SLEEP More, WEIGH Less

Did you know that under-sleeping can lead to poor performance and impaired judgement and has also been linked to depression, obesity, diabetes and hypertension. A new study of 1,200 people showed that the average Australian adult gets less than seven hours sleep a night, below the seven to eight hours recommended by sleep experts.

A study by Columbia University, found people who slept four hours or less per night were 73% more likely to be overweight or obese. Also, people who habitually slept for five hours had 15% more ghrelin, a hormone which increases feelings of hunger, than those who slept for eight hours. Those who slept for less time were also found to have 15% less leptin, a hormone which suppresses appetite. "These differences are likely to increase appetite, and therefore contribute to obesity" Dr Taheri states. The subjects in the study also tended to eat more sweet and starchy foods when sleep was cut short.

While research continues, sleep still remains one of the body's most mysterious processes. We do know that sleep is absolutely necessary for survival and even occasional sleeping problems can make daily life feel more stressful or cause you to be less productive. Sleep loss also affects growth hormone secretion that is linked to obesity and impairs the body's ability to use insulin, which can lead to the onset of diabetes. It is paramount that we discover more about this activity where we spend a third of our lives - sleeping.

There are prescriptions and non-prescription drugs, herbs, remedies, technologies, etc that may help you get a good night's sleep. Some work for some and not for others.

Here are some tips you can try at home tonight. These tips are intended for the average adult, but not necessarily for children or persons experiencing medical problems:

• Imagining - Think of a hammock - you're up off the ground, wrapped in a cocoon of comfort, swaying gently in the open air. The sun is warm on your face and there's a cool breeze blowing you back and forth. This visualisation helps you "see" what the reward for sleeping will be, getting you more in the mood to sleep. Visualisation has proved helpful in developing the appropriate brain wave patterns for sleep.
• Magnesium - Has a calming effect on the nervous system. It is part of bones and cells, especially the smooth cells of arteries, and assists in the absorption of calcium and potassium. Over 300 enzymes in our body need magnesium to function properly. It is so important, that the brain stores a "safety supply" to have in the event of a drop in the magnesium reserves.
• Nutmeg - Grind fresh nutmeg and serve it with warm low fat milk and a touch of honey. Milk is naturally high in calcium and rich in tryptophan; together they can be a powerful tranquilizer (and very delicious).
• Hot foot baths - In the Eastern World, a hot foot bath is a traditional remedy; it draws blood from the brain to calm a racing mind. Try soaking your feet in a hot bath with a cupful of Epsom salts and a few drops of lavender essential oil, which will soothe you. Your feet absorb the magnesium from the Epsom salts and relax you further.
• Stomach rub - Soothes down the digestive system and helps bring about deeper relaxation. Lie on your back and place your hand on your belly button. Begin to make small circles in a clockwise direction as you gently glide your hand over your stomach. Let your circles gradually become bigger and bigger. When your circles reach the outside of your stomach, gradually reduce their size until you are back at your belly button again. Reverse the direction; repeat the whole series with your other hand and do this several times. Doing this with lavender oil can create an even more relaxing experience.
• Listening to an audio book - The brain works like a tape player - with one main auditory loop that processes words. If you fill that loop with an interesting book, there's no room for your own worrisome internal narrative. Especially helpful for those who have continuous thoughts running through their heads.
• Deep breathing - Take a deep breath in then slowly release out - focussing on your breathing causes your mind to get distracted from your worries and focussed on your breathing. Doing this for a few minutes can relax your mind and help you get a more peaceful sleep.
• Turn it off - Sleep experts suggest refraining from doing work, watching television, or being on the computer at least an hour before bed time. This allows your brain to start to 'wind down'.

Gangwisch. D, Malaspina. D, Boden-Albala. B, (2005) Inadequate Sleep as a Risk Factor for Obesity: Analyses of the NHANES I; COlumbia University, College of Physicians and Surgeons, New York, NY.

Taheri. S, Lin. L, Austin. D, Young. T, Mignot. E, (2004) Short Sleep Duration is Associated with Reduced Leptin, Elevated Ghrelin, and Increased Body Mass Index. PLos Med 1(3): e62. doi:10.1371/journal.pmed.0010062.

Major Fast Food Outlets Required to Disclose the Number of Calories in their Food by 2012.

Businesses with more than 200 outlets across Australia, or with 50 in Victoria, will have to display the amount of calories in their food under new Victorian State Government legislation by 2012.

As people order their Big Mac or bucket of crispy chicken, they will be able to see on the menu or on the display board how many kilojoules come with it. (Note: 1 calorie equals 4.2 kilojoules).

Victorian Premier John Brumby says his government is making it compulsory to display the details in a bid to cut down the rate of diabetes and obesity.

'The reason we are doing this is because we have a runaway epidemic in Victoria, right across Australia, particularly with diabetes,' Mr Brumby told reporters.

He said there are up to 270,000 Victorians with diabetes, with a further 20,000 becoming diabetic every year.

'This is a runaway train and we need to drag it back - the best way is by healthier eating and giving consumers information about their eating choices.' Mr Brumby said.

'Many people don't realise that if you eat a big hamburger, with a big coke and a big bag of chips that will be around half of your daily food intake.'

'Many people also don't realise the calories in a large Coke, almost 1,000kj or 20 teaspoonfuls of sugar.' Mr Brumby continued.

Health groups also support the move.

VicHealth Chief Executive Officer, Todd Harper said the plan was likely to be followed by other states.

'I have no doubt it will be popular initiative with consumers and hope that fast food outlets that fall under the threshold will voluntarily adopt it.' Mr Harper said.

'Until now, fast food companies have managed to keep kilojoule counters out of their displays but the time has come to put health first.'

Jane Martin, Senior Policy Adviser for the Obesity Policy Coalition, says clearer labelling on menus will help consumers 'sort the fat from fiction at a glance.'

'Many consumers would be surprised to find that some seemingly innocuous items such as frappes and smoothies contain one quarter of an adult's recommended daily energy intake,' Ms Martin said in a statement.

'To make matters worse many products with healthy sounding names are at the top of the worst offenders list.'

She says some of the highest kilojoule products have names such as Blueberry Blast, Garden Goodness and Green Tea Venti.

'While some of these products contain valuable nutrients, few people would realise that there's less than a 100 kilojoules difference between a Big Mac and the McDonald's Crispy Chicken Caesar Salad,' she said.

Story courtesy of Bigpond News.

Modifiable Risk Factors that Explain 90% of Stroke Risk! ‘Interstroke Study’

A modifiable risk factor is a health risk which is in your control. Age, gender and genetics are non-modifiable factors as we cannot change them. A modifiable risk factor however, can be eliminated with the correct lifestyle.

A recent study of 6,000 people from 22 countries called 'Interstroke' evaluated risk factors of stroke. The study showed that 10 risk factors are associated with 90% of the incidence of stroke and that most of these can be changed by lifestyle.

A stroke can be devastating resulting in death or a lifetime of physical impairment. The good news from this study is that many strokes can be predicted and the resultant burden of the disease reduced by following certain measures. Of the modifiable risk factors, blood pressure (hypertension) control was identified as the most important.

Five modifiable risk factors of hypertension, current smoking, abdominal obesity, diet and physical activity accounted for 80% of stroke.

When additional risk factors such as having Type 2 Diabetes, a high alcohol intake, psychosocial issues, abnormal apoliproprotein ratios and cardiac causes (such atrial fibrillation or flutter, previous myocardial infarction or valve disease) are taken into account these 10 risk factors account for 90% of the risk of stroke (1).

The following are key strategies for significantly reducing the risk of stroke:

• Maintain a healthy weight
• Limit your salt, processed and takeaway food intake
  
• Eat a balanced diet of vegetables, fruit, fish, poultry, meat, nuts and seeds, low fat dairy and whole grain carbohydrates
  
• Limit alcohol intake. Aim for no more than 2 standard drinks per day
  
• Go to your GP for a check up regularly
  
• Monitor your cholesterol levels
  
• Quit smoking
  
• Measure your waist regularly
  
• Exercise daily - aim for at least 30 minutes
  
• Get treatment for depression or stress

Unlike cardiac disease where there can be a lifetime of medication in order to reduce risk factors, the above strategies are all about leading a healthy lifestyle and that is free.

(1) O'Donnell. M. J, Xavier. D, Liu L, et al. Risk factors for ischemic and intracerebal haemorrhagic stroke in 22 countries (The Interstroke Study): Lancet 2010; DOI: 10.1016/S01140-6736(10)60834-3. Available at: http://www.thelancet.com/

Are You Getting Enough Sleep to Lose Weight?

In the last 40 years, the average duration of nightly sleep has decreased by 1-2 hours (1), a time during which the number of people classified as overweight or obese has doubled. It's been hypothesised that there is a correlation between these two trends: and it's not just because more waking hours means more time to eat.

Research has found that sleep deprived rats eat more than rats that are allowed normal amounts of sleep (2,3) . And several studies with human subjects show that people who sleep less are more likely to be overweight (4).

The cause is believed to be two hormones that regulate appetite and energy expenditure: Ghrelin and Leptin. The level of Leptin, a hormone that suppresses appetite, is decreased with sleep deprivation; and the level of Ghrelin, a hormone that stimulates appetite, is increased with sleep deprivation. So if you are trying to lose weight it's important that you are getting enough sleep.

How Much Sleep is Enough?

There's no perfect level of sleep for everyone, but the following table identifies the 'rule-of-thumb' amounts most experts have agreed:

Age / Sleep Needs Per Night (hours)
1-2 months: 10.5 - 18
3-11 months: 9-12 + 1-4 x 0.5 - 2 hour naps
1-3 years: 12-14
3-5 years: 11-13 hours
5-12 years: 10-11 hours
11-17 years: 8.5-9.25 hours
Adults: 7-9 hours
Older adults: 7-9 hours

To determine your own sleep needs, assess how you feel with different amounts of sleep.

How Can I Get More Sleep?

1. Make sleep a priority - don't make it the thing you do when everything else is done. If you have a daily planner; schedule sleep into it.
2. Drink a glass of milk before going to bed. Milk contains the amino acid Tryptophan, which may facilitate sleep.
3. Don't eat in the 2-3 hours before going to bed and aim to go to bed feeling content (i.e. neither full nor hungry). Going to bed hungry can affect your sleep as much as going to bed on a full stomach.
4. Exercise on a regular basis; avoiding the three hours before your bedtime. Some people exercise close to bedtime in the hope it will exhaust them; but this tactic can backfire as exercise stimulates the body by increasing your heart rate and metabolism.
5. Reduce your alcohol consumption. Although alcohol may help you fall asleep, it can disrupt your normal sleep pattern during the second half of the night and leave you feeling tired.
6. Avoid caffeinated drinks and foods after midday. This includes coffee, tea, cola and chocolate. If you are having trouble sleeping; try avoiding caffeine entirely and see if your sleep patterns improve.
7. Avoid smoking in the six hours before your bedtime (nicotine is a stimulant).
8. Avoid drinking too many fluids before bedtime to minimise night time urination.

References:

1. National Sleep Foundation, 2002, 'Sleep in America'
2. Danguir J and Nicolaidis S. 1979, 'Dependence of Sleep on Nutrients' Availability' Journal of Physiology and Behaviour vol. 22, pp. 735-740.
3. Everson CA, Bergmann BM, Rechtschaffen A. 1989, 'Sleep Deprivation in the Rat: III. Total Sleep Deprivation' Sleep vol. 12 pp. 13-21.
4. Hasler G, Buysse D, Klaghofer R, Gamma A, Ajdacic V, et al. 2004, 'The Association Between Short Sleep Duration and Obesity in Young Adults: A 13-year Prospective Study' Sleep vol.27 pp. 661-666.

Social Support in Weight Loss

It’s important to define what support you want from your family and friends when you are losing weight. You need to decide who you want to support you, and just as importantly what type of support you want.

Some people want their friends and family to totally ignore what they eat and whether they exercise; they prefer that their spouses never comment on their weight loss efforts. Other people wish to be praised every time they do well and ignored when they slip. And yet other people wish to be monitored and told outright that they don’t need a second helping, or that they shouldn’t buy chocolate at the supermarket.

Consider what type of support has worked for you in the past and what might work best for you in the future. And think about who you want to support you. We’ve listed some scenarios below to help you brainstorm. Think about if you want support and who you want support from:

- Ignore my weight management efforts completely (never mention them)
- Reinforce my successes and ignore my setbacks
- Monitor my weight management behaviours with verbal reminders
- Never offer me anything fattening
- Offer me whatever everyone else is having and let me decide
- Eat differently when they're with me
- Encourage me to exercise
- Comment on my physical appearance
- Ask how my weight management efforts are progressing
- Ask how they can help
- Ask me how much weight I've lost
- Comment on how well I'm doing
- Be there for me in difficult times
- Prepare low fat foods for me to eat.

It’s important to be confident in your knowledge of the kind of support that you want, otherwise well meaning family and friends may inadvertently perpetuate problems.

Outsmarting a Weight Plateau

You've been checking the scales each week and progress is steady, you'll achieve your weight loss goals in no time! But suddenly the scales refuse to budge... It doesn't make sense! You haven't changed your diet and you haven't skipped an exercise session...

It's disappointing, it's frustrating and it's called a weight plateau. But the good news is that you aren't the first to experience it, and that you can take steps to outsmart it:

Maintain your Metabolism

When you restrict your calorie intake it's almost inevitable that your metabolism will slow. Try incorporating more resistance training into your exercise program to maintain your metabolically active muscle tissue and eat small but regular meals.

Adjust Your Exercise Routine

As you become fitter your body becomes more efficient at performing a given exercise, i.e. you burn less energy. To burn more energy, try changing the type of activity that you do to challenge different (and less efficient) muscle groups. Try cycling, swimming, rowing, using a cross trainer or learning to use different equipment at the gym.

If you don't want to change your activity type, you will need to exercise at a slightly higher intensity. You can increase the speed or incline of your walks, the resistance on your exercise bike or your swimming speed in the pool. At this stage you may wish to consider purchasing a heart rate monitor to make sure that you are still exercising in your fat burning zone.

Reduce Your Stress and Anxiety Levels

Chronic stress means chronically elevated levels of a hormone called Cortisol in your body, which may predispose you to storing fat (1). If you are feeling stressed or anxious, investigate some stress management techniques.

Be Honest with Yourself

How long has it been since you weighed your meat portions or measured your cereal serves? Should you be counting that thick slice of raisin toast as one serve or two? These little things might not seem like much, but added together they determine if you gain weight or lose it.

Start weighing your food portions and recording your intake of food, including calories. Recording can be cumbersome, but it might just be enough to help you identify where the problem lies.

Are You Really at a Plateau?

Are your clothes feeling looser but the scales aren't moving (or even moving in the wrong direction)? It might be the case that your body composition is changing, i.e. you are gaining muscle tissue (which is heavier than fat). This is possible if you have changed your exercise regime to include more resistance training, or you have changed the type of exercise that you are doing. To find out if you have gained muscle, measure your waist and hip circumference instead of stepping onto your scales.

The benefits of exercise, stress reduction and healthy eating extend beyond losing weight - they bring out the best in your body. So focus on enjoying how you feel rather than focusing on the number on your scales. If you have lost weight you are probably feeling more healthy and energetic, and that's something to celebrate.

How to Set Weight Loss Goals

Before you change your lifestyle you need to set realistic goals, have realistic expectations and devise a master a plan for action: you can't just wake up every morning and react to what happens. At the Wesley Weight Management Clinic we recommend that people set SMART goals; goals that are specific, measurable, attainable, realistic and timely:

Specific

- What do you want to achieve?
- What would you like to change or improve on?
- Why do you want to reach your goal weight?
- What aspects of your lifestyle do you need to change to lose weight?
- Are there any habits that are holding you back?

Measurable

Set goals for the number of:

- Hours that you will sleep each night
- Litres of water that you will drink every day
- Minutes of exercise that you will do every week
- Healthy meals that you plan to cook / not skip.

Attainable

Allocate sufficient energy, time and effort for your goals. And make them flexible and realistic. For example, to achieve your exercise goals when you are busy you may have to shorten your exercise sessions or focus on incidental (non-planned) activity such as walking.

Realistic

Accept your body's natural ability to lose weight - otherwise you are setting yourself up for disappointment. Many people find it difficult to lose more than half a kilogram per week.

Make your goals achievable and if you succeed sooner than anticipated it will increase your confidence. Expecting that you will be ready to run a marathon the year after your first personal training session can be soul destroying!

Timely

Give yourself ample time to achieve your goals. When people place too much pressure on themselves to lose a particular amount of weight it can lead to anxiety. Or when they progress too quickly with exercise they suffer injuries.

Don't forget that weight loss is a marathon not a sprint. It takes time and perseverance to change ingrained habits, but with hard work, dedication and professional weight loss support you'll achieve your goals.

10 Tips for Weight Maintenance

If you've worked hard to achieve your weight loss goal, you'll want to enjoy your healthy weight for life. Here are our top ten tips for weight maintenance:

1. Monitor Your Weight

Check your weight each week (don't weigh yourself too often it's natural for your weight to fluctuate daily). Use your bathroom scales, or find a pair of pants that are comfortable at your goal weight and identify if they get significantly tighter or looser.

It's normal for your weight to fluctuate by 1-2 kilograms, but if you notice your weight increasing on two or more consecutive weeks try one (or a combination) of the following three actions:

1. Decrease your calorie intake
2. Increase the duration and / or frequency of your exercise sessions
3. Be honest with yourself: are there any areas of your lifestyle, behaviour or environment that have changed?

You should set an upper and a lower limit on your weight (a Dietitian can help you set appropriate limits). If you hit your upper or lower limit, seek professional help from a Dietitian or Doctor as soon as possible. And don't procrastinate for too long - it's much easier to reverse a 1-2kg weight gain than it is to reverse a 5-7kg weight gain!

2. Monitor Your Eating Patterns

Keep a food diary to ensure that you are eating the right amounts of food from each of the five food groups. It may sound tedious, but a food diary helps you to check that you are eating regularly. Try to maintain a consistent eating pattern, including weekends and holidays.

3. Exercise

To maintain your weight you need to exercise at a moderate intensity (a rate at which your heart rate is elevated but you can still carry out a conversation) for at least 250 minutes per week. Try walking for 30 minutes on five days of every week. For the fitter members of the audience, you can try vigorous cardiovascular exercise such as jogging for 20 minutes a day on three days of the week.

If you want to change the shape of your body or strengthen your muscles, try resistance training, or performing exercise against an opposing force such as water, free weights, weight machines, a theraband, a fit ball or even your own body weight. Resistance training increases the proportion of lean body tissue (muscle) in your body contributing to a higher metabolic rate, as well as improving your posture, flexibility and strength. If you are interested in starting a resistance training program, it's best to have a program designed by an Exercise Physiologist or a personal trainer.

4. Continue to Set Goals

The goal of weight loss is change, whereas the goal of weight maintenance is no change. It can be hard to maintain your resolve when you don't see results for the effort you are putting in. To account for this, try setting other life goals that are better enjoyed at a lower weight (e.g. joining a community walking group or travelling).

5. Reward Yourself

When you were losing weight you were probably enjoying the associated rewards: complements from friends, the excitement of fitting into smaller clothes and a dropping body weight. You'll have to devise a new set of rewards to keep you motivated during weight maintenance: treat yourself to a massage, buy a book or have a manicure of pedicure at the end of every month. You'll need to reward yourself for at least the first few years after weight loss.

6. Enlist Support

While you were losing weight it's likely that you received encouragement from family, friends and health professionals. Weight maintenance can be just as difficult as weight loss at times - and it can be a more isolated process. But it doesn't have to be that way. Tell the important people in your life that maintaining your healthy weight is important to you, and that you'd like their support and encouragement for the long term.

7. Stay Vigilant

It's easy to become complacent when you achieve your weight loss goal. People sometimes fall into the trap of thinking, "I can have an extra scoop of chocolate ice cream - I've lost a lot of weight and I'm feeling really good". Just because you've lost weight it doesn't mean that extra calories don't add up anymore!

It's important to treat yourself from time to time, but it's also important to recognise when extra treats are creeping into your diet too often. By keeping a food diary (or just listing your treats on a notepad) you can identify how frequently you are indulging. You should consume no more than 2-3 treats per week, and try to limit your treats to a 200 Calorie portion.

8. Be Organised

It's hard to manage your weight when the rest of your life is in chaos. Leave plenty of time to relax, sleep, shop for healthy foods, prepare healthy meals and exercise.

9. Maintain a Healthy Level of Self Esteem

Don't link how you feel about yourself to your weight. Be happy with you weight and proud of the weight loss that you have achieved.

10. Don't Use Food to Stabilise Your Moods

If you are feeling stressed or upset, find a non-food related way of calming yourself - go for a walk or call a friend.

Lastly, don't forget that weight maintenance can be just as challenging as weight loss (if not more so in the first two years). But it gets easier with time, and by following our advice you will be well on your way to success.

Alcohol and Weight Loss

At the Wesley Weight Management Clinic we're often asked if drinking alcohol can hinder weight loss. Here's our answer:

To lose weight, you will probably need to moderate your alcohol consumption. We don't want to demonise alcohol (or any other food or drink) - we're strong believers in the saying "all things in moderation" and you still need to go out and enjoy yourself when you are losing weight. But it's important that you appreciate that drinking alcohol will hinder your weight loss efforts.

Alcohol is High in Calories

Alcohol contains 70 calories per serve. To put this into perspective, the following meals contain the same number of calories as three standard drinks:

- 100g lean pork/steak/chicken breast + 2 cups of salad
- 1 x 95g can tuna (98% fat free) + 4 Vita Wheat crackers
- 1 Weight Watchers Beef Burgundy frozen meal + 2 cups of vegetables

These meals provide important nutrients, vitamins and minerals, which can't be said for alcohol: alcohol calories are 'empty calories', or energy without any substantial vitamins or minerals. Additionally, alcohol may directly promote fat storage by slowing fat and carbohydrate digestion and increasing appetite (1).

If you were on a 1500 Calorie a day meal plan during weight loss and chose to consume 500 of these calories from alcohol (approximately 4 x 375mL cans of regular beer), you would need to provide all your essential nutrients from the remaining 1000 Calories. This may be difficult; and it's possible that nutritional deficiencies may occur over time.

And if you consumed 1500 Calories of food per day plus 500 Calories of alcohol per week (approximately 4 x 375mL cans of regular beer), you might gain 5kg of weight per year!

Can Alcohol be Beneficial to My Health?

The risks of consuming alcohol far outweigh any possible benefits. There are health benefits from drinking alcohol, but these can be obtained by drinking as little as half a standard drink per day (2).

How much Alcohol is Safe to Consume?

The Australian Alcohol Guidelines have recently been updated (3) and consist of four recommendations:

1. For healthy men and women, drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury (note that it is no longer considered safe for men to drink four standard drinks per day).
2. For healthy men and women, drinking no more than four standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion.
3. For children and young people under 18 years of age, not drinking alcohol is the safest option. 4. For women who are breastfeeding, pregnant or planning a pregnancy; not drinking is the safest option.

What is a Standard Drink?

See the image to the right. Note that there is no standard glass size used in Australia: you will often be served more than one standard drink.

How can I Reduce My Alcohol Intake?

Try the following practical tips for reducing your alcohol intake:

- Eat before you drink alcohol: food fills you up, slowing your drinking pace and possibly slowing your absorption of alcohol
- Drink water or a diet soft drink before drinking any alcohol and avoid salty foods while you are consuming alcohol
- Sip alcohol slowly and put your glass down between sips
- Intersperse your alcoholic drinks with non alcoholic drinks such as water or diet soft drinks
- Dilute wine with ice, water, juice or natural mineral water; dilute beer with diet lemonade or soda water and mix spirits with diet soft drinks or soda water
- Choose light beer over full strength
- Don't let other people 'top up' your glass: be more assertive and do not to let peer pressure make you drink more than you want to
- Avoid 'shouts' or get a glass of water when it's your turn to buy a round
- Volunteer to be the designated driver to avoid peer pressure to drink.

So go easy on the alcohol when you are trying to lose weight and you'll reap the rewards.

References:
1.National Health and Medical Research Council (2003), Dietary Guidelines for Australian Adults Commonwealth of Australia
2.Lewis S, Campbell S, Proudfoot E et al (2008) Alcohol as a Cause of Cancer, Cancer Institute NSW, Sydney
3.National Health and Medical Research Council (2009) 'Australian guidelines to reduce health risks from drinking alcohol' Commonwealth of Australia

Non-Hungry Eating: How to Take Control

If you eat when you aren't hungry you may be finding it difficult to lose weight. Here are some tips to help you fight the urge to eat when you aren't hungry, a habit which we call 'non-hungry eating':

What are Your Eating Cues?

When you understand why you eat when you aren't hungry you can take positive steps to prevent it from happening again. Do you eat when you are feeling down or lonely? When you are engaging in certain habits or activities? Because the weather is gloomy? Or simply because food is put in front of you?

Next time you catch yourself heading to the pantry when you aren't hungry, think about your motivations for wanting to eat. Then you can work toward re-gaining control of how you respond to your cues. Try removing the cue (e.g. take the packet of chips away from the TV room if you eat when you watch TV). Or you can actively respond to the cue in a different way (e.g. call a friend instead of heading to the kitchen when you are bored).

Don't be disheartened if you don't succeed in changing your habits straight away. Change is a process that takes time, dedication and the courage to persevere - even when you don't succeed.

Measure Your Hunger

Be aware of when you are engaging in hungry eating because hunger is an appropriate cue to eat. To ascertain your level of hunger, try using the following scale to rate your hunger before eating, then five minutes after you have started eating and then again when you have finished your meal:

Rating / Physical Sensation
1 Starvation, physical pain
2 Definite physical symptoms: headache, low energy, light headed feeling, empty stomach
3 Beginning of physical signs of hunger
4 Could eat if suggestion was made
5 Neutral
6 Satisfied
7 Feel food in stomach
8 Stomach protrudes, beginning of mood alteration
9 Bloated, definite mood alteration
10 Definitely full: physical pain and numbness

People who are successful at weight loss generally wait until they are at a rating of 2 or 3 before they eat, and then they only eat to a rating of 6.

Remember that you are in control of how you respond to your eating cues. And when you control how you respond to your eating cues, you can start to control your weight.

Reference: Kausman, R. 1998. If Not Dieting, Then What? Allen & Unwin

Five Tips for Easier Weight Loss

When it comes to changing your lifestyle, it's human nature to look for the easiest option. So why not make the easiest option the healthiest option? Here are five tips to get you started:

1. Write a meal plan Create a weekly meal plan that accommodates your daily appointments, work commitments and children’s activities. On nights where time is precious, schedule in leftovers from the night before. Leftovers are a better option than takeaway meals as they are more nutritious and lower in calories - and they will save you money. No plan = no organisation, and no organisation = stress. And stress can make weight loss very difficult!

2. Include snacks in your meal plan To maintain your metabolism you need to eat every 2-3 hours (see our post about meal timing for weight loss). When choosing snack foods, plan nutritious foods from the five food groups, and make sure you serve yourself enough to leave you feeling satisfied for at least two hours. See our article on healthy snack ideas.

3. Write a shopping list – and stick to it! Compile a shopping list from your weekly meal plan. Shop once or twice a week to keep your pantry and fridge stocked with the ingredients you need. If you follow your list when shopping, you will be less likely to make impulse purchases.

4. Organise your pantry and fridge Keep commonly used foods in easily accessible spots in your fridge and pantry. And place calorie dense foods such as biscuits, chips and chocolate at the back of the top shelf of your pantry away from sight.

5. Plan your exercise When you are busy exercise can be the first thing to disappear from your 'to do' list. By scheduling exercise sessions on a weekly planner or diary, you are reserving this time to work on your health and fitness before you fill it with other duties. You make time for events such as medical appointments, work meetings, and coffee with friends – why not make an appointment with yourself (or with a friend or personal trainer) to exercise? It's just as important! Schedule slot for exercise and adjust your other commitments to accommodate it.

Meal Timing for Weight Loss

If you are trying to lose weight (or maintain a healthy weight) you need to eat approximately every 3 hours and consume five small meals a day. If you consume less than five small meals a day your metabolism will slow making it difficult for you to lose weight. At the Wesley Weight Management Clinic we recommend eating at the following times:

• Breakfast: 6.00am - 8.00am
• Morning Tea: 10.00am - 11.00am
• Lunch: 12.00pm - 2.00pm
• Afternoon Tea: 3.00pm - 5.00pm
• Dinner: 6.00pm - 8.00pm (try and finish your last meal before 8.00pm).

If you leave more than three hours between your meals you may feel hungry - and it's very difficult to maintain your resolve to lose weight when you feel hungry all the time! Plus when you know when your next meal is, you are less likely to turn to convenience foods.

Healthy Meals

A healthy meal or snack is small in portion size but fills you up for at least 2-3 hours. So next time you are tempted to grab fast food on the run or reach for the biscuit jar at work, ask yourself, "Is there a better choice I could make to help me get through the day?". Then try the following:

- If your meal or snack won't fill you up for at least two hours, consider more healthy options. Low fat, low GI snacks with protein will help you feel full for longer: try low fat yoghurt, fruit, light cheese and wholegrain crackers.

- If it's less than three hours before your last meal, think about your real motivation for eating. Ask yourself questions such as, "Am I really hungry?" and "How will I feel afterwards?". You may find that you are engaging in non hungry eating.

- If you have a tendency to eat out of habit, i.e. you tend to snack at certain places or times of the day, think of ways to break these habits. For example, don't keep a stash of chocolate in your top drawer at work.

- Don't attach emotions to food. If you eat when you are stressed or bored; think about alternate, non food-related ways to improve your mood such as going for a brief walk.

- Before you eat, sit down and place your food on a plate: that way you are more likely to acknowledge the calories.

Eating the right foods at the right time can make a huge impact on your weight loss efforts. For more information, see our article Five Tips for Easier Weight Loss.

Habitual Eating: How to Break the Cycle

Here are some tips to help you outsmart habitual eating and take control of your weight:

Eat Slowly

People who eat quickly are twice as likely to be overweight than those who eat more sensibly. And people who eat quickly and eat too much are three times as likely to be overweight than those who eat more sensibly (1). Here's how to eat in a more controlled manner:

- Allocate 20 minutes for main meals and 10 minutes for snacks
- Put a jug of water on the table and sip water throughout your meal
- Put your cutlery down between mouthfuls
- Cut your food into small bite sized pieces and eat one piece at a time
- Increase the number of times you chew your food before swallowing
- Pause in the middle of meals or between courses
- Talk during mealtimes: people who do so are often still eating after their companions have finished.

By eating slowly, you give your taste buds time to register the flavours in your food. Plus you experience a greater sense of control as you have more time to decide how much food you will eat.

Portion Your Food

Most people use visual cues to tell them when to stop eating, so when a big portion is placed in front of them they eat the whole lot (2). Some tips for limiting your portion sizes are:

- Serve yourself in medium sized portions from the stove (if your serve sizes are too small you will return for second helpings) and avoid placing dishes on the table.
- Eat your food from a plate to increase your awareness of how much you are eating: don't eat out of bags or containers.
- Remove any leftovers as soon as possible after eating. Put them in the fridge for the next day, throw them away or if you are entertaining, give them to guests to take home. Don't fall into the trap of thinking that you are wasting food by throwing it away: unlike excess food in the bin, excess food in your stomach can lead to weight gain and poor health!
- If your plates are large, don't feel the need to fill them with food.
- Leave a small portion of food on your plate at the end of every meal. Don't feel that you have to 'clean your plate': many people are conditioned to do this from an early age but it's not healthy.
- If you are eating out, don't feel that you need to eat the entire dish: take the leftovers home.

Take Control of Emotional Eating

Emotions can become powerful cues to eat inappropriately. People use food to reduce frustration, control boredom, or to comfort themselves when they are feeling lonely, anxious, angry or depressed. If you eat as a means of coping with emotions, you need to find non food-related ways to deal with your emotions such as going for a walk, taking a bath or calling a friend.

It's also useful to learn to attune to your body and distinguish between physical hunger (where your stomach is rumbling and you physically need to eat) and psychological hunger (where cues such as emotions, settings, social occasions and sights and smells of food encourage you to eat). Physical hunger is a useful and appropriate cue to eat - psychological hunger is not.

Practice Mindful Eating

Take the time to sit down and savour the flavours of your food rather than eating on the run:

- Limit your eating to a specific room such as the dining room or kitchen. Eating in other rooms such as the bedroom or living room can trigger a desire to eat when you are in these rooms: even when you aren't hungry.
- Break the link between eating and activities such as talking on the phone or watching a movie.
- Clear you mind of distractions before you eat so you can register an enjoyment of your food and acknowledge the calories.
- Sit down and enjoy your meal so your brain has time to register that your stomach is full.

Breaking ingrained habits can be tough, but if you give yourself time to practice and persevere when you make mistakes, you will regain control of your eating habits.

References:
1. Maruyama K, et al. 2008, 'The joint impact of self reported behaviours of eating quickly and eating until full on overweight: cross sectional survey' British Medical Journal 337:a2002.
2. Dr Elizabeth Denney-Wilson, Research Fellow at the University of NSW quoted by ABC News in Science

Meal Replacements: A Great Tool with the Right Advice

Meal replacements are designed to assist in controlling calorie intake, a critical plank for weight loss. But they can also be confusing, frustrating and disappointing and leave you back where you started.
That's because most meal replacements are sold without any advice, or any supervision from a health professional; as demonstrated by a recent CHOICE Magazine study. This lack of advice leaves you to work out your own treatment plan, adding to the increased chance of failure.

The Benefits of Using Meal Replacements

Used correctly, meal replacements can be a great short term weight loss tool. At the Wesley Weight Management Clinic we've found that meal replacements:

• Help you to become accustomed to eating smaller portion sizes
• Promote independence from food
• Narrow your food choices, allowing you to manage the amount and type of food you consume (people consume fewer calories when presented with a smaller selection of food)
• Increase your rate of weight loss
• Help you to feel satiated (not hungry) for longer
• Can provide all of the essential vitamins and minerals that your body needs if you choose a nutritionally balanced formulation (at the Wesley Weight Management Clinic we use Optifast 800)
• Help to regulate your blood sugar levels and maintain energy levels
• Help you form a habit of eating at regular intervals and focusing on one meal or snack at a time
• Require minimal preparation and fit easily into a busy schedule.

Get the Right Advice

If you want to use a meal replacement as a tool for weight loss, you should engage the assistance of a suitably qualified health professional such as a Dietitian or Doctor.

A health professional can help you work out an appropriate schedule of meal replacements, monitor your rate of weight loss and the nutritional quality of your diet, provide advice if you experience any side effects and help you transition back onto normal food when you reach your weight loss goal.

This advice is critical if you have Diabetes or Hypertension: meal replacements can change your symptoms or impact upon the effectiveness of your medication.

Life After Using a Meal Replacement

Meal replacements aren't a long term weight loss solution. When you reach your weight loss goal you need to transition back onto 'normal' food gradually. You also need to learn the skills you need to keep your weight off for life, including meal planning, healthy grocery shopping, meal portioning, exercise and low fat cooking.

For more information about the healthy use of meal replacements, talk to your Doctor or you can ask the health professionals at the Wesley Weight Management Clinic about our weight loss program.