OBESITY: DIETARY MODIFICATION AND EXERCISE PATTERN
Prevention of obesity is most desirable and should start from infancy. Three essential principles to be remembered in diet therapy are
1. Adherence to the diet plan
2. Maintenance of the diet and
3. Maintenance of Energy balance
Principles of dietetic management
Low calorie - restricted carbohydrate, restricted fat but with normal protein, vitamins and minerals (except sodium) liberal intake of fluid and high in fibre is given.
Energy: 20 Kcal per Kg ideal body weight is prescribed for a sedentary worker and 25 Kcal for moderately active worker.
Proteins: 0.8 to 1g of protein / kg body weight is prescribed for tissue repair.
Carbohydrates: High carbohydrate content foods like potatoes and rice are restricted. Sugar which gives empty calories should be totally avoided. Fruits rich in carbohydrate like banana should be avoided. To produce a feeling of satiety and regular bowel movements, bulk-producing carbohydrates like green leafy vegetables and fruits are given.
Fat: Low fat or no fat should be given as calories are reduced. Foods rich in fat like nuts and oil seeds are avoided. Skim milk should be given.
Vitamins: With prolonged restriction of fats, there is likely to be a restriction of fat soluble vitamins A and D which may be supplemented.
Minerals: Sodium intake is to be restricted as excess sodium predisposes to retention of fluid.
Fluid: If salt is restricted then fluids can be taken liberally as extra fluids are excreted by the healthy kidneys. A glass of water taken before meals may help to cut down the intake of food.
High fibre: High fibre, low calorie food like green leafy vegetables, fruits, vegetable salads, whole grain cereals and pulses can be included in the diet. The advantages of using high fibre foods are.
1. They are low in calorie.
2. Foods like greens provide vitamins and minerals.
3. High fibre diets give satiety.
4. Help in regulating bowel movements.
5. Reduce blood cholesterol.
1. Soups prepared from vegetables/pulses without the addition of fats or starch should be included in the diet.
2. Salads prepared using raw tomato, cucumber, cabbage, capsicum, radish, lettuce, carrots, sprouted green gram or bengal grams can be included.
3. Root vegetables, like potato, beetroot and carrot should be avoided.
4. High calorie fruits like mangoes, bananas and dry fruits should be avoided.
5. Lean mutton/chicken/fish should be steamed and not fried.
6. Cottage cheese to be used for processed cheese.
7. All fried foods like puries, parathas etc., should be avoided.
8. Avoid concentrated sweets like sugar, honey, ice cream, puddings, chocolate, candy etc.
9. Alcoholic beverages to be avoided.
Management after reduction: During weight reduction and after achieving normal weight, individuals are advised to follow the following instructions for the future control of obesity.
1. Avoid snacks between meals and restrict helping of
2. Cereal products
3. Fried foods and foods to which fat is added liberally for cooking
4. Milk products prepared from cream or butter
7. Decrease consumption of meat and fatty poultry
9. Increase consumption of fruits and vegetables except tubers
10. Increase consumption of fish.
11. Check the weight at least every week on a reliable scale.
12. Daily exercise with the same zeal as during the reducing program.
13. Three regular meals should be taken.
14. Avoid skipping breakfast as it increases food intake during lunch.
Physical Exercise: A low calorie diet accompanied by moderate exercise is effective in causing weight loss. Aerobic exercises for 15-30 minutes in which speed and resistance is constant for eg. in walking, running and swimming can be performed as it directly increase the daily energy expenditure and is useful in long term weight maintenance. Further 50% of glucose and 50% of fat is metabolised to give energy when such exercise are performed. Exercise also preserves lean body mass and prevents the decrease in basal energy expenditure. Anaerobic exercise in which speed and resistance are not constant for eg. climbing stairs uses 100% glucose to give energy and does not use fat. Anaerobic form of exercise is not very effective in weight reduction. Passive exercise devices such as mechanical vibrators are ineffective methods of achieving loss of body fat. Some benefits of regular sustained exercise include
1. Increased work capacity
2. Cardiovascular efficiency
3. Reduction in total fat stores
4. Increased HDL-cholesterol and
5. Improved muscle tone.