Beautify Me !

Sports and Teens: How To Reduce Some of the Stress


By: Donald E. Greydanus, MD

If you are like many parents, you are probably very interested in having your children and teenagers become active in sports. The hope is that sports activity will be a beneficial experience for both you and your children. As a pediatrician, I am often asked a number of questions about adolescents, sports and stress. “Will my teenager experience stress as a result of sports play?” “How can I reduce some of the potential emotional problems involved in sports?” This article explores some of the factors that may lead to a negative reaction by your teenagers as they take part in various sports.



Stress and Sports
Stress is a natural part of sports participation, as stress is natural in many aspects of life.

Stress can be a good learning experience
Experiencing stress in sports can be a good learning experience for teenagers. Sports participation can teach your athlete how to handle competition, defeat, and even performance anxiety. It can teach your teenager about physical fitness, how to develop social skills and friendships, and the importance of team-play in sports and in life. The stress of trying out and not being accepted on a team can be a positive learning experience if handled well, or a very negative one if handled badly. Parents and clinicians can be very helpful to teenagers by acknowledging this fact and discussing such issues with them.

Stress can also lead to problems
Negative consequences of overwhelming stress are many, including chronic fatigue (‘athletic burnout syndrome’), depression and rapid loss of previously learned skills. ‘Burnout’ can also result from over-training, encouraged by overzealous parents, coaches, or the teenagers themselves. Children and teenagers should enjoy their sports participation and not be forced by parents or coaches to specialize in one sport too early, in the hopes of producing a famous professional superstar. Teenagers who excel at one sport may feel sad or anxious during its off-season. Encouraging other, perhaps noncompetitive sports and social activities during this time may help teenagers who are temporarily on break from their sport.

Helping to relieve sports-related stress
There are a number of techniques that can be helpful in preventing or reducing sports-induced stress. Relaxation training, meditation, hypnosis, breath control, yoga, prayer, and biofeedback are all techniques that help to relieve stress. I recommend that athletes who are under excessive sports-induced stress work with sports medicine clinicians or psychologists who can teach them some of these methods. You can talk to your health care professional to get more information or a referral, if needed.

Developing positive sports goals
Parents should avoid joining the current milieu of ‘victory at any cost’, which is noted in many organized sports programs, including high school competition. I recommend that parents and school personnel encourage adolescents to set positive goals in their sports activities. Learning the joy of physical activity and acquiring a sense of competence are two such positive goals. Our teenagers should not be placed under overwhelming pressure to win. You should not push your children beyond their abilities nor teach your children that self-esteem comes only from winning. Some young people I have treated feel that they are loved and valued only if they do well in sports. Just go to a sports event at any junior high or high school and you can see parents yelling at their children, coaches, umpires and fellow parents, in a vain attempt to teach love only through victory. Parents must be aware of this attitude and guard against it.



Psychosocial Development
We should remember that children, young teenagers and older teenagers are at different stages of development, and their level of development may influence their sports performance.

Young teenagers
Young teenagers (ages 11-14) may not be able to see into the future very well and they may only be able to manage the ‘here and now’ issues; if your child is like this, he is called a concrete thinker. Also, young teenagers often raise many concerns about various aches and pains that are sometimes (though not always) related to sports activities. Some young teenagers worry that these normal aches and pains are associated with a more grave condition. This transient stage of worry is called the hypochondriacal stage of early adolescence.

Now with all these factors combined, you may have a young athlete who has various aches or pains and is afraid the discomfort will never end. Young athletes who suffer from a minor injury may really struggle with being out of the game for a short period of time, and a short period of time may feel like forever to them. I find that a month may seem like forever to some young, concrete-thinking teenagers. You, and your child’s coach, should understand this dilemma and should not be surprised if your young teenager is temporarily irritable.

Older teenagers
Many older teenagers (ages 15-19) develop more reasoning skills as their minds mature. These so-called abstract thinkers need more logical explanations in response to questions, whether about sports, school or other aspects of their lives. Parents and coaches should be patient with these increasingly demanding minds, and provide them with explanations.

If you have an adolescent who is experiencing rapid deterioration of his athletic performance, he may be overwhelmed by common adolescent concerns of current times, such as family conflicts, mood swings, drug abuse, or depression. Keeping in mind the normal psychosocial development of teenagers can be helpful for you as you watch your children mature, in athletics and in all aspects of their lives. Do not, however, be afraid to get an evaluation from your primary care clinician or other health care professional who is knowledgeable about the effects of sports, if you suspect problems are developing.



Precocious Development
The precocious teenage athlete who starts physical development before his or her other peers (the early developer) may be called a ‘superstar’ and may become the object of considerable attention and praise from parents, other family members, coaches, and fellow students. This can be seen even in pre-junior high school sports.

Putting eggs in more than one basket
If you have a child like this, please note that only one-fourth of these young ‘superstars’ will remain in this enviable category through high school and beyond, as other peers catch up and even surpass the early developer. The resulting frustration can be quite severe for you and your child. Your teenager may be accused of being a ‘loser’ or of being lazy because she is no longer more successful than her peers. A teenager in this position may find himself considerably disturbed by these circumstances. He may experience depression or anxiety, and may express a number of negative behaviors. I advise parents of these young stars to follow them carefully and provide them with alternative activities so that they can develop healthy, well-rounded lifestyles. Actually, all parents of athletes should ensure the normal development of their teenagers’ other abilities (e.g., music, art, scholarship).






Delayed Puberty
Young people with delayed puberty (delayed physical development) are smaller than other teenagers their age, and in the sports arena they are often ignored by peers and sports coaches. When they compete against more physically advanced peers who are usually larger and stronger, the risk of injury to the less mature teenager dramatically increases. Parents should be sure that school officials match up their athletes properly to provide as low a risk of injury as possible. Those teenagers with delayed puberty should be assured that full puberty will eventually occur.

Patience, the golden rule
Maximal weight gain and muscle strength normally occurs several months after ‘the growth spurt’. A tall, thin, late-maturing boy may grow tall quickly but still not have the muscle strength and power of a shorter, more physically developed peer. Parents and coaches should avoid placing premature expectations on a teenager who may not be able to compete against more physically mature peers for several months or even years. If a developing teenager is pushed too fast, psychological and physical injury may result. Today’s pressure for victory may result in false charges of ‘sub-par’ performance - frustrating all involved with long-lasting consequences.



Adolescent Awkwardness
‘Adolescent awkwardness’ refers to a temporary time of motor incoordination in some teenage boys during their growth spurt. This temporary awkwardness is often seen in rapidly-growing boys. It can last approximately six months and affect important skills such as balance and general coordination. The growth in teenage boys, from trunk to legs, may influence this phenomenon. These teenagers should know that it is a normal growth phase and it will pass. Unrealistic performance should not be expected of these athletes.



Obesity
Some parents who perceive their children as obese may ‘push’ their children into active sports play in the hope that it will help their children lose weight. Though sports activity may be useful in helping a teenager control and even lose weight, my advice is that severely overweight children often benefit more in the long run from nutrition counseling and exercise training. Obese children may be more or less developed than their peers, but if an obese teenager is less developed, he or she may be at risk of serious injury in collision sports. Adipose tissue (fat tissue) is not as strong as muscle tissue, and puts these children at greater risk of injury.



Chronic Illness and Disability
Teenagers with chronic illness or disability can still experience the joy of participating in some modified sports. Clinicians and school personnel can work together to see that this is possible and encouraged. Parents can work with their teenager’s clinician to craft a physical activity to suit the teenager’s level of ability. Chronic illness or physical disability should not deter teenagers from participating in realistic sports activity.



Injuries
As parents of teenagers who play sports, we all fear that our children will be injured at some time in their sports careers. In fact, many are hurt and need thoughtful attention. A careful injury-management plan should be developed, and it is important not to minimize the extent of the injury. There is often a great temptation, on the part of a parent, a coach, or the athlete himself, to rush through recovery. Some teenagers find that their time away from a sport is actually a positive experience. Many do not.

Teenagers’ response to injury

The response of athletes to physical injury may involve five stages:
1. Disbelief with Denial and Isolation
2. Anger
3. Bargaining
4. Depression
5. Acceptance and Resignation with Hope

Initially, an athlete may not believe that she is injured and may try to continue playing her sport. An injured teenage athlete may isolate herself from family and friends and may become angry. She may then become depressed when she fully realizes that she will need to stop playing her sport during the recovery period. This realization may be overwhelming for a teenager. Understanding the ‘injury stage’ your teenage athlete is in can be helpful in responding to any injury-induced behavior. Various behavioral techniques, such as relaxation training or problem solving methods are helpful in combination with medical treatments and physical therapy. The teenager’s physician should be able to recommend medical professionals who can help.

Don’t succumb to the pressure
An injured teenager may not recover as quickly as he wishes and may push his parents or clinician to let him get back to the game before he’s fully recovered. You should avoid yielding to your teenager’s desire to return early to his sport. Certainly, parents should avoid putting pressure on a teenager to return to practice or competition early. Identifying realistic goals in the recovery process is important, and a teenager should get back to his sport at the appropriate time, after he has achieved the best possible recovery.



Summary
Sports offer teenagers a wealth of positive experiences. Sports participants can learn how to win gracefully and lose without losing hope. They can also learn how to put winning and losing in perspective. Many teenagers are not physically active - 50% of high school females and 25% of males are not involved in vigorous exercise. Participation in a sports regimen as a teenager may help teenagers continue regular physical activity into their adult lives.

There are, however, a number of factors that may interfere with a positive sports experience. Teenage level sports have, in recent times, become very highly organized and very competitive activities. In many cases we have lost the spontaneous, fun aspects of participating in a sport. Parents’ familiarity with adolescent psychological and physical development may help them regain their own perspective about the real benefits of sports activity for their teenage children.

Sex and Teens: What's Going On?


By: Jennifer Johnson, MD, MS & David Bell, MD

If there's one age group that parents wring their hands over, it's teenagers between the ages of fourteen and seventeen. They are in the throes of adolescence, which often means they are moody, private, likely to take risks, and likely to challenge authority and conventions. One day they behave like five-year-olds, the next like mature adults.

Most teenagers have entered puberty, and are actively exploring their sexuality, and it can be a profoundly confusing time.

Below, two adolescent health experts discuss what parents and their middle adolescent children need to know about sex and sexuality.



What is one of the primary concerns among teenagers, as their hormone levels are increasing and they are beginning to see changes in their bodies?
DAVID BELL, MD: One of the main things teenagers want to know is that everything is normal. They're comparing themselves a lot with their peers, and part of the process is to figure out what's normal and what's not.

JENNIFER JOHNSON, MD: There's a lot of comparing of naked bodies among kids, they're thinking, "What's he look like, compared with what I look like?" That's what happens in the showers in the gym. Of course, no one admits to looking at anybody else, but they do it because they're coming to terms with their new body and seeing it compared with other people's bodies. It's really important.



In terms of sexual development, is masturbation normal at this time?
JENNIFER JOHNSON, MD: Yes, I think the majority of kids have masturbated, especially by the time they've reached the ages of sixteen or seventeen. Most kids do it, regardless of what they've been told about it.

Medically, we know that masturbation is perfectly safe and, in fact, can be a very healthy outlet for these strong sexual drives that kids are experiencing.



Are wet dreams normal at this age as well?
DAVID BELL, MD: Yes. During their sleep at some point during puberty, boys may have a nocturnal emission, or a "wet dream." Basically it's the release of semen or sperm during the night, during their sleep.



Is this disturbing for some boys?
DAVID BELL, MD: Yes. And that's one important reason for parents to have a discussion with their teenage boys about wet dreams before they happen, just as we do with females before their first period, to prepare them for it. If a boy does not know what a wet dream is, he may think he urinated in the bed, and that can be devastating.



Is same sex experimentation normal at this time as well? How common is it?
JENNIFER JOHNSON, MD: We don't have a lot of information about how common same sex experimentation is. But certainly when and if it does happen, it's very normal. Again, it's a way for teenagers to assess their own growth, and compare themselves to their peers.

DAVID BELL, MD: I think it is important both for parents and for the teenager not to label their sexual orientation based on episodes like these.

JENNIFER JOHNSON, MD: Right. Sexual orientation is often still emerging in adolescents, and sometimes it changes during a person's life. It's important to differentiate sexual orientation from sexual behavior, because guys and girls may have same-sex sexual experiences and be completely heterosexually oriented. By the same token, boys and girls who are gay may have heterosexual relationships, including intercourse, and not have homosexual experiences until later in life.





Are children between the ages of fourteen and seventeen having sex? What does the research tell us?
JENNIFER JOHNSON, MD: The national data show that by the time teenagers are in their senior year of high school, about 60%, maybe 70% of boys have had sex, and probably about 50% of girls have had sex. By 'sex', they mean oral sex or intercourse.

So if you want to view it strictly in behavioral terms, having sex in high school is, in our society, a normative behavior, meaning more people do it than don't.



Do you find that kids who want to abstain from sex feel comfortable in abstinence? Or do they feel a lot of pressure to be sexually active?
JENNIFER JOHNSON, MD: In some schools there are very, very strong abstinence movements, and the cool thing to do is to say you're not going to have sex. But it varies a lot from teenager to teenager and from peer group to peer group.

One thing that is very certain is that the behavior in a peer group is the indication of the level of risk for a member of that group. If my daughter is hanging around with girls who smoke and drink beer at parties, I know that she in danger, because certain risk behaviors, like smoking, are linked with the initiation of sexual activity.

DAVID BELL, MD: There's also data from the Adolescent Health Survey that shows that the more connected teenagers are to either their family, to school, or to extracurricular activities, the safer they are in their relationships and behaviors.



What are the statistics on contraception use among sexually active teenagers?
JENNIFER JOHNSON, MD: One of the recent national representative surveys of teenagers found that, in contrast to the 1970s, almost two-thirds of teenagers use contraception the first time they have sex. That is a far cry from the 10-20% that we were seeing in the Seventies.



Is this increase a result of education campaigns?
JENNIFER JOHNSON, MD: Yes, I think so. Kids know about birth control and why it's important to use it. And, in general, they have access to at least condoms.



Teenagers may not ask their parents directly for information about sex, but do they want to hear what their parents have to say on the subject?
DAVID BELL, MD: I think, in some respects, yes, they do, but it's a delicate balance of when and how to deliver the information.

Sometimes the adolescent will ask about sex in reference to a friend. That opens up an opportunity for the teenager to share their own values and thoughts.

JENNIFER JOHNSON, MD: Parents need to know what's going on in these areas. On the other hand, I think it's important for parents to recognize that teenagers are becoming independent and they do, to some extent, have rights to privacy. They do have the right to have time alone in their room without anybody being in there.

That doesn't mean that parents can't talk to kids. But rather then just telling them what you think, you may open the door a lot better if you ask their opinion too.

I also think it's really important for parents to spend time with their teenager. It is very helpful, in terms of keeping communication open and demonstrating your commitment, if you do something together that you both enjoy doing.

DAVID BELL, MD: Some of the best conversations with your teenager come at unexpected times, whether riding in a car or on a camping trip...it's not this formal, sit-down talk about the birds and the bees

Club Drugs and HIV: The Agony and the Ecstasy


With: Perry Halkitis, PhD

People take street drugs to escape from the realities of their lives. But when they come down in the middle of the night, or the next morning, their problems are still there waiting for them. And statistics show that people who take club drugs like methamphetamine, also known as crystal, may wake up to a brand new problem: HIV infection.

Club drugs like methamphetamine release people from their inhibitions, leading some otherwise sexually responsible men, women and teenagers to engage in risky sexual behavior. For people with HIV, club drug use can interfere with their ability to stick to their drug schedule—and may make the virus replicate faster in their bodies. Below, Perry Halkitis, PhD, a chair of the department of applied psychology at New York University, discusses the relationship between club drugs and HIV infection.



What is the state of the HIV epidemic today?
We've seen a worsening of the HIV epidemic in the last several years. Infection rates were stable during the 1990s, but in the last few years there's been a spike in new HIV transmissions across the population, especially among gay and bisexual men. In this population, there was a 14 percent increase in new HIV infections between 1999 and 2001.



What has lead to this increase?
First of all, there's a fatigue around HIV in the gay population and in the general population. People feel that the HIV epidemic is over, and they're more complacent about safer sex practices. They think there's a cure and, as a result, people are not being as safe or as responsible in their sexual behavior.

Number two, prevention efforts haven't evolved as people have become sophisticated about HIV. So "Use a condom every time" campaigns, which worked fine in the early 1980s and the mid-1980s, are no longer effective.

We're also seeing a complex interaction between sexual risk-taking and drug use in the gay population and also in the straight population. We're seeing this in particular with a subset of drugs known as "club drugs" because of their association with dance clubs and bars.



Are people still going to clubs to do these drugs?
Twenty years ago, these substances were used a lot in dance club situations. Our research shows very clearly that people do them at home, they do them with their friends, they do them in the park—they do them wherever they need to do them. Some people have suggested that maybe a better label for them would be "party drugs" because these are the drugs that people do to have wild and inhibited sex, to go dancing, or to do both of those things in combination.



Which drugs are contributing to increase HIV risk?
We're talking about methamphetamine, also known colloquially as "crystal." We're talking about MDMA, which is known commonly as "ecstasy." We're talking about ketamine, Rohypnol and we're still talking about cocaine, to some extent. Most importantly, we need to think about not just each of these drugs in isolation, but these drugs being used in combination with each other, and in combination with alcohol and prescription drugs such as Viagra.



Which drugs are the most worrisome and why?
Perhaps the most worrisome is methamphetamine. This is a psychostimulant and a form of speed. Crystal is a hypersexual drug. It's a hugely disinhibiting drug. We know, and it's been clearly documented, that people who are using this substance have sex without rational thinking, they have multiple partnerings, they just let go. They feel like they're on top of the world, so nothing is a problem and any logical thinking around safer sex practices gets wiped away.

Methamphetamine is also a problem because it's a highly addictive drug from a psychological perspective, so people have a very difficult time coming off of it because the cravings are so intense.



Does the way methamphetamine is administered affect HIV risk?
Absolutely. When a person first starts using it, methamphetamine is usually snorted. Eventually chronic users begin to smoke it because it is a more effective way of ingesting the drug; it gives a better and a longer and a faster high.

Eventually, people who are dependent on the substance become injectors of methamphetamine. They inject it in their veins or muscles because it creates a much quicker and more intense high. So transmission through injection and the sharing of needles and the sharing of works creates another route of HIV transmission that is linked to methamphetamine use.






Do we know how much club drug use is affecting HIV risk?
We know—anecdotally in New York City and from documentation on the West Coast—that when we look at gay men who have become HIV-positive, more often than not, in the last several years, these men report having used methamphetamine with sex.

So while we're not able to put an exact number on it, you can bet that a large percentage of new seroconversions are among people who are drug users.



Does methamphetamine make oral sex riskier?
We know that the mouth produces saliva, which has protective factors that assist in the prevention of HIV. When people are high on methamphetamine, they have extremely dry mouths. Suppose an HIV-negative person is using methamphetamine and is having sex with an HIV-positive person. That is more dangerous than having sex with a person who is not high on methamphetamine.



What role does depression play in drug use?
We should never deny the fact that drugs make people feel good; that's why they do them, right? What we know, also, is that people often use drugs in our society to mask bad feelings. So people who are experiencing depression or loneliness or low levels of self-esteem, which can be addressed with therapy and with medications, are self-medicating by using these substances.

The unfortunate cycle that develops is that people who are depressed, for example, go on crystal, use crystal, feel better while they're high and then crash and feel even worse than when they started.

When we address HIV in the United States, I think it's incredibly important that we think about the link that exists between drug abuse, mental health and HIV. Addressing one of those issues in isolation doesn't seem to be sophisticated any more. We need to address all those three things together.



How does drug use affect people on HIV therapy?
What we know, from our work, is that adherence—taking your medications the way you're supposed to take them—is a problem across the board. If we believe the literature, people are supposed to be adherent 95 percent of the time. It's very hard for people to be adherent 95 percent of the time when they're high. When they're feeling good, the last thing they want to do is actually stop to remember to take their medications.

Number two, we know that methamphetamine is an immunosuppressant. Methamphetamine that is sold on the street is not pure methamphetamine. It's been cut with talc, heroin and variety of other substances that have an effect on people's immune systems.

Number three, and probably most alarming of all, is that some recent studies indicate that even if an individual is highly adherent to his or her medications, if they are using methamphetamine, replication of the virus in the brain is accelerated.



What do you want to say to people who use methamphetamine?
To people who haven't started who hear wonderful tales about this drug, don't start using it. This is not a wonderful drug. The price that you will pay in the long run is not worth it.

To people who are started, I say, look for help. Because what do we know about methamphetamine and its effects on people's lives? People become physically ill and they become socially ill. They lose their friends, they lose their family and they lose their jobs. Methamphetamine has often been referred to as the "Grim Reaper," because of horrible and devastating effects it has on people's lives.



How can people reduce their risk of HIV?
Clearly, one of the strategies is abstinence from both sex and intravenous drug use. For young adults and for adolescents, becoming totally informed and educated about HIV and its transmission is going to be a very important strategy, as well as considering delaying the onset of sex until an individual is at a point where he or she can make the right choices around sex.

The consistent use of condoms, of course, is important with anonymous or casual partners. Even in the context of some relationships that are not monogamous, the use of condoms is actually a really good idea.

Finally, the mixing of sex and drugs is not a good idea. Try to keep those things separate. A glass of wine is very different from two lines of methamphetamine. The combination of drugs and sex is where a lot of the risk is happening now and where a lot of the transmissions are actually occurring, so do not mix those two things.

It's extremely important for individuals in our country to remain informed. The disease is constantly changing. There are new medications that are coming out that are effective. But people are not necessarily living their whole lives with HIV; people are still dying. So remaining informed about HIV and remaining informed about strategies for safer sex is important.

Are You Overweight? Using the New NIH Weight Guidelines


By: Judith M. Ashley, Ph.D., R.D.

If you are facing the effects of "creeping" weight gain, how do you know when you should really get serious about losing those extra pounds? After all, based on the growing percentage of Americans who are overweight (see Table 1), it is likely that many of your friends, colleagues, and relatives are experiencing the same weight gain. How do we know if those "love handles" are not just a middle age phenomenon or a problem that you need to deal with?

In 1998, The National Institutes of Health (NIH) issued standards to help you determine if you are overweight or obese. These standards are based on the most extensive review of the scientific literature conducted to date regarding the relationship between weight and health risk by the Obesity Education Initiative Expert Panel. The Panel systematically evaluated published scientific literature from 1980 to 1997. The report established guidelines, or "standards of care," for physicians and health professionals to utilize in managing patients with a broad range of weight problems. The guidelines included what measurements to use to determine if a person is overweight or obese, as well as how to initiate and maintain a weight loss program.

The NIH recommends two measurements that you can determine at home---the body-mass index (BMI) and waist circumference---which will give you an accurate idea of what shape you are really in. These numbers go beyond a simple bathroom scale reading or a number from a weight-for-height table hanging in your physician's office.



Taking the Right Measurements
Body Mass Index

The BMI describes body weight relative to height and is strongly correlated with how much body mass, including fat, a person has.

To calculate the BMI, either weight in pounds and height in inches OR weight in kilograms and height in meters, can be used.

The BMI is the weight in kilograms divided by the height in meters squared [wt (kg)/ht (m)2] or the weight in pounds divided by the height in inches squared times 703 [wt (lbs.)/ht (in)2] ] x [703] (see Table 2).

For example, for someone who is 5'7" tall, their BMI would be 25 at 159 pounds, or their BMI would be 30 at 191 pounds (see Table 3).

The range that is considered healthy is between 19 to 25. A person with a BMI of 25 or greater is considered overweight; with a BMI of 30 or greater the person is considered obese; and with a BMI of 40 or greater, the person is considered extremely obese.

Solid evidence demonstrates that the risk for various diseases rises significantly when the BMI is over 25 and that risk of death increases as the BMI reaches and surpasses 30. The BMI number applies to both men and women. Some people who are very athletic and have a heavier muscle mass may have a higher BMI without the same health risks. The BMI is also used to determine whether weight loss drug prescriptions or surgery should be considered. FDA approved weight loss drugs are only recommended for those with a BMI > 30, or a BMI > 27 when an obesity-related disease already exists. Surgery for weight loss is an option when conventional methods have failed for those with clinically severe obesity measured by a BMI > 40, or a BMI > 35 with an obesity-related disease.

Waist Circumference

The waistline, or waist circumference, is a familiar body dimension that reflects abdominal obesity. The easiest way to measure yourself at home is by measuring your waistline at the level of the navel or at the narrowest waist midpoint using a tape measure. A health professional may be more specific in this measurement, using the midpoint between the lower border of the rib cage and the crest of the hip. A woman with a waist circumference over 35 inches (88 cm), or a man with a waist circumference over 40 inches (102 cm), is carrying too much fat around the abdominal organs. Fat around the middle changes the way the body uses fat, which can lead to diabetes, heart disease and cancer. Fat in a large abdomen is more likely to break down and enter the blood where it can clog the arteries.



NIH Weight Loss and Maintenance Recommendations
The NIH guidelines also include strategies for weight loss and maintenance.

The first recommended strategy is to focus on reducing overall calories. The diet should be individually planned to help cut back between 300 and 1,000 calories a day.

It is estimated that 3,500 calories translates into approximately 1 pound of weight loss, so cutting back on 500 calories over 7 days would mean a 1 pound weight loss in a week. As an example, for those with a BMI in the typical range of 27 to 35, a decrease of 300 to 500 calories per day will result in weight losses of about 1/2 to 1 pound a week and a 10 percent loss in 6 months. For more severely obese people with a BMI > 35, cutting back on 500 to 1,000 calories per day will lead to weight losses of about 1 to 2 pounds per week and a 10 percent weight loss in 6 months. If further weight loss is necessary, an evaluation is made at that point, with adjustment of the diet plan, since it is common to see the rate of weight loss decline and plateau after 6 months because of reduced energy expenditure (lower basal metabolic rate) at the lower weight.

The second recommended strategy takes into account the output part of the energy balance equation: physical activity and exercise. Increasing the loss of calories through physical activity not only helps with weight loss, but it also has benefits of its own, including improvement in physical fitness and appearance. Physical activity should be initiated slowly and become part of any weight loss or maintenance plan. The recommendation is to start out with 30 to 45 minutes of activity, three-to-five days a week, including activities such as walking or swimming at an acceptable pace. With this regimen, an additional expenditure of 100 to 200 calories per day is possible. The goal is to reduce sedentary activity (sitting, lying down, etc.). For many people this translates into a simple habit of getting up and walking as often as possible throughout their normal day. (Please see our article, Weight Loss and Physical Activity, for further information on this topic.)







Summary
The NIH guidelines discussed in this article will be influential on many fronts. By classifying certain measurements into categories (overweight, obese, extremely obese), it will help people decide if they should ask their doctors about their weight problems and the risk it may be posing to their overall health. It will also help physicians and other health professionals to determine if a particular patient should start a weight management program, and what type of goals should be set. Furthermore, since these NIH guidelines are considered the "standard of care," they are laying the groundwork for the types of services and medications covered by managed care companies and other insurance plans in the area of weight management.

Why Weight Matters: Obesity and Your Health


By: Robert Kushner, MD

We are a growing nation. In fact, according to the National Institutes of Health, more than sixty percent of Americans aged twenty years and older are overweight, and one-quarter of American adults are also obese.

What does this mean for the health of our nation? Nothing good. Obesity-related diseases are "implicated" in more than a quarter million deaths every year. Below, Dr Robert Kushner, Director of the Wellness Institute at Northwestern Memorial Hospital, discusses the grave consequences of our growing sizes.



How serious is the problem of obesity?
ROBERT KUSHNER, MD: It's the most serious problem we are facing today. Next to cigarette smoking, overweight is the second leading cause of preventable death in this country. It's estimated that 300,000 deaths per year is attributable to our diet, physical inactivity and resulting obesity.



What are the current statistics on overweight and obesity?
One in four is obese, and about one in three is considered overweight. Combined, over 60% of adult Americans are now overweight or obese. That means that the minority of this population is able to maintain a healthy body weight.



We're now hearing a lot about children being obese. What is the number there?
It's about 1 in 10, or 10%. The troubling factor there is that children are following in our oversized footsteps. An overweight or obese child is more likely to be an obese adult. So we are looking at an epidemic among our children as they become adults, and are likely to be more obese than we are today.



Why has the number of heavy people increased?
That's still debatable, and a lot of research is being done. But most of us think that it's due to our society and culture. We really live in an obesogenic society where food is plentiful, physical inactivity is everywhere. Those two factors combined lead to gaining weight.



How is obesity defined?
We currently define obesity by using a term called the body mass index, also known as the BMI. Everyone knows their cholesterol and everyone knows their blood pressure. It's equally important that everyone knows their BMI. It's a weight for height relationship that's fairly easily calculated on tables. A BMI between 25 and 30 is defined as overweight. A BMI of 30 or more is obese.

Roughly speaking, about 30 or more pounds overweight already defines one as obese.



Just 30 pounds?
Just 30 pounds. It doesn't take much to have the health complications that are associated with obesity.







Talk about those complications, the health effects of obesity
Obesity is the major cause of type 2 diabetes in this country. Obesity is the number one reason why diabetes is increasing in this country. It is fueling that disease. In addition to diabetes, obesity is also linked to increased risk of high cholesterol, high blood pressure, gastroesophageal reflux disease, certain cancers, in addition to psychological and emotional problems, as well as quality of life changes. It eventually leads to earlier death.



What are the leading causes of obesity?
The most significant factor really is our lifestyle. That's the only way that we can understand why the numbers of obese patients or individuals has risen so quickly. Again, that's the food that's everywhere and the physical inactivity.

But genetics plays a role as well. We currently think that genetics determines a vulnerability to our environment, which then brings out the obesity.

There are other causes, although less common. They include drug-induced obesity, such as people on different corticosteroids or different hormonal agents. Those medications can increase body weight, not to mention things like antidepressants and other drugs used for mental health disorders.

Rarely is an underlying medical condition a cause for obesity. That would be something like Cushing's syndrome or different kinds of glandular problems. But they are, once again, very uncommon.



What is the first step in getting treatment for obesity? Where does a person go for help?
There are several places an individual can go for help. One is, and the first that I would recommend, is to see his or her doctor. A doctor should be an active partner to a patient who is trying to get control of body weight. The doctor can also make sure that you don't have an underlying problem that is either being caused by obesity or causing the obesity itself. That needs to be ruled out right away.

Once you've done that, you can either work with your doctor or work with a registered dietitian or seek help with some of the commercial programs that are available, which can be very helpful.

Low-Carbohydrate Dieting: Exposing the Myths and Realities


By: Fred Pescatore, MD, MPH

Everywhere we look, we see something about low-carbohydrate dieting—television, radio, bookstores, and newspapers. Everyone we know seems to be on a low-carbohydrate diet. But what is low-carbohydrate dieting and how do we know which diet to follow, which is the healthiest, and most important, does it really work? In this brief article I am going to show you exactly what low-carbohydrate diets are and compare and contrast the most popular ones currently available with a diet I have been working with for the past few years.

I used to be the associate medical director of the Atkins Center for Complementary Medicine. Yes, that is the same Dr. Atkins whose very popular diet plan has swept the nation. In the five years I worked there, I was able to learn, first-hand, the health benefits of low-carbohydrate eating, but I was also able to learn which aspects were healthy and which ones were just hype.

When I first started working there, I had just finished residency training and knew nothing about nutrition. After all, they didn’t teach nutrition in medical school, nor was it emphasized when you were working in a hospital trying to handle life and death emergencies. Nutrition was something that was always left up to the dieticians. The doctor had to order the diet, but none of us really knew what the diets we ordered ever consisted of. Looking back, I now know what a terrible mistake this was.



Low-Carbohydrate Dieting
In a nutshell, low-carbohydrate dieting consists of eliminating most forms of carbohydrates. Carbohydrates come in many forms. They can be sugars, breads, pastas, pretzels, crackers, fruit, vegetables, and soda and fruit juices. Many people can’t believe that fruit and fruit juices are carbohydrates because they are really mostly sugar. Several recent studies even go so far as to suggest that the rise in obesity in our population is directly attributable to the rise in the consumption of fruit juices.

Sugar
For those of you who may not be aware of how fattening fruit juices can be, apple juice has more sugar in it than the same amount of soda. Sugar is the food that is eaten the most in this country. We eat 150 pounds per person, per year. That translates to 33 tablespoons each day. That may seem like an unrealistic amount, but when you begin to understand what you are eating, it is really quite easy to get to that level quickly without even realizing it. When I place my patients on the diet program I use in my practice, they come back in two weeks into the program, after having read all the food labels, and tell me that they can’t believe certain foods actually contain sugar. What’s worse, there are more than 300 foods that are not required by the federal government to list sugar as an ingredient, when in fact, they do contain sugar. As Americans, we consume more calories of sugar than we do of meat, chicken, vegetables, and breads combined.

Different forms of sugar
One of the main reasons we don’t know how much sugar we consume is because sugar has many disguises, such as brown sugar, corn syrup, honey, molasses, maple syrup, high-fructose corn syrup, dextrin, raw sugar, fructose, polyols, dextrose, hydrogenated starch, galactose, glucose, sorbitol, fruit juice concentrate, lactose , brown rice syrup, xylitol, sucrose, mannitol, sorghum, maltose, and turbinado. Essentially, any word on a food label that ends in -ose, or -ol is a sugar in disguise.

Carbohydrates
Why is keeping a low carbohydrate level so important? The explanation requires a little understanding of the basics of how food is metabolized in the body. Our bodies metabolize food in the same manner as the bodies of our prehistoric ancestors. The body preferentially uses sugar for fuel since the body doesn’t have to expend any energy to break it down for fuel. Next, the body will utilize simple carbohydrates such as pasta, bread, pretzels, and the like, simply because it doesn’t take much energy to convert these into sugar for fuel. Next, the body uses complex carbohydrates such as vegetables, brown rice, legumes, and whole-grain starches as fuel because the body has to expend energy to process these foods back into sugar in order to be used by the body. The body will then use protein for fuel, and use fat last.

Fat
The reason the body uses fat last is because fat is the perfect storage molecule for the body. Fat holds more than twice the amount of energy than either a carbohydrate or a protein, so the body, in its infinite greatness, will store those bits of energy (also known as calories) for a rainy day. For most of us in this country, that rainy day never comes and it is our hips and waist that suffer the brunt of this storage of energy.

The next logical assumption should be to eliminate fat from the diet and by doing so would solve the fat problem—right? Wrong! Because our bodies create stores of fat molecules, namely triglycerides, we have an excess of sugar in our bodies. The real key to dieting is therefore to eliminate the bottom of the food chain—sugar and simple carbohydrates—thus, forcing our bodies to utilize the complex carbohydrates, protein, and fat that we consume. Our bodies then begin to operate as they were meant to operate. Our prehistoric forefathers never had processed foods, and that is all sugar and simple carbohydrates are.






Losing Weight
By eliminating sugar and simple carbohydrates, we can lose weight easily and efficiently. I explained this concept to a patient I will refer to as Susan. She was 43 years old and was a strict believer in the low-fat philosophy, yet no matter how strict she was, she gained weight, felt less energetic each day, and needed to lose about 60 pounds. In order to explain the concept of how food is metabolized, I often measure blood insulin levels. Her insulin level was twice the normal amount when she was fasting and more than four times the normal amount two hours after she had eaten.

Insulin levels
High insulin levels have been linked to a variety of diseases: Diabetes, blocked coronary arteries, high cholesterol, high triglyceride levels, high blood pressure, strokes and most important, obesity.

Insulin is the hormone in your body that reduces your blood sugar. When there is too much blood sugar, in a condition known as insulin resistance, your body becomes overwhelmed and can’t do its job. A high-carbohydrate, low-fat diet can never correct this insulin imbalance or any underlying cause of obesity because it is too high in sugar. When you eat a low-carbohydrate, high-protein diet, your body can better metabolize the food that you eat and the insulin levels return to normal, and the weight comes off. Even if you are not overweight, the proper regulation of insulin levels is the key to avoiding some of the deadliest diseases that we face in this country.



Safe and Healthy Eating
I keep emphasizing low carbohydrate rather than no carbohydrate because that is the real key to dieting in this way in a safe and healthy fashion. Bill, a 54-year-old executive came into my office about 40 pounds overweight. He had tried all of the more popular low-carbohydrate diets and had lost about 50 pounds, but he suddenly got stuck, and for the past six months, was unable to get the scale to budge, despite having increased his sessions with his personal trainer.

I explained to him my theory as to why the body needs some good carbohydrates—in order to get the metabolism to function efficiently. I also explained to him that when the body is placed into ketosis, for example, for an extended period of time, that gimmick stops to work. Ketosis is actually what happens to your body when it is starving and your body begins to break down muscle protein. Your body will adapt and the ketosis becomes less effective at helping the body to lose weight. You can only fool Mother Nature for so long. I gave him the program I use, which consisted of more carbohydrates than he had been consuming for over a year, and within three months, he lost the remaining 40 pounds and an extra 10 to “play around with,” as he put it. He was able to do this because he had learned which carbohydrates to eat, and was not told, “eat all you want.”



Moderation is the Key
Many of the low-carbohydrate diets that are currently popular encourage the notion of “all you can eat.” While this certainly works in Las Vegas, it can’t possibly be expected to work over the course of someone’s lifetime. You simply can’t tell an overweight person to eat all of anything. It is the wrong message to send out.

The message to eat all the fat you want without worrying about it is also wrong. The most important thing I learned while at the Atkins Center was that the amount of fat does play a role in how much weight a person will lose. Also, the type of fat is vitally important. There are good and bad fats available for us to consume. I just don’t buy the belief that eating all the bacon fat you want is healthy for you.

The medical literature supports the theory of “good” and “bad” good fats such as omega-3 fatty acids—the type you find in fish. The medical literature similarly supports the theory that there are fats you shouldn’t be consuming, like the trans fats found in margarine and the hydrogenated fats found in most oils, except for olive oil and canola oil. The current fad-diet books do not take any of this research into account when helping you devise an eating plan that is supposed to make you healthy and stay that way.

Another popular book tells you that you should eat a meal that consists of anything you want as long as you do it in a certain time frame and that it is a certain set number of meals. For example, every third meal, you are allowed to eat all you can eat for an hour. That is a gimmick if you ask me. As you cannot tell an overweight person to eat all of anything, you cannot tell an overweight person they can eat any kind of food and still lose weight healthily. In medical school, I went on a chocolate pudding and French-fry diet and managed to lose weight, but it was not a healthy way to do so. Many people want to lose weight. More than half of us are seriously overweight. If you want to do something about it, you need to learn how to eat a proper diet.



The Thin Mind
Thin people think and treat food differently than we do. We need to learn how to eat and think like they do if we want to have any hope for success in the long run. And isn’t that what it’s all about—a lifetime of good health and looking good?

I should know, as I was once 80 pounds heavier than I am today. For the first time in my life, I can actually say that I have been thinner for longer than I was ever overweight. It is because I have been able to incorporate a sensible low-carbohydrate diet into my life.



Conclusion
Don’t be afraid of low-carbohydrate dieting—it is healthy and it does work. Be afraid of gimmick diets. They may just be snake oil after all.