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Weight Management...

INDEX

Chapter 1

Aetiology...11

Chapter 2

How Obesity Measured...16

Chapter 3

Body Fat Distribution...20

Chapter 4

What Causes Obesity...21

Chapter 5

What are the  consequences of obesity... 27

Chapter 6

Weight Management...51

Chapter 7

Our Weight loss treatment by alternative ways...62

Chapter 8

What is R.M.R or B.M.R...66

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Chapter 9

Green Tea...73

Chapter 10

Brewing & Serving Green Tea...77

Chapter 11

Green tea & Weight  loss...79

Chapter 12

Green Tea; Fat Fighter...81

Chapter 13

Weight  Maintenance after

Reduction...84

Chapter 14

Success Stories 101

Chapter 15

Variety of green tea...104

Chapter 16

Scientific Study about green tea..120

Chapter 17

Obesity In Children...131

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Chapter 18

Treatment For  Child Obesity...134

Chapter 19

Obesity & Type 2 Diabetes ...139

Chapter 20

Obesity & Metabolic Syndrome...142

Chapter 21

Obesity Polycystic  ovary

Syndrome...143

Chapter 22

Obesity &

Reproduction/Sexuality...144

Chapter 23

Obesity & Thyroid Condition... 146

Chapter 24

Hormonal Imbalance ...148

Chapter 25

Salt & Obesity...156

Company Profile & Dr.Pratayksha

Introduction...161

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About us

We are an emerging health care & slimming center established in 2006. We have achieved tremendous success in

the field of curing disorders like obesity,

Blood Pressure, All type of Skin

disorders and Diabetes with

Homeopathic medical science.

The foundation of the centr was laid by

Dr.PrataykshaBhardwaj, His work has been recognised by many Indian and international organizations in the field of skin care & slimming.

Shree Skin Care was earlier founded by

Smt. S. L. Bhardwaj in 1983. She is a beauty therapist and has broken all the barriers in her profession. She has achieved the milestone of 25 years in this hygienic profession. She specially diagnoses skin problems like pimples, acne, black heads, blemish marks & other general skin

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Diseases.

On other side she is a social worker. She

is active life member of Indian Red

Cross Society from last five years.She also conducts camps for skin care from time to time and educate people about skin care.

We are unique in terms that we have incorporated traditional homeopathy medical science with the modern

diagnostic approach. We make it sure  that we provide treatments which are

effective, natural but without any

slightest side effects.

Our goal has been to keep you in the best of your health so that you can be ready for whatever life has to offer.

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We have achieved tremendous results in

slimming like 12 Kgs. in period of 25  days and losing 5 kgs. in 20 days have

become our benchmark and that too

with completely natural methods and

exercises & no side effects.

We deliver results and are committed to

our work. We understand how

important good health is.Our motto is "

The Patient First"

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Why I, chose

obesity as a subject

I, myself is the biggest example of success of our weight loss program. I had tried everything including gymn, dieting, exercising and all possible ways of weight loss available to me but nothing seemed to work. Then I studied and created this

unique method which helped me to lose 23

Kgs. weight in just 6 months

when I was myself treading on hard in life  to loose weight i was facing lack of proper

resources & ways of reduction. Tired of

non-effective ways of gyms and others  around I became hopeless that I would be

able to lose weight ever. Then gave it a

fresh start with my own natural & herbal  ways along with active exercise and proper

diet control. The results were terrific. My

weight loss was the major inspiration for

me to open up this venture & I got  dedicated to make people loose their extra

& unwanted weight."

"Thinking that when I can lose weight why

can't  I help others suffering from same  disorder. I started with a single room of my

mother's beauty clinic. Today I am able to

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put smile on distressed & cynical faces

suffering with obesity."

"Tried in my own way to usher in the  mantra of "Look Good & Feel Great".

Nothing gave me a bigger high than to see the glow on a patient's face who, acouple of months ago came to me dejected and with no confidence. My dedicated staff helps the members to recreate that persona. With this idea I have set up this institute with the help of my mom. Thereby me and all my team members welcome you to Shree Skin

Care & Slimming Center, Yamuna Nagar with a humble hope that we can once again bring back smiles & confidence in one & all. Thanks a lot."

Conservative management of body

weight...

It refers to the disliking of body weight

The conservative management of obesity

has three main goals:

  a mildly hypocaloric diet

  increased exercise

  behaviour modification

general strategies to help people achieve

and maintain a healthy weight

  Diet

o  base meals on starchy foods such

as potatoes, bread, rice and pasta,

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choosing wholegrain where

possible

o  eat plenty of fibre-rich foods  such as oats, beans, peas, lentils,

grains, seeds, fruit and vegetables,

as well as wholegrain bread, and

brown rice and pasta

o  eat at least five portions of a

variety of fruit and vegetables  each day, in place of foods higher

in fat and calories

o  eat a low-fat diet and avoid

increasing your fat and/or calorie

intake

o  eat as little as possible of: - fried

foods- drinks and confectionery

high in added sugars- other food  and drinks high in fat and sugar,  such as some take-away and fast

foods

o  eat breakfast

o  watch the portion size of meals

and snacks, and how often you

are eating

o  for adults, minimise the calories

you take in from  alcohol

  Activity

o  make enjoyable activities  - such

as walking, cycling, swimming,

aerobics and gardening  - part of

everyday life

o  minimise sedentary activities,

such as sitting for long periods

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watching television, at a

computer or playing video games

o  build  activity into the working

day  - for example, take the stairs  instead of the lift, take a walk at

lunchtime

weight loss programmes  are recommended

only if they:

o  are based on a balanced healthy

diet

o  encourage regular physical

activity

o  expect people to lose  no more

than 0.5-1 kg (1 -2 lb) a week

  programmes that do not meet these

criteria are unlikely to help people

maintain a healthy weight in the long

term

  people with certain medical conditions

- such as type 2 diabetes, heart failure

or uncontrolled hypertension or

angina  - should check with their  general practice or hospital specialist

before starting a weight loss

programme.

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Chapter 1

Aetiology

Energy balance is a fundamental principle of physics that regulate weight gain and loss. An organism will stock fat when absorbing more energy through feeding than what it consumed by physical activity and its basal metabolism.The opposite is also true: reducing calorie intake and increasing physical activity creates a negative balance that translates into weight loss.

Even when admitting that the main cause of obesity is an inadequacy between energy intake and expenditure, there remains a lot to be learned in order to properly manage the epidemic. Research is barely shedding light on the mysteries of this complex disorder. In Canada, between 1981 to 2004, daily calorie intake got up of 17%, that is

381 calories per day.

The theory may sound simple, but reaching and maintaining a healthy weight remains difficult in the present environment.  Research on the influence of physiological, behavioural and environmental factors on

energy balance is essential to the

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development and implementation of

effective prevention and treatment

programmes.

Despite significant recent advancements made towards unraveling the complexity of obesity, there still remain a large number of unanswered questions. The available data suggest that multiple systems regulate energy homeostasis. Familial clustering and the high concordance of body weight among monozygotic twins provide strong evidence for a genetic component to human obesity and a number of genes associated with human obesity have been identified. Research must advance knowledge  within and across these domains in order to understand the interactions of

known homeostatic mechanisms, recognize

new ones, and place these into the context

of the human-environment interface.

The obesity epidemic did not occur overnight. Obesity and overweight are chronic conditions. Overall there are a

variety of factors that play a role in obesity.

This makes it a complex health issue to

address.

  Overweight and obesity result from an

energy imbalance. This involves eating

too many calories and not getting

enough physical activity.

  Body weight is the result of genes,

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metabolism, behavior, environment,

culture, and socioeconomic status.

  Behavior and environment play a large

role causing people to be overweight

and obese. These are the greatest areas

for prevention and treatment actions.

Overweight and obesity are a result of energy imbalance over a long period of time. The cause of energy imbalance for each individual may be due to a combination of several factors. Individual

behaviors, environmental  factors, and  genetics all contribute to the complexity of

the obesity epidemic.

Oesity has reached epidemic proportions in

India in the 21st century, with morbid obesity affecting 5% of the country's population. India is following a trend of other developing countries that are steadily becoming more obese. Unhealthy, processed food has become much more accessible following India's  continued integration in global food markets. Indians are genetically susceptible to weight accumulation especially around the waist.

While studying 22 different SNPs near to

MC4R gene, scientists have identified a

SNP (single nucleotide polymorphism)

named rs12970134 to be mostly associated

with waist circumference

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States  Male

Male Female Female

s (%)  s rank  s (%)  s rank

India  12.1  14   16   15

P)u)n)j)a)b)  30.3  1 Kerala  24.3  2

37.5   1

34    2

Goa   20.8  3   27    3

Tamil

Nadu  19.8  4   24.4   4

Andhra

Pradesh  17.6  5   22.7   10

Sikkim  17.3  6   21    8

Mizoram  16.9  7   20.3   17

Himachal

Pradesh  16   8   19.5   12

Maharashtr 15.9  9

a

18.1   13

Gujarat  15.4  10   17.7

Haryana  14.4  11   17.6 Karnataka  14  12  17.3

7

6

9

Manipur  13.4  13

Uttarakhand   11.4  15

17.1   11

14.8   14

Arunachal

Pradesh  10.6  16   12.5   19

Uttar

Pradesh  9.9  17   12   18

Jammu and

Kashmir  8.7  18   11.1   5

Bihar   8.5  19   10.5   29

Nagaland  8.4  20   10.2   22

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Weight Management...

States  Male

Male Female Female

s (%)  s rank  s (%)  s rank

Rajasthan  8.4  20 Meghalaya  8.2  22

Orissa   6.9  23

9    20

8.9   26

8.6   25

Assam   6.7  24   7.8   21

Chattisgarh  6.5  25   7.6   27

West

Bengal  6.1  26

Madhya

Pradesh  5.4  27

7.1   16

6.7   23

Jharkhand  5.3  28

Tripura  5.2  29

5.9   28

5.3   24

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Chapter 3

How Obesity Measured

Measuring the exact amount of a person's body fat is not easy. The most accurate measures are to weigh a person underwater or in a chamber that uses air displacement to measure body volume, or to use an X-ray test called Dual Energy X-ray

Absorptiometry, also known as DEXA.

These methods are not practical for the average person, and are done only in research centers with special equipment.

There are simpler methods to estimate body fat. One is to measure the thickness of the layer of fat just under the skin in several parts of the body. Another involves sending a harmless amount of electricity through a person's body. Results from these methods, however, can be inaccurate if done by an inexperienced person or on someone with extreme obesity.

Because measuring a person's body fat is difficult, health care professionals often rely on other means to diagnose obesity.  Weight-for-height tables, used for decades, have a range of acceptable weights for a person of a given height. One problem with these tables is that there are many versions, all with different weight ranges. Another

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problem is that they do not distinguish  between excess fat and muscle. According  to the tables, a very muscular person may  be classified obese when he or she is not.

The Body Mass Index (BMI) is less likely to misidentify a person's appropriate weight-for-height range.

B.M.I.

The BMI is a tool used to assess overweight and obesity and monitor changes in body weight. Like the weight-for-height tables,

BMI has its limitations because it does not

measure body fat or muscle directly. It is  calculated by dividing a person's weight in

pounds by height in inches squared and

multiplied by 703.

Men and women can have the same BMI but different body fat percentages. As a rule, women usually have more body fat than men. A bodybuilder with a large muscle mass and low percentage of body fat may have the same BMI as a person who has more body fat. However, a BMI of

30 or higher usually indicates excess body fat

.  Table 1: Body Mass Index

B.M.I. =weight / Height in cm2

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You can use the above table to determine

your BMI. Find your height in the left-hand

column labeled "Height." Move across to

your weight. The number at the top of the

column is the BMI for that height and

weight. Pounds have been rounded off.

A BMI of 25 to 29.9 is considered

overweight. A person with a BMI of 30 or

higher is considered obese. Please review  your findings with your health care provider  if your BMI is outside of the normal range.

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Chapter 4

Body  Fat Distribution

Health care professionals are concerned not only with how much fat a person has, but also where the fat is located on the body.  Women typically collect fat in their hips and buttocks, giving them a "pear" shape. Men usually build up fat around their bellies, giving them more of an "apple" shape. Of

course, some men are pear-shaped and

some women become apple-shaped,

especially after menopause.

Excess abdominal fat is an important, independent risk factor for disease.

Research has shown that waist

circumference is directly associated with

abdominal fat and can be used in the

assessment of the risks associated with

obesity or  overweight. If you carry fat

mainly around your waist, you are more

likely to develop obesity-related health

problems.

Women with a waist measurement of

more than 35 inches and men with a

waist measurement of more than 40

inches may have more health risks  than  people with lower waist measurements

because of their body fat distribution.

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Chapter 5

What  causes obesity

Obesity occurs when a person consumes more calories from food than he or she

burns. Our bodies need calories to sustain  life and be physically  active, but to maintain

weight we need to balance the energy we

eat with the energy we use. When a person  eats more calories than he or she burns, the  energy balance is tipped toward weight gain

and obesity. This imbalance between  calories-in and calories -out may differ from

one person to another. Genetic,

environmental, and other factors may all

play a part.

Genetic Factors

Obesity tends to run in families, suggesting a genetic cause. However, families also share diet and lifestyle habits that may contribute to obesity. Separating genetic from other influences on obesity is often difficult. Even so, science does show a link between obesity and heredity.

Environmental and Social Factors

Environment strongly influences obesity.  Consider that most people in the United  States alive today were also alive in 1980, when obesity rates were lower. Since this

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time, our genetic make-up has not changed,

but our environment has.

Environment includes lifestyle  behaviourssuch as what a person eats and his or her level of physical activity. Too often

Americans eat  out, consume large meals

and high-fat foods, and put taste and  convenience ahead of nutrition. Also, most

people in the United States do not get

enough physical activity.

Environment also includes the world

around us—our access to places to walk

and healthy foods, for example. Today,  more people drive long distances to work  instead of walking, live in  neighbourhoods

without sidewalks, tend to eat out or get

"take out" instead of cooking, or have  vending machines with high-calorie, highfat snacks at their workplace. Our

environment often does not support

healthy habits.

In addition, social factors including poverty

and a lower level of education have been

linked to obesity. One reason for this may

be that high-calorie processed foods cost  less and are easier to find and prepare than

healthier foods, such as fresh vegetables

and fruits. Other reasons may include  inadequate access to safe recreation places

or the cost of gym memberships, limiting

opportunities  for physical activity.

However, the link between low

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socioeconomic status and obesity has not  been conclusively established, and recent

research shows that obesity is also

increasing among high-income groups.

Cultural Factors

An individual's cultural  background may also play a role in his or her weight. For instance, foods specific to certain cultures that are prepared with a lot of fat or salt may hamper one's weight-loss efforts.

Similarly, family gatherings offering large amounts of food may make it difficult to pay attention to proper portion control and serving sizes. Lastly, research has shown that individuals originally from countries other than the United States have difficulty adjusting to the calorie-rich foods offered here. These individuals  may not be able to prepare food with the ingredients they would use in their native countries.

Although you cannot change your genetic makeup, you can work on changing your eating habits, levels of physical activity, and other environmental factors. Try these ideas:

  Learn to choose sensible portions of

nutritious meals that are lower in fat.

  Learn healthier ways to make your

favorite foods.

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  Learn to recognize and control  environmental cues (like inviting smells or  a package of cookies on the counter) that

make you want to eat when you are not

hungry.

  Have a healthy snack an hour or two

before a social gathering to prevent  overeating. Mingle and talk between bites

to prevent eating too much too quickly.

  Engage in at least 30 minutes of

moderate-intensity physical activity (like

brisk walking) on most, preferably all,

days of the week.

  Take a walk instead of watching

television.

  Eat meals and snacks at a table, not in

front of the TV.

  Pay attention to why you are eating.  Determine if you are eating because you

are actually hungry or because you are

bored, depressed, or lonely.

  Keep records of your food intake and

physical activity.

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Other Causes of Obesity

Some illnesses may lead to or are associated with weight gain or obesity. These include:

  Hypothyroidism, a condition in which the

thyroid gland fails to produce enough

thyroid hormone. It often results in

lowered metabolic rate and loss of vigor.

  Cushing's syndrome, a hormonal disorder

caused by prolonged exposure of the

body's tissues to high levels of the

hormone cortisol. Symptoms vary, but

most people have upper body obesity,

rounded face, increased fat around the

neck, and thinning arms and legs.

  Polycystic ovary syndrome, a condition

characterized by high levels of androgens

(male hormone), irregular  or missed

menstrual cycles, and in some cases,

multiple small cysts in the ovaries. Cysts

are fluid-filled sacs.

A doctor can tell whether there are

underlying medical conditions that are

causing weight gain or making weight loss

difficult.

Lack of sleep may also contribute to obesity. Recent studies suggest that people with sleep problems may gain weight over time. On the other hand, obesity may contribute to sleep problems due to medical conditions such as sleep apnea, where a

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person briefly stops breathing at multiple

times during the night. Certain drugs such  as steroids, some antidepressants, and some

medications for psychiatric conditions or

seizure disorders may cause weight gain.  These drugs may slow the rate at which the

body burns calories, stimulate appetite, or

cause the body to hold on to extra water.

Be sure your doctor knows all the  medications you are taking (including over-thecounter medications and dietary supplements). He or  she may recommend a different medication that has

less effect on weight gain.

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Chapter 3

What are the consequences of

obesity

Health Risks

Obesity is more than a cosmetic problem.  Many serious medical conditions have been linked to obesity, including type 2 diabetes, heart disease, high blood pressure, and stroke. Obesity is also linked to higher rates of certain types of cancer. Men who are considered obese are more likely than nonobese men to develop cancer of the colon, rectum, or prostate. Women who are considered obese are more likely than nonobese women to develop cancer of the gallbladder, uterus, cervix, or ovaries.  Esophageal cancer has also been associated with obesity.

Other diseases and health problems linked to obesity include:

  Gallbladder disease and gallstones.

  Fatty liver disease (also called

nonalcoholicsteatohepatitis or NASH).

  Gastroesophagealreflux, or what is

sometimes called GERD. This problem

occurs when the lower  oesophageal

sphincter does not close properly and

stomach contents leak back—or reflux—

into the  oesophagus.

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  Osteoarthritis, a disease in which the

joints deteriorate. This is possibly the

result of excess weight on the joints.

  Gout, another disease affecting the joints.

  Pulmonary (breathing) problems,

including sleep apnea, which causes  a

person to stop breathing for a short time

during sleep.

  Reproductive problems in women,

including menstrual irregularities and

infertility.

Health care professionals generally agree that the more obese a person is, the more likely he or she is to develop health problems.

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Psychological and Social Effects

Emotional suffering may be one of the most painful parts of obesity. American society emphasizes physical appearance and often equates attractiveness with slimness, especially for women. Such  messages may make people considered overweight feel unattractive.

Many people think that individuals who are considered obese are gluttonous, lazy, or both. This is not true. As a result, people who are considered obese often face

prejudice or discrimination in the job  market, at school, and in social situations.  Feelings of rejection, shame, or depression

may occur.

Body fat and metabolic syndrome

The metabolic syndrome is a constellation

of metabolic risk factors that consist of the

following

Atherogenicdyslipidemia [serum elevations    of   triglycerides, apolipoprotein B (apo B), and small   low-density   lipoprotein  (LDL) particles plus low high-density   lipoprotein    (HDL) cholesterol]

Elevated blood pressure

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Elevated glucose associated with insulin resistance

Prothrombotic state

Proinflammatory state

Many of these factors can be identified through special testing but are not measured in clinical practice. Recently the  National Cholesterol Education Program  Adult Treatment Panel III report proposed

a simple scheme for the routine diagnosis  of metabolic syndrome. According to this  scheme, a diagnosis of metabolic syndrome  can be made if a person has three of the  following five features:

Increased waist circumference

(≥102 cm in men and ≥ 88 cm in

women)

Elevated   triglycerides   (≥150 mg/dl)

Reduced HDL cholesterol (<40 mg/dl in men and < 50 mg/dl in women)

Elevated    blood    pressure  (≥130/85 mm Hg or on treatment for hypertension)

Elevated glucose (≥100 mg/dl)

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When the waist circumference is 102 cm or

more in men or 88 cm or more in women,  the term abdominal obesity can be applied.  The advantage of measuring waist  circumference is that an excess abdominal

fat is correlated more closely with the  presence of metabolic risk factors than total  body fat. The cut points for defining  abdominal obesity are arbitrary. For  susceptible individuals, lesser accumulations  of abdominal fat can precipitate or  aggravate metabolic risk factors. This is  particularly so in certain populations; for  example, in Asian populations lower waist  circumference cut points have been  identified to define abdominal obesity.

Patients with diabetes (fasting glucose ≥  126 mg/dl) are said to have the metabolic syndrome if two other features are present.  If a person qualifies for the metabolic

syndrome under Adult Treatment Panel III

criteria, measurement of a 2-h postprandial  glucose may uncover a diagnosis of diabetes  (2-h glucose ≥ 200 mg/dl) or impaired  glucose tolerance (IGT) (2-h glucose 140– 199 mg/dl) (The presence of IGT indicates  an increased risk for type 2 diabetes  Additional testing can provide confirmation  of the metabolic syndrome. Confirmatory

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biomarkers for this syndrome include high  levels of fasting insulin, 2-h postprandial  insulin, apo B, increased small LDL  particles,   C-reactive  protein   (CRP),  fibrinogen, and plasminogen activator  inhibitor (PAI) -1. The clinical utility of  detecting these additional abnormalities  beyond confirmation of the syndrome is  uncertain, although investigations are  underway to evaluate potential utility.  For  example, the presence of elevated CRP may  indicate a greater risk for acute coronary  syndromes

A disputed area in the relation of obesity and metabolic syndrome concerns the role of insulin resistance. Most persons with multiple metabolic risk factors are insulin resistant. This observation led to the

concept that insulin resistance is the cause  of the metabolic syndrome  .This concept in  turn generated an alternative term for the  metabolic syndrome, namely the insulin  resistance  syndrome.  Various pathogenic  schemes have been proposed to explain the  connection between insulin resistance and

metabolic risk factors. There is no doubt

that insulin resistance is a risk factor for

IGT and type 2 diabetes. A causal relationship between insulin resistance and

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other metabolic risk factors is less certain.

Moreover, the interaction between obesity and defects in insulin signaling is so complex that it is so far not possible to disentangle the two. For example, obesity causes insulin resistance, whereas insulin resistance seemingly exacerbates the adverse effects of obesity. A strong case can be made for a role of genetic forms of insulin resistance being a contributor to the metabolic syndrome in the general population. On the other hand, there is little doubt that increasing prevalence of overweight/obesity is mainly responsible to the rising prevalence of the metabolic syndrome in the United States and worldwide

Our understanding of the relation between obesity and metabolic risk factors is growing rapidly. This understanding is based on the discovery of multiple products released from adipocytes. In the presence of obesity, these products are released in abnormal amounts. Each of these products has been implicated in the causation of one or another of the metabolic risk factors.

The following is a list of the factors most implicated in the development of metabolic syndrome

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Nonesterified fatty acids (NEFAs)

Inflammatory cytokines

PAI-1

Adiponectin

Leptin

Resistin

Current concepts of the relation of  each of these products to metabolic risk factors can be reviewed.

Previous SectionNext Section

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NEFA.

Obese persons release increased amounts

of NEFAs into the circulation.  NEFAs are

derived by lipolysis of adipose tissue  triglycerides. The greater the amount of fat  in adipose tissue, the more the amounts of  NEFAs released will be. This greater release  of NEFAs proceeds despite the higher  insulin levels that are present in obese  persons. Even though high  insulin levels  suppress adipose tissue lipolysis, they  cannot reduce NEFA release to normal in

obesity. NEFAs are the primary source of  nutrient energy in the fasting state. With  obesity, however, NEFA flux exceeds tissue  needs, and defense mechanisms must come  into play. The consequences of these  defense    mechanisms    undoubtedly  contribute to metabolic risk factors.

Excessive influx of NEFAs into muscle

leads to insulin resistance. The mechanisms

whereby increased fatty acids in muscle  cause insulin resistance have not been fully

elucidated. Randle  et al. early postulated that  excess fatty acids inhibit glucose oxidation  (glucose-fatty acid cycle). Recent research  suggests that muscle levels of diacylglycerol  are raised, which stimulates the serine

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phosphorylation of the insulin receptors  and thereby inhibits normal insulin  signaling. Other mechanisms have been  proposed and may play a role. The resulting  insulin resistance in muscle predisposes to  hyperglycemia; the latter becomes clinically  manifest in those persons to acquire a  defect in insulin secretory capacity.

Influx of excess NEFAs into the liver

increases the triglyceride content of the  liver (fatty liver) .Fat accumulation in the  liver seemingly produces insulin resistance  as it does in muscle. Reduction in insulin

action in liver allows for enhanced

glyconeogenesis and increased hepatic  glucose output; this will accentuate  hyperglycemia in those patients who have  reduced   insulin   secretory   capacity.  Increased fat in the liver also promotes  development of atherogenicdyslipidemia. It  provides a stimulus for increased formation  and secretion of very LDL (VLDL)  particles. The result is higher serum levels  of triglyceride, apo B, and small LDL  particles. High serum triglycerides reduce  HDL-cholesterol concentrations through  exchange of VLDL triglycerides with HDL  cholesterol    esters.    HDL-cholesterol

lowering is accentuated by an increase in

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synthesis of hepatic lipase that occurs in  people with obesity-induced fatty liver;  lipase degrades HDL particles, converting  large HDL into small HDL.

An important but unresolved question is whether high NEFA levels contribute to higher blood pressure or a proinflammatory state. Hypotheses have been developed to link higher NEFA levels to higher blood

pressures.  Whether the link is causal  remains to be determined. Moreover,  accumulation of fat in the liver has been

reported to be associated with increased  hepatic synthesis of PAI-1, fibrinogen, and  inflammatory cytokines, the key mediators  of the prothrombotic and proinflammatory

states.

Inflammatory cytokines.

Adipose tissue synthesizes and secretes  TNFα, IL-6, and other cytokines. The production of these cytokines is increased in obese persons. This increased synthesis may interfere with the action of insulin to

suppress  lipolysis; if so, this would represent  insulin resistance of adipose tissue. Obese persons in

addition have elevated circulating cytokines; so far, it

is uncertain whether these circulating cytokines have

systemic effects,  i.e. promoting insulin  resistance in muscle  ,increased synthesis of

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Weight Management...

acute-phase reactants in the liver (CRP and  fibrinogen), or activation of macrophages in  atheromatousplaques .It    is    possible  increased release of acute-phase reactants  from liver may be the result entirely of lipid  accumulation in this organ.

PAI-1.

Adipose tissue synthesizes PAI-1, too.  Reports suggest that abdominal adipose tissue is more active in PAI-1 synthesis than

lower-body adipose tissue  .A fatty liver may  be another source of PAI-1. The resulting

high PAI -1 levels in obese persons together  with the high plasma fibrinogen observed  in such persons contributes to a  prothrombotic state.

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Weight Management...

Other adipose tissue products.

Several other products of adipose tissue may influence development of the metabolic syndrome. Their precise role, however,   remains   to   be   fully determined.Adiponectin is one potentially important product  .This substance has been reported to have antiinflammatory and antiatherogenic properties. Obese persons generally have low levels of adiponectin and hence may be deprived of its protective effects against the metabolic syndrome.  Leptin also may play a systemic role beyond being an adipose tissue-derived appetite suppressant. Whether the systemic effects of leptin are direct or secondary to its action on the central nervous system is currently being debated. Regardless, this hormone has been reported to have a beneficial effect on the liver to protect against fatty liver  .Its mechanism may be to enhance fatty acid oxidation in the liver.  Finally, resistin is an adipose tissue-derived hormone that seemingly opposes the action of insulin  .Whether it has a physiological role in humans has not yet been determined.

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Weight Management...

Obesity-induced metabolic syndrome as

a multidimensional risk factor for

ASCVD and type 2 diabetes

Several recent reports indicate that the presence of the metabolic syndrome is associated with increased risk for both

ASCVD and type 2 diabetes. Persons with the metabolic syndrome have at least a 2-fold increase in risk for ASCVD, compared with those without  .Risk for type 2 diabetes in both men and women is increased about

5-fold  .  The risk for diabetes is highest in  those with impaired fasting glucose or IGT.  Once a patient develops type 2 diabetes,  risk for ASCVD is enhanced. Not only is  relative risk for coronary heart disease  (CHD) raised by 2- to 3 -fold, but once  CHD becomes manifest in a patient with  diabetes, the prognosis for survival is  greatly reduced  .In addition, diabetes is  accompanied by microvascular disease,  which is a common cause of chronic renal

failure. The relationship between the  metabolic risk factors and development of  ASCVD is complex and certainly not well  understood. Nonetheless, a brief review of  hypothesized mechanisms may be of  interest.

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Weight Management...

Atherogenicdyslipidemia.

This condition is characterized by an increase in elevated triglycerides (and increased   VLDL  particle   number), increased small LDL particles, and low  HDL cholesterol  .It is commonly present in obese persons. The increased number of  VLDL and LDL particles accounts for the increased level of total apo B usually observed with atherogenicdyslipidemia. The atherogenic potential of each lipoprotein abnormality has long been a topic of great interest but one that is not fully resolved.

For   many   years   triglyceride-rich lipoproteins (TGRLPs) were thought not to be atherogenic. Nonetheless, there is growing evidence that smaller TGRLP  (remnant   lipoproteins)   are   in   fact atherogenic.This evidence comes from studies in laboratory animals, patients with genetic   disorders   causing   remnant accumulation,     metaanalysis     of epidemiological studies, and clinical trials

.TGRLPs as a class are a mixture of

lipoproteins, and it has been difficult to  differentiate between atherogenic and  nonatherogenic   forms   of   TGRLPs.

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Weight Management...

Nonetheless, there is a growing consensus among investigators that TGRLP fraction definitely contains atherogenic lipoproteins.

The LDL particles associated with the metabolic      syndrome      and atherogenicdyslipidemia tend to be small and dense. A theory widely held is that smaller LDL particles are more atherogenic than larger LDLs Smaller LDLs may filter

more readily into the arterial wall. They  further may be more prone to atherogenic  modification. Even so, not all investigations  are convinced that small LDL particles are  unusually atherogenic, compared with other  apo B-containing lipoproteins. Nonetheless,  when  small LDLs are present, the total  number of lipoprotein particles in the LDL  fraction usually is increased   .Most  researchers will agree that the higher the  number of LDL particles present, the  higher will be the atherogenic potential. In  other words, small LDL particles are often  a surrogate for an increased LDL particle  number.

A simple strategy for assessing the sum of atherogenic particles is measurement of either LDL+VLDL cholesterol (non-HDL cholesterol) or total apo B In persons with metabolic      syndrome      and

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Weight Management...

atherogenicdyslipidemia, both LDL+VLDL  cholesterol and total apo B typically are  elevated. These measurements should be

used increasingly both in risk assessment  and as targets of therapy in persons with  the metabolic syndrome.

A low HDL level is another characteristic

of atherogenicdyslipidemia.As a risk  predictor, a low HDL rivals an elevated  total apo B (or VLDL+LDL cholesterol).  This fact has led to the concept that HDL  is intimately involved in the atherogenic  process. The theories abound as to the  mechanisms    whereby    HDL    is

antiatherogenic,   e.g. enhanced reverse  cholesterol transport, antiinflammatory  properties, ability to protect against LDL  modification, among others. Although  HDL   in   fact   may   be   directly  antiatherogenic, it also is a marker for the  presence of other lipid and nonlipid risk  factors. Obesity itself reduces HDL levels

,and obese patients with metabolic  syndrome and atherogenicdyslipidemia  almost always have low HDL levels. Thus,

the association between low HDL and

ASCVD risk is complex and the various components of this association are difficult to differentiate. Regardless of mechanism,

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Weight Management...

however, the presence of a low HDL level  carries strong predictive power for  development of ASCVD.

Elevated blood pressure.

Obese persons have a higher prevalence of elevated blood pressure than lean persons.  Moreover, a higher blood pressure is a strong risk factor for cardiovascular disease  (CVD) Well-known complication of hypertension are CHD, stroke, left ventricular hypertrophy, heart failure,  and chronic renal failure. Yet some reports suggest that the elevated blood pressure accompanying obesity is less likely to produce CVD than when it occurs in lean persons. The implication is that obesity-induced hypertension is not particularly dangerous  to the cardiovascular system.  This concept generally is not accepted by the hypertension community, nor was it supported by the Framingham Heart Study

Elevated plasma glucose.

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There is no question that persons with

diabetes are at increased risk for ASCVD.

In epidemiological studies, the onset of diabetes is accompanied by increased risk for ASCVD, suggesting that hyperglycemia per se is atherogenic. Limited data that directly address the question of whether hyperglycemia accelerates the development of   atherosclerosis    are    available.

Nonetheless, one recent study indicated that intensive diabetes therapy in type 1 diabetes is accompanied by a reduction in intima-media thickness of carotid arteries.

Although this finding is consistent with epidemiology, it generally has not been possible to demonstrate an atherogenic potential of hyperglycemia in animal models.    Moreover,   whether    the hyperglycemia of type 1 diabetes promotes atherogenesis has been uncertain. The major cause of death in persons with type 1 diabetes is CVD; even so, it is possible that most atherosclerotic disease develops later in the course of the disease after

development of chronic renal failure and

hypertension.

A variety of mechanisms have been proposed whereby hyperglycemia might promote atherosclerosis Examples include

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nonenzymatic glycosylation of lipids and  proteins, pathogenic effects of advanced  glycation products, increased oxidative  stress, activation of protein kinase C, and  microvascular disease of the vasa vasorum

of the coronary arteries. All of these  potential mechanisms are of interest, but so  far, none has been shown to play a direct  role in atherogenesis; most likely all are  involved in one way or another. But a  fundamental question remains to be  answered, namely whether hyperglycemia is  directly atherogenic.

Another possibility is that insulin resistance

per se is independently atherogenic. In  prospective studies, the presence of insulin  resistance is associated with increased

ASCVD risk But in persons with insulin resistance, confounding by other known risk factors makes it difficult to be certain

that insulin resistance (or resulting  hyperinsulinemia) is directly atherogenic If  so, the mechanisms  for such an effect are  entirely speculative at this time.

Prothrombotic state.

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Obesity is accompanied by a large number of    coagulation    and    fibrinolytic abnormalities This suggests that obesity induces a prothrombotic state. What is not known at present is how a prothrombotic state will either promote the development of atherosclerosis or participate in the development of acute ASCVD events.  Perhaps the most attractive candidate for enhanced atherogenicity associated with coagulation and fibrinolytic abnormalities is endothelial dysfunction. It is believed by many workers that endothelial dysfunction is somehow involved in the atherogenic

process   .Several pathways have been  proposed; so far, however, none of these  have been substantiated. Perhaps more  likely, the obesity-induced procoagulant and  antifibrinolytic factors contribute to a  worsening of acute coronary syndromes.  Thrombosis occurring with plaque rupture  or erosion is a key element in determining  the severity of the syndrome. If normal  coagulation and fibrinolysis are impaired at  the time of plaque rupture or erosion, then  a larger thrombus should form. An  attractive hypothesis is that acute plaque  disruption is common, but only when  thrombosis is large is there a significant  acute coronary syndrome. If so, such could

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make the presence of a prothrombotic state  important for determining the clinical

outcome.

Proinflammatory state.

The cardiovascular field has recently shown great interest in the role of inflammation in the development of ASCVD. The basic concept is that atherogenesis represents a state of chronic inflammation. It is

characterized by lipid-induced injury that  initiates invasion of macrophages followed  by proliferation of smooth muscle cells. All  of these processes are classic features of  chronic inflammation albeit occurring at a  very slow rate. The finding that elevations  of serum CRP carry predictive power for  the development of major cardiovascular  events led to the concept that advanced and  unstable atherosclerotic plaques are in  an  even higher state of inflammation than  stable plaques  .It is of interest that obese  persons and particularly those with the  metabolic syndrome also have elevated  levels of CRP. This finding has suggested  that obesity is a proinflammatory state and  is   somehow   connected   with   the

development of unstable atherosclerotic  plaques. So far, however, a mechanistic  connection has not been made. The

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associations are suggestive, but how  elevations of CRP associated with obesity  could promote or precipitate major

cardiovascular events is not clear. This lack

of identified mechanism does not rule out a

causative connection. But so far the

connection has not been uncovered.

Obesity is a major underlying risk factor for  ASCVD. It is associated with multiple  ASCVD risk factors, and it also is a risk factor for type 2 diabetes. Diabetes itself is a cardiovascular risk factor. Despite the strong association between obesity and  ASCVD, the mechanisms underlying this relationship are not well understood. Our understanding of the connection between obesity and vascular disease is complicated by a plethora of possibilities. Obesity acts on so many metabolic pathways, producing so many potential risk factors, that it is virtually impossible to differentiate between the more important and less important. The possibilities for confounding variables are enormous. This complexity provides a great challenge for basic and clinical research. It also raises the possibility for new targets of therapy for the metabolic syndrome. With this said, the fundamental challenge is how to intervene at the public health level to

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reduce the high prevalence of obesity in the  general population. This approach offers  the greatest possibility for reducing the  cardiovascular risk that accompanies  obesity.

Abbreviations:    apo    B,

Apolipoprotein   B;   ASCVD, atherosclerotic    cardiovascular

disease; BMI, body mass index;  CHD, coronary heart disease;  CRP, C-reactive protein; CVD,  cardiovascular   disease;   HDL,

high-density lipoprotein; IGT,  impaired glucose tolerance; LDL,  low-density lipoprotein; NEFA,  nonesterified fatty acid; PAI,  plasminogen activator inhibitor;  TGRLP,      triglyceride-rich  lipoprotein; VLDL, very LDL.

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Chap ter 6

Weight Management

Weight management means keeping your body weight at a healthy  level.

 Balanced diet

 Exercise and weight loss

 Tips for losing weight

A BALANCED DIET

 Do not eat meat more than once a

day. Eat fish and poultry more often

than red or processed meats because

they are less fattening.

 Avoid frying food. Fried food absorbs

the fats from the cooking oils,

increasing your dietary fat intake.

Instead, bake or broil food. If you do

fry, use polyunsaturated oils, such as

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corn oil.

 Cut down on your salt intake. Limit

table salt, or flavor intensifiers that

contain salt, such as monosodium

glutamate (MSG).

 Include adequate  fiber in your diet.

Fiber is found in green leafy

vegetables, fruit, beans, bran flakes,

nuts, root vegetables, and whole-

grain foods.

 Do not eat more than 4 eggs per

week. Although they are a good

source of  protein, and they're low in

saturated fat, eggs are very high in

cholesterol.

 Choose fresh fruit for dessert, rather

than cookies, cake, or pudding.

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 Eat a well-balanced diet. Too much of

anything  \-- calories or a particular

type of food  \-- has its drawbacks.

 Follow the recommendations of the

food guide pyramid

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Exercise and weight loss

How much exercise you need to make a difference in your weight depends on how much you eat and what activity you are doing.  A medium-sized adult would have to walk more than 30 miles to burn up  3,500 calories, the equivalent of one pound of fat. Although that may seem like a lot, you don't have to walk the 30 miles all at once. Walking a mile a day for 30 days will achieve the  same result, as long as you don't eat more than usual.

If you eat 100 calories a day more than your body needs, you will gain approximately 10 pounds in a year. You could lose the weight or keep it off by doing 30 minutes of moderate exercise daily. The combination of exercise and diet is the best way to control your weight.

AEROBIC EXERCISE

Aerobic exercise is exercise in which you are continuously moving a large muscle group such as in your arms legs and hips for a period of time. Your heart rate gets faster and your breathing becomes deeper and faster.

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All adults should get 2 1/2 hours of aerobic exercise spread out over a week, but should be done for at least 10 minutes

at a time.

If you have not been active, start slowly and build up over weeks or  even months.  Walking can be a good exercise to start with.

Every week increase the time you spend with the activity, do it more often or add a second activity. You can increase the speed of your activity or the difficulty of the activity, such as going up  hills.

STRENGTHENING

All adults should do exercises to

strengthen the muscles at least two days a  week. These activities can include push- ups, situps, using resistance bands, or  lifting weights. Make sure to do exercises  that work on all the parts of  your body.

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Weight Management...

If you are doing a regular program of strength training (weight lifting), your muscles will get bigger. It is possible that your overall weight will increase, because muscle weighs more than fat. However, your clothes will probably fit better  and your body will be more toned. Your body composition is a better indicator of your overall health than the number on the scale.

If proper technique is followed, most people of any age can safely lift weights. It is important, however, to check with yourdoctor before you start to train with weights. Also, consult an experienced personal trainer or coach prior to beginning a weight lifting program. This can help prevent injuries and the loss of muscle strength and endurance that occurs with bed rest and inactivity.

Look for other activities house activities

that improve strength or endurance, such

as gardening.

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Weight Management...

Those recovering from heart attacks can benefit greatly from supervised cardiac rehabilitation programs.

Making a Commitment

The decision to keep  fit requires a lifelong commitment of time and effort.

Exercising and eating right must become things that you do without question, like bathing and brushing your teeth. Unless you are convinced of the benefits, you will not succeed.

Patience is essential. Don't try to do too much too soon and don't quit before you have a chance to experience the rewards.  You can't regain in a few days or weeks what you have lost in years of sedentary living, but you can get it back if you keep at it. And the prize is worth the price.

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WEIGHT LOSS TIPS

One pound of fat contains approximately  3,500 calories, so to lose one pound a week, a person should consume approximately 3,500 fewer calories per week. This can be done by reducing the daily intake by 500 calories per day (500 x  7 days will provide a deficit of 3,500 calories per week). To lose 2 pounds per week, a deficit of 1,000 calories per day is required.

If this seems impossible, remember that physical activity also contributes significantly to weight loss. The  deficit of  500 to 1,000 calories can come from a combination of increased physical activity and reduced intake on a daily basis.

Therefore, you don't need to experience significant food deprivation. The lowest intake per day recommended for women is 1,200  calories, unless they are in a medically-supervised, very low-calorie regimen which may have a daily level of  500 to 800 calories per day.

The lowest level recommended for men is

1,500 calories per day. A very low-calorie  diet can also be used by males if  they are  in a medically-supervised program.

Tips for preventing weight gain:

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 Avoid foods that are high in fat and

sugar.

 Reduce how much alcohol you drink.

 Avoid stress, frustration, and

boredom.

 If you are depressed, seek medical

treatment.

Avoid a sedentary lifestyle by increasing your activity level:

 Perform aerobic exercise for at least

30 minutes a day, 3 times a week .

 Increase physical activity by walking

rather than driving.

 Climb stairs rather than using an

elevator or escalator.

 Always talk to your health care

provider before starting an exercise

program.

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Weight Management...

FAD DIETS

A fad diet is one that makes unrealistic promises. Most fad diets are very low in carbohydrates and in calories, causing fluid loss from the body, which indicates a loss of weight on the scale. Once the body gets rehydrated with water, the weight will come right back.

Evaluation of a fad diet:

 Is the diet medically and nutritionally

safe? Get an opinion from a

physician and a registered  dietician.

 Red flags for fad diets include:

overemphasis on a specific food

group or groups, limited food

choices, and a "calories do not

count" approach.

These are ways to decide whether to use a diet or not. If there is no nutritionally or medically reliable information provided, and if there are no statistics to back the claims, then it is not a good diet to consider. Remember, if it sounds too good to be true, then it probably is.

For weight loss to be successful, here is a summary of basic guidelines:

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 Aerobic physical activity will assist in

increasing muscle tissue which will

burn more calories. You should plan

on 20-minute sessions at least 3 times

per week.

 Gradual changes in eating habits will

help encourage a permanent lifestyle

change.

 A slow weight loss of 1 or 2 pounds a

week, until the desirable body weight

is reached, is best.

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Chapter 7

Our Weight loss treatment by alternative ways........

Exercise  exercise you need to make a difference in your weight depends on how much you eat and what activity you are doing. A medium-sized adult would have to walk more than 30 miles to burn up  3,500 calories, the equivalent of one pound of fat. Although that may seem likea lot, you don't have to walk the 30 miles all at once. Walking a mile a day for 30 days will achieve the same result, as long as you don't eat more than usual.

If you eat 100 calories a day more than your body needs, you will gain approximately 10 pounds in a year. You could lose the weight or keep it off by doing 30 minutes of moderate exercise daily. The combination of exercise and diet is the best way to control your weight.

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AEROBIC EXERCISE

Aerobic exercise is exercise in which you are continuously moving a large muscle group such as in your arms legs and hips for a period of time. Your heart rate gets faster and your breathing becomes deeper and faster.

All adults should get 2 1/2 hours of aerobic exercise spread out over a week, but should be done for at least 10 minutes

at a time.

If you have not been active, start slowly and build up over weeks or even months.  Walking can be a good exercise to start with.

Every week increase the time you spend with the activity, do it more often or add a

second activity. You can increase the  speed of your activity or the difficulty of  the activity, such as going up hills.

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STRENGTHENING

All adults should do exercises to

strengthen the muscles at least two days a  week. These activities can include push- ups, situps, using resistance bands, or  lifting weights. Make sure to do exercises  that work on all the parts of your body.

If you are doing a regular program of strength training (weight lifting), your muscles will get bigger. It is possible that your overall weight will increase, because muscle weighs more than fat. However, your clothes will probably fit better and your body will be more toned. Your body composition is a better indicator of your overall health than the number on the

scale.

If proper technique is followed, most people of any age can safely lift weights. It is important, however, to check with your doctor before you start to train with weights. Also, consult an experienced personal trainer or coach prior to beginning a weight lifting program. This can help prevent injuries and the loss of muscle strength and endurance that occurs with bed rest and inactivity.

Look for other activities house activities that improve strength or endurance, such as gardening.

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Those recovering from heart attacks canbenefit greatly from supervised cardiac rehabilitation programs.

Making a Commitment

The decision to keep fit requires a lifelong commitment of time and effort.

Exercising and eating right must become things that you do without question, like bathing and  brushing your teeth. Unless you are convinced of the benefits, you will not succeed.

Patience is essential. Don't try to do too much too soon and don't quit before you have a chance to experience the rewards.  You can't regain in a few days or weeks what you have lost in years of sedentary living, but you can get it back if you keep at it. And the prize is worth the price.

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Chapter 8

R.M.R or B.M.R.

BMR and RMR are estimates of how many calories you would burn if you were to do nothing but rest for 24 hours. They represent the minimum amount of energy required to keep your body functioning, including your heart beating, lungs breathing, and body temperature normal.

  BMR stands for Basal Metabolic Rate,

and is synonymous with Basal Energy

Expenditure or  BEE. BMR

measurements are typically taken in a

darkened room upon waking after 8

hours of sleep; 12 hours of fasting to

ensure that the digestive system is

inactive; and with the subject resting in

a reclining position.

  RMR stands for Resting Metabolic

Rate, and is synonymous with Resting

Energy Expenditure or REE. RMR

measurements are typically taken

under less restricted conditions than

BMR, and do not require that the subject spend the night sleeping in the test facility prior to testing.

Most people searching the internet for information on their metabolic rate search

for BMR because the term is so widely

used. In fact, as explained in the Technical

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Notes, below, RMR is likely to be more appropriate for your needs and is the more

accurate  estimation.

However, if you are looking for an estimate of how many calories you need or burn in a day, we suggest that you not use BMR or  RMR at all. We suggest that you calculate the actual activities that you perform in a 24 hour period as described in  Calculating  Daily Calorie Needs.

We Do the Math

The  BMR & RMR Calculator will calculate

your BMR and RMR for you. And don't  worry if you measure yourself in pounds,  feet or centimeters, or even stones, we'll  convert the numbers to fit the equations.

We explain the equations in detail in the  Technical Notes, below. But whether  or not such details interest you, you might find a few observations about them interesting:

  When your age goes up, your BMR

and RMR go down.

  When your height goes down, your

BMR and RMR go down.

  When your weight goes down, your

BMR and RMR go down.

This means that as you get older, shorter, and lose weight, your BMR and RMR will go down and you will need to eat less or

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exercise more to maintain your current  weight. Oh my, it's tough getting old. At  least as we get older we get wiser. Well,  hopefully.

Using  the Calculations

As BMR and RMR only represent resting energy expenditure, an adjustment must be made to reflect your activity level. This is done by multiplying your BMR or RMR by an activity factor (McArdle et al 1996).  Note that the following activity factors also take into account  The Thermic Effect of

Food:

Activity

Factor  Category    Definition

1.2

1.375

Sedentary Little or no exercise and desk job

Lightly    Light exercise or

Active   sports 1 -3 days a week

1.55  Moderately

Moderate exercise

Active  or sports 3-5 days a week

Hard exercise or

1.725  Very Active  sports 6-7 days a

week4

1.9   Extremely   Hard daily exercise

Active    or sports and physical job

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Use of these activity factors produces a very rough estimate, and there are many different opinions on what these activity factors should be. So again, we suggest that you calculate the actual activities that you perform as described in  Calculating Daily  Calorie Needs.

And when you do, note that calculations made with the Activity Calculator reflect the total number of calories burned during the period of time calculated.Therefore when calculating how many calories you need or burn in a day, do not add your  BMR or RMR.

Technical Notes

BMR and RMR Equations

Equations have been developed to estimate  BMR and RMR when testing is not practical. We use the Harris-Benedict equation for  BMR, and the Mifflin equation for RMR.

The Harris -Benedict equation has been the standard for decades and is still the most widely used for estimating BMR. This is why we offer it to our users. However, numerous studies have shown it to be

inaccurate for a number of reasons:

  According to today's test standards the

Harris-Benedict equation does not

estimate BMR, but rather RMR. This

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is because the test subjects did not  spend the night at the test facility.

  The test subjects used to develop the

Harris-Benedict equation did not

include an adequate representation of

obese people, nor of younger and

older people. These omissions

continue to become more significant

as populations become older and

heavier.

  While all equations for predicting

energy expenditure only  make

estimates, the Harris-Benedict

equation typically overestimates by 5%

or more.

  Since the Harris-Benedict equation

was first published in 1919, a number

of studies have attempted to improve

it. Of these, none has been shown to

produce more accurate  results than the

Mifflin equation we use for calculating

RMR.

  For further details please refer to

Validation of several established

equations for resting metabolic rate in  obese and nonobese people, Journal  of the American Dietetic Association,  September 2003, David C.  Frankenfield, et al.

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The Harris -Benedict equation for BMR:

  For men: (13.75 x w) + (5 x h)  - (6.76

x a) + 66

  For women: (9.56 x w) + (1.85 x h)  -

(4.68 x a) + 655

The Mufflin equation for RMR:

  For men: (10 x w) + (6.25 x h)  - (5 x a)

\+ 5

  For women: (10 x w) + (6.25 x h)  - (5

x a)  - 161

Where:

w = weight in kg h = height in cm

a = age

Body Composition

The equations do not take into account body composition, a measure of the percentages of muscle and fat composing your body. It is therefore  less accurate if you have a non-typical amount of muscle.  This is because muscle burns calories, while fat does not.

A person with an above average amount of muscle will have a higher BMR or RMR than calculated; a person with a below average amount of muscle will have a lower  BMR or RMR than calculated.

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The vast majority of our users will never read this far into these notes, and they will do just fine using the calculators so long as they remember that the calculations are only estimates. But for those who want to fully understand how the calculators work, we would like to clarify one last point.

As explained in  How the Activity  Calculator Works, the calculator does not make use of your BMR or RMR calculations in calculating calories burned.  Instead, it uses a constant based on your weight alone. Thus the parameters for sex, age and height are ignored in calculating calories burned.

It is therefore somewhat of an "apples and oranges" disparity  to compare your BMR or  RMR calculation with your calories burned calculations. You can see the discrepancy by calculating Sitting  - quietly for 24 hours.  Ideally, this calculation would equal your  RMR.

Perhaps it is beginning to sound as if the calculators are flawed. While it is true that

they only make estimates, we believe that  they are the most accurate you will find.  Something we do that is unique is to  explain how they work, inaccuracies and all.

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Chapter 9

Green Tea

Tea consumption has its legendary  origins in China of more than 4,000 years ago. [] Green tea has been used as both a beverage and a method of traditional medicine in

most of Asia, including China, Japan,  Vietnam, Korea  and Thailand, to help  everything from controlling bleeding and  helping heal wounds to regulating body  temperature, blood sugar and promoting  digestion. A book written in the Tang  Dynasty of China is considered one of the  most important in the history of green tea.

Green tea is made solely from the leaves of

Camellia sinensis that have undergone

minimal  oxidation during processing. Green  tea originates in  Chinaand has become  associated with many cultures throughout  Asia. It has recently become more  widespread in the  West, where  black tea is  traditionally consumed. Many varieties of  green tea have been created in countries

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where they are grown. These varieties can  differ substantially due to variable growing  conditions, horticulture, production  processing, and harvesting time.

Over the last few decades green tea has been subjected to many scientific and medical studies to determine the extent of its long-purported health benefits, with some evidence suggesting that regular green tea drinkers may have a lower risk of developing  heart disease and certain types of cancer. Although green tea does not raise the metabolic rate enough to produce immediate weight loss, a green tea extract containing  polyphenols and  caffeine has been shown to induce  thermogenesis and stimulate fat oxidation, boosting the metabolic rate 4% without increasing the heart rate.

According to a survey released by the  United States Department of Agriculture in  2007, the mean content of  flavonoids in a cup of green tea is higher than that in the same volume of other food and drink items

that are traditionally considered of health  contributing nature, including fresh fruits, vegetable juices or wine. Flavonoids are a  group of phytochemicals in most plant  products that are responsible for such  health effects as anti-oxidative and  anticarcinogenic functions. However, based  on the same USDA survey, the content of

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flavonoids may  vary dramatically amongst

different tea products.

Green tea is processed and grown in a variety of ways.........

depending on the type of green tea desired.  As a result of these methods, maximum  amounts of  polyphenols and  antioxidants are retained, giving maximum green tea  benefits. The growing conditions can be  broken down into two basic types  - those  grown in the sun and  those grown under  the shade.

The green tea plants are grown in rows that are pruned to produce shoots in a regular manner, and are generally harvested three times per year. The first flush takes place in late April to early May. The second harvest usually takes place from June through July, and the third picking takes place in late July to early August

Sometimes, there will also be a fourth harvest. It is the first flush in the spring which brings the best quality leaves, with higher prices to match. Processed green teas, known as "aracha" are stored under low humidity refrigeration in 30 or 60 kg paper bags at 0-5°C (32-41°F). This aracha has yet to be refined at this stage, with a final firing taking place before  blending, selection, and packaging takes place. The leaves in this state will be re-fired

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throughout the year as they are needed,  giving the green teas a longer shelf life and  better flavor. The first flush tea of May will  readily store in this fashion until the next  year's harvest. After this re-drying process,  each crude tea will be sifted and graded  according to size. Finally, each lot will be  blended according to the blend order by the

tasters  and packed for sale

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Chapter 10

Brewing and serving

Green tea leaves steeping in a  gaiwan

Steeping is the process of making a cup of tea; it is also referred to as  brewing. In general, two grams of tea per 100ml of water, or about one teaspoon of green tea per five ounce cup, should be used. With very high-quality teas like  gyokuro, more than this amount of leaf is used, and the leaf is steeped multiple times for short durations.

Green tea steeping time and temperature varies with different tea. The hottest

steeping temperatures are 81°C to 87°C  (180°F to 190°F) water and the longest  steeping times two to three minutes. The  coolest brewing temperatures are 61°C to  69°C (140°F to 160°F) and the shortest  times about 30 seconds. In general, lower- quality green teas are steeped hotter and  longer, while higher-quality teas are steeped  cooler and shorter. Steeping green tea too  hot or too long will result in a bitter,  astringent brew, regardless of the initial  quality. It is thought that excessively hot  water results in  tannin chemical release,  which is especially problematic in green  teas, as they have higher contents of these.  High-quality green teas can be and usually  are steeped multiple times; two or three

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steepings is typical. The steeping technique  also plays a very important role in avoiding  the tea developing an overcooked taste. The  container in which the tea is steeped or  teapot should also be warmed beforehand  so that the tea does not immediately cool  down. It is common practice for tea leaf to  be left in the cup or pot and for hot water  to be added as the tea is drunk until the

flavour degrades.

With increasing pressure on maintaining the way one looks for both purposes of beauty and health, many people are looking towards weight loss techniques. However, most people cannot visit high-tech gymnasiums and undertake weight loss programs because of their work schedules and busy lives. This is where weight loss with diet modification and mild exercise comes into play. Green tea has been used as a mean for weight loss for hundreds of years because of its medicinal properties. However, drinking green tea alone for weight loss will have any major benefit. It is advisable that one should try and incorporate a healthy lifestyle in order to reap the weight loss benefits of green tea.

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Chapter 11

Green Tea and Weight Loss

Green tea accelerates the process of weight loss because it contains an ingredient called polyphenols which effectively dissolves the triglyceride deposits in the body. Although triglycerides are important for the body as they are the source of energy but excessive triglyceride deposits lead to fat storage in the body.

It has also been seen that polyphenols contain epigallocatechingallate or

EGCG which accelerates a person's metabolism. The metabolic rate decides

how a body responds to weight loss

techniques. Therefore, green tea  accelerates weight loss by increasing the

metabolic rate which in turn benefits

from exercising regimes. The two

combine to lead to weight loss.

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The caffeine content in green tea along with EGCG aid weight loss by triggering a process called thermogenesis.

Thermogenesis is the process by which heat is produced in organisms which uses calories and it is estimated that the

thermogenesis from drinking at least 5

cups of green tea leads to the burning of

80 calories.

Green tea boosts the endurance level of

a person which means that now a  person can exercise for longer durations

to aid weight loss. Green tea stimulates

the liver and muscle cells to use fatty

acids which provide increased energy.

The effect of green tea on endurance

has been tested on lab rats and it has

been seen that after consuming green tea  the rats could swim for longer durations

without being exhausted.

Green tea is a beneficial item that people trying to lose weight should include in their diet. However, it is important to remember that just by drinking green tea one cannot lose weight. Exercise and a healthy diet are equally important for the body to have metabolism in order to burn calories and let fat deposits.

Calorie in Indian Food

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Chapter 12

Green Tea: Fat Fighter

Black tea, oolong tea, and green tea come from the same  Camellia sinensis plant. But unlike the other two varieties, green tea leaves are not fermented before steaming and drying.

Most teas contain large amounts of polyphenols, which are plant-based substances that have been shown to have

antioxidant, anticancer, and antiviral

properties.

However, green tea is particularly rich in a type of polyphenols called catechins. These substances have also been shown to have

anti-inflammatory and anticancer  properties, but recent research in animals  show that catechins may also affect body  fat accumulation and  cholesterol levels.

In this study, researchers looked at the effects of catechins on body fat reduction and weight loss in a group of 35 Japanese

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men. The men had similar weights based on  theirBMI(body mass index, an indicator of  body fat) and waist sizes.

The men were divided into two groups. For three months, the first group drank a  bottle of oolong tea fortified with green tea extract containing 690 milligrams of catechins, and the other group drank abottleofoolongteawith22milligramsof catechins.

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During this time, the men ate identical breakfasts and dinners and were instructed

to control their calorie and fat intake at all

times so that overall total diets were similar.

After three months, the study showed that the men who drank the green tea extract lost more weight (5.3 pounds vs. 2.9 pounds) and experienced a significantly greater decrease in BMI, waist size, and total body fat.

In addition, LDL "bad" cholesterol went down in the men who drank the green tea

extract.

The catechin content varies by amount of green tea used and steeping time. But general recommendations, based  on previous studies on the benefits of green tea, are at least 4 cups a day. Green tea extract supplements are also available.

Researchers say the results indicate that catechins in green tea not only help burn calories and lower LDL cholesterol but may also be able to mildly reduce body fat.

"These results suggest that catechins

contribute to the preventi

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Chapter  13

Weight Maintenance after

weight reduction

There is a general perception that almost no one succeeds in long-term maintenance of weight loss. However, research has shown that ≈20% of overweight individuals are successful at long-term weight loss when defined as losing at least 10% of initial body

weight and maintaining the loss for at least  1 y. The National Weight Control Registry  provides information about the strategies  used by successful weight loss maintainers  to achieve and maintain long-term weight  loss. National Weight Control Registry  members have lost an average of 33 kg and  maintained the loss for more than 5 y. To  maintain their weight loss, members report  engaging in high levels of physical activity  (≈1 h/d), eating a low-calorie, low-fat diet,  eating breakfast regularly, self-monitoring weight, and maintaining a consistent eating  pattern across weekdays and weekends.  Moreover, weight loss maintenance may get  easier over time; after individuals have  successfully maintained their weight loss for  2–5 y, the chance of longer-term success  greatly increases. Continued adherence to  diet and exercise strategies, low levels of  depression and disinhibition, and medical  triggers for weight loss are also associated  with long-term success. National Weight

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Control Registry members provide evidence that long-term weight loss maintenance is possible and help identify the specific approaches associated with long-term

success.

SUCCESSFUL WEIGHT LOSS

MAINTENANCE

The perception of the general public is that no one ever succeeds at long-term weight loss. This belief stems from Stunkard and

McLaren-Hume's 1959 study of 100 obese individuals, which indicated that, 2 y after treatment, only 2% maintained a weight loss  of 9.1 kg (20 lb) or more More recently, a New England Journal of  Medicine editorial titled  Losing Weight: An  Ill-Fated New Year's Resolution echoed the

same pessimistic message.

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The purpose of this paper is to review the data on the prevalence of successful weight loss maintenance and then present some of the major findings from the National  Weight Control Registry (NWCR), a database of more than 4000 individuals

who have indeed been successful at longterm weight loss maintenance.

DEFINING "SUCCESSFUL WEIGHT

LOSS MAINTENANCE"

Wing and Hill  proposed that successful weight loss maintainers be defined as  "individuals who have intentionally lost at least 10% of their body weight and kept it off at least one year." Several aspects of this definition should be noted. First, the definition requires that the weight loss be

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intentional. Several recent studies indicate  that unintentional weight loss occurs quite  frequently and may have different causes  and consequences than intentional weight  loss.

Thus, it is important to include intentionality in the definition. The 10% criterion was suggested because weight losses of this magnitude can produce substantial improvements in risk factors for diabetes and heart disease. Although a 10% weight loss may not return an obese to a

non-obese state, the health impact of a 10%  weight loss is well documented. Finally, the  1 -y duration criterion was proposed in  keeping with the Institute of Medicine  criteria.Clearly,   the   most   successful  individuals have maintained their weight  loss longer than 1 y, but selecting this  criterion may stimulate research on the  factors that enable individuals who have  maintained their weight loss for 1 y to  maintain it through longer intervals.

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PREVALENCE OF SUCCESSFUL

WEIGHT LOSS MAINTENANCE

There are very few studies that have used this definition to estimate the prevalence of successful   weight   loss   maintenance.  McGuire et al reported results of a random digit dialing survey of 500 adults, 228 of whom were overweight or obese [body mass index (BMI) ≥27 kg/m2] at their maximum nonpregnant weight. Of these  228, 47 (20.6%) met the criteria for successful weight loss maintenance: they had intentionally lost at least 10% of their body weight and maintained it for at least 1 y. On average, these 47 individuals had lost  20.7 ± 14.4 kg (45.5 lb;  19.5 ± 10.6% from maximum weight) and kept it off for 7.2 ±  8.5 y; 28 of the 47 had reduced to normal weight (BMI <27 kg/m2).

Survey data such as these have the perspective of a person's entire lifetime and thus may include many weight loss attempts, some which were successful and some unsuccessful. It is more typical to assess "success" during one specific weight loss bout. In standard behavioral weight loss programs, participants lose an average of 7–10% (7–10 kg) of their body weight at the end of the initial 6-mo treatment

program and then maintain a weight loss of  ≈5–6 kg (5–6%) at 1 -y follow-up. Only a  few studies have followed participants for  longer intervals; in these studies, ≈13–20%

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maintain a weight loss of 5 kg or more at 5  y. In the Diabetes Prevention Program,  ≈1000   overweight   individuals   with  impaired glucose tolerance were randomly  assigned   to   an   intensive   lifestyle  intervention. The average weight loss of  these participants was 7 kg (7%) at 6 mo;  after 1 y, participants maintained a weight  loss of ≈6 kg (6%), and, at 3 y, they  maintained a weight loss of ≈4 kg (4%). At  the end of the study (follow-up ranging  from 1.8 to 4.6 y; mean, 2.8 y), 37%  maintained a weight loss of 7% or more.

Thus, although the data are limited and the definitions varied across studies, it appears that ≈20% of overweight individuals are successful weight losers.

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THE NATIONAL WEIGHT

CONTROL REGISTRY

Although it is often stated that no one ever succeeds in weight loss, we all know some people who have achieved this feat. In an effort to learn more about those individuals

who have been successful at long-term  weight loss, Wing and Hill established the  National Weight Control Registry in 1994.  This registry is a self-selected population of  more than 4000 individuals who are age 18  or older and have lost at least 13.6 kg (30  lb) and kept it off at least 1 y. Registry  members are recruited primarily through  newspaper and magazine articles. When  individuals enroll in the registry, they are  asked   to   complete   a   battery   of  questionnaires detailing how they originally  lost the weight and how they now maintain  this weight loss. They are subsequently  followed annually to determine changes in  their weight and their weight-related  behaviors.

The demographic characteristics of registry members are as follows: 77% are women,  82% are college educated, 95% are  Caucasian, and 64% are married. The average age at entry to the registry is 46.8 y.  About one-half of registry members report having been overweight as a child, and almost 75% have one or two parents who are obese.

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Participants self-report their current weight and their maximum weight. Previous studies suggest that such self-reported weights are fairly accurate (slightly underestimating actual weight.In  the  NWCR, participants are asked to identify a physician or weight loss counselor who can provide verification of the weight data.  When, in a subgroup of participants, the information provided by participants was compared with that given by the professional, the self-report information was found to be very accurate.

Participants in the registry report having lost an average of 33 kg and have maintained the minimum weight loss (13.6 kg) for an average of 5.7 y. Thirteen percent have maintained this minimum weight loss for more than 10 y. The participants have reduced from a BMI of 36.7 kg/m2 at their maximum to 25.1 kg/m2 currently. Thus, by any criterion, these individuals are clearly extremely successful.

Previously, we reported information about the way in which registry participants lost their weight ; interestingly, about one-half  (55.4%) reported receiving some type of help with weight loss (commercial program, physician, nutritionist), whereas the others  (44.6%) reported losing the weight entirely on their own. Eighty-nine percent reported using both diet and physical activity for weight loss; only 10% reported using diet

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only, and 1% reported using exercise only  for their weight loss. The most common  dietary strategies for weight loss were to  restrict certain foods (87.6%), limit  quantities (44%), and count calories (43%).  Approximately 25% counted fat grams,  20% used liquid formula, and 22% used an  exchange system diet. Thus, there is  variability in how the weight loss was  achieved (except that it is almost always by  diet plus physical activity).

The earliest publication regarding the registry documented the behaviors that the members (n = 784) were using to maintain their weight loss. Three strategies were reported very consistently: consuming a low-calorie, low-fat diet, doing high levels

of   physical   activity,   and   weighing  themselves frequently. Recently, a fourth  behavior   was   identified:   consuming  breakfast daily. Each of these behaviors is  described  below.   Registry   members  reported eating 1381 kcal/d, with 24% of  calories from fat. In interpreting their data,  it is important to recognize that 55% of  registry members report that they are still  trying to lose weight and to consider that  dietary intake  is typically underestimated by  20–30%. Thus, registry members are  probably eating closer to 1800 kcal/d.  However, even with this adjustment, it is  apparent that registry members maintain

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their weight loss by continuing to eat a lowcalorie, low-fat diet.

More recently, we have examined other aspects of their diet. Of particular interest is the fact that 78% of registry members report eating breakfast every day of the week.   Only 4% report never eating breakfast. The typical breakfast is cereal and fruit.  Registry members also report consuming 2.5 meals/wk in restaurants and  0.74 meals/wk in fast food establishments.

Another characteristic of NWCR members is high levels of physical activity. Women in the registry reported expending an average of 2545 kcal/wk in physical activity, and men report an average of 3293 kcal/wk .  These levels of activity would represent ≈1 h/d of moderate-intensity activity, such as brisk walking. The most common activity is

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walking, reported by 76% of the  participants. Approximately 20% report  weight lifting, 20% report cycling, and 18%  report aerobics.

Registry members also reported frequent monitoring of their weight. More than 44% report weighing themselves at least once a day, and 31% report weighing themselves at least once a week. This frequent monitoring of weight would allow these individuals to catch small weight gains and hopefully initiate corrective behavior changes.

The vigilance regarding body weight can be seen as one aspect of the more general construct of cognitive restraint (ie, the degree of conscious control exerted over eating behaviors). Registry members are asked to complete the Three Factor Eating  Inventory ,which includes a measure of cognitive restraint. Registry members scored high on this measure (mean of 7.1), with levels similar to those seen in patients who have recently completed a treatment program for obesity, although not as high as   eating-disordered   patients.   These findings suggest that successful weight loss maintainers continue to act like recently successful weight losers for many years after their weight loss.

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FACTORS ASSOCIATED WITH

WEIGHT REGAIN

Registry participants are followed over time to identify variables related to continued success at weight loss and maintenance.  Findings from the initial follow-up study indicated that, after 1 y, 35% gained 2.3 kg  (5 lbs) or more (7 kg on average), 59%

continued to maintain their body weight,

and 6% continued to lose weight.

Participants who regained weight (>2.3 kg) were compared with those who continued to maintain their body weight to examine whether   there   were   any   baseline characteristics that could distinguish the two groups. The single best predictor of risk of regain was how long participants had successfully maintained their weight loss

.Individuals who had kept their weight off  for 2 y or more had markedly increased  odds of continuing to maintain  their weight  over the following year. This finding is  encouraging because it suggests that, if  individuals can succeed at maintaining their  weight loss for 2 y, they can reduce their  risk of subsequent regain by nearly 50%.

Another predictor of successful weight loss maintenance was a lower level of dietary disinhibition, which is a measure of periodic loss of control of eating.  Participants who had fewer problems with disinhibition [ie, scores <6 on the Eating

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Inventory subscale were 60% more likely to

maintain their weight over 1 y. Similar  findings were found for depression, with  lower levels of depression related to greater  odds of success. These findings point to the  importance of both emotional regulation  skills and control over eating in long-term

successful weight loss.

Several key behavior changes that occurred over the year of follow-up also distinguished maintainers from regainers.  Not surprisingly, those who regained weight reported significant decreases in their physical activity, increases in  their percentage of calories from fat, and decreases in their dietary restraint. Thus, a large part of weight regain may be attributable to an inability to maintain healthy eating and exercise behaviors over time. The findings also underscore the importance   of   maintaining   behavior changes in the long-term maintenance of weight loss.

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Triggering events

Another variable that has been examined in the registry is the presence of a "triggering event" leading to participants' successful weight loss. Most registry participants reported a trigger for their weight loss  (83%). Medical triggers were the most

common (23%), followed by reaching an all  time high in weight (21.3%), and seeing a  picture or reflection of themselves in the  mirror (12.7%).

Because medical triggers have been shown to promote long-term behavior change in other areas of behavioral medicine, we examined whether individuals who reported medical triggers were more successful than those who reported nonmedical triggers or no triggers. A medical trigger was defined broadly and included, for example, a doctor telling the participant to lose weight and/or a family member having a heart attack.  Findings indicated that people who had medical reasons for weight loss also had better initial weight losses and maintenance.  Specifically, those who said they had a medical trigger lost 36 kg, whereas those who had no trigger (17.1%) or a nonmedical trigger (59.9%) lost 32 kg.  Medical triggers were also associated with less regain over 2 y of follow-up. Those with medical triggers gained 4 kg (≈2 kg/y), whereas those with other or no medical

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triggers gained at a significantly faster rate,

averaging 6 kg in both groups.

These findings are intriguing because they suggest that the period following a medical trigger may be an opportune time to initiate weight loss to optimize both initial and long-term weight loss outcomes.

Dieting consistency

The topic of dieting consistency was also recently   examined   in   the   registry.  Participants were asked whether they maintained the same diet regimen across the week and year, or if they tended to diet more strictly on weekdays and/or nonholidays.  Few people said they dieted more strictly on the weekend compared with the rest of the week (2%) or during holidays compared with the rest of the year  (3%). Most participants reported that their eating was the same on weekends and weekdays (59%) and on holidays/vacations and the rest of the year (45%). The remaining groups reported that they were stricter during the week than on weekends  (39%) and during nonholiday times compared with holidays (52%).

We evaluated whether maintaining a consistent diet was related to subsequent weight regain after 2 y. Interestingly, results indicated that participants who reported a consistent diet across the week were 1.5

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times more likely to maintain their weight  within 5 lb over the subsequent year than  participants who dieted more strictly on  weekdays. A similar relationship emerged  between dieting consistency across the year  and subsequent weight regain; individuals  who allowed themselves more flexibility on  holidays had greater risk of weight regain.  Allowing for flexibility in the diet may  increase exposure to high-risk situations,  creating more opportunity for loss of  control. In contrast, individuals who  maintain a consistent diet regimen across  the week and year appear more likely to

maintain their weight loss over time.

Recovery from relapse

We also examined different patterns of weight change among registry participants followed over time. We were particularly interested in evaluating whether participants who gained weight between baseline and year 1 were able to recover over the subsequent year. We found that few people  (11%) recovered from even minor lapses of  1–2 kg. Similarly, magnitude of weight regain at year 1 was the strongest predictor of outcome from year 0 to 2. Participants who gained the most weight at year 1 were the least likely to re-lose weight the following year, both when "recovery" was

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defined as a return to baseline weight or as

re-losing at least 50% of the year 1 gain.

Although participants gained weight and recovery was uncommon, the regains were modest (average of 4  kg at 2 y), and the vast majority of participants (96%) remained  >10% below their maximum lifetime

weight, which is considered "successful" by

current obesity treatment standards.

These findings, nonetheless, suggest that reversing weight regain appears most likely among individuals who have gained the least amount of weight. Preventing small regains from turning into larger relapses appears critical to recovery among successful weight losers.

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Chapter14

Success Stories

Jernail Singh

I believe, Shree Skin Care & Slimming

Center is the best place to reduce your weight without any harmful exercises and starvation. I lost 12 Kgs. of weight in just one month by their innovative treatment and guidance. I enjoy my life better now than ever before.I really thankfull to  Dr.Pratayksha and his team for guide me to become slimm and more active in my daily life.

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Mona Sharma

Before coming to Shree Skin Care

&Slimminmg Center I really thought that I would never lose weight nor gain my  lost confidence.  After losing 18kgs at Shree Skin

Care & Slimming Center I would say that I rediscovered myself and now live my life with much more enthusiasm. It happened so easily by their treatment.

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Neha chawla

You can see thamerical done by  DrPratayksha .I still can't belive it. I have reduce 15kg weight in just  45days.I have regained my lost confidence.It feels like  I,have got a new birth.

SandeepRozer

Shree Slimming has brought a tremendous change in my life.It has helped me in improving my personality.

Previously ,I feel shy in going outside but  DrPratayksha and his team ,who has incredibly put their effort in bringing desirable change in my life. He had a great source of motivation for me .I have

reduced 32kg weight in just 3 months.ot a

new birth

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Chapter 15

Varieties of green tea

Chinese green tea

Province

  JunshanYinzhen (Silver Needle tea),

known as one of the ten most famous

Chinese Teas, is one variety of Yellow  Tea, like the Huo Mountain Yellow  Buds and the Mengding Yellow Buds . It is cultivated on Junshan Island,  Yueyang City, Hunan Province.

Zhejiang Province is home to the most famous of all teas, Xi Hu  Longjing, as well as many other high-quality green teas.

  Longjing

Maybe the most well-known green tea in China. It originates in  Hangzhou, the capital of Zhejiang Province.  Longjing in Chinese literally means dragon well. It is pan-fried and has a distinctive flat appearance. The tasteless frying oil is obtained from tea seeds and other plants. Falsification of  Longjing is very common, and most of the tea on the market is in fact

produced in  SichuanProvince[and

hence not authentic Longjing.

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  Hui Ming

Named after a temple in  Zhejiang.

  Long Ding

A tea from  Kaihua County known as

Dragon Mountain.

  Hua Ding

A tea from  Tiantai County, named

after a peak in the Tiantai mountain

range.

  Qing Ding

A tea from Tian Mu, also known as

Green Top.

  Gunpowder

A popular tea also known as  zhuchá. It originates in  Zhejiang but is now grown elsewhere in  China.

This tea is also the quintessential ingredient in brewing Moroccan green tea with fresh mint.

Province

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A plate of  Bi  Luo Chun tea, from Jiangsu

Province in China

  Bi Luo Chun

A  Chinese famous tea also known as

Green Snail Spring, from  Dong Ting. As with  Longjing, falsification is common and most of the tea marketed under this name may, in fact, be grown in  Sichuan.

  Rain Flower

A tea from  Nanjing.

  Que She (Tongue of golden altar

sparrow)

originate in Jin Tan city of Jiangsu

Province.

  White Cloud

Province

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Camellia sinensis, the tea plant

Fujian Province is known for mountain-grown organic green tea as

well as  white tea and  oolong tea. The  coastal mountains provide a perfect  growing environment for tea growing.  Green tea is picked in spring and

summer seasons.

  Jasmine tea (Mo Li Hua Cha)

A tea with added jasmine flowers.

  Mao Feng tea

Meaning "furry peak".

  Cui Jian

Meaning "jade sword".

Hubei Province

  Yu Lu

A steamed tea also known as  Gyokuro

(Jade Dew) in Japanese, made in the

Japanese style.

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Henan Province

An example of a Chinese green tea, called

Mao Jian.

  Xin Yang Mao Jian

A  Chinese famous tea also known as

Green Tip, or  Tippy Green.

Jiangxi Province

  Chun Mee

Meaning "precious  eyebrows"; from

Jiangxi, it is now grown elsewhere.

  Gou GuNao

A well-known tea within China and

recipient of numerous national awards.

  Yun Wu

A tea also known as  Cloud and Mist.

Anhui Province

Anhui Province is home to several

varieties of tea, including three

Chinese famous teas . These are:

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  Da Fang

A tea from  Huangshan also known as

Big Square suneet.

  HuangshanMaofeng

A  Chinese famous tea from

Huangshan.

  Liuan Leaf

A  Chinese famous tea also known as

Melon Seed.

  HouKui

A  Chinese famous tea also known as

Monkey tea.

  Tun Lu

A tea from  Tunxi District.

  Huo Qing

A tea from  Jing County, also known as

Fire Green.

  Wuliqing

Wuliqing was known since the Song dynasty. Since 2002 Wuliqing is produced again according to the original processing methods by a company called Tianfang.  Zhan Luojiu a tea expert and professor at the

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Anhui Agricultural University who relived its production procedure.

  Hyson

A medium-quality tea from many p)r)o)v)i)n)c)e)s), )an early-harvested tea.

Sichuan Province

  Zhu Ye Qing

Also known as  Meng Ding Cui Zhu or

Green Bamboo.

  Meng Ding Gan Lu

A yellowish-green tea with sweet aftertaste.

Japanese green tea

Japanese green tea

Genmaicha

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Green tea (Ryokucha?) is ubiquitous in  Japanand therefore is more commonly known simply as "tea" (ocha?). It is even referred to as "Japanese tea" (nihoncha?) though it was first used in China during the  Song

Dynasty, and brought to Japan by  Myōan  Eisai, a Japanese Buddhist priest who also introduced the  Rinzai school of  Zen

Buddhism. Types of tea are commonly graded depending on the quality and the parts of the plant used as well as how they are processed. [] There are large variations in both price and quality within these broad categories, and there are many specialty green teas that fall outside this spectrum.  The best Japanese green tea is said to be that from the  Yame yame(  ?) region of

Fukuoka Prefecture and the

Kyoto [citation needed]

Uji region of

.  Shizuoka Prefecture

produces 40% of raw tea leaf.

  Gyokuro (Jade Dew)

Gyokuro is a fine and expensive type that differs from  Sencha in that it is

grown under the shade rather than the  full sun for approximately 20 days.

The name "Gyokuro" translates as  "jade dew" and refers to the pale green  color of the infusion. The shading  causes the amino acids (Theanine) and  caffeine in the tea leaves to increase,  while  catechins (the source of  bitterness in tea, along with caffeine)

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decreases, giving rise to a sweet taste.

The tea also has a distinct aroma.

  Kabusecha (covered tea)

Kabusecha is made from the leaves grown in the shade prior to harvest, although not for as long as  Gyokuro. It has a more delicate flavor than  Sencha.  It is sometimes marketed as Gyokuro.

  Sencha (

?, decocted tea)

The first and second flush of green tea made from  leaves that are exposed directly to sunlight. This is the most common green tea in Japan. The name describes the method for preparing the beverage.

  Fukamushicha (long-steamed

green tea)

Sencha, which, in the processing of the leaves, has been steamed two

times longer than usual Sencha, giving  it a deeper color and producing a fuller  flavor in the beverage.

  Tamaryokucha ( lit. ball green tea)

Tamaryokucha has a tangy, berry-like taste, with a long almondy aftertaste and a deep aroma with tones of citrus, grass, and berries. It is also called  Guricha.

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  Bancha (coarse tea)

Lower grade of  Sencha harvested as a third- or fourth-flush tea between

summer and autumn.  Aki-Bancha (autumn Bancha) is not made from  entire leaves, but from the trimmed  unnecessary twigs of the tea plant.

  Kamairicha (pan-fired tea)

Kamairicha is a pan-fired green tea that does not undergo the usual steam treatments of Japanese tea and does not have the characteristic bitter taste

of most Japanese tea.

  By-product of Sencha or Gyokuro

  Kukicha (stalk tea)

A tea made from stems, stalks, and twigs.  Kukicha has a mildly nutty, and slightly creamy sweet flavor.

  Mecha (buds and tips tea)

Mecha is green tea derived from a collection of leaf buds and tips of the early crops.  Mecha is harvested in spring and made as rolled leaf teas that are graded somewhere between  Gyokuro and  Sencha in quality.

  Konacha(coarse) powdered tea)

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Konacha is the dust and smallest parts after processing  Gyokuro or  Sencha. It is cheaper than  Sencha and usually served

at  Sushi restaurants. It is also marketed

as  Gyokurokoor  Gyokurokocha.

  Other

  Matcha (powdered tea)

A fine ground tea made from  Tencha.

It has a very similar cultivation process

as  Gyokuro. It is expensive and is used

primarily in the  Japanese tea

ceremony.  Matcha is also a popular

flavor of ice cream and other sweets in

Japan.

  Genmaicha ( brown rice tea)

Bancha (sometimes  Sencha) and roasted

genmai (brown rice) blend. It is often  mixed with a small amount of  Matcha

to make the color better.

  Hōjicha (roasted tea)

A green tea roasted over  charcoal

(usually  Bancha).

  Tencha ( milling tea)

Half-finished products used for  Matchaproduction. The name indicates its intended eventual milling into matcha.  Because, like  gyokuro, it is cultivated in shade, it has a sweet aroma. In its

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processing, it is not rolled during

drying, and tencha therefore remains  spread out like the original fresh leaf.

  Aracha (raw green tea)

Half-finished products used for  Sencha

and  Gyokuro production. It contains all

parts of the tea plant.

  Shincha (a new tea)

First flush tea. The name is used for

either  Sencha or  Gyokuro.

  funmatsucha (instant powdered

tea)

Milled green tea, used just like instant coffee.  Another name for this recent style of tea is  "tokeruocha," or "tea that melts."

Other green teas

  G)r)e)e)n) )t)e)a) )f)r)o)m) )C)e)y)l)o)n)

  Kahwah

Research and health effects

This section  may need to be rewritten entirely to comply with  Wikipedia's  quality standards , as more weight is placed on this section when compared to the other sections. This greater weight is undue unless this section is

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actually more important, in which  case it should be moved to the top  of the article and perhaps divided  into sub-sections, such as heart  effects, brain effects, etc. .

Health effects of tea

Green tea contains  salubriouspolyphenols,

in particular  catechins , the most abundant  of which is  epigallocatechingallate (EGCG).  Green tea also contains carotenoids,  tocopherols , ascorbic acid (vitamin C),  minerals such as chromium, manganese,  selenium or zinc, and certain  phytochemical compounds. It is a  more potent antioxidant  than  black tea [],  although black tea has  substances that green tea does not such as  theaflavin.

In vitro, animal, preliminary observational, and clinical human studies suggest that green tea can reduce the risk of cardiovascular disease, dental cavities, kidney stones, and cancer, while improving bone density and cognitive function.  However, the human studies are inconsistent.

Green tea consumption is associated with reduced heart disease in epidemiological studies. One study has shown that it can reduce total and "bad" (LDL) cholesterol by decreasing cholesterol absorption in the gut.  However, other several small, brief

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human trials found that tea consumption

did not reduce cholesterol in humans.[citation

needed] In 2003 a randomized clinical trial

found that a green tea extract with added

theaflavin from black tea reduced

cholesterol.

A study performed at the  University of  Birmingham showed that average fat oxidation rates were 17% higher after ingestion of green tea extract than after ingestion of a placebo. Likewise, the contribution of fat oxidation to total energy expenditure was also significantly higher by a similar percentage following ingestion of green tea extract. This implies that ingestion of green tea extract can not only increase fat oxidation during moderately intensive exercise but also improve insulin sensitivity and glucose tolerance in healthy young

men.

A study performed at the  Queen Margaret  University,  Edinburgh looked at the effectsof short-term green tea consumption on a group of students between the ages of 19– 37. Participants were asked not to alter their diet and to drink 4 cups of green tea per day for 14 days. The results showed that short-term consumption of commercial

green  tea reduces systolic and diastolic  Blood Pressure, fasting total cholesterol,  body fat and body weight. These results  suggest a role for green tea in decreasing  established potential cardiovascular risk

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factors. This study also suggests that  reductions may be more pronounced in the  overweight population where a significant  proportion are obese and have a high risk  of cardiovascular disease.

In a study performed at the Israel Institute of Technology, it was shown that the main antioxidant polyphenol of green tea extract,  EGCG, when fed to mice induced with  Parkinson's and Alzheimer's disease, helped to protect brain cells from dying, as well as  'rescuing' already damaged neurons in the brain, a phenomenon called neurorescue or neurorestoration. The findings of the study, led by Dr. Silvia Mandell, were presented at the Fourth International Scientific  Symposium on Tea and Human Health in  Washington D.C., in 2007. Resulting tests underway in China, under the auspices of the  Michael J. Fox Foundation, are being held on early Parkinson's patients.

A study  [] performed at the National institute of Chemistry in  Ljubljana,  Slovenia, demonstrated that  EGCG from green tea inhibits an essential bacterial

enzyme  gyrase by binding to the  ATP binding site of the B subunit. This activity  probably contributes to the antimicrobial  activity of green tea extract and may be  responsible for the effectiveness of green  tea in oral hygiene.

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In a recent case-control study of the eating habits of 2,018 women, consumption of mushrooms and green tea was linked to a  90% lower occurrence of  breast cancer.

A recent study on rats at the  University of  Hong Kong, published in the February issue of Journal of Agricultural and Food  Chemistry, found that the  catechins in green tea were absorbed by the ) l)e)n)s),)  retinaand other parts of the  eye. The absorbed catechins reduced oxidative stress in the eye for up to 20 hours, suggesting that green tea may be effective in preventing  glaucomaand other diseases of the eye.

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Chapter 16

Scientific studies about

green tea

2011 research by the Linus Pauling Institute  at  Oregon State University found that  EGCG in green tea has a powerful ability

to increase regulatory T cells in the body  and boost the immune system and suppress  autoimmune disorders.

According to research reported at the Sixth

International Conference on Frontiers in

Cancer Prevention, sponsored by the  American Association for Cancer Research, a standardized green tea polyphenol preparation (Polyphenon E) limits the growth of colorectal tumors in rats treated with a substance that causes the cancer.  "Our findings show that rats fed a diet containing Polyphenon E are less than halfas likely to develop colon cancer," Dr. Hang  Xiao, from the Ernest Mario School of  Pharmacy at  Rutgers University, noted in a statement.

A study published in the September 13, 2006 issue of the  Journal of the American Medical

Association concluded "Green tea consumption is associated with reduced mortality due to all causes and due to cardiovascular disease but not with reduced mortality due to cancer." The study,

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conducted by the  Tohoku University

School of Public Policy in Japan, followed  40,530 Japanese adults, ages 40–79, with no  history of  stroke, coronary heart disease, or  cancer at baseline beginning in 1994. The  study followed all participants for up to 11  years for death from all causes and for up

to 7 years for death from a specific cause.  Participants who consumed 5 or more cups  of tea per day had a 16 percent lower risk of  all-cause mortality and a 26 percent lower  risk of cardiovascular disease ("CVD") than

participants who consumed less than one

cup of tea per day. The study also states, "If

green tea does protect humans against

CVD or cancer, it is expected that

consumption of this beverage would

substantially contribute to the prolonging

of life expectancy, given that CVD and

cancer are the two leading causes of death

worldwide."

A study in the February 2006 edition of the  American Journal of Clinical Nutrition concluded "A higher consumption of green tea is associated with a lower prevalence of cognitive impairment in humans."

In May 2006, researchers at  Yale University  School of Medicine weighed in on the issue with a review article that looked at more

than 100 studies on the health benefits of  green tea. They pointed to what they called  an "Asian paradox," which refers to lower  rates of heart disease and cancer in Asia

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despite high rates of  cigarette smoking.  They theorized that the 1.2 liters of green  tea that is consumed by many Asians each  day provides high levels of  polyphenols and  other  antioxidants . These compounds may  work in several ways to improve  cardiovascular health, including preventing  blood platelets from sticking together (this  anticoagulant effect is the reason doctors  warn surgical patients to avoid green tea  prior to procedures that rely on a patient's  clotting ability) and improving cholesterol  levels, said the researchers, whose study  appeared in the May issue of the  Journal of  the American College of Surgeons. Specifically,  green tea may prevent the oxidation of  LDL cholesterol (the "bad" type), which, in  turn, can reduce the buildup of plaque in  arteries, the researchers wrote.

A study published in the August 22, 2006 edition of Biological Psychology looked at the modification of the stress response via  L-Theanine, a chemical found in green tea.  It "suggested that the oral intake of L- Theanine could cause anti-stress effects via the inhibition of cortical neuron excitation."

In a  double-blind, randomized, placebo-controlled trial conducted by Division of  Cardiovascular Medicine,  Vanderbilt  University Medical Center, Nashville,  Tennessee; 240 adults were given either theaflavin-enriched green tea extract in form of 375 mg capsule daily or a placebo.

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After 12 weeks, patients in the tea extract group had significantly less low-density lipoprotein cholesterol (LDL-C) and total cholesterol (16.4% and 11.3% lower than baseline, p<0.01) than the placebo group.  The author concluded that theaflavin-

enriched green tea extract can be used

together with other dietary approaches to

reduce LDL-C.

A study published in the January, 2005 edition of the American Journal of Clinical  Nutrition concluded "Daily consumption of tea containing 690 mg catechins for 12 wk reduced body fat, which suggests that the ingestion of catechins might be useful in the prevention and improvement of lifestyle-related diseases, mainly obesity."

According to a  Case Western Reserve  University School of Medicine study published in the April 13, 2005 issue of the  Proceedings of the National Academy of  Sciences, antioxidants in green tea may prevent and reduce the severity of rheumatoid arthritis. The study examined the effects of green tea polyphenols on collagen-induced arthritis in mice, which is similar to rheumatoid arthritis in humans.

In each of three different study groups, the mice given the green tea polyphenols were significantly less likely to develop arthritis.  Of the 18 mice that received the green tea, only eight (44 percent) developed arthritis.  Among the 18 mice that did not receive the

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green tea, all but one (94 percent)  developed arthritis. In addition, researchers  noted that the eight arthritic mice that  received the green tea polyphenols  developed less severe forms of arthritis.

A German study found that an extract of green tea and hot water (filtered), applied externally to the skin for 10 minutes, three times a day could help people with skin damaged from radiation therapy (after 16– 22 days).

A study published in the December 1999  American Journal of Clinical Nutrition found that "Green tea has thermogenic properties and promotes fat oxidation beyond that explained by its caffeine content per se. The green tea extract may play a role in the control of body composition via sympathetic activation of thermogenesis, fat oxidation, or both."

In lab tests,  EGCG, found in green tea, was found to prevent  HIV from attacking T- Cells. However, it is not yet known if this has any effect on humans.

A study in the August, 2003 issue of a new potential application of Cellular and  Molecular Life Sciences found that "a new

potential application of (–)epigallocatechin-3 -gallate [a component of

green tea] in prevention or treatment of

inflammatory processes is suggested"

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However, pharmacological and toxicological evidence does indicate that green tea polyphenols can in fact cause oxidative stress and liver toxicity in vivo at certain concentrations. This would imply that consumers should exercise caution

when consuming herbal products produced  from concentrated green tea extract. Other  evidence presented in the review cautions  against the drinking of green tea by  pregnant women.

A more frequent consumption of green tea was associated with a lower prevalence of depressive symptoms in a Japanese study.  Researchers conducted a cross- sectional

study in 1,058 community-dwelling elderly  Japanese individuals 70 years of age. The  prevalence of mild and severe depressive  symptoms was 34.1 percent and 20.2  percent, respectively. After adjustment for  confounding factors, the odds ratios for  mild and severe depressive symptoms when  higher green tea consumption was  compared with green tea consumption of 1  cup/d were: 2 to 3 cups green tea/d and 4  cups green tea/d. Similar relations were also  observed in the case of severe depressive  symptoms.

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A 2004 study found that components of green tea (catechins) were effective against the parasite  Trypanosomacruzi, which

causes  Chagas' disease, a major disease in

South and Central America.

In a paper published by researchers from  Western University, California in the  November of issue of the Journal of  American Diabetic Association, the following plus points of green tea were observed.

  Green tea while keeping the HDL

level intact did however decrease the

LDL and total cholesterol levels in

subjects as compared to the control

group.

  For an effective dosage of 145–3000

mg of green tea antioxidant

concentrate per day, the measurable

change in the cholesterol level of the

subjects was seen within 3 weeks.

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Unproven claims

Green tea has been credited with providing a wide variety of health benefits. However, many of these claims have not been validated by scientific evidence.

  The prevention and treatment of

cancer. See also  flavonoid and cancer.

  Treating  multiple sclerosis.

  Some green tea drinkers restrict their

intake as it contains  caffeine. Too

much caffeine can cause  nausea,

insomnia or  frequent urination.

United States Food and Drug

Administration

The article  Tea: A Story of Serendipityappeared in the March 1996 issue of the  United States ) F)o)o)d) )a)n)d) )D)r)u)g) ) A)d)m)i)n)i)s)t)r)a)t)i)o)n) Consumer Magazine and

looked at the potential benefits of green tea.  At that time the FDA had not done any  reviews of the potential benefits of green  tea and was waiting to do so until health  claims were filed. The FDA has since

denied two petitions to make qualified

health claims as to the health benefits of

green tea.

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On June 30, 2005, in response to "Green  Tea and Reduced Risk of Cancer Health  Claim", the FDA stated: "FDA concludes that there is no credible evidence to support qualified health claims for green tea consumption  and a reduced risk of gastric, lung, colon/rectal, esophageal, pancreatic, ovarian, and combined cancers. Thus, the  FDA is denying these claims. However, the  FDA concludes that there is very limited credible evidence for qualified health claims specifically for green tea and breast cancer and for green tea and prostate cancer, provided that the qualified claims are appropriately worded so as to not mislead consumers."

On May 9, 2006, in response to "Green Tea and Reduced Risk of Cardiovascular  Disease", the FDA concluded "there is no credible evidence to support qualified health claims for green tea or green tea extract and a reduction of a number of risk factors associated with CVD."

However in October 2006, the FDA approved an ointment based on green tea.  New Drug Application (NDA) number  N021902, for kunecatechins ointment 15%  (proprietary name Veregen) was approved on October 31, 2006, and added to the  "Prescription Drug Product List" in  October 2006. Kunecatechins ointment is

indicated for the topical treatment of

external  genital and perianal warts.

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Possible drug interactions

A 2009 study at the  University of Southern  California using mouse models showed that several of the polyphenolic ingredients of green tea, such as  EGCG, can bind with the anticancer drug  bortezomib, significantly reducing its bioavailability and thereby rendering it therapeutically useless. This chemical reaction between EGCG and

bortezomib is highly specific and depends  on the presence of a  boronic acid functional group in the  bortezomib  molecule. Dr. Schönthal, who headed the  study, suggests that consumption of green  tea, concentrated green tea extract, and  other green tea products (such as EGCG  capsules) be strongly contraindicated for  patients undergoing bortezomib treatment. Use of green tea in conjunction with  anticoagulants may result in reduced  effectiveness; there is a correlation between  the quantity of tea consumed and the  method of production may affect the  amount of  Vitamin K [citation needed].

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Caffeine

Unless specifically decaffeinated, green tea contains  caffeine.

Safety of green tea extract

:  Epigallocatechingallate#Drug Interactions

In 2008 the  US  Pharmacopeia reviewed the safety of green tea extract. It found 216 case reports, 34 on liver damage, of which  27 were categorized as possible and 7 were categorized as probable. Potential for adverse effects is increased when extracts are used, in particular on an empty stomach

Cc

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Chapter 17

Obesity in children

Obesity means having too much body fat.  It is not the same as overweight, which means weighing too much. A person may be overweight from extra muscle, bone, or water, as well as too much  fat.

Both terms mean your weight is higher than what is thought to be healthy for your height.

This article discusses obesity in children.

Causes, incidence, and risk factors

When children eat more than they need, their bodies store the extra calories in  fat

cells to use for energy later. If this pattern  continues over time, and their bodies do  not need this stored energy, they develop  more fat cells and may develop obesity.

Infants and young children are very good at listening to their bodies' signals of  hunger and fullness. They will stop eating as soon as their bodies tell them they have had enough.

But sometimes a well-meaning parent tells them they have to finish everything on their plate. This forces them to ignore their fullness and eat everything that is served to them.

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Some people may use food to reward good behavior or seek comfort when sad.

These learned habits lead to eating no matter if we are hungry or full. Many people have a very hard time breaking these habits.

The family, friends, schools,  and community resources in a child's environment reinforce lifestyle habits regarding diet and activity.

Children are surrounded by many things that make it easy to overeat and harder to be active. Watching television, gaming, texting, and playing on the  computer are activities that require very little energy.  They can take up a lot of time and replace physical activity. And, when children watch television, they often crave the unhealthy high-calorie snacks they see on commercials. See also: Screen time and

children

The term eating disorders refers to a group of medical conditions that have an

unhealthy focus on eating, dieting, losing or

gaining weight, and body image. Obesity

and eating disorders often occur at the

same time in teenage girls and young-adult

women who may be unhappy with their

body image.

Certain medical conditions, such as hormone disorders or low  thyroid function,

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and certain medications, such as steroids or  anti-seizure medications, can increase a  child's appetite. Over time this increases  their risk for obesity.

Signs and tests

The health care provider will perform a physical exam and ask questions about your child's medical history, eating habits, and exercise routine.

Blood tests may be done to look for  thyroidor endocrine problems, which could lead to weight gain.

Child health experts recommend that children be screened for obesity at age 6.  Your child's body mass index (BMI) is calculated using height and weight. A health care provider can use BMI to estimate how much body fat your child has.

However, measuring body fat and diagnosing obesity in children is different than measuring these things in adults.

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Chapter18

Treatment for child obesity

SUPPORTING YOUR CHILD

The first step in helping your child get to a healthy weight is to consult with their doctor. The doctor can help to set healthy goals for weight-loss and help with monitoring and support.

Try to get the whole family to join a weight-loss plan, even if weight loss is not the goal for everyone. Weight-loss plans for children focus on healthy lifestyle habits. A healthy lifestyle is good for everyone.

Having support from friends and family may also help your child lose weight. See also: Supporting a child with weight loss

CHANGING YOUR CHILD'S

LIFESTYLE

Eating a balanced diet means you child consumes the right types and amounts of foods and drinks to keep their body healthy.

  Know what size portions are child

should eat to meet your body's needs

for nutrients, without getting too

much of some and not enough of

others.

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  Stock your pantry and refrigerator

with healthy foods. See also: Healthy

grocery shopping

  Choose a variety of healthy foods

from  each of the food groups and eat

foods from each group at every meal.

  Learn more about eating healthy and

eating out.

Choosing healthy snacks and drinks for your children is important, but can be a challenge. See also: Snacks and sweetened drinks  - children

  Fruits and vegetables are good choices

for healthy snacks. They are full of

vitamins and low in calories and fat.

Some crackers and cheeses also make

good snacks.

  Avoid junk-food snacks like chips,

candy, cake, cookies, and ice cream.

The best way to  keep kids from eating

junk food or other unhealthy snacks is

to not have these foods in your house.

  Avoid sodas, sport drinks, and

flavored waters, especially ones made

with sugar or corn syrup. These drinks

are full of calories and can lead to

weight gain, even in active children. If  needed, choose beverages with  artificial (manmade) sweeteners.

Children should not watch more than 2 hours of TV a day. This can be difficult

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because watching TV is part of their daily  routine. See also: Screen time and children

Children should have many chances to play, run, bike, and play sports during the day.  Experts recommend they get 60 minutes of moderate activity every day. Moderate activity means you breathe and your heart beats faster than normal. If your child is not athletic, find ways to motivate your child to be more active. See also: Exercise and

activity  - children

WHAT ELSE TO THINK ABOUT

You may see ads for supplements and herbal remedies that claim they will help with weight loss. But many of these claims

are not true, and some of these  supplements can have serious side effects.  Talk to your health care provider before  giving them to your child.

Weight loss drugs are not recommended for children.

Bariatric surgery is currently being performed for some children, but only after they've stopped growing. See also: Weight-loss surgery in children

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Complications

A child who is overweight or obese is more likely to be overweight or obese as an adult.  Obese children are now developing health problems that used to be  seen only in adults. When these problems begin in childhood, they often become more severe when the child becomes an adult.

Children with obesity are at risk for developing these health problems:

  High blood glucose (sugar) or  diabetes

  High blood pressure (hypertension)

  High blood cholesterol and

triglycerides (dyslipidemia or high

blood fats)

  Heart attacks due to coronary heart

disease, congestive  heart failure, and

stroke later in life

  Bone and joint problems  \-- more

weight puts pressure on the bones and

joints. This can lead to  osteoarthritis, a

disease that causes joint pain and

stiffness.

  Stopping breathing during sleep (sleep

apnea). This can cause daytime fatigue  or sleepiness, poor attention, and  problems at work.

Obese girls are more likely not to have regular menstrual periods.

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Obese children often have low self-esteem.  They are more likely to be teased or bullied, and they may have a hard time making friends.

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Chapter  19

Obesity and Type 2

Diabetes

More than 80 percent of people with Type  2 diabetes, the most common form of the

disease, are obese or overweight. Data from

the  Centers for Disease Control and

Prevention (CDC) National Health and

Nutrition Examination Survey III shows

that two-thirds of adult men and women in

the U.S. diagnosed with Type 2 diabetes

have a  body mass index (BMI) of 27 or

greater, which is classified as overweight

and unhealthy.

Type 2 diabetes develops when either the body does not produce enough  insulin in

the blood or cells ignore the insulin  produced. As obesity diminishes insulin's  ability to control blood sugar, there is an  increased risk of developing diabetes  because the body begins overproducing  insulin to regulate blood sugar levels. Over

time, the body is no longer able to keep

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blood sugar levels in the normal range.

Eventually the inability to achieve healthy

blood sugar balance results in the

development of Type 2 diabetes.

Furthermore, obesity complicates the

management and treatment of Type 2

diabetes by increasing insulin resistance and

glucose intolerance, which makes drug

treatment for the disease less effective.

Obesity and Heart Disease

Overweight and obese people have an increased incidence of heart disease, and

thus fall victim to heart attack,  congestive  heart failure, sudden cardiac death, angina,  and abnormal heart rhythm more often

than those that maintain a healthy body

mass index.

Obesity often increases the risk of heart

disease because of its negative effect on  blood lipid levels, which increase in obese  patients and then, in turn, increase  triglyceride levels and decrease high-

density lipoprotein  – which is also known

as HDL or "good cholesterol."

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People with an excessive amount of body fat have higher levels of triglycerides and

low-density lipoprotein  – which is also

known as LDL or "bad cholesterol"  – as

well as lower levels of HDL cholesterol in

the blood. This recipe creates optimal

conditions for developing heart disease.

Obesity and Hypertension

Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood.  Hypertension,or high blood pressure, greatly raises your risk of heart attack, stroke or kidney failure.

Being overweight or obese increases the

risk of developing high blood pressure. In

fact, blood pressure rises as body weight

increases. Losing even 10 pounds can lower

blood pressure—and losing weight has the  biggest effect on those who are overweight  and already have hypertension.

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Chpter 20

Obesity and Metabolic

Syndrome

Obesity adversely impacts existing

endocrine and  metabolic disorders. In

fact, one out of every  five overweight  people is affected by the  metabolic  syndrome, or "Syndrome X."

Metabolic  syndrome is one of the fastest

growing obesity-related health concerns in  the United States and is characterized by a

cluster of health problems including

obesity, hypertension, abnormal lipid levels,

and high blood sugar.

Patients with  polycystic ovary syndrome

(PCOS),  Cushing's syndrome and other

conditions have an increased risk of

developing metabolic syndrome.

According to the  Centers for Disease

Control and Prevention (CDC), the

metabolic syndrome affects almost one

quarter (22 percent) of the American

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population  – an estimated 47 million  people. The assemblage of problems  characterized as comprising the metabolic  syndrome can increase a patient's risk for

developing more serious health problems,

such as diabetes, heart disease, and stroke.

Chapter 21

Obesity and Polycystic

Ovary Syndrome (PCOS)

The majority of patients diagnosed with polycystic ovary syndrome (PCOS) , the

most common hormonal disorder in

reproductive-age women, are either

overweight or obese35.

The syndrome is  associated with an

accumulation of incompletely developed

follicles in the ovaries and is characterized

by irregular menstrual cycles, multiple

ovarian cysts, and excessive hair growth.

PCOS is a leading cause of infertility and is

a significant cause of insulin resistance  –

and thereby a major factor in increasing a

woman's risk of developing diabetes.

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Overweight adolescent girls are also susceptible to developing PCOS.

Hyperinsulinemia – or excessive insulin

in the blood  – insulin resistance, and being

overweight are all associated with PCOS in

adolescents. Common characteristics

among post-pubertal adolescents and adults

with PCOS include excessive hair growth,

irregular menses and cystic or non-cystic

acne.

Chapter 22

Obesity and

Reproduction/Sexuality

Obesity in men has been associated with reproductive hormonal abnormalities, sexual dysfunction, and infertility. In

women without  polycystic ovary  syndrome (PCOS), obesity also

compromises reproductive outcomes.

Obesity and Dyslipidemia

Obesity has a negative effect on lipid levels

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in the blood, which often lead to the

development of a condition known as  dyslipidemia. Dyslipidemia, a primary risk  factor for coronary artery disease, occurs

when LDL cholesterol (bad cholesterol)

and triglyceride levels are high and HDL

cholesterol (good cholesterol) is low.

Physicians often attribute this abnormal

shift in lipid levels to weight gain. Losing  weight, conversely, has an opposite effect.  Weight loss of about 20 pounds has been

shown to:

  Reduce LDL levels by 15 percent.

  Reduce triglyceride levels by 30 percent.

  Increase HDL by eight percent.

  Reduce total cholesterol levels by 10

percent.

  Obesity and Thyroid Conditions

Childhood Obesity

Obesity in childhood continues to grow in prevalence among adolescents in the United  States. In some states, obesity is found in

nearly forty percents of children. It is

estimated that one-third of children born in

2000 will develop obesity-related diabetes,

half of which will be in the Latino and

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African American communities.

Childhood obesity causes liver, lung, heart and musculoskeletal complications as well

as psychological ones. Grass root efforts at

changing urban planning, legislation, and

school practices need to be employed to

help stem the tide of obesity. Lifestyle

change is the most  effective treatment, but  the hardest to implement. As a result of  higher childhood obesity rates, more and  more adolescents are subjecting themselves  to gastric banding.

Chapter 23

Obesity and Thyroid

Conditions

Thyroid hormones drive metabolism,

which is why it is often assumed that there

is a direct link between obesity and the

thyroid gland. It is true that individuals with

an overactive thyroid gland

(hyperthyroidism or thyrotoxicosis)

typically will lose weight, and those with

underactive thyroids (hypothyroidism) will

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Weight Management...

tend to gain weight, but a direct or strong

correlation of obesity with deficient thyroid

function is uncertain as the medical

literature provides conflicting conclusions.

In some studies, thyroid function is

perfectly normal in obese individuals

compared to normal weight controls, while

other studies show a clearly higher  frequency of mild ("subclinical") to  moderate hypothyroidism in obese children

and adults. Additional studies will be

required to illuminate the relationships

between the brain-thyroid axis, the  metabolic syndrome, thyroid dysfunction,  and obesity.

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Chapter  24

Hormonal  Imbalance

Hormones are the chemical messengers in the body that travel the bloodstream to the

o)r)g)a)n)s) and ) t)i)s)s)u)e)s). )They slowly work and  affect many of the body's processes over  time.  Endocrine glands, which are special  groups of ) c)e)l)l)s), )make hormones.

There are )m)a)n)y )endocrine glands  in the body with the main ones being the  pituitary gland,  thyroid,  thymus,  adrenal glands, and the  pancreas . Hormones are dominant and it only requires a small amount of them to cause significant changes throughout the body. Both men and women produce hormones in the same areas with one

exception, the sexual organs. Additional  male hormones are produced in the  testes while women's are produced in the  ovaries.

If hormone imbalance is left untreated it can result in serious medical conditions like

diabetes. If the imbalance is taking place in  the pituitary glands, growth disorders are  possible and will require treatment of a  growth hormone. It is possible that the  imbalance could also cause an

overproduction of growth hormones and

cause medical conditions such as  gigantism

and  acromegaly. There are approximately

6,000  endocrine disorders that result

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because of hormone imbalance. An  imbalance of hormones is experienced at  different times during life. As the body  changes from childhood to adulthood,  puberty is experienced by both male and  females. Women will then again experience  a change later in life after their childbearing  years have been passed. Hormonal  imbalance is defined as chemical

messengers which regulate our body's  systems and that are no longer functioning  properly. This dysfunction can be an  overproduction or an underproduction of  specific hormones. The primary hormone  that causes these changes is  estrogen.

Estrogen and progesterone

A hormonal imbalance occurs as a reaction

to the elevated level of estrogen and  lowered level of  progesterone within a  woman's body. Estrogen is naturally  produced  by the ovaries and is the female  hormone necessary for normal sexual  development. It also works to regulate the  menstrual cycle to prepare and maintain the  body during childbearing years. Estrogen is  dominant during the  follicular phase of the  menstrual cycle. Progesterone is dominant  during the  luteal phase of the menstrual  cycle by the  corpus luteum, and is needed  for implantation of the fertilized egg. Later  in life, the ovaries begin to decrease their  production of estrogen and progesterone,

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causing symptoms of hormone imbalance

to develop. Estrogen replacement therapy is

a common treatment for hormone

imbalance. Frequently, only estrogen is  replaced. Some health care providers,  especially alternative medicine practitioners,  feel it is important to supplement  progesterone as well, as the balance  between estrogen and progesterone is  important.  Estrogen dominance, in which  there is too much estrogen relative to  progesterone, can cause infertility, PMS,  menstrual problems, abdominal weight

gain, and possibly increased risk of breast

cancer.

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Causes

There are multiple causes for hormone imbalance, but the majority of cases are experienced due to estrogen dominance or increased amounts of  estrogen in the body and not enough of progesterone. Common causes include birth control pills, ) s)t)r)e)s)s), )overuse of cosmetics, and non organic animal products. Other medical causes include  genetics, obesity, and tumors. Other causes include lack of exercise,  pregnancy, lactation,  autoantibody production, and a

sedentary  lifestyle. Of all of these causes,  obesity is the number one medical cause for  hormone imbalance while pregnancy is the  number one lifestyle change that causes the  condition.

Symptoms

Some of the symptoms experienced during hormone imbalance are shared by

 male

 female,

while some are more specific to each

gender.

Some of the most commonly shared symptoms include

 f)a)t)i)g)u)e),)

 skin problems

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 acne,

 mood swings,

 weight problems,

 diminished sex drive, and

 no memory.

If the reactions become more severe then we run into actual hormone

allergy where we find a group of more  serious disorders. The disorders  include

 arthritis,

 chronic fatigue syndrome,

 fibromyalgia,

 anxiety attacks.

 urinary tract infections,

 increased dryness in the mouth,  eyes,

 genitalia,

 Abnormal  heartbeat can also be

experienced.

The majority of these symptoms are experienced due to menopause.

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Menopause

Menopause is the permanent end of menstruation and  fertility, defined as occurring 12 months after your last menstrual period. It is the time  in a woman's life when the ovaries stop producing eggs and the body doesn't produce the same amount of progesterone or estrogen. Menstruation is less frequent and eventually stops altogether. It is a biological process that is natural and is not a medical illness. Hormonal imbalance is the cause for the physical and emotional experiences associated with menopause.  These symptoms include hot flashes, broken sleep patterns or insomnia, and changes in sexual response. There is no need for prevention of menopause, but there are steps that can be taken to prevent specific side effects. Regular exercise, calcium and  vitamin D supplements, a  low-

fat diet, and controlling  blood pressure and

cholesterol levels are recommended.

Treatment for hormone

imbalance

It is important to understand all the risks and benefits of  hormone  replacement

therapy (HRT). Patients with a history of  active or past  breast cancer,  blood clots,  liver disease, pregnancy, or  endometrial

cancer should talk with a physician before

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using an over the counter or prescription  therapy. There are two main types of HRT.  The first is estrogen replacement. It is  available in tablet form, cream, or a patch.  It is administered alone and is given in the  lowest dose possible to relieve symptoms.  The second type of therapy is a  combination of estrogen and progesterone.  It is commonly known as HRT  combination therapy. These two hormones  are given continuously for the shortest time  possible to reduce the risk for possible side  effects. Side effects of treatment include

irregular spotting, breast tenderness, fluid  retention, headaches, dizziness, and  blood  clots or  stroke.

Alternatives to HRT

Patients that are worried about these side

effects can use natural products that can be  bought over the counter. Diet and exercise  have also been proven effective against the  symptoms of menopause. As the body goes  through these changes, adjusting diet and a  person's level of activity will promote  healthy bones and reduce the risk of heart  disease as well.

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Improper use of hormones

A dangerous or fatal hormone imbalance can occur in those who use  anabolic

steroids. While the endocrine system is  developing, use of these hormones can  result in a hormone imbalance that causes

an increase in aggressive behavior, mood  swings, or developmental disorders. Steroid  use is required for some patients, but  should only be administered and taken  under the care of a health professional to  reduce these risks.

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Chapter  24

Salt and obesity

Introduction

Obesity is an increasing problem in the UK.  A third of all British adults will be obese by  2012 if current trends continue, equating to  13 million people. Obesity is defined as a  Body Mass Index over 30. Male  obesity in the UK has increased from 13.2% in 1993

to 23.1% in 2005 while obesity amongst  women has increased from 16.4% to 24.8%  over the same period.1 Obesity amongst  children is also a problem, increasing from  10.9% in 1995 to 18.0% in 2005 amongst  boys aged 2-15. Amongst girls of the same  age group obesity has increased from 12.0%  to 18.1%.

Obesity is huge health burden and is associated with many health conditions.  These include diabetes, hypertension, cardiovascular disease, sleep apnea and shortness of breath. In 2002, the direct cost of treating obesity was between 45.8 and  £49.0 million pounds and the indirect cost  (treating consequences) was around 1 billion pounds.

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Who is at risk of obesity?

Everyone is at risk of obesity if they consume an unhealthy diet or have an unhealthy lifestyle. However, those most at risk include ex-smokers, people of black

African descent, inactive individuals and children (or adults) who also have a high intake of sugared-soft drinks.

How does salt contribute?

Whilst salt is not a direct cause of obesity it is a major influencing factor through its effect on soft drink consumption. Salt makes you thirsty and increases the amount of fluid you drink. 31% of the fluid drunk by 4-18 year olds is sugary soft drinks2 which have been shown to be related to

childhood obesity.

It has been

estimated that

a reduction in

salt intake

from 10 g/d  to the WHO  recommende

d level of 5

g/d would  reduce fluid

consumption

by ≈350   Figure 1- Relationship between

mL/d. A   salt intake and fluid consumption

study which  in children and  adolescents. Source:

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analysed the  sales of salt

He et al, 2008

and

carbonated

beverages in

the USA

between 1985

and 2005

showed a

close link

between the

two, as well

as a parallel

link with

obesity.

An analysis of

the NDNS

for young  people (4  –

18years)  showed salt

intake was

associated

with both  fluid intake

and sugar-

sweetened  soft drink

consumption.

A reduction  in salt intake  by 1 g/d was

found to be

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Weight Management...

associated

with a

difference of

100g/day in  total fluid and

27 g/d in

sugar-

sweetened

soft drinks.

This

demonstrates

that salt

intake is an

important  determinant

of total fluid

and sugary

soft drink

consumption

in children.

Reducing salt intake could

therefore be

important in  reversing the  current trend

of increasing

childhood

obesity.

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Current Salt Intake and Dietary

Advice

Almost everyone in the UK (and the rest of the Western world) eats too much salt. The daily recommended amount is no more than  6 grams a day; the current average salt intake is 8.6g a day although many people are eating more than this.

People with or considered at risk of obesity should ensure that they keep their salt intake below the recommended maximum of

6g. This can be achieved by simple changes,  such as consuming less processed foods and  checking product labels before purchase.

To further reduce your risk of obesity you should make sure you eat at least 5 portions of fruit/vegetables per day, increase the amount of exercise you do (at least 30 minutes, 5 times a week) and reduce the amount of saturated fat, fat, sugar and calories that you eat.

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Company Profile

We shree slimming tea's corporation always look forward in future but in the boundaries of nature means we always use herbal products with new fashioned &innovative style, so our present & next generation love's to use natural products in their own taste.

We deals in herbal tea, slimming tea extracts, green tea powder & extracts & other tea products ,soaps, designer soaps, handmade soap, herbal soaps, hand made shampoos, herbal shampoos. We also deal in specialized herbal laxatives. The main quality of our product is that they all are made from totally natural extracts. Even in bulk orders we can customize the product

(their ingredients, name embossed on thesoap, fragrance & shape) as per customer requirement.

We are No1 Instant tea, soap, shampoo & laxative manufacturing company with latest equipment

&

Having our own chain of weight management & Laser Institutes in India or

even in out of India.

With ultra modern weight reduction & laser

treatment techniques

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Weight Management...

We are the first weight management company in North who are certified & awarded by many national & international organizations, like

We are the 1 st I.S.O.9001:2008 certified

company not just in service, even in

products also.

We are 1 st HACCP Certified Company

(Certificate of food safety & quality assurance)

We are the only company who are the certified member of ILA of India. (Indian

Laser Association)

Having our own laser specialist.

We are the only we ight management company who are supervising under two time's gold medallist doctor who are specialised in weight management.

We are the only company having a bench mark of 5 kg weight reduction in just 20 days even in any medical problem & in any

age.

We are 1 st weight reduction company who are having a clients from the age of 5 year up to 86year old.

We are the 1 st company having 99.9%

results with 100% satisfied clients.

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Weight Management...

We are the 1 st company who believe in relationship because we have members who joined us three/four/five  years back

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Weight Management...

Dr Pratayksha Bhardwaj

Dr.Pratayksha Bhardwaj is a well known personality in weight reduction system.

He him Self a

legend. He has been  won two times gold

medal in weight

management. He

has been establish

this company by his

own honesty &

hardworking. The foundation of

Shree Slimming Tea's Corporation

is laid by Dr.Pratayksha,He is also

one of the biggest example of his

weight

management  programme. He

lost 28kg in the

period of 5  - 6months by own

made slimming

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tea composition without any side

effect. He belongs to very smalltown, Jagadhri (Haryana).He has

been started his journey from a  single room & now he has been set-

up manyFact doesn't Pratayksha ko parman ki kya franchise & dealerships in

metro cities. His magical &

tremendous achievements told his

success stories! He won many

awards in weight management field Awayashakta"

from national & international

organisations.

As his name "Pratayksha", he

proves that

"Fact doesn't correctrequired proof to stand required proof to stand

correct."

Or

"Pratayksha ko parman ki kya

Awayashakta"

...END...

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