sweets.
Focus on nutrient-dense foods. The 2010 Dietary Guidelines suggest replacing foods that contain sodium, solid fats, added sugars and refined grains with nutrient-dense foods and beverages. These foods include vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats, poultry, eggs, beans and nuts and seeds.
Health care professionals recommend women have moderate fat consumption, between 20 to 35 percent or less of your total calorie intake. Most fats should come from polyunsaturated fats and monounsaturated fats, which are found in vegetable sources. The Dietary Guidelines for Americans 2010 recommend consuming less than 10 percent of calories from saturated fats and restricting trans fats (also known as trans fatty acids) as much as possible. The guidelines also recommend limiting cholesterol to less than 300 milligrams per day.
Strategies for reducing saturated fat and cholesterol include:
Get 10 percent of less of your fat from saturated fat sources such as red meats, processed meats, organ meats or high-fat dairy products.
Choose low saturated-fat protein sources, such as fish, turkey, chicken, legumes (dried peas and beans), nuts and seeds.
Use lean cuts of meat and trim excess fat.
Substitute skim and low-fat milk for high-fat dairy foods.
Broil, bake or boil foods instead of frying.
Increase your consumption of fruits, vegetables and whole grains.
You’ve probably heard of “good” fats and “bad” fats. These labels refer to the effects various types of fat have on your body and health. Saturated fats are commonly found in animal-based food products, as well as in palm and coconut oils. They are solid at room temperature. Excess amounts of saturated fat are considered unhealthy because they can contribute to fatty deposits in the arteries, clogging them and leading to heart disease. Unsaturated fats are liquid at room temperature and are known as oil. Two types of unsaturated fats are monounsaturated and polyunsaturated, both of which are thought to help lower cholesterol. Examples of these fats are olive and canola oils. Monounsaturated fats also are found in avocados, nuts and olives.
Trans fats are actually unsaturated fats that have been chemically modified. Manufacturers add hydrogen to vegetable oil in a process called hydrogenation. This increases the shelf life and the flavor stability of foods containing these fats. Trans fats can be found in vegetable shortenings, some margarines, crackers, cookies, snack foods and other foods made with or fried in partially hydrogenated oils. Like saturated fat and dietary cholesterol, they raise LDL cholesterol and increase your risk for cardiovascular disease.
Essential fatty acids are a category of fatty acids found in polyunsaturated fats your body needs but cannot manufacture itself. Good sources of polyunsaturated fatty acids include soybean, corn and cottonseed oils.
When an unsaturated fat is solidified—into margarine, for example—the process turns it into partially hydrogenated oils, which contains trans fatty acids.
The Skinny On Fad Diets
Despite the ads that claim miracle weight-loss for some products, there simply is no magic formula for losing weight. Fad diets, like those based on cabbage soup, grapefruit or protein, may help you lose some pounds in the short run, but they don’t work in the long term because they’re impossible and unhealthy to maintain. The truth is permanent weight loss takes time and requires a permanent change in eating and exercise habits.
Extreme diets of less than 1,000 calories per day carry health risks and could trigger excessive overeating following the period of extreme caloric restriction. Such diets usually provide insufficient vitamins and minerals as well. Severe dieting also has unpleasant side effects, including fatigue, intolerance to cold, hair loss, gallstone formation and menstrual irregularities. Most of the initial weight loss is in fluids; later, fat is lost, but so is muscle.
It is very dangerous to be on severe diets longer than 16 weeks or to fast for more than two or three days. There have been rare reports of death from heart arrhythmia when liquid formulas didn’t have sufficient nutrients.
High-protein, low-carbohydrate diets are still used by some people for weight loss. Although a high-protein diet will lead to quick weight loss, its long-term health and safety benefits are uncertain. One byproduct of this type of diet is the release of substances called ketone bodies, which can lead to a condition called ketosis and cause nausea and lightheadedness because you are restricting your body’s source of fuel. Such high-protein diets may also be high in saturated fat and low in fiber-rich and healthful whole grains, fresh fruits and vegetables.
Carbohydrates provide your body with its main source of fuel and energy, namely, a form of glucose called glycogen. This complex carbohydrate is stored in liver and skeletal muscle. Simple carbohydrates (sucrose) offer quick energy boosts, while complex carbohydrates provide the body with fuel for several hours.
Examples of simple carbohydrates include fruit sugars (fructose) found in fruits, milk sugars (lactose) found in milk products, and other forms of sugar (sucrose) found in sweeteners such as corn syrup, honey, dextrose, high-fructose corn syrup and fruit juice concentrates. Complex carbohydrates are found in whole grains, rice, peas and dried beans, such as lentils and black, kidney and pinto beans.
Carbohydrates stored in the body are packed with water. That’s why introducing a low-carbohydrate diet leads to rapid weight loss as the body turns to stored carbohydrates for energy, eliminating large amounts of fluid from your body. After the stored carbohydrates are gone, your body turns to fat and lean body tissue for fuel, inducing further weight loss.
Many people on low-carbohydrate diets eat less but feel fuller due to the high-protein, high-fat foods they consume. However, this creates more work for your kidneys, which have to process the high amounts of protein. This is especially dangerous for people with diabetes. Additionally, excess protein excretion can cause valuable calcium to be excreted.
Many health care professionals believe that rather than adhere to a low-carbohydrate diet, it’s healthier to consume healthy carbohydrates in reasonable amounts. This means focusing on complex carbohydrates like beans, whole grains and vegetables, as well as simple carbohydrates that pack plenty of fiber, such as fruits.
Choosing A Diet Plan
With all of the fad diets circulating these days, you need to do your homework before embarking on a new weight-loss plan. The following questions will help you determine if a diet is healthy and legitimate or just a scam:
Does the plan promise dramatic and rapid weight loss? If a program is promising results that sound too good to be true, they probably are. A 10-pound loss in two weeks is unrealistic and may harm your overall health. A weight-loss goal of one to two pounds per week is a safe and effective rate for long-lasting results.
Does the plan exclude entire groups of foods? If a weight-loss plan excludes an entire group of foods such as grains, fruits, vegetables, dairy or protein, you risk missing out on essential vitamins and minerals.
Does the plan require extremely low calorie levels? Most experts agree that we need to consume at least 1,200 calories each day to maintain a healthy body. This is a minimum; most people actually need more. If a weight-loss plan restricts calories below this level, it’s not nutritionally adequate, and you’ll be in danger of nutrient deficiencies.
Are you required to buy special foods or supplements to follow the program? Weight-loss programs that rely on special foods or supplements tend to be money-making schemes to benefit the seller. These types of programs will drain your wallet without teaching you about nutrition and healthy eating habits.
Does the plan address lifestyle changes, such as increased exercise and improved eating habits? Realistic weight-loss plans should focus on the causes of your weight gain and on long-term lifestyle changes, not just on short-term losses.
Can you continue this way of eating for the rest of your life? Weight loss is difficult, but maintaining that weight loss is even harder. Any plan that allows you to lose weight should also be a plan you can continue indefinitely to maintain that weight.
The following claims and promotions should alert you to the probability of a bogus weight-loss scheme:
The plan is touted as requiring no sacrifice—no exercise or no change in your eating habits.
No reliable evidence or scientific proof is offered to back up claims that the plan is safe and effective.
Testimonialsand case histories of people who have supposedly been successful on the plan are offered as “proof” of its effectiveness. A few successes don’t prove the plan will work for everyone.
The plan is described in sensational articles, or worse, advertisements made to look like articles, in tabloids and weight-loss magazines.
The plan is promoted as “cleansing” the body of “toxins” to let the body’s “natural” curative powers help in your weight loss efforts.
Today’s most popular weight-loss programs vary greatly. No single diet is appropriate for everyone, so you’ll want to weigh factors that vary by plan, such as types of food you can eat, reliance on supplements or drugs, calorie levels allotted and support offered.
Popular Weight-Loss Plans
Mediterranean-Style DietThe Mediterranean diet is really a way of eating, rather than a particular diet. Some large studies point to the Mediterranean style of eating as a good alternative to low-fat dietary approaches as a way to reduce weight and, consequently, reduce your risk of heart disease and diabetes. Like the low-fat diets, the Mediterranean eating pattern focuses on fruits, vegetables, whole grains, nuts and seeds, but it also includes olive oil as a significant source of monounsaturated fat and wine in low to moderate amounts. The major protein sources are dairy, fish and poultry, with minimal red meat.The Mediterranean eating style allows a higher percentage of calories from fat than the low-fat diets typically endorsed by health organizations, but several recent major studies have shown that the diet is an alternative to low-fat diets, especially for lowering risk of diabetes and heart attacks, often related to weight.
Weight WatchersThis diet program, one of the most popular among health care professionals, has helped millions of people worldwide lose unwanted pounds since it was founded in 1963. In general, the plan is healthy—long on fruits and vegetables and short on fat, protein and sugar. Weight Watchers provides two options—weekly in-person meetings or Weight Watchers Online. Weight Watchers meetings offer member support. (Your weight is kept private.) Meeting leaders have achieved their own weight loss goals with Weight Watchers and have been able to maintain their goal weight. The discussions can be helpful because they focus on the common challenges you face when trying to lose weight—what to do about eating in restaurants or at a wedding, for example. They also let members exchange dietary advice on tasty alternatives or ideas for trimming calories. Weight Watchers Online offers members comprehensive guides to help them learn how to follow the Weight Watchers approach and food plan, including interactive tools and customized sites for men and women. Exercise is stressed as part of the program.In the past, Weight Watchers used a system that assigned point values to each food. Dieters were allowed to consume a specific number of points per day based on their weight, and members weren’t given much direction about how to divide those points between the various food groups. As a result, a dieter on this program could eat too much of a single, and perhaps unhealthy, type of food. However, with the Points Plus program launched in 2010, dieters get more direction on how to make healthy food choices. The program still focuses on calorie restriction, but it encourages members to choose healthful foods that are high in nutrients and low in sugar and fat.
NutriSystemThis diet is based mostly on NutriSystem’s prepackaged foods and involves reducing participants’ calorie intake to an average minimum of 1,200 calories per day for women and 1,500 for men. The NutriSystem program is now completely at-home—participants have the option to go online to chat with one of their weight loss counselors about diet and exercise. While the program was developed by registered dietitians and health educators with input from physicians, there have been some complaints in the media that the counselors are not highly trained. If you are concerned about this, you may want to ask about credentials at your center, and always discuss any diet plan with your health care professional.Because clients eat prepackaged meals, they have few food decisions to make. Thus they’re not learning how to make choices in the real world or change their lifestyles. The program also sells vitamin and mineral supplements.
Jenny CraigThis program also relies on its own brand of prepackaged foods, plus some additional supermarket foods, and provides calorie recommendations depending on your gender and current weight. Clients can attend weekly lifestyle classes and receive one-on-one counseling or choose an at-home program that allows for consultations via phone. As their comfort level grows, clients are given the option to transition to regular foods.Jenny Craig emphasizes increased physical activity, changing ingrained eating habits and learning how to balance meals and food choices. The program was developed by registered dietitians and psychologists with input from physicians.Relying on prepackaged foods makes dining out and socializing difficult and de-emphasizes behavior modification and lifestyle change that are very important to long-term weight loss. Also, Jenny Craig makes “weight-loss supplements” an integral part of the system. While vitamin and mineral supplements may be helpful to overall health, no herbal or enzymatic supplements should be relied upon for weight loss.
Liquid Fasting Programs (Optifast, HMR and New Directions)These programs consist of a highly structured dieting approach that combines medical, behavioral and nutritional knowledge and skills to support weight loss. The medical team (physician, registered nurse, dietitian or psychologist) provides medical supervision for the dieter in an out-patient medical setting. The diets use vitamin-fortified liquid-meal replacements or prepackaged foods to achieve a reduced calorie intake. Part of the structure includes mandatory weekly group sessions that support the weight-loss efforts and promote positive eating behaviors. In some settings, one-on-one counseling is available.The programs emphasize changes in lifestyle behaviors to support weight loss including daily physical activity and menu planning. Once the diet is completed, the patient transitions back to a recommended, healthy eating plan. In many locations, exercise physiologists are available to help design personal exercise plans.During the weight-loss phase of the programs, dieters use only the meal replacement products. Because of this, some dieters find it difficult to transition from liquid to regular food. The support of the trained program staff is essential to this transition. Most programs emphasize that the maintenance phase of these programs is the key to success with long-term weight maintenance.
Due to the close contact with medical professionals, these programs are beneficial for individuals with significant weight to lose or for those with serious health problems associated with their weight. Participation involves the approval of your health care professional. Some locations may also offer the opportunity to utilize prescription weight-loss medications.
Low-Carb DietsThese trendy diets, including the Atkins, Sugar Busters and Protein Power plans, claim that carbohydrates—and not fat or an overindulgence in calories—are what make people gain weight. They go against the recommendations of the U.S. Department of Agriculture (USDA), the American Heart Association, the American Dietetic Association and the American Diabetes Association.Fat and protein intake are unlimited in some of these plans, more limited in others. The higher fat and protein level of the Atkins Diet can provide more fullness with meals and snacks. Foods containing simple carbohydrates are restricted, so blood sugar surges after a high-carbohydrate meal doesn’t occur, helping control appetite. This also prevents blood sugar levels from rapidly plummeting, which contributes to hunger.These diets rebel against the past decade’s message for healthy eating—moderate fat; increased whole grains, fruits and vegetables; and moderate amounts of protein. These recommendations are based on scientific evidence that eating a well-balanced diet will decrease risks of chronic disease and increase health. While high-fiber diets rich in fruits and vegetables are shown consistently to decrease chronic diseases, diets high in animal protein continue to raise concern of possible increased risks for certain cancers.
Several recent studies found that high-protein diets have no proven effectiveness in long-term weight reduction and may damage health of those who stay on them for a long time.
Note: Because prolonged ketosis (a side effect of high-protein diets) can lead to kidney damage, people with a family history of renal disease or who have renal problems should avoid high-protein diets.
The ZoneThis diet relates excess weight to both overeating and/or to unbalanced consumption of calories from the carbohydrate, fat and protein groups. In the Zone, your diet is exactly one-third lean protein, two-thirds fruits and vegetables and a dash of monounsaturated fat. The diet claims that this is “the metabolic state in which the body works at peak efficiency.” The diet consists of one gram of fat for every two grams of protein and three grams of carbohydrates.Compared to many other low-carb regimens, this diet promotes a higher percentage of low-fat protein foods. This diet is most likely successful because it restricts caloric intake enough to lose weight. The average person eating in the Zone consumes no more than 800 to 1,200 calories a day. Some critics consider this a strict, controlled eating regimen, requiring significant effort to adhere to a complex set of rules, charts and tables.
South Beach DietThe South Beach Diet is sometimes lumped in with low-carb diets like Atkins, but it differs in some significant ways. It focuses on replacing “bad carbs” with “good carbs” and “bad fats” with “good fats.” It restricts simple carbohydrates, such as refined sugar and enriched grains, but permits complex, fiber-rich carbohydrates such as whole-grain bread and brown rice. It also allows more vegetables and focuses on the “glycemic index,” which relates to how quickly the body digests foods. Simple carbs digest quickly and cause spikes in blood sugar. It recognizes that while foods rich in “bad fats” may help control the hunger cycle, they also contribute to high cholesterol and heart disease. So the South Beach Diet replaces them with foods rich in unsaturated fats and omega-3 fatty acids, such as lean meats, nuts and fish. The three-phase diet ends with a maintenance phase to help you learn how to maintain a healthy weight.
Flat Belly DietThe Flat Belly Diet follows many of the same principles as the Mediterranean diet but also emphasizes how much and how often you should eat. It starts with a four-day “jump start” and then has a four-week plan that focuses on: eating an unsaturated fat at every meal; limiting meals to 400 calories per meal; and eating every four hours during the day. It teaches you how to eat a balanced diet with proper portions of vegetables, fruits, whole grains, nuts and seeds, low-fat dairy products and low-fat proteins, such as fish, poultry and beans. It also includes an exercise plan to help you manage your weight.
Single-Food DietsDiets that push grapefruit or eggs, cabbage soup or oranges have surfaced over the years. These diets are dangerous because they’re unbalanced nutritionally and rely on too few calories.
Liquid Meal Replacement DietsThese liquid meal replacements, such as Slim-Fast, are milk-based products that have added vitamins and minerals. If “balanced” is defined as containing adequate amounts of the nutrients the government has established as the Reference Daily Intakes (RDIs), then Slim-Fast meets the requirements. Slim-Fast users get a daily menu of three snacks, two shakes or meal bars and one balanced meal, customized to their tastes.Recent research shows that meal-replacement diet plans such as Slim-Fast work. A landmark 10-year study demonstrated that the Slim-Fast Meal Replacement Plan helped individuals lose weight and maintain body weight long-term. Participants weighed an average of 33 pounds less after 10 years than a matched group.After analyzing studies comparing several types of restricted-calorie diets, the American Dietetic Association issued a practice guideline concluding that structured meal-replacement plans could be at least as effective for losing weight as reduced-calorie diets and sometimes more effective. The guidelines also suggest that for overweight and obese adults who struggle with food selection and portion control, one or two daily meal replacements fortified with vitamins and minerals and supplemented with self-selected meals and snacks may be a successful weight loss and maintenance strategy.
Using Medication to Lose Weight
Women with increased medical risk from their obesity may benefit from adding a weight-loss medication to their nutritional and exercise regimen.
Most research-based and professional associations recommend lifestyle therapy for at least six months before embarking on a weight-loss plan using physician-prescribed drug therapy. Even then, it must be used only as part of a comprehensive weight-loss program that includes dietary therapy and physical activity. Currently available prescription medications include:
phentermine (Adipex-P, Fastin, Ionamin, Obenix, Oby-Cap, Teramine, Zantryl)
diethylpropion (Tenuate, Tepanil)
phendimetrazine (Adipost, Bontril, Melfiat, Obezine, Phendiet, Plegine, Prelu-2)
orlistat (Xenical)
Most prescription weight-loss drugs are FDA-approved for short-term use only, usually less than 12 weeks. Orlistat (Xenical) is the only drug approved for long-term use. Orlistat also is now available over the counter under the brand name Alli in 60 mg pills, half the strength of the prescription dosage in Xenical, making it the first FDA-approved over-the-counter weight loss drug. Like Xenical, Alli blocks digestion of about 25 percent of the fat eaten at a meal. Orlistat has been found to be safe and effective in combination with a low-fat (less than 30 percent fat), low-calorie diet and can help people lose 50 percent more weight than dieting alone.
Safety is an issue with some weight-loss medications. The drug sibutramine (Meridia) was removed from the market in 2010 because studies showed an increased risk for heart problems, including non-fatal heart attack and stroke. The FDA is also reviewing reports of serious liver injury in people taking orlistat. No definite association has been established, but people taking orlistat should watch out for any symptoms of liver injury, such as weakness, fatigue, fever, jaundice or brown urine and report these signs to their doctors.
Most of these drugs decrease appetite by affecting levels of certain brain neurotransmitters that affect appetite. Orlistat does not act directly on the central nervous system but instead blocks an enzyme essential to fat digestion so your body doesn’t absorb fat. In general, combining weight loss medications with an increase in activity level and a decrease in calories can help you lose 10 pounds more than what you might lose with nondrug obesity treatments.
If you are, may be or could become pregnant or are nursing, be sure to tell your health care professional. The effects of most of these drugs have not been tested on unborn babies; however, medications similar to some of the short-term appetite suppressants have been shown to cause birth defects when taken in high doses. Also, diethylpropion and benzphetamine pass into breast milk.
Before you take any product for weight loss, be sure to discuss it with your health care professional first. There are numerous potentially dangerous over-the-counter drugs and herbs that claim to help you lose weight. These over-the-counter drugs, except for Alli, and herbs have not been approved by the FDA and may cause significant health complications and even death.
Surgery
For clinically severe obesity, your health care provider may recommend surgery for weight loss. Many people, including some health care professionals, wrongly believe that obese people merely need to stop eating so much to lose weight. In reality, extreme obesity is a potentially deadly disease that sometimes requires a treatment as dramatic as surgery. Surgery is an option for carefully selected patients under the care of a health care professional. The surgery, called bariatric surgery, reduces the size of your stomach, limiting the amount of food it can hold. Most physicians consider people for the surgery who:
have tried other methods of weight loss (changes in eating behavior, increased physical activity and/or drug therapy) and are still severely obese
have a BMI of at least 40 (or 35 in addition to other medical conditions such as diabetes, hypertension and heart failure)
understand the procedure, risks of surgery and effects after surgery
are motivated to make a lifelong behavioral commitment that includes well-balanced eating and physical activity needed to achieve—and maintain—desired results
There are several types of bariatric surgery:
Roux-en-Y gastric bypass (RYGB). In this procedure, sometimes referred to as “stomach stapling,” the stomach is reduced to the size of a golf ball. The stomach is divided into a large portion and a small portion. The small portion is sewn or stapled together to make a small pouch, which holds only about a cup of food. The small pouch is then disconnected from the upper portion of the digestive tract and reconnected to a lower portion of the intestine. Not only do you eat fewer calories, but your body absorbs fewer calories because part of the intestine, the duodenum, has been bypassed.
Adjustable gastric band. This procedure is performed laparoscopically, through a small incision in the abdomen. The surgeon wraps a saline-filled silicone band around the top of the stomach to create a small pouch about the size of a thumb. The size of the pouch can be altered by increasing or decreasing the amount of saline (salt water) in the pouch. You eat less because you feel full sooner.
Other less common procedures include:
Biliopancreatic bypass with duodenal switch (BPDS). In this procedure, much of the stomach is removed, leaving only a “gastric sleeve” that is attached to the small intestine, completely bypassing the duodenum and upper small intestine.
Biliopancreatic diversion with duodenal switch is a similar procedure, but a smaller portion of the stomach is removed, and the remaining stomach (gastric sleeve) remains attached to the duodenum. The duodenum is connected to the lower part of the small intestine. As with the gastric bypass procedure, you absorb fewer calories with both of these procedures. You also eat less because your stomach is smaller. Removing part of the stomach is also thought to reduce production of an appetite-related hormone called grehlin. This procedure is generally used for people who have a body mass index of 50 or more.
All procedures can lead to complete remission of diabetes, sleep apnea, hypertension, kidney failure and other weight-related medical conditions.
While bariatric surgery is extremely safe, the greatest risks come after the surgery. Some occur soon after the operation, such as hemorrhage, obstruction, infection, hernias, pulmonary embolisms (blood clots in the lung) and leaks between the areas where tissue was sewn together.
Long-term complications include nutritional deficiencies, including malabsorption of vitamin B12, iron and calcium; and hypoglycemia, or low blood sugar, which can lead to various medical conditions, including neuropathy.
Most people undergoing bariatric surgery have rapid and extreme weight loss. It often helps patients lose as much as 50 percent of their excess body weight. Just over half of people who undergo weight loss surgery have kept the weight off five years after the procedure.
After surgery, you have to learn to eat smaller amounts of food at one time, to chew food well and to eat slowly. If you don’t adjust your eating habits, you won’t lose as much weight. Additionally, especially in the first three months after surgery, you must be sure to eat the proper amounts of protein, calories, minerals and vitamins as recommended by your health care professional and you will likely need nutritional supplements for the rest of your life.
Trying To Gain Weight?
For the underweight woman who needs to gain weight, either for health reasons or appearance’s sake, the journey can be difficult. Weight gain can be more difficult than weight loss. The underweight woman may have a higher metabolism, fewer fat cells or a genetic tendency to be leaner. She may also be taller, or just not care about food.
Winning at weight gain comes down to pairing a balanced eating pattern with regular physical activity—like any healthy lifestyle. The trick is to make sure you eat more calories than you burn. But you shouldn’t give up exercise because it has many health benefits! Consider adding a weight training program because building muscle will increase your weight. Here are some more tips that can help:
Plan ahead for extra meals and snacks. Instead of the traditional three square meals a day, add two or three substantial snacks between three moderate-size meals. By spreading out your food choices during the day, you’ll be more likely to enjoy your meals and snacks without feeling stuffed.
Concentrate on calories. Tip the scales toward weight gain by choosing foods that are calorie-dense, or high in calories. While rich desserts and fried foods quickly come to mind, the emphasis should be on foods that pack other nutrients, such as protein, vitamins and minerals, in addition to calories. These include dairy foods, nuts, peanut butter or avocados. Aim for the higher end of the recommended number of servings from each group in the Food Pyramid. And watch your use of added sugars and saturated and trans fats.
Let snacks work in your favor. Smart snacking plays an important role in gaining weight. Choose snacks that add calories, vitamins and minerals, such as powdered milk added to a yogurt or ice cream-based shake with fruit and fruit juice, nuts and seeds. Dip crackers, chips and fresh vegetable relishes into high-calorie dips made with low-fat cheese, low-fat sour cream, mashed beans or salad dressings made with mono- or unsaturated oils. Space out snacks during the day so you don’t spoil your appetite for later meals.
Physical Activity is Key to Weight Management
Daily physical activity is essential to weight management. Exercise not only burns calories, it also tempers your appetite, boosts metabolism, improves sleep and provides psychological benefits, such as an increased feeling of control and self-esteem, as well as reducing stress.
If you are over 40, have been inactive for some time, suffer from shortness of breath or weakness that interferes with daily activities, or have a chronic health condition, consult a health care professional before increasing your physical activity. Notify your health care professional about any chest pain, faintness or dizziness, or bone or joint pain you’re experiencing and any medications you’re taking.
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in energy expenditure. The best kinds of exercises for burning calories are moderate- to vigorous-intensity physical activities. The calories burned per hour are listed for a 140-pound healthy woman.
Moderate-intensity activities include:
hiking (386 calories)
light gardening/yard work (302 calories)
dancing (319 calories)
golf, walking and carrying the clubs (244 calories)
bicycling, less than 10 mph (370 calories)
tennis, singles (386 calories)
walking, 3.5 mph (370 calories)
yoga (336 calories)
Vigorous-intensity physical activities include:
aerobics, high-impact (445 calories)
calisthenics (512 calories)
running/jogging, 5 mph (580 calories)
swimming (580 calories)
bicycling, 12-14 mph (554 calories)
racquetball, casual (445 calories)
skiing, downhill (554 calories)
weight lifting, vigorous (400 calories)
While you and your health care professional should set up a detailed exercise plan based on your individual health status, the 2010 Dietary Guidelines recommend that for substantial health benefits, healthy women engage in at least150 minutes of moderate-intensity aerobic exercise or at least 75 minutes of vigorous aerobic exercise per week while not exceeding caloric intake requirements. For additional and more extensive health benefits, the guidelines recommend at least 300 minutes of moderate-intensity aerobic exercise or at least150 minutes of vigorous-intensity aerobic exercise per week. The guidelines also recommend muscle-strengthening activities that involve all major muscle groups on two or more days per week.
If you have been inactive, you need to work up slowly to this amount so you don’t get injured or overly fatigued and then become discouraged. Start with five or 10 minutes (or whatever you’re comfortable with) every other day, adding one minute every other session. Low- to moderate-intensity physical activity, like housework, gardening and walking the dog provide a great deal of general health benefits, but for weight loss, you need to up the ante and exercise at a higher intensity with more vigorous activities like brisk walking or jogging, singles tennis or other racquet sports, aerobics classes, ice or roller skating, swimming or cycling.
Because the goal of moderate to vigorous physical activity is to work your heart muscle, your exercise needs to increase your heart rate. One way to determine if you are exercising intensely enough is to measure your heart rate. After warming up and sustaining an aerobic activity for about five minutes, take your pulse by placing two fingers on the carotid artery on the side of your neck, just under your jaw line and about one to two inches in front of your ear. Count the beats for 10 seconds.
Your heart rate should be about 50 to 85 percent of its maximum, which is your age subtracted from 220.
If you’re out of shape or older than 60, aim for an intensity at the lower end of the 50 to 85 percent range of your maximum heart rate. To determine what your heart rate should be during exercise, subtract your age from 220; divide that number by six for a 10-second heart rate count, then multiply that number by 0.5 for the lower end of the range and 0.85 for the higher end. For example, if you’re 70:
220 – 70 = 150 (this would be your maximum heart rate for one minute)
150 / 6 = 25 (this would be your maximum heart rate for 10 seconds)
25 x 0.50 = 12.5 (this would be 50 percent of your maximum, or the lower end of where your 10-second heart rate should be when you’re exercising)
25 x 0.85 = 21.25 (this would be 85 percent of your maximum, or the higher end of where your 10-second heart rate should be when you’re exercising).
The following chart illustrates recommended heart rate counts based on your age. (These are rates per minute; use the instructions above to convert your 10-second count to heart beats per minute.)
20 years 100-170 beats per minute 200 beats per minute
25 years 98-166 beats per minute 195 beats per minute
30 years 95-162 beats per minute 190 beats per minute
35 years 93-157 beats per minute 185 beats per minute
40 years 90-153 beats per minute 180 beats per minute
45 years 88-149 beats per minute 175 beats per minute
50 years 85-145 beats per minute 170 beats per minute
55 years 83-140 beats per minute 165 beats per minute
60 years 80-136 beats per minute 160 beats per minute
65 years 78-132 beats per minute 155 beats per minute
70 years 75-126 beats per minute 150 beats per minute
An easier way to judge intensity is the “talk test.” You shouldn’t be exercising so hard that you can’t talk with a friend or recite a poem. If you can’t talk without gasping for breath, slow down. On the other hand, if your exercise is easy enough that you can sing a song out loud, you probably need to increase your intensity.
Another type of exercise has received much attention over the past several years for its contribution to weight loss efforts. Strength training, which includes weight lifting and isometrics, or using your own body weight as resistance, not only improves muscular strength and endurance but raises metabolism, enabling you to burn more calories.
Make sure you take a few minutes to warm up before doing any kind of exercise and stretch when you finish.
It’s best to incorporate a combination of both types of exercise into your lifestyle— moderate to vigorous physical activities to burn fat and strength training to build muscle. Neither is as effective alone.
At the same time, you need to reduce the amount of television you watch, since TV watching is independently associated with weight gain.
Some Techniques May Not Live Up to Expectations
Spot exercising, or training particular areas of your body, won’t reduce body fat in specific locations because exercise draws on fat stores throughout your body. Gimmicky devices such as bust developers, vacuum pants and exercise belts do absolutely nothing to reduce fat in specific locations or, in the case of the bust developer, to add bulk. Electrical pads wrapped around the waist, arms or thighs have been reported to cause burns and fires. Similarly, cellulite-removal creams have been shown in several studies to be ineffective. Their apparent effect on fat may simply be from constricting blood vessels and forcing water from the skin, which could potentially be dangerous for people with circulation problems.
Liposuction is an increasingly popular technique to reduce fat in specific areas on the body. Liposuction, also called lipoplasty or suction lipectomy, is a surgical procedure that vacuums out fat from beneath the skin’s surface to reduce fullness in areas such as the abdomen, hips, thighs, knees, buttocks, upper arms, chin, cheeks and neck. But depending on how much fat is removed, liposuction may not lead to weight loss, and it definitely won’t change any behaviors associated with weight gain. It is also not an appropriate strategy for everyone, as age and skin tone can play a role in how successful the technique will be.
Get Your Mind In Gear
Another key to successful weight loss is incorporating behavioral strategies into your new eating and exercise activities. These include learning about nutrition, planning what to eat and making sure you eat regularly to end impulsive and thoughtless eating.
Some specific and helpful behavioral strategies include:
Set the right goals. Your goals should focus on specific dietary and exercise changes, such as, “I will eat five servings of fruits and vegetables every day this week,” or, “I will work up to being able to walk briskly for 30 minutes at a time,” rather than just on weight loss. Select two or three goals at a time to incorporate into your lifestyle rather than trying to change everything at once. Effective goals are specific, attainable and forgiving, which means that you don’t have to be absolutely perfect. Remember, too, in setting your goals, that losing more than one to two pounds per week can be unhealthy and greatly increases the chances of regaining the weight.
Reward success. To encourage yourself to attain your goals, reward yourself for successes. An effective reward is something that is desirable and timely such as attending the cinema or taking an hour for yourself. Don’t use food as a reward!
Keep a food and exercise diary. Many behavioral psychologists believe it’s necessary to track your daily food consumption to achieve long-term weight loss. From a simple pad of paper to a computerized program that provides reports and analyses of your progress, the best tool is the one you use every day. Incorporate your goals, such as eating five servings of fruits or vegetables each day, into your self-monitoring efforts.
Monitor your weight sensibly. Keep track of your weight, but don’t weigh too often. One day’s diet and exercise patterns won’t have a measurable effect on the scale the next day, and your body’s water weight can change from day to day, which may frustrate you and derail your efforts.
Join a support group. Weekly meetings with a nearby support group or even over the Internet can help in a variety of ways. They provide accountability, helpful ideas, emotional support, an outlet for sharing frustrations and a variety of other psychological benefits.
Use positive self-talk. Take responsibility and see yourself as in control, able to talk yourself into exercising every day rather than being angry, hopeless or in denial.
Find ways other than food to respond to stress and other situations in your life. Certain cues, from stress to watching television, may stimulate unhealthy eating. In some cases, you can avoid those cues; don’t go to that Mexican restaurant where you always eat too many chips, for example. For situations that can’t be avoided, however, such as the business lunch or an argument with your spouse, relearn new ways to respond. If you track the situations surrounding your overeating in your food diary, you can more easily determine the cues you need to be aware of.
Change the way you go about eating. There are a variety of tricks—from using a smaller plate to eating more slowly—that can help you eat less. Setting an eating schedule, starting meals with a broth-based soup, only buying foods on a pre-planned menu and other similar efforts can all help.
When eating out, don’t feel compelled to finish your entire meal if portion sizes are too large. The steady growth of food portion sizes served both in restaurants and at home has encouraged the overeating that is fueling the obesity epidemic in the United States, according to survey by the American Institute for Cancer Research.
Appropriate portion size is very important. When dining out, for instance, try to take home at least half of your dish. You can ask the waiter to box up half of it before you start eating. When eating at home, serve your plate and leave the remaining food in the kitchen; do not place it on the table. Half your plate should be filled with vegetables, one quarter with a protein and one quarter with grain products such as whole-grain bread, pasta, whole-grain rice and cereals. Never, ever, supersize any kind of fast food or takeout meal.

Prevention

It’s best to use weight management techniques before you become overweight, to prevent weight gain in the first place. The federal government issues helpful dietary guidelines, spelling out how much and which food you should eat and how much you should exercise to stay healthy. The guidelines, which are revised every five years (most recently updated in 2010), are widely used by health care professionals, food makers and educators, and also form the basis of the well-known U.S. Department of Agriculture (USDA) Food Pyramid used to teach healthy eating habits based on food groups such as grains, vegetables and fats.
The 2010 Dietary Guidelines recommend:
Addressing the obesity epidemic in the United States by reducing calorie intake and increasing physical exercise
Be physically active most days of the week
Letting the Food Pyramid guide your food choices
Eating a variety of grains daily, especially whole grains
Eating a variety of fruits and vegetables daily
Keeping food safe from foodborne illness
Choosing beverages and foods that limit intake of sugars
Choosing and preparing foods with less salt
Drinking alcoholic beverages in moderation
Choosing a diet low in saturated fat, trans fatty acids and cholesterol, and moderate in total fat
Specifically, the 2010 Dietary Guidelines recommend the following for adult women; to find the amounts that are right for you (exact amounts vary based on your age), visit the Food Pyramid Web site at www.MyPyramid.gov:
Meats and beans (Protein)
Eat five ounces of protein every day (five and a half ounces if you are between the ages of 19 and 30) .Vary your choices of meats, poultry, fish, beans, peas, nuts and seeds).
Fruits, vegetables and milk
Eat at least one and a half cups a day of fruit (two cups if you are between the ages of 19 and 30) and two-and-a-half cups a day of vegetables (two cups if you are age 51 or older).
Eat a variety of fruits and vegetables every day and choose from all of the five vegetable subgroups (dark green, orange, legumes, starchy vegetables and other vegetables) several times per week. You may consume fresh, frozen, canned or dried; go light on fruit juices.
Drink three cups per day of either fat-free or low-fat milk or equivalent milk products such as yogurt and cheese.
Carbohydrates
Eat six servings (five servings if you are 51 or older) of grains (cereal, breads, crackers, rice or pasta) a day. At least three ounces should be whole grain, and the other three enriched or whole grain. One ounce equals about one slice of bread, one cup of cereal or one-half cup of cooked rice, cereal or pasta.
Eat fruits and vegetables that are high in fiber and choose whole grains
Try to avoid adding sugar or sweeteners to foods and beverages
Sodium and Potassium
Do not consume more than 2,300 mg (approximately 1 teaspoon) of sodium per day. Reduce sodium intake to 1,500 mg per day if you are 51 or older, are African American, or have hypertension, diabetes or chronic kidney disease.
Use little or no salt when preparing foods
Eat fruits and vegetables high in potassium such as potatoes, sweet potatoes, soybeans, bananas and spinach.

Facts to Know

About 68 percent of the nation is overweight or obese.
According to the CDC, there has been a dramatic increase in obesity in the United States over the past 20 years. In 2009, only the District of Columbia and Colorado had a prevalence of obesity less than 20 percent.
According to the National Eating Disorders Association (NEDA), 40 percent of newly identified cases of anorexia are in girls ages 15 to 19, and over half of teenage girls use unhealthy weight control behaviors, such as skipping meals, fasting, smoking cigarettes, taking laxatives and vomiting.
Obesity rates for children are 12.4 percent in those ages 2 to 5, 17 percent in those ages 6 to 11 and 17.6 percent in those ages 12 to 19.
Children and teens who are overweight often have a lifelong struggle with their weight and are at high risk for developing diabetes, high blood pressure, diseased arteries, damaged hearts and liver damage.
If a woman’s waist circumference divided by her hip measurement is greater than 0.8, she is considered to have a high amount of visceral fat, which is the type of fat that surrounds the internal organs. This is especially true if her waist measurement is more than 35 inches. This type of fat is associated with higher risk of certain diseases and conditions like diabetes and heart disease.
If you eat 250 calories per day fewer than needed to maintain your weight and exercise enough to burn an additional 250 calories a day, you will lose about a pound per week.
Your basal metabolic rate (BMR) is the number of calories your body needs just to maintain its basic functions. You need additional calories to provide energy for daily activities; the more active you are, the more calories you need. Several factors go into the calculation of your BMR, including your age, height, weight and gender. To get an idea of your BMR, go to http://www.bmi-calculator.net/bmr-calculator.
The CDC reports that compared with whites, African Americans have a 51 percent higher prevalence of obesity, and Hispanics have a 21 percent higher prevalence.
Despite the ads that claim miracle weight-loss for some products, there simply is no magic formula for losing weight. The truth is, permanent weight loss takes time and requires a permanent change in eating and exercise habits.

Key Q&A

How do I know if I’m overweight, underweight, or if my weight is normal?One measure of overweight and obesity is your body mass index (BMI), which can be determined by dividing your weight in pounds by your height in inches squared and then multiplying by 703. For example, a woman who is 5 feet 6 inches and weighs 140 would have a BMI of 22.6, as follows:
5 feet 6 inches = 66 inches
66 squared = 4,356
140 divided by 4,356 = 0.0321
0.0321 x 703 = 22.6
If a woman’s BMI is under 18.5, she is considered underweight; between 18.5 and 24.9, she is considered of normal weight; between 25 and 29.9, overweight; 30 or greater, obese. However, if she has more muscle mass than normal, these numbers won’t apply, and her health care professional should measure her body composition to determine her degree of overweight. BMI is also adjusted for age, as well as gender, for people under age 18.
My health care professional says I need to lose 10 pounds. Why should I bother with such a small amount?Being overweight, even by 10 pounds, can be bad for your health. If you are overweight, you are more likely to develop health problems including heart disease and stroke, type 2 diabetes, some forms of cancer, gout, gallbladder disease, sleep apnea and osteoarthritis.
As hard as I try, I just can’t lose that 10 pounds. Shouldn’t I just give up?No, because your weight management efforts may be paying dividends, even if you aren’t losing pounds. Eating more healthfully and adding physical activity to your day have health benefits of their own, including improvements in your chronic disease risk factors such as blood pressure, blood sugar levels and cholesterol.
I need to lose 10 pounds. Are weight-loss drugs appropriate for me?Weight-loss medications may be appropriate for carefully selected patients who are at significant medical risk because of their obesity. They are not recommended for use by people who are only mildly overweight unless they have health problems that are made worse by their weight. These prescription drugs should be used only with the careful supervision of a health care professional. When they are used, these medications must also be combined with physical activity and improved diet.
My health care professional says my weight is normal, but I need to exercise more. Why should I exercise if I don’t need to lose weight?Exercise not only improves your cardiovascular health and conditioning, but it can help ward off illnesses like cancer, diabetes and osteoporosis. Plus, it has psychological benefits and helps reduce stress.
My health care professional says I’m underweight. What’s so bad about that?Underweight women are susceptible to vitamin and mineral deficiencies, resulting in a loss of bone density and muscle tissue.
What sort of health care professional can help me set and achieve weight management goals?A physician may be the best place to start for a full health assessment and referral. An endocrinologist is a physician who specializes in metabolic conditions including obesity. A registered dietitian can evaluate your diet and suggest ways of fighting various health problems or simply becoming healthier by modifying your diet. A personal trainer provides one-on-one goal setting and professional expertise, most often in the area of fitness and exercise.
Is liposuction an effective way to lose fat?Liposuction does, indeed, remove fat from specific regions of your body. But if you haven’t learned to eat healthfully and incorporate physical activity into your lifestyle, you will regain any lost weight (although your new fat deposits may develop in different sites on your body). In addition, liposuction surgery has side effects and can have serious complications. You should talk to an unbiased health care professional, such as your primary care physician, before making any decisions about liposuction.
What is a healthy diet?Half your plate at main meals should consist of colorful vegetables, one quarter should consist of grain products such as whole-grain bread, pasta, whole-grain rice and cereals and one quarter should consist of meat, fish or poultry. Several times a week, substitute dishes made from dried beans or peas as your main course. Eat plenty of fruits. Eat three cups of low-fat milk products like yogurt each day. These proportions will help lower your saturated fat intake and increase the amount of fiber in your diet, both of which have been shown to decrease risk for heart disease. While you should try to cut back on fats and sugars, allow for an occasional treat. Also, most of your fat consumption should come from monounsaturated or polyunsaturated fats with saturated fats accounting for less than 10 percent of your fat intake.
How much should I exercise?The “Dietary Guidelines for Americans 2010” recommend that for substantial health benefits, healthy women engage in at least150 minutes of moderate-intensity aerobic exercise or at least 75 minutes of vigorous aerobic exercise per week while not exceeding caloric intake requirements. For additional and more extensive health benefits, the guidelines recommend at least 300 minutes of moderate-intensity aerobic exercise or at least150 minutes of vigorous-intensity aerobic exercise per week. The guidelines also recommend muscle-strengthening activities that involve all major muscle groups on two or more days per week.
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Yeast Infections

Vaginal yeast infections, also calledcandida vaginal infections or candidiasis, are common and easily treated in most women. Candida is a fungus. It commonly exists in small amounts in the vagina, mouth and gastrointestinal tract. When the fungus overgrows in the vagina, a yeast infection develops. This causes uncomfortable symptoms such as vaginal itching, burning and discharge. Uncontrolled diabetes and the use ofantibiotics, the contraceptive sponge, thediaphragm and spermicides are associated with more frequent yeast infections. Women who use hormonal birth control—birth control pills, the birth control patch or the vaginal ring—may also have more yeast infections.
Characteristics of Yeast Infections
Most women––as many as 75 percent––will have at least one diagnosis of vaginal yeast infection during their lifetimes. Yeast infections (also called yeast vaginitis or vaginal candidiasis) are one of the most common causes of vaginitis, an inflammationof the vagina characterized by discharge and irritation.
Yeast infections are more common during pregnancy. It seems that the higher levels ofestrogen in pregnancy cause the vagina to produce more glycogen (sugar), which feeds the yeast. Similarly, people with diabetes get yeast infections more frequently.
Recurrent Yeast Infections
About 5 to 8 percent of women develop recurrent vulvovaginal candidiasis (RVVC), defined as four or more symptomatic vaginal yeast infections during a 12-month period. Although RVVC is more common in women who have diabetes or problems with their immune system, most women with RVVC have no underlying medical illness that would predispose them to recurrent candida infections.
Conditions Mistaken for Yeast Infections: Bacterial Vaginosis and Trichomoniasis
Vaginal infections can also be caused by bacterial vaginosis (BV), the most common cause of vaginitis in women of childbearing age, and trichomoniasis, a sexually transmitted infection. BV and trichomoniasis are associated with more serious reproductive health concerns, such as premature birth and increased risk of contracting sexually transmitted diseases. Because these infections can have symptoms similar to those of yeast infections, yet can have more serious reproductive effects, it’s important to see a health care professional to evaluate and diagnose any vaginal symptoms. A variety of medications can treat vaginal infections, but proper diagnosis is key.

Diagnosis

Possibly because they are so common, women often self-diagnose yeast infections and self-treat with over-the-counter products.
But self-diagnosis may be a misdiagnosis. In one study, only 11 percent of women accurately diagnosed their yeast infections, and among women who had previously had a yeast infection, only 35 correctly diagnosed the condition. A handful of other vaginal infections, such as bacterial vaginosis (BV) and trichomoniasis cause similar symptoms.
Vaginal yeast infections may cause the following symptoms:
Vaginal itch and/or soreness.
A thick cottage cheese-like vaginal discharge, which may smell like yeast. A fishy odor is a symptom of BV, not of a yeast infection. The vagina normally produces a discharge that is usually described as clear or slightly cloudy, non-irritating, and having a mild odor. There may also be no discharge with a yeast infection or a discharge that is thin and watery.
A burning discomfort around the vaginal opening, especially if urine comes into contact with the area.
Pain, dryness or discomfort during sexual penetration.
Redness and swelling of the vulva and vagina
Contact your health care professional if you have any of these symptoms.
During the normal menstrual cycle, the amount and consistency of vaginal discharge varies. At one time of the month, you may have a small amount of a very thin or watery discharge, while another time of the month the discharge may be thicker. These variations are normal. The normal mid-cycle discharge is slippery.
However, a vaginal discharge that has an offensive odor with irritation is not normal. The irritation can be described as itching or burning or both and often worsens at night. Sexual intercourse typically makes the irritation worse.
To diagnose your vaginal symptoms, your health care professional will perform a gynecological examination and check your vagina for inflammation and abnormal discharge. A sample of the vaginal discharge may be taken for laboratory examination under a microscope, or for a yeast culture, test to see if candida fungi grow under laboratory conditions. Looking under a microscope also helps rule out other causes of discharge such as BV or trichomoniasis, which require different treatment.
Treatment
Antifungal medications are used to treat yeast infections. These medications are available in various over-the-counter (OTC) preparations and in one-, three- and seven-day doses. They include:
butoconazole (Gynazole, Femstat 3)
terconazole (Terazol)
tioconazole (Vagistat-1)
miconazole (Monistat)
clotrimazole (Gyne-Lotrimin)
Differences among the various OTC medications include the length of treatment indicated, preparation type and cost. The shorter course of treatment is more convenient but often more expensive. The one-, three- and seven-day durations of treatment appear to be equally effective. Prescription antifungal treatments also are available.
In general, it’s acceptable to use OTC antifungal medication to self-treat your symptoms if you’ve had a yeast infection diagnosed by a health care professional before and you are now experiencing the same symptoms.
However, if you meet any of the following circumstances, do not self-treat. Instead, contact a health care professional for guidance.
You’ve never had a yeast infection.
You have a fever and/or abdominal pain.
Your vaginal discharge is foul-smelling.
You are diabetic, HIV-positive, pregnant or nursing.
You used an over-the-counter yeast treatment but your symptoms have not gone away or they returned almost immediately.
If you take medication to treat a yeast infection—OTC medication or prescription medication—be sure to take the full course of the prescription. Don’t stop using it, even if you begin to feel better.
If your symptoms don’t respond or return shortly after they’d cleared up, consult your health care professional. Don’t just try a different over-the-counter treatment; your symptoms may not be caused by yeast.
Studies find up to an 89 percent error rate in self-diagnosis of yeast infections. Thus, if you think that you have a yeast infection, there’s a high chance you’re wrong. If your symptoms don’t ease after a few days of self-treatment with OTC medicine, or if they return promptly, see your health care professional. Keep in mind, however, that vaginal and vulvar irritation may persist for two weeks.
Yeast infections also may clear up without any treatment. However, there is a very small chance that a yeast infection may lead to a serious infection known as systematic candidal disease. This complication usually only occurs in women with compromised immune systems.
Side effects of OTC medications for yeast infections are generally minor and include burning, itching, irritation of the skin and headache. However, as with any medication, more serious side effects are possible, though rare, and may include hives, shortness of breath and facial swelling. Seek emergency treatment immediately if any of these symptoms occur.
Antifungal medications may damage condoms and diaphragms, so if you’re using such a medication, take other precautions to protect against pregnancy and sexually transmitted diseases. Also, don’t use tampons while treating yeast infections with medication inserted into the vagina.
If you see a health care professional, he or she may prescribe a single dose of oral fluconazole (Diflucan) or a generic equivalent, although this treatment is not recommended during pregnancy. Also, do not take fluconazole if you are taking cisapride (Propulsid) because this drug combination could cause serious, even fatal, heart problems. In rare cases, fluconazole has also caused liver damage, sometimes resulting in death. Also, notify your health care professional immediately if you develop a rash while taking fluconazole. Other, less serious side effects may be more likely to occur. These include:
diarrhea
headache
dizziness
stomach pain
heartburn
There have been reported drug interactions between warfarin, an anticoagulant (blood thinner) medication and topical miconazole nitrate products (such as Monistat) and oral fluconazole (Diflucan). Additionally, fluconazole may cause liver damage in rare instances, particularly in conjunction with alcohol use. Discuss all the medications you may be taking when you discuss your symptoms with your health care professional.
If you have a yeast infection, your sexual partners do not need to be treated. However, if a male sex partner shows symptoms of candida balanitis-redness, irritation and/or itching at the tip of the penis-he may need to be treated with an antifungal cream or ointment.
Medications cure 80 to 90 percent of vaginal yeast infections within two weeks or less, often within a few days with less severe infections.
About 5 to 8 percent of women experience recurrent vulvovaginal candidiasis (RVVC), defined as four or more yeast infections per year. Treatment involves a longer course of treatment—between 7 and 14 days of a topical cream or suppository or oral fluconazole followed by a second and third dose three and six days later. Your health care professional may also recommend a preventative treatment after the infection has resolved. This treatment may involve a 150 mg dose of fluconazole or 500 mg of topical clotrimazole once a week.

Prevention

Among the strategies that may prevent vaginal yeast infections are:
Keep the external genital area clean and dry.
Avoid irritating soaps (including bubble bath) and vaginal sprays.
Avoid scented soaps, powders or toilet tissue.
Avoid daily use of panty liners, which can trap moisture and prevent good airflow.
Change tampons and sanitary napkins frequently.
Wear loose cotton underwear that doesn’t trap moisture.
After swimming, change immediately into dry clothing instead of staying in your wet bathing suit.
If you have diabetes, try to maintain stable blood sugar levels.
Take antibiotics only when prescribed by your health care professional and never for longer than directed. In addition to destroying bacteria that cause illness, antibiotics kill off the “good” bacteria that keep the yeast in the vagina at a normal level. If you tend to get yeast infections whenever you take an antibiotic, ask your doctor to prescribe a vaginal antifungal agent at the same time.
Wipe from the front to the rear (away from the vagina) after a bowel movement or urination.
Don’t use douches. Douching with vinegar or other chemicals increases the rate of vaginal yeast infections because it alters the vaginal bacterial balance.
Facts to Know

Seventy-five percent of women are likely to have at least one yeast infection during their lifetime; nearly half have two or more.
Vaginal yeast infections are the second most common cause of abnormal vaginal discharge in the United States (the first is bacterial vaginosis).
Yeast infections are quite common during pregnancy. It seems that the higher levels of estrogen in pregnancy cause the vagina to produce more glycogen (sugar), which feeds the yeast. Yeast infections are also more common in women with diabetes.
About 5 to 8 percent of women develop recurrent vulvovaginal candidiasis (RVVC), defined as four or more symptomatic vaginal yeast infections in a 12-month period. Most women with RVVC have no underlying medical illness that would predispose them to recurrent candida infections.
A woman’s vagina normally produces a discharge described as clear or slightly cloudy, non-irritating and odor-free or having only a mild scent. During the normal menstrual cycle, the amount and consistency of discharge may vary.
Douching disrupts the balance of normal bacteria in the vagina and can cause more frequent vaginal infections.
Vaginal yeast infections can clear up without treatment. However, if you don’t treat a yeast infection, there is a very small chance you may develop a serious infection.
If you have a yeast infection, treatment of sexual partners is usually not generally recommended, since it’s not clear if vaginal yeast infections are transmitted sexually. However, if a woman has recurrent infections and her male sex partner shows symptoms of candida balanitis—redness, irritation and/or itching at the tip of the penis—he may need to be treated with an antifungal cream or ointment.
Medications cure 80 percent to 90 percent of vaginal yeast infections within two weeks or less, often within a few days.
Take antibiotics only when prescribed by your health care professional and never take them for more or less time than directed. In addition to destroying bacteria that cause illness, antibiotics kill off the “good” bacteria that normally live in the vagina. Stopping treatment early, even when symptoms have improved, can cause infections to return and make them resistant to the medication.

Key Q&A

I think I might have a yeast infection, but I’m not sure. Should I go ahead and try one of the over-the-counter preparations to see if my symptoms go away?If you’ve had a yeast infection before and now have the same symptoms—vaginal discharge that has a yeast-like smell,with burning, itching and discomfort—self-treatment with an over-the-counter antifungal treatment is generally acceptable. However, many vaginal infections, including some that can cause serious reproductive health conditions, such as premature birth or increased risk of sexually transmitted diseases, have similar symptoms. If you’re not sure, have never had a yeast infection before, are pregnant or have a health condition, consult a health care professional for an evaluation of your symptoms before treating yourself with OTC medications.
I’m on the third day of a seven-day treatment and my symptoms are all gone. Can I stop using the medication?No, you need to use all of the medication as directed. Your symptoms can disappear before your infection is completely treated. If you stop using the medication now, the yeast infection could recur.
I have vaginal itching and a discharge with a fishy odor. Is this a yeast infection?No, a discharge with a fishy odor is not a symptom of a yeast infection. It’s a symptom of bacterial vaginosis (BV), another common, but more serious, vaginal infection. BV requires a different treatment than that used for yeast infections. Contact a health care professional for additional guidance.
What is the risk of self-treating yeast infection for women who are pregnant or nursing or those who have diabetes or HIV?First, women who are pregnant or have diabetes or HIV have a higher risk of developing a yeast infection. Second, and most important, these woman, as well as nursing mothers, should always see their health care professional if they suspect a yeast infection rather than self-treat because yeast medications may interfere with medications needed for their other health problems (HIV, diabetes) or pose risks for the baby.
If I’m pregnant, can a yeast infection hurt my developing baby?No, but you do need to see your health care professional for treatment. Also, some treatments currently on the market, such as fluconazole (Diflucan), are not recommended during pregnancy. Be sure your health care professional and pharmacist are both aware that you are or may be pregnant.
I keep getting recurrent yeast infections. Should my sexual partner be treated?It’s not clear whether vaginal yeast infections can be transferred during sexual intercourse. However, if your sexual partner has the symptoms of candida-redness, irritation and/or itching at the tip of the penis in a male-he may need to be treated. In rare cases, treatment of partners of women with recurrent yeast infection is recommended. Additionally, recurrent yeast infections may be representative of a different problem. Thus, it is important to see your health care provider for an evaluation.
I thought douching helped keep a woman clean. What is the risk in douching?The healthy vaginal ecosystem requires just the right balance of bacteria flora. The vaginal mucosa, which protects against pathogens, is made up predominantly of healthy bacteria called lactobacillus. These bacteria make hydrogen peroxide, which keeps unhealthy bacteria from getting out of hand. This, in turn, keeps the amount of yeast at a normal level. Too much douching can disrupt the bacterial balance and lead to infection.
My health care professional has prescribed antibiotics to treat an unrelated illness. What precautions should I take to avoid getting a yeast infection?Wear loose clothing and loose cotton underwear. Keep yourself clean and dry. Avoid scented or irritating soaps, powders, and toilet tissue. Avoid douching. Use a preventive dose of yeast medication.
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Yoga

Yoga is a physical and mental practice that involves the body, mind and spirit. The practice, which originated in India, is designed to enhance awareness, create a mind-body-spirit balance, cleanse, heal and strengthen the body, liberate the true self and, as practiced today, improve fitness. The most common form practiced in the United States is hatha yoga, which includes specific movements or postures (asana) and various breathing techniques (pranayama) and is often complimented with meditation (dhyana). 
Yoga’s gentle, mindful and controlled movements can provide a non- or low-impact workout for people in almost any physical condition. Yogic exercises—and there are many—can ease tense muscles, improve flexibility and enhance strength, balance and endurance. Poses, breathing practices and meditation can also increase concentration, reduce stress and, among other therapeutic benefits, relieve back pain.
No one seems quite sure when yoga began, but it goes back thousands of years. Stone carvings in the Indus Valley depicting yoga positions date back 5,000-plus years.
Traditionally, yoga was a spiritual practice, its goal being union with the absolute or the divine. The various exercises we associate with hatha yoga were performed to prepare the body for long periods of meditation. The word “yoga” means to join or bind together, and the practice joins together the body, mind and spirit. On a spiritual level, it can refer to the union of the individual with the absolute truth or true self (Atman). It’s often associated with Hinduism, but yoga predates the religion. Hinduism has incorporated elements of yoga into its practices, as have other religions.
As it’s typically practiced in the West, the focus of yoga is more on the physical fitness aspects. Of course, it can be a spiritual experience, if you choose to use it as such.
Yoga is now practiced around the world for its psychological, physical and spiritual benefits. Americans have practiced it for more than 100 years, but it gained popularity in the 1960s as young people developed a taste for all things Eastern. According to results of a 2012 survey conducted by Sports Marketing Surveys USA on behalf of Yoga Journal, 20.4 million Americans, or 8.7 percent of U.S. adults, are believed to practice yoga.
Although this report focuses on hatha, here are some other traditional types of yoga:
Raja: Called the “royal road,” its focus is primarily on meditation; it incorporates exercise and breathing practice with meditation and study.
Jnana: Called the path of knowledge or wisdom, it is the path of yoga that uses the mind to get beyond the mind by asking questions such as, “Who am I?” “What is reality?” and “What is permanent and unchanging?
Bhakti: The path of love and devotion focuses on devotion to and concentration on the guru or chosen deity and often includes chanting.
Karma: In the yogic system of action and service, everything (including the yoga postures) is done with the mind centered on the divine; activities are done selflessly for the greater good.
Tantra: The path of ritual, it’s based on the principle of consciously embracing the whole of life to unite with deity. It uses the energies of the body— including sexual—to transcend worldly attachments.
There also are many contemporary styles of yoga, most of which are variations of hatha yoga. All yoga styles seek balance of body, mind and spirit, but they may differ in how the asanas are done and in other ways, such as the focus on postures, alignment, flow of movement or breathing. Some may be designed to suit particular groups, such as pregnant women or older people, while others may use props or vary temperature.
Many websites offer detailed descriptions of the styles available;Â lists nearly two dozen traditional styles, 42 contemporary styles, and 10 others. The site takes an objective and instructive approach to yoga and may be a good place for beginners to start.
Do your research and visit some classes if possible to decide which style and teacher best suits your needs. A few examples of some of the more popular modern yoga styles are:
Ananda: Emphasizes meditation through breath awareness, affirmations and yoga postures. Its distinct feature is the use of affirmations while in the postures.
Anusara: Means “following your heart” and respects each student’s abilities and limitations. It integrates the celebration of the heart, principles of alignment and balanced energetic actions in performance of the postures.
Ashtanga: Sometimes known in the United States as power yoga. It’s a fast-paced, physically demanding series of postures designed to create heat and energy flow.
Bikram: Sometimes known as hot yoga. This form consists of a series of 26 postures and two breathing exercises performed vigorously in a studio heated to 105 degrees with 40 percent humidity.
Forrest: Intense long-held poses designed to develop skills in awakening the senses. It uses heat, deep breathing and vigorous sequences to sweat out toxins, while also focusing on strengthening and centering your core.
Integral: Focuses on the healing power of relaxation. This form emphasizes control of breath and meditation almost as much as the postures.
Iyengar: Uses props such as straps, blankets, wooden blocks and chairs to achieve postures that focus on symmetry and alignment. Poses are usually held longer than in most other yoga styles.
Jivamukti: Uses vigorous poses in a flowing series while incorporating a variety of ancient and modern spiritual teachings. Classes provide a “yoga education” with chanting, meditation, readings, music and affirmations.
Kripalu: Emphasizes proper breath, alignment, coordinating breath and movement and honoring the body’s wisdom. It involves three stages, the final one being surrendering to the body’s wisdom, by which time the student should be able to do the postures spontaneously and unconsciously.
Kundalini: Designed to awaken kundalini energy, which is stored at the base of the spine and is often depicted as a coiled snake. The emphasis is on chanting and breathing, rather than postures.
Sivananda: Takes a gentle approach that includes postures, chanting, meditation and deep relaxation in each session. Students are encouraged to lead a healthy lifestyle that includes a vegetarian diet.
TriYoga: A systematic flowing yoga with an emphasis on the wave-like movement through the spine and on maintaining alignment through meditative transitions. Practices include basics through advanced asana, pranayama and meditation techniques.
Viniyoga: A gentle flowing form of yoga that emphasizes coordinating breath with movement. It is often used with beginners and in therapeutic settings.
Vinyasa: A general term referring to many styles of yoga that use a series of flowing postures combined with rhythmic breathing for an intense body-mind workout. It doesn’t adhere to a specific sequence of poses, but is usually based on a series of postures that together are known as sun salutations.
Is It Right For You?
Yoga is both gentle enough and athletic enough to appeal to many people. The beauty of yoga is that you don’t have to be able to do all the positions; you can work within your own limitations and tailor your practice to your specific needs.
If you decide to try yoga, finding a teacher won’t be hard. Classes are available through recreation centers, senior centers, YMCAs, YWCAs, hospitals, health centers, community centers, meditation centers and dedicated yoga studios. Many classes are relatively inexpensive—they may even be free with your membership at a gym, community center, etc. And check your health plan; some insurance companies cover the cost of classes.
Ask your regular health care professional for suggestions. He or she may know of a yoga class that meets your particular needs. There are also resources on the Web for finding classes, including  and the Yoga Journal online directory at
You can take individual lessons, too, but they will be more costly. Whether you decide to learn in a class or one-on-one, try to do so in person. Books, tapes and DVDs abound, but ideally, they should supplement what you learn from class, and they can help you as you establish your practice at home.
Before your first class, consider sitting in on a session, if this is permitted. Would you be comfortable in the class with this teacher? Is the pacing right for you? Make sure you find a class and teacher that feel right for you. If you have a particular medical condition, make sure the instructor has experience dealing with other folks in your situation. And once you find a teacher you like, be sure you tell him or her about any health problems.
Be advised, however, that there’s no licensing requirement to teach yoga, and many teachers may have done little more than complete a weekend training or correspondence course. If a yoga teacher is untrained, you may be at a higher risk of sustaining an injury in his or her class. A teacher-organized group called Yoga Alliance  recommends 200 to 500 hours of expert training. Teachers who complete the recommended training can register with the Yoga Alliance, which provides an online directory of teachers. If you have a special need, the International Association of Yoga Therapists can help you find a specialist.
Health Benefits
Yoga’s most obvious benefits relate to stress reduction, flexibility and relaxation. But as more studies are conducted, there is evidence of other tangible health benefits. While it’s no cure, yoga can be an effective adjunct therapy for a variety of conditions, including cancer, heart disease, arthritis, asthma, diabetes, depression, fibromyalgiaand migraines. Even if you are in perfect health, you can benefit from yoga. It improves strength, flexibility, coordination and range of motion. And since yoga promotes relaxation, improves circulation and reduces stress and anxiety, it enhancescardiovascular health and benefits the respiratory and nervous systems. Because it promotes relaxation, yoga also aids sleep and digestion.
Yoga can make you more aware of your own body—more conscious of its strengths, weaknesses and needs.
Medical experts aren’t exactly sure why yoga offers so many health benefits, but more studies are under way. Some of its physiological effects can be attributed to stress reduction and relaxation; since many health problems are triggered or aggravated by stress, stress-reduction can only help. And when you do yoga, especially meditation and breathing exercises, you often induce what is known as the relaxation-response, a stress-neutralizing physiological state that boasts a wide range of physical and mental benefits.
Yoga requires no special equipment or clothes, though an inexpensive yoga mat may help provide cushion and grip. You can do the exercises at home or at the office. If you have limited mobility, you can even do them from a chair or bed.
Here’s a look at how yoga can improve some specific conditions affecting women. As always, consult with your health care professional before beginning any new exercise program.
Arthritis and fibromyalgia. Yoga may ease the pain associated with these conditions, and there are classes designed specifically for people with arthritis or fibromyalgia. Few studies have been done, but anecdotal evidence indicates that arthritis sufferers find relief from yoga. A Stanford University study suggests that mind-body techniques (including yoga) are effective complementary therapies for musculoskeletal disorders, including osteoarthritis. For both arthritis and fibromyalgia, the stretching can temporarily relieve stiff joints, improve flexibility and circulation and stimulate the release of endorphins. The deep breathing and meditative aspects can help you deal with the stress of illness, especially something as frustrating as fibromyalgia.
Asthma. The breathing exercises that are an integral part of yoga seem to give some people an element of control over their breathing, thus reducing the symptoms of asthma. It also strengthens the respiratory system.
Back pain. Yoga can provide temporary relief from back pain. It can also help you avoid certain kinds of back pain by making your back and abdominal muscles stronger. Yoga stretches and strengthens back muscles; yoga and physical therapyuse some similar movements. Some postures strengthen abdominal muscles, which help support the back. Moreover, through regular practice, yoga will help you learn to spot potential trouble spots. For instance, you may be able to identify tense muscles and relax them before they become tight and sore. Alignment yoga can help realign posture, diminishing the chance of reinjury both in yoga classes and in daily life. It can also offer relief from nerve compression, which can cause back pain and sciatica.
Carpal tunnel syndrome. Research indicates that yoga is an effective treatment for this repetitive stress injury. One study, reported in the Journal of the American Medical Association, revealed that carpal tunnel sufferers who regularly attended yoga classes experienced less pain, greater flexibility and a stronger grip than those who used the usual treatment, a wrist splint.
Endometriosis. Yoga, like some other relaxation and meditative techniques, seems to provide some women with relief from the pain associated with endometriosis.
Epilepsy. Some studies suggest that yoga may help patients manage epilepsy. It may come down to stress reduction; stress can be a precipitating factor for some seizures, and yoga promotes relaxation and stress reduction. But researchers haven’t drawn any conclusions yet, contending that more studies are needed.
Chronic pain. Yoga and other relaxation techniques have been shown to help reducechronic pain. They are especially effective for chronic headache and muscle tension.
Diabetes. Yoga is well suited for diabetics in that it improves circulation and promotes a regular exercise regimen.
Heart/coronary artery disease. Yoga improves circulation and, as a stress-reducing or stress-management technique, it may play a role in halting or reversing heart disease. Health care professionals often recommend yoga or something similar for their heart patients.
High blood pressure. Evidence suggests that yoga reduces stress and increases relaxation, which may have a favorable effect on blood pressure rates. And there are studies suggesting that yoga may be effective in controlling hypertension, but more research needs to be done.
Menopause. Yogic breathing techniques seem to help some women reduce hot flashes and other symptoms. And according to the American Yoga Association, some yogic exercises stimulate the glandular and reproductive systems, helping balance body chemistry.
Insomnia. According to the National Institutes of Health, relaxation therapies and physical exercise, including yoga, can help alleviate insomnia.
Multiple sclerosis. Yoga may help women with MS to increase physical functioning. Some chapters of the National Multiple Sclerosis Society offer yoga classes, and there are specialists in yoga for MS around the country.
Osteoporosis. Since yoga is a low-to-no-impact exercise, some of the gentler postures may be appropriate even if you already have the condition; yoga may help lessen the pain associated with osteoporosis. Certain poses that position part of the body’s weight on the hands may also aid in retaining bone density in the upper extremities and spine. Care must be taken, however, to avoid excessive pressure or range of motion, such as spinal extension. Each woman’s condition varies.
Premenstrual syndrome and menstrual cramps. Yoga, when practiced regularly, can reduce symptoms of severe PMS, including anxiety and depression in some women. Some postures can reduce pressure on the uterus, relieving cramps, and yoga’s gentle stretching can ease stiffness and tension in the lower back. According to the American Yoga Association, irritability, depression and moodiness can be eased by regular meditation, which is a part of many yogic practices. The association also explains that some yogic exercises stimulate the glandular and reproductive systems, helping balance body chemistry. And, of course, a regular exercise program of any sort helps lessen the severity of cramps for many women.
Pregnancy. Prenatal yoga classes are generally gentler than regular classes, and there’s a greater focus on breathing and relaxation. Mild-to-moderate exercise during pregnancy is important for both you and your baby, and yoga’s gentle, relaxing movements may be ideal. And it can help you deal better with the stress associated with pregnancy. Consider looking for a course designed for pregnant women, and talk to your health care professional before starting any exercise program. Some methods and teachers caution that women who are pregnant or breastfeeding focus on breathing and meditation exercises rather than the more strenuous yoga poses, particularly cautioning against inverted poses for pregnant women. However, many serious yoga schools offer women’s classes with modified, supported poses that may bring strength, confidence, rest and relief to pregnant and nursing women. Yoga Alliance requires at least 85 hours of specialized training for prenatal yoga instructors.

Treatment

If you have a medical condition for which you are receiving treatment, yoga should be considered an additional therapy, not a replacement. Talk to your health care professional if you have arthritis, multiple sclerosis, fibromyalgia or other serious medical conditions. Many places offer special classes designed just for people with these conditions.
Even if you don’t need a specialized class, you need to be aware of certain warnings before starting a class. For instance, high blood pressure, glaucoma or a history of retinal detachment or heart disease may mean that you should not perform certain exercises or positions (the ones that turn you upside down, like a handstand). Again, talk to your health care professional first.
For the vast majority of women, yoga is an ideal way to improve overall health. It requires little advance preparation, so once you find a class, you can jump right in.
What To Expect
Wait at least two hours after eating before starting your yoga workout. Don’t worry about the “proper” outfit. Wear something comfortable that will allow you to move—leotards or yoga pants are good choices, but you can wear a T-shirt and shorts, too. Some instructors may not want you to wear baggy clothes because they want to be able to watch your form as you practice the postures. Also, baggy tops tend to fall up over the head during semi-inverted poses. Most people practice yoga in their bare feet.
The session will probably start with gentle warm-up exercises, probably a series of breathing exercises and gentle stretches. From there, the instructor will take you through several postures (asanas). You may hold these positions for a few seconds or a few minutes. Depending on the specific posture, you will start from a seated, standing or prone position.
You may already know some of these movements—for example, the cross-legged seated Lotus position. Others will feel like the shoulder rolls or stretches you may already do. Some will be unfamiliar, though.
Don’t worry if you can’t do each posture perfectly—as long as you keep it safe and mindful, the pose is always perfect. Yoga is about the process itself. You don’t have to do everything the class does. Go at your own pace. Eventually, you will perfect your form. Remember, the point isn’t to push beyond your limits.
During the process, be sure to breathe slowly and deeply from your diaphragm and move gently. Take breaks as often as you like, and never do anything that causes any genuine pain or discomfort.
Most yoga classes will end with a final relaxation or “corpse pose.” There may also be a short meditation.
Classes generally last 60 to 90 minutes, and you may attend class once or several times a week. It’s important to develop a daily practice. This means doing yoga on days you aren’t in class—shoot for about 30 minutes. If that sounds daunting, start with five or 10 minutes and work up. If your schedule doesn’t allow for daily practice, try for four times a week for about 45 minutes.
Aside from your regular practice, you can work on some of the seated postures during the day while at the computer. And you can practice the deep, diaphragm-based breathing techniques anywhere.
The time of day you practice depends not only on your schedule, but on your goals. In the morning, a yoga routine may energize you and prepare you for the day. That’s the preferred time of day for many folks. In the evening, relaxing poses can lead to better sleep.
Many yoga classes offer a gentler workout. While yoga is not like an aerobics class, it will still be challenging. There is a great increase, too, in the number of physically strenuous, faster-paced classes on schedules these days. Regardless of which experience you choose, when you finish, you shouldn’t feel exhausted. You should feel refreshed, relaxed and energized.
There are no negative side effects to yoga, but as with any exercise program, it’s always possible to hurt yourself, especially if you try to explore advanced postures before you are ready. While you are practicing yoga, always listen and respond to what your body is telling you. One of the fundamental concepts in yoga is nonviolence or “ahimsa,” and it begins with the self. This mindfulness will help you reduce the chances of injury, and it’s really at the heart of yoga.
At first, it’s natural to feel a little sore, especially if you haven’t been exercising lately. But if the soreness is severe or persists, talk to your instructor. If you feel pain in your joints, talk to your instructor right away. A reasonable amount of muscle soreness is normal; joint pain is not. If the joint pain persists, talk with your regular health care professional.
It’s always advisable to check with your health care professional before embarking on any exercise program, particularly if you are out of shape, over 65 or have serious health problems. You definitely need to do so if you have high blood pressure, glaucoma, arthritis (particularly rheumatoid arthritis), spinal disk injuries, a history of retinal detachment or heart disease, or if you are pregnant. And be sure to inform the yoga instructor, too. If you have any of these conditions, it may be a good idea to begin your journey with one or more private sessions so you can better understand how to tailor the practice to accommodate your needs.
You may notice that your general health improves as you continue to make yoga a regular part of your life. But no matter how good you feel, don’t stop your regular treatments. Continue to take any prescribed medications until your health care professional advises otherwise.

Facts to Know

Yoga has been practiced in the United States since the late 19th century, but it gained popularity in the 1960s.
According to results of a 2012 survey conducted by Sports Marketing Surveys USA on behalf of Yoga Journal, 20.4 million Americans, or 8.7 percent of U.S. adults, are believed to practice yoga.
Yoga has been proven to reduce stress and anxiety; accordingly, it is often recommended to relieve the pain and anxiety of chronic conditions.
Yoga is thousands of years old. Stone carvings in the Indus Valley depicting yoga positions date back 5,000-plus years.
During your practice, focus on your breathing as well as the positions and stretching of the yogic postures. Breathing is as important a part of yoga as the stretching.
A fundamental tenet of yoga is that the body, mind and spirit are inexorably connected and need to be in a state of balance.
You can work on some of the techniques throughout the day—seated at your desk, in your car, even at the computer.
Since yoga involves weight-bearing postures, the practice is especially beneficial to your musculoskeletal system and may help prevent osteoporosis. It also benefits the organs of the body through the compression and expansion of the abdomen and inversions and rotation of the body in relation to gravity.
Yoga is not a religion, but many of its elements are incorporated into various religious traditions. Practicing yoga won’t interfere with your religious practice—and it might enhance it.
Even within hatha yoga, there are various styles and approaches. When looking for a yoga teacher, it’s helpful to check out different classes to find the one best suited to your needs.

Key Q&A

Is yoga a religion?No. However, it can be part of a religious/spiritual practice.
Is yoga a replacement for conventional treatment?No. You should continue any current medication or treatment program. Yoga can help relieve the symptoms of various conditions, and it’s good for your overall well-being, but it’s not a treatment itself. And remember: If you do have specific health problems, make sure your health care provider knows you are planning to take up yoga.
I’m not that flexible. Can I still practice yoga?Of course! You may want to start with a beginner’s class. Yoga allows you to work at your own pace within your own limitations. No one expects you to be able to do advanced postures right away—or even ever. But the advantage is that yoga will make you stronger and more flexible.
Why does yoga have all these health benefits?Scientists aren’t exactly sure why yoga has physiological benefits, but at least some of its success can be attributed to stress reduction, the relaxation response and the “exercise” element with benefits that parallel other forms of exercise.
I have several books on yoga. Do I really need to take a class?Yoga practitioners generally maintain that the best way to learn is in person. If you are homebound, there are countless books, websites and DVDs available. Just remember that the best and safest way to learn is with a teacher guiding you.
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