Publication
The little book of white lies
Scotland's getting bigger...and it's affecting health and enjoyment of life more than ever.
Losing weight, and keeping off the weight you’ve lost, can mean you get more out of life, and live longer. Weight can have a dramatic effect on health, as this booklet shows.
Now, there’s a substantial amount of research to indicate precisely what the health effects of being overweight are. The research also shows exactly how health can be improved by weight loss, how important it is to keep weight steady, and to maintain an active life.
What we know about healthy eating has remained the same for many years.
Fad ‘diets’ come and go, and promises of ‘miracle’ cures for overweight individuals hit the newspapers and magazines from time to time.
But today’s mainstream advice is based on good knowledge and solid evidence that has stood the test of time, and we now know more about how to put that advice into practice in everyday life.
This booklet can be used in different ways.
It’s been written so you can use it alongside help from your health professional. It could also be one of the resources available to a group of people aiming to change their eating and activity levels together. It’s also something you can use as back-up if you’re aiming to make changes on your own.
You’ll find more information to help you at the end of this document, where we give you some useful websites and contacts.
The diet starts tomorrow
WHY YOUR WEIGHT MATTERS.
The health risks of being overweight, and the health benefits of maintaining a steady weight.
Your weight affects your health - and not just in the physical ways you’re first likely to be aware of.
There are also social benefits, and psychological ones, in maintaining a healthy weight. You feel fitter, more energetic and generally livelier. Your confidence is improved, and you enjoy taking part in events and activities more than you did.
But there are other health benefits associated with maintaining a healthy weight and an active life.
They include less risk of raised blood pressure, less risk of coronary heart disease, stroke, diabetes, gall bladder disease, arthritis, back pain, varicose veins and some cancers.
Of course weight is not the whole story in the development of these conditions - some of them have other causes, and there are plenty of slim, trim people who get them, too. But research over many years, looking at the health of many thousands of people, shows the risk of these conditions increases with your weight - and more importantly, you can lower your risk if you lose weight, and stay at that lower level.
So lighten up?
If you need to lose weight, it’s best to lose it in small amounts, steadily, over a period of time.
You might want to look slimmer, and want to lose a lot of weight quickly, so you can have something to show for it.
But getting that small, gradual and consistent loss really does pay off.
Why?
• It’s easier to achieve - trying to lose large amounts week after week doesn’t work.
• It allows you to enjoy treats - who wants to miss out on all their favourite foods and drinks?
• Larger amounts, lost quickly, don’t stay off. As soon as you start eating ‘normally’ again, your weight is regained - maybe even more than the amount you lost in the first place.
The health risks of being overweight, and the health benefits of maintaining a steady weight.
Keep it steady!
Most people do gain weight gradually over time, and it’s a real achievement to stop this happening. Preventing weight gain is an important factor in your health, especially if you have other risk factors, such as a family tendency to weight-related illness, or if you already suffer from high blood pressure or other conditions that could be made worse by extra weight (like arthritis). The same applies if you have lost weight - you need it to stay lost!
You’ll notice that when you have lost even a small amount of weight, you’ll feel better (probably some time before you actually see much difference in the mirror). Feeling more energetic helps you to become more active, and gives you some incentive to stick to healthy eating, as well.
PREVENTION IS BETTER THAN CURE, AS THE SAYING GOES.
Your waist and your health
Some people find a lot of their extra weight sits on their waistline. If your waist is actually more of a memory than a reality, then it could be a sign you are at a higher risk of coronary heart disease. The fat that lies there is known as ‘intra-abdominal fat’ and you can measure the extent of it by measuring your waist.
Research has shown that generally, the risk of coronary heart disease for both men and women grows progressively along with their waist measurement.
Men have an increased risk if their waist measures 94cm (37 inches) or more.
Women have an increased risk if their waist measures 80cm (32 inches) or more.
Men have a substantially increased risk if their waist measures 102cm (40 inches) or more.
Women have a substantially increased risk if their waist measures 88cm (35 inches) or more.
Although the research shows these ‘cut off’ points between ‘increased risk’ and ‘substantially increased risk’, the message for real life is that the risk of coronary heart disease increases as the tape measure expands.
How do we know?
Studies were done in America, where researchers measured a lot of waistlines (about 51,000), and matched the results up to other known risk factors for coronary heart disease. They found the waist measurement was a very reliable indicator - with the advantage that it was quick and easy to do, compared to checks such as weighing, checking blood pressure and measuring cholesterol.
‘Losing a bit means gaining a lot ... in health benefits we mean’
It’s true!
The research shows that if you are overweight or obese, you don’t have
to slim down to a ‘perfect’ weight to experience substantial reductions
in risk.
Even small losses have an effect. Regardless of original size, if someone who is overweight loses between 5-10kg (3/4 -1 1/2 stones) they will:
• improve back and joint pain
• improve lung function
• reduce breathlessness
• sleep better
• experience social and psychological benefits.
A loss of 10kg (1.5 stones) or more means:
• a greater than 20% reduction in risk of death from any cause
• a greater than 30% reduction in the risk of dying from a diabetes-related condition
• a greater than 40% reduction in the risk of dying from obesity-related cancer.
The loss of relatively few pounds also removes a substantial amount of blood fats such as cholesterol, the fatty deposits which clog up your arteries and make it harder for your heart to do its job.
I don't have the time to exercise
IN THE BALANCE
Everyday we take in energy - in the form of food - and we use it up simply by living.
The more actively we live, the more energy we expend
Making sure you eat the right foods for your needs
Energy is measured in calories - you may often see ‘kcal’ written. A person who has an active job, hauling machinery or building materials around, and climbing up and down scaffolding, is going to expend more energy than someone who works at a desk and rarely leaves it.
So these two people need very different amounts of energy from the foods they eat.
• If your food intake is equal to the energy you use, you’ll stay the same weight.
• If your food intake is less than the energy you use, you’ll lose weight (because stored fat gets used up when the body needs more energy).
• If the energy you use is less than the food you take in, you’ll gain weight.
Small changes can make a difference - both ways!
If your job or your life changes in some way, your weight can change. For instance, if you switch your active job for one behind a desk or a wheel, or if you retire, you could find your weight creeps up. You’re using less energy than you used to, and that shows on the scales.
In the same way, a change of routine so you become more active can mean you lose weight.
You might find changes in your life mean you eat differently. Perhaps you skip meals, and then end up eating high-fat foods because you feel the need to satisfy hunger quickly. After a while, this is likely to mean you gain weight.
If you’ve found any of this applies to your life, then the challenge is to match your eating to your activity... and over time, your weight will stabilise at a healthy level.
Getting up and going...
There are no rules about being more active - except to say you do need to do some form of extra physical activity several times a week for it to have any effect.
You won’t keep it up, or do it often, if you have to force yourself. You need to find something you enjoy for its own sake.
Ask yourself what’s putting you off, or what has been your downfall in the past, when you resolved to exercise and then found your enthusiasm faded.
‘It’s too costly’
Walking costs nothing, and can be done anywhere, without any special equipment.
Also, classes, swimming and gym facilities can often be cheaper than you think... go for local authority-run places, which tend to cost less, and which often have ‘club’ cards which allow cheaper admission.
You may be in an age or occupation group which allows even greater discounts.
‘I look awful in a leotard’
Don’t wear one, then! If you want to do exercise or gym classes, rest assured the days of having to look fantastic before you can exercise belong in the 1980s! Today, an old pair of leggings, shorts or trousers worn with a baggy T-shirt are just fine.
‘It’s a bit lonely’
Ask a friend to join a class with you. You can motivate each other.
‘I prefer to exercise on my own’
That’s fine, too. Go swimming, and sort out your day in your head, or write your life story, as you go up and down.
Choose a gym where you can watch TV or listen to music as you exercise. You can even read a magazine or a book.
‘It’s boring’
It doesn’t have to be. Learn a new skill which challenges you, mentally and physically. And when you’ve done that, learn something else.
If you’re not used to activity, start small and build up.
Walk to the shops instead of driving or taking the bus. Use the stairs and not the lift. Swim two lengths of the pool. Increase the time, and the frequency, of your exercise and notice how it gets easier.
To have a beneficial effect, your activity needs to:
• take place on most days of the week
• make you feel warmer and breathe a bit harder than normal.
These are signs you’re doing yourself good, and not that you’re doing ‘too much’.
YOUR PHYSICAL ACTIVITY DOESN’T HAVE TO BE AN ORGANISED CLASS OR SESSION. GARDENING, ACCOMPANYING YOUR CHILDREN TO SCHOOL, WALKING AT LUNCHTIMES, CAN BE JUST AS EFFECTIVE.
How foods can help you to maintain a healthy life - Balancing your diet
EATING FOR HEALTH
A healthy diet:
• is one you enjoy
• boosts your energy
• protects your body against infection and disease
• provides your body with the right foods to work efficiently.
Eating in a way that helps you manage your weight - to get it lower, and then to keep it at that level - doesn’t mean eating anything special, odd or unfamiliar to you.
It doesn’t mean eating ‘slimming foods’.
In fact, it just means choosing a balance of foods - a balance that’s been shown to reduce your risk of a range of health problems, to allow you to enjoy a longer, healthier life.
• Protect yourself by cutting down on fats, especially saturated fats (found mainly in animal products), e.g. full fat dairy products and the white fat on meat.
Diets high in fat can lead to hardened, narrowed arteries. When the heart has to work harder to get the blood round the body because of this, you’re at risk of high blood pressure, coronary heart disease and stroke.
• Protect yourself by eating more fruit and vegetables.
Fruit and vegetables are high in antioxidant vitamins, which help maintain the immune system, so you stay healthy.
Fruit and vegetables are comparatively low in calories - you can eat large amounts, without worrying about their effect on your weight. So increasing your intake helps you maintain a healthy weight, too.
• Protect yourself by ensuring your diet is high in fibre - found in the cell walls of fruit, vegetables, and grains, and present in ‘wholegrain’ versions of bread, pasta and rice.
Fibre helps your digestive system work well, and eating foods with it in means you are more likely to avoid constipation and piles. Fibre fills you up - it actually swells in the stomach, and allows you to feel fuller, sooner, so it can help you to avoid overeating.
Make sure you drink plenty of fluids throughout the day as well. Aim for 8-10 mugfuls of fluids in total each day. Choose from drinks such as water, sugar-free diluting juice, diluted natural fruit juice, semi-skimmed/skimmed milk, weak tea.
Aim to make changes to your diet, so it looks more like this.
The Eating for Health plate shows the best proportions of the different food groups;
keeping your own diet in roughly similar proportion will give the healthiest diet, according to good research.
The food groups and what’s in a measure.
Fruit and Vegetables - fresh, frozen or canned; pure juices and dried fruits.
A measure is:
• 1 small glass fruit juice
• 2 tablespoons of vegetables
• 1 piece of fresh fruit
• small handful of fruits such as grapes or strawberries
• small bowl of salad.
How much? 5-9 measures a day.
Bread, Cereals and Potatoes - crackers, noodles, oats, chapattis, pasta and rice also come into this group.
A measure is:
• 1 slice of bread
• 5 tablespoons of breakfast cereal
• 2 tablespoons of cooked rice, pasta or noodles
• 2 egg-sized potatoes.
How much?
5-14 measures a day.
Milk and Dairy Foods - low-fat types are better, so go for semi-skimmed or skimmed milk, and lower fat cheeses like gouda or edam, and cottage cheese.
A measure is:
• 200 ml (one-third of a pint) of semi-skimmed/skimmed milk
• 30g (1 ounce) of cheese
• 1 small pot of yogurt
• 120g (4 ounces) cottage cheese.
How much?
2-3 measures a day.
Lean Meat, Poultry, Fish and Alternatives
- try to have fish two or three times a week, including oil-rich fish such as mackerel or salmon. ‘Alternatives’ are pulses, nuts, seeds and soya products.
A measure is:
• 60-90g (2-3 ounces) meat, poultry or oily fish
• small can of beans
• 240g (8 ounces) cooked pulses
• 120g (4 ounces) fish
• 1 egg (not fried).
How much?
2-3 measures a day
Fatty and Sugary Foods - use all these in small quantities. This group includes margarine and butter, cooking oils and sugar, so it means fewer fried foods, crisps, biscuits and high-fat, high-sugar snacks.
How much?
Cut back; you don’t actually need any of these.
Research looking at what Scottish people eat indicates that for many of us, too many of our calories come from the fatty and sugary food group. We don’t eat enough starchy foods, fruits and vegetables, and we don’t drink enough water.
1 ounce = 28g. Measures have been rounded for ease of use..
Read your labels!
Understanding food labels will help you make your choice.
Most packaged foods on sale in the UK have to contain:
• a name
• a date mark
• a list of ingredients (listed in descending order of weight)
• the name and address of
• the manufacturer or packer.
Any foods saying they’re low in fat orhigh in fibre or similar have to supporttheir claim with more detail. You canfind this on the label.
TIP: Look at the amount of fat and saturates first. Choose the foods with the least amount, if you are comparing. Then check the sodium content - the lower the better.
How much is a lot?
It’s helpful to have a few rough rules of thumb when deciding on whether a meal or a snack is a healthy choice overall.
Try using the following to give you an idea whether a food has ‘a lot’ or ‘a little’ of a particular nutrient.
For a complete main meal or 100g of a snack food.
A lot ... is this amount or more:
10g of sugars
20g of fat
5g of saturates
3g of fibre
0.5g of sodium
A little ... is this amount or less:
2g of sugars
3g of fat
1g of saturates
0.5g of fibre
0.1g of sodium
How healthy is your eating?.
Try this quiz to find out how well balanced your diet is!
(scan of quiz table??)
Section A
What type of milk do you usually use?
a: Ordinary (4)
b: Semi-skimmed (2)
c: Skimmed (1)
How do you spread margarine/butter on bread?
a: Thickly (8)
b: Medium [6]
c: Thinly (2)
How often do you eat biscuits, cakes or pastries in a week?
a: 6 or more times (6)
b: 3-5 times (4)
c: Once or twice (2)
d: Very occasionally or never (0)
How often do you eat sweets, chocolates and confectionery in a week?
a: 6 or more times (6)
b: 3-5 times (4)
c: Once or twice (2)
d: Very occasionally or never (0)
How often do you eat chips or crisps in a week?
a: 6 or more times (6)
b: 3-5 times (4)
c: Once or twice (2)
d: Very occasionally or never (0)
How often do you eat sausages/meat pies/burgers in a week?
a: 6 or more times (8)
b: 3-5 times (6)
c: Once or twice (2)
d: Very occasionally or never (0)
TOTAL A: ............
Section B
How many slices of bread (or equivalent in rolls or chapattis, etc.) do you eat most days?
a: 6 or more (8)
b: 4-5 (6)
c: 2-3 (2)
d: 1 or less (0)
How often do you eat boiled or baked potatoes, rice, pasta or noodles in a week?
a: 6 or more times (8)
b: 3-5 times (6)
c: Once or twice (2)
d: Very occasionally or never (0)
How many potatoes (about the size of an egg) do you usually eat as part of a meal?
a: 5 or more (8)
b: 4 (6)
c: 3 (2)
d: 1-2 (1)
How many times in a week do you eat a breakfast cereal?*
a: 6 or more times (8)
b: 3-5 times (6)
c: Once or twice (2)
d: Very occasionally or never (0)
*(Add 2 points if it is usually a wholewheat/wholegrain variety)
How many portions of fruit and vegetables (fresh, frozen or tinned) do you eat every day?
a: 6 or more (8)
b: 3-5 (6)
c: 2 (2)
d: 1-2 (0)
TOTAL B: ..........
What the scores mean.
Section A
The lower your score for Section A the better. Below 10 is really good. Above 25 suggests you need to reduce the amount of fat in your diet.
Section B
The higher your score for Section B the better. A score above 30 is very good. Less than 10 and changes are needed to increase the amount of bread, cereals, potatoes, fruit and vegetables in your diet.
You should aim to have a low score for A and a high score for B, which means a diet which is, overall, low in fat and high in cereals, bread, fruit and vegetables.
If your score for A is greater than for B then you really do need to make a change in your diet. To help show where you can make the necessary changes look again at your answers. The questions in Section A which gave you a high score, and those in Section B which gave you a low score are the areas to concentrate on.
Maybe just one more?
READY FOR CHANGE?
Understanding why you may have put on weight can help you workout how to lose it ... and to make sure you maintain your new, healthier weight, and a more active life.
Which reasons apply to you?
• You’ve gradually become less active, maybe because your routine has changed, maybe because you’ve ‘slowed down’ as you’ve become older.
• You’ve tended to snack, rather than eat at mealtimes (or as well as eating at mealtimes) and the snacks you choose are high in calories/fat.
• The foods and drinks you choose tend to be high in calories/fat.
• Your alcohol consumption has increased.
Being overweight is a complex issue. If it was easy to lose weight, or not to gain it in the first place, we’d all be the ‘right’ weight ... but eating and drinking is far more than just a way to stay alive. We use food to celebrate, to soothe, to feel good, to relieve boredom, to reward ourselves for being ‘good’ and to comfort ourselves when we feel ‘bad’.
Thinking about the roles food and drink play in your own life can help you work out ways to change your choices. Talk to other people, or to the health professional helping you. Write down when you eat, and what you eat, over a period of several days.
Think of alternatives you could have chosen. If you always have chocolate biscuits when watching TV, can you replace the plate with the fruit bowl? Is there something else you can give yourself as a treat when you’re home from work, instead of a bag of microwavable chips?
BMI
Body Mass Index uses your height and your weight to work out a number which is your ‘BMI’. Note there’s no ‘ideal’ weight you ‘ought’ to be; instead, there is a range of weights in each category.
(The formula for BMI is your weight divided by your height squared - both using the metric system.)
Alchohol And Your Weight
Check the current advice on sensible drinking.
For men:
• If you drink 3-4 units per day there will be no significant health risk. Consistently drinking 4 or more units a day is not advised.
For women:
• If you drink 2-3 units per day there will be no significant health risk. Consistently drinking 3 or more units a day is not advised.
(In later life drinking a small amount of alcohol is thought to help prevent coronary heart disease. For men over 40 and women through the menopause this is thought to be 1-2 units a day.)
1 unit of alcohol = 1 small glass of wine or a measure of spirits or 1 /2 pint of beer.
Cutting down on alcohol means you’ll cut down on your calorie intake, too. For example, a pint of beer is actually higher in calories than a bag of crisps. Changing the type of alcohol you drink is another way of reducing your calorie intake.
• A pint of stout has more calories than a pint of beer.
• A small glass of wine has less than half the calories of a pint of beer.
Other ways of reducing your intake:
• Making longer drinks with low-calorie or calorie-free mixers.
• Alternate alcoholic drinks with non-alcoholic, low-calorie ones.
• Alternate pints with half pints.
Note: alcohol-free beers are high in sugar, and not low in calories.
Keeping Track
KEEPING TRACK.
Date................................................. Weight now: .................................................
Aims (tick):
reduce fat [ ]
reduce sugar [ ]
reduce calories [ ]
increase exercise [ ]
Action plan (write here more details of the practical changes you want to make, for example go swimming twice a week; cut back alcohol by half; swap chips for jacket potatoes most days).
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DIARY
Record your weight loss, the changes you’ve made, and other achievements here:
Week 1-4.......................................................................................................
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Week 5-8.......................................................................................................
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Week 9-12.....................................................................................................
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Research shows that most of us are unable to continue a weight reduction programme for longer than 12 to 16 weeks at a time. The first 12 to 16 weeks should be followed by a further 12 weeks of staying the same weight... and then if you need to lose more, you can start a weight reduction plan once more.
WHAT WORKS BEST?
Here are some tips, all based on good evidence, that can help you achieve success.
• Doing it all on your own is less likely to be successful.
• Support from your family is helpful.
• Support from specially-trained staff, such as community health professionals with training in this field, is helpful.
• Group support from others with the same aims means you are likely to achieve a better weight loss (the exception to this is that some very overweight men appear to maintain their weight loss better with individual support).
• Combining exercise with a change in diet is more effective in achieving weight loss than diet or exercise alone.
• Active living helps prevent you from regaining your lost weight.
Further Information
Websites
Scottish site for general and specialist health education information,including information on healthy eating.
www.bbc.co.uk/food/healthyeating
UK site with information on the principles of healthy eatingand the main food groups.
American site managed by academics, health care professionalsand government, providing evidence-based guidance on strategiesfor achieving and maintaining a healthy weight.
Online training:
A training resource for primary care staff on adultand child weight management.
Useful contacts
Local health promotion departments
Contact the health promotion department of your local health board (listed under ‘Health’ in your telephone directory).
SIGN
(Scottish Intercollegiate Guidelines Network)
Tel: 0131 247 3617
References:
The references for the material used in this booklet come from:
• The Scottish Intercollegiate Guidelines Network (SIGN), Guideline 8 (1996). SIGN Secretariat, 9 Queen Street, Edinburgh EH2 1JQ.
• HEBS research into weight management materials, carried out by Market Research UK Limited.
1858 08/2002