A Change In Attitude

So you want to lose weight. Half the world does. Obesity is a worldwide epidemic so it’s only natural that every second person you meet is keenly seeking the holy grail of weight loss. Dinner conversations invariably return to feelings of guilt over indulgences. The Internet is flooded with clever advertising to lure vulnerable individuals into buying some product or the other with the promise of ‘losing ten kilos in ten days’ or similar fantastic claims.
You may not be thrilled with your body right now, in fact, you may view it with a good deal of distaste. Let’s ask ourselves a question, how did we get this way? How did we pile on the pounds? Where is that slender teenager? No doubt there are some who struggle with obesity all their lives. Over weight as children and teenagers, they are often faced with ridicule and marginalized. A large percentage of the population however, grows obese with age. A certain amount of weight gain with age is acceptable. But to become obese and as a result develop various obesity related complications like pain and discomfort, diabetes, heart disease, anxiety, depression, indigestion and so on, is not.
Take stock of your lifestyle.
– Are you physically active all day or does your job entail a lot of sitting behind a desk?
– Do you exercise regularly?
– Do you stay home and watch a lot of television and do little physical labor?
– Do you deal with an inordinate amount of stress? More importantly, are you one of those people who does not handle stress well? Do you develop acidity, anxiety or insomnia as a result of your stress? Do your work and relationships suffer? Do you become an insufferable boss or mother?
– Do you go on eating or drinking binges?
– Do you starve yourself often with the hope of losing weight only to go back to binge eating?
– Do you get enough sleep? (Six to eight hours a night of uninterrupted sleep is recommended.)
– Do you eat well-balanced meals with plenty of vegetables, fruit nuts, protein and healthy fats or are you loading up on the bread/cereal group (rice, rotis, bread, etc.), refined, processed, packaged food with additives and sugars out of packets as is common and convenient?
– Do you eat home cooked meals or depend on canteens and hotels and takeaways?
– Do you travel a lot, subjecting yourself to different time zones, food, lack of sleep and stress?
– Does your life involve a lot of socializing with indiscriminate eating and drinking?
– Are you addicted to sugar and need to eat something sweet ever so often?
The list of poor lifestyle habits is endless. These are some of the reasons you could be steadily gaining weight. Each problem has to be addressed independently with a combination of life skills, dietary advise and regular exercise. There is no way around it. Whatever the reason for the weight gain, the solution is to eat better, exercise and change your lifestyle.
Here’s the problem – most people think an hour of exercise alone will solve everything. It takes more than that, although that’s a good place to start. Your lifestyle (as shown above) is important. What you do for the rest of the twenty-three hours counts far more than one hour of working out. This means change. A change in attitude towards your lifestyle and not just one aspect of it.
A new mind set and not just a new menu is what is required.
The real secret to losing weight and more importantly, keeping it off is your attitude. The ability to look at your lifestyle with a certain amount of objectivity and a critical eye and then take the necessary steps to change what needs to change. The ability to get the necessary professional help when required. It’s not easy to change a whole lifestyle. There are other people involved – family, friends, colleagues and boss who are probably helping you preserve the current lifestyle. Change may involve others and this is not always welcome. For change to be sustainable however, it has to be holistic.
Adopt a slow and steady approach. Help your body and mind gradually learn to eat better, exercise more, live healthier, sleep earlier, relax and breathe. Most importantly, learn to appreciate yourself and your efforts. Learn to respect yourself and your body.
Dr. Sheela Nambiar MD Obgyn
Fitness & Lifestyle Consultant, NAFC
Author – Get Size Wise & Gain To Lose (Published by Rupa)

Exercise Guidelines For Indians

Almost 30-60% of Indians in urban India have been found to be overweight or obese or have abdominal obesity. It has also been found that Indians are at a higher risk of developing obesity related problems like Diabetes, Hypertension and Heart disease at lower cut off values for BMI (Body Mass Index) and Waist Circumference. Indians suffer inherently from a lower muscle mass or sarcopenia. This leads to several of the health problems like central or abdominal obesity that the Indian is more prone to. Our fat percentage and waist circumference is higher for a comparative body weight to our caucasian counterparts.This is one of the major causes for the higher incidence of diabetes and Coronary Heart Disease in the Indian subcontinent.

According to the Consensus statement for physical activity for Asian Indians (Misra et al JAPI vol 57 Feb 2009) – Cut off values of BMI for the Indian population :

Normal BMI = 18.0-22.9 kg/m

Overweight = 23-24.9 kg/m

Obesity = more than 25 kg/m

Consensus statement for cut off values for Waist circumference:

Women = 31.1 inches (80cm) and above should be considered obese

Men = 35.5 (90 cm) and above to be considered obese requiring intervention.

Definitions of Physical Activity Intensity Levels

1. Low-intensity physical activity elicits a slight increase in breathing rate. (e.g., slow walking less than 3 km/h on level firm ground, house work like cleaning, cooking and dusting).

2. Moderate-intensity physical activity elicits a moderate, noticeable increase in depth and rate of breathing, while still allowing for conversation (e.g., walking 3–6 km/h on level firm ground, water aerobics, moderate intensity aerobics, cycling at a speed of <16 km/h and hiking).

3. Vigorous-intensity physical activity elicits a noticeable increase in depth and rate of breathing. The individual will not be able to speak more than a few words without pausing for a breath (e.g. walking a kilometer in less than 10 minutes, jogging/running, cycling, higher intensity aerobic dancing, and jumping rope).

Exercise guidelines for healthy adults: consensus statement –

If you participate in Moderate Intensity Exercise – Aerobic activity of moderate intensity : brisk walking, stair climbing, cycling, jogging – for 30 minutes 5 days a week

Muscle strengthening exercises : resistance training, own body weight exercises, exercises, exercises using dumbells or machines – 1-3 sets of 8-12 repetitions targeting major muscle groups. This is to be done 2-3 times a week.

If you participate in High Intensity Exercise – Aerobic activity of higher intensity like running, high intensity aerobics, football etc for 20 minutes 3 days a week is sufficient

Muscle strengthening exercises – more than 3 sets targeting major muscle groups 2-3 days a week.

Exercise guidelines for Children and youth aged 5–17 years consensus statement –

Children who are sedentary and obese should start with at least 30 minutes of moderate intensity aerobic activity everyday. This volume of exercise should increase gradually to obtain at least 60 minutes of aerobic activity daily. – Those children who are already quite active and not obese require at least 60 minutes of vigourous exercise, which could be in the form of sports everyday. – In addition they will require muscle strengthening exercises for a minimum of 20-30 minutes 2-3 times a week. Exercises like jumping, squats, push-ups, situps, lunges etc using own body weight may be performed.

Television and computer time involving sedentary activity should be restricted to less than 2 hours a week.

Exercise guidelines for pregnant women consensus statement –

All pregnant women should get a clearance from their Obstetrician before starting or continuing to exercise during their pregnancy. – There are certain contraindications to exercise in pregnancy such conditions as threatened pre-term labour or bleeding and this needs to be discussed with the Obstetrician. – Healthy pregnant women, with no other contraindications can continue to exercise as per the recommendations for the Healthy Adult – A minimum of 30-60 minutes of Aerobic activity per day.

– The aerobic activity should be low impact. Avoid high impact activities like running or high impact aerobics or contact sports.

– Resistance training should be performed to strengthen the specific muscles about 2-3 times a week. – One exercise per body part can be chosen – 2-3 sets of 12-15 repetitions of each exercise using light weights may be done.

– Stretching to be done for a few minutes everyday.

– Pelvic floor strengthening exercises may be continued throughout the pregnancy.

As the pregnancy advances the woman may be unable to exercise at the same intensity as during the first two trimesters. She may continue to do a low intensity aerobic workout, stretches and relaxation everyday.

There are some do’s and dont’s while exercising in pregnancy –

– Avoid very high intensity exercise. Avoid exercising in the heat. Drink enough water. Avoid high impact exercise or contact sports. Stop if you feel faint or dizzy. Avoid exercise if there is a history of pre-term labour, hypertension or bleeding. Avoid any exercise that requires you to lie on your back after the first four months of pregnancy. Exercise with perfect form to avoid injury.

After a normal delivery she may start exercising once she feels comfortable which may be in a week to ten days. After a caeserean she can start exercising after six weeks.

Exercise guidelines for the elderly consensus statement –

All adults over the age of 40 need a medical clearance from their physician before commencing an exercise routine for the first time. If one has been exercising throughout their life, they may continue to do so with some decrease in intensity levels if so required. The focus of exercise in the elderly is more on building strength and muscle mass than on weight loss. Increasing muscle mass and strength is beneficial in allowing the older individual to continue to live as normal a life as possible without being dependent on others.

– Recommended doses of aerobic activity and muscle-strengthening exercises for men and women over 65 years of age are similar to those for healthy adult population. That is aerobic activity for about 30-45 minutes a day at a moderate intensity.

– Resistance training to improve strength and muscle mass needs to be incorporated on at least 2-3 days/week which should involve all the major muscle groups, one exercise per body part, 2-3 sets of 8-12 repetitions is recommended. The benefits of resistance training include preservation of muscle mass and prevention of age-related sarcopenia.

– Greater muscle strength and power enable the maintenance of function and prevention of disability, including a lower risk of falling. Balance training, along with activities to strengthen the muscles of the legs, back and core muscles is the best strategy to reduce falls and complications from falls. This also increases the chances of the elderly person staying independent throught his/her life which is essential for morale. – Daily “activities” that involve moving around, climbing stairs, lifting, carrying, pushing, gardening, cleaning etc should be maintained as long as possible because they can also benefit muscle and bone health.

– In sedentary individuals, gradual escalation of physical activity is recommended, after pre-activity medical evaluation especially in those with chronic diseases, particularly CHD. All decisions regarding the initiation of exercise programs for the elderly should be taken in consultation with a physician.

– Sudden commencement of physical activity, especially wihtout medical clearance should be avoided in the elderly.

Exercises for persons with disabilities cannot be generalised. The exercise routine needs to be designed according to the disability encountered.

Dr Sheela Nambiar MD Obgyn, Fitness & Lifestyle Consultant NAFC (USA)

This article was originally written for Sports Authority Of Tamil Nadu. http://www.sdat.tn.gov.in/index.php/fitness/daily-fitness-regime

My second book…..

A long hiatus after my last post. I had almost forgotten that I blogged!
Been so busy with my day job as an Obgyn besides numerous other things like travel, talking about my book – “Get Size Wise” at various book readings and discussions, teaching fitness classes and lately, scrambling to finish my second book. The manuscript submission date has long gone by. My publishers have been very accommodating. I have spent the last two months wringing my hands in frustration after having lost a ton of data (my first several chapters, research references and so on) from my crashed computer. And no….. I hadn’t backed it up! Thank you for asking! Fortunately, I have managed to recover it through a Data Recovery Lab in Chennai. Taught me a profound lesson – don’t take your computer for granted! But…… Life happens and you roll win it.

More importantly, the lost data gave me an opportunity to rethink what I was writing. Re-write some parts, analyse more deeply and hopefully put together something better.

The premise of my second book is that gaining and/or maintaining muscle mass is the only way to prevent and aid fat loss. This seems particularly true of Indian women who seem to have very low lean body mass (muscle). The the urban woman who rarely does anything physical during the natural course of her day. As a result, she ends up gaining fat and losing muscle with age as she becomes less and less physical (except perhaps for the hour of obligatory cardio she puts into her day). Cardio mostly helps burn calories, and improve the heart, lungs and circulatory system but rarely builds muscle. In fact too much of it can deplete muscle. The weight gain is interestingly often limited to the abdominal area widening the waistline and endangering heart health.

So, it seems that the only way to circumvent this is to actually train with weights to build muscle. Not very popular with most women I see. Those who do train, do so sporadically and usually restrict themselves to light weights. Why? Because they think they will become “masculine” if they train with weights.

So here’s the thing – ‘masculinity’ (the deep voice, facial hair, sterotypical male body type) is not determined by the weight one lifts but by the presence of the hormone Testosterone which males have infinitely more of circulating in their system. Just lifting weights does not increase testosterone. Women who train for body building as a sport and profession and gain a fair amount of muscle, keeping body fat percentage to the minimum, look the way they do because they train the way they do (several hours of intense training). I don’t see that happening with recreational training. One can of course progress to more serious training if inspired to, or, one can maintain moderate training to gain modest amounts of muscle and look toned.

Physically of course one becomes stronger, firmer, more balanced in muscle mass/strength and distribution. Due to our modern lifestyle which encourages sitting for hours, typing, bending over, staring at the computer screen or TV, alcohol, rich food and sedentary life we develop certain muscle imbalances and bad posture which eventually results in pain. To correct some of these problems, weight training to strengthen the weaker muscles and stretching to improve flexibility of tighter muscles will create a more balanced, functional body. Gaining muscle also increases our Basal Metabolic Rate causing us to burn (however marginally) more calories even at rest which goes a lon way in preventing fat gain with age.

Increasing muscle mass is also beneficial in various other situations. For instance, it has been found that type 2 diabetics have better control of blood sugar and may even be able to reduce medication by increasing muscle mass with weight training. Cardio and diet are not the only lifestyle changes the diabetic needs to make. Recovery from prolonged illness or surgery is hampered with poor muscle mass. Osteoporosis and osteopenia can be prevented and treated using strength training protocols. Physical aging is more profound when one has low lean body mass.

Building muscle therefore is enormously important. Weight training is an art and science. It has so many benefits besides just the aesthetic that it truly should be a part of ones fitness routine. There is something so very zen about lifting that barbell and putting it down. Such a simple action with such a profound impact on ones body, mind and health.

Ref –

– Len Kravitz – Yes Resistance Training Can Reverse The Aging Process.
– Jan Sundell. Resistance Trainign Is An effective Tool Against Metabolic and Fraility Syndromes. Adv in Prev Med. 2011
– Len Kravitz – Resistance Training: Adaptations and Health Implications.
– Hurley et al – Does Strength Training Imporve Health Status. Jour Strength & Conditioning. 1994
– P J O’Connor- Mental Benefits of Strength Training In Adults. Am jour Of Lifestyle Med. Sept 3010.
– S B Going – Osteoporosis and Strength Training. Am Jour of Lifestyle Med. Aug 2009.

TFL Fitness Retreat Oct 2013

A Fitness Retreat is something I have wanted to organize for the longest time….. and it finally happened in October 2013 in Ooty through – TFL ~ Training For Life.

The purpose of the retreat? To enlighten people about Fitness, the various aspects of it, the fun factor, to motivate, inspire and have them take away from the retreat –

~ A Weight Training Routine (that they can even use at home).
~ A ‘Total Body Stretch’ to improve flexibility.
~ An understanding of Cardio intensities and quantities. (most people don’t quite understand this even though they have been “walking” for years :))
~ An understanding of the principles of diet, food ….needless to say…a pandoras box opens here!!!

The purpose of the Retreat ~ is also to help people understand their bodies better. To EMPOWER them to take control over their health, bodies, fitness, weight and………. so much more.

Those who registered had a great time… am happy to say. The following pictures tell only part of the story…..

After a morning walk, demonstrating and experimenting with “intensity” of cardio.

After a morning walk, demonstrating and experimenting with “intensity” of cardio.

Still smiling.....

Still smiling…..

Food is so exciting. Even when you are supposedly “dieting”. The purpose of this demo was to show how food can be interesting, tasty AND healthy. Using GOOD QUALITY PRODUCTS is the key.

Food is so exciting. Even when you are supposedly “dieting”. The purpose of this demo was to show how food can be interesting, tasty AND healthy. Using GOOD QUALITY PRODUCTS is the key.

Early morning walk to the Grasslands. A beautiful, misty morning...

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Weight Training session

“Poinsettia" ~ The guest house where the guests were accomodated

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