loss.

2. Patients with a genetic predisposition to obesity or with a long history of obesity should have their previous exercise history carefully considered before any prescription as to the type of planned physical activity is given.

3. More attention needs to be given to duration, frequency and intensity of physical activity with pre-menopausal women and particularly those with gynoid-form obesity.

4. Greater attention needs to be paid to the combination of diet and physical activity in the case of long term obesity.

5. More emphasis should be placed on energy input in the initial stages of severe obesity with activity limited to incidental activity or weight-supportive exercise.

6. Consideration needs to be given to the different fat loss responses to exercise in post-menopausal compared to premenopausal women, and in android compared to gynoid forms of overfatness.

7. There is a need for greater attention to spontaneous activity in older patients. This tends to decline naturally and may do so even further after the introduction of a planned, daily physical activity session.

8. Different levels of intensity of physical activity may be required for clients with different levels of cardiovascular fitness.

9. It should not be assumed that individuals of equal fatness have equivalent cardiovascular fitness. Prescription needs to be specific to each individual.

10. For programs that are gym or fitness centre based, provision needs to be made for organised physical activity on days when the gym is not used (i.e. making up a total of 6-7 days/week of organised physical activity).

11. It should be recognised that total energy use and substrate utilisation can vary between individuals depending on gender and age. These variables need to be recognised in developing any individualised prescription.

12. It should be recognised that many people over-estimate the amount of physical activity they carry out during the course of a day. Hence, activity diaries, or pedometers or other measurement tools are suggested to keep track of daily efforts.

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2. When assessing the health importance of obesity for an individual, total fat, fat distribution and risk of disease all need to be considered.

3. It is more crucial for abdominally obese people to reduce fat for health reasons than for people with a more gynoid pattern.

4. The primary* location of fat storage in an individual (i.e. upper or lower body) influences not only the health risk but also the degree to which changes can be made in body fat content. Abdominal body fat stores tend to be more mobile than those in the lower body.

5. For this reason, body fat in android-shaped males is likely to be more easily mobilised than in most gynoid-shaped females.

6. Because of possible significant genetic, psychological and metabolic differences, long term cases of severe and morbid obesity should be regarded differently to short term cases of overfatness.

7. Because of hormonal changes, the fat loss response of postmenopausal women may be different to that of younger women and hence fat loss treatments may need to be different.

8. The genetic contribution to overfatness needs to be assessed to help determine the difficulty of the potential fat loss response.

9. Look for and consider less obvious health problems that may be related to excessive overfatness, e.g. bad back, bad knees, poor sleep, all of which may affect the fat loss response.

10. Be sensitive to psycho-social problems and sexual disorders in people who are excessively fat.

11. Accept that there are many factors influencing body fat and body shape that cannot be significantly modified, i.e. genetics, gender, age.

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“I was always thinking about what my next meal would be,” says the 28-year-old Glenwood, Iowa, native. “When I’d go out to eat, I’d try to pick places with the biggest portions or the most courses. I especially liked Quarter Pounders with Cheese, nachos, pizza with extra cheese, and anything with Alfredo sauce.”Always on the hefty side, Kelly couldn’t stop eating—or stop: gaining weight. By Christmas 1997, she had reached 220 pounds. “In a picture with my husband and my two kids, my little 1-year- old looks like a doll in my huge lap,” she recalls. “I thought to myself, ‘I don’t want my children to have a fat, unhealthy mother/”

It was time to change her life.

Using information she gathered from magazine and books by weight-loss guru Richard Simmons, Kelly determined that she would need to trim her daily calorie intake to 1,400 in order to achieve and maintain a healthy weight.

Obviously, that was far fewer calories than she had been consuming. To help herself stay on course, she began keeping a food diary. Kelly would write down every morsel she ate and every drop she drank—usually before she ate or drank it. She also noted the calorie and fat content of each item.

To help herself burn calories, Kelly started using a Health Walker, a nonimpact machine that allows the legs to swing back and forth to simulate striding. At first, she worked out for 15 minutes per session, then gradually built up to an hour a day—a schedule that she still maintains. She also does strength training twice a week, exercises to a kickboxing video, and jumps rope.

In 1 year, Kelly lost 95 pounds. And the weight hasn’t come back. For that, she credits her food diary. “I never really knew how much I was eating until I starting writing it down and reviewing it,” she explains. “Even though I’ve learned what I can eat and how much, I still keep a diary. It’s a good tool for helping me maintain my present weight.”

WINNING ACTION

Keep a diary. Buy a small spiral-bound notebook and carry it with you. Immediately after meals and snacks, write down what you’ve consumed, along with the food’s fat and calorie content. Studies show that people tend to be more true to their diets when they keep a record of what they eat. At first, you’ll probably be amazed at how much—and how often—you eat. Later, you’ll be proud of the positive choices that you’re making.

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