PROFESSOR TRIM’S QUICK START THE WEIGHT-LOSS PROGRAM for new mothers and mothers-to-be pdf

PROFESSOR TRIM’S PROFESSORSProfessor John BlundellPhD, C Psychol, MBPS Professor of Bio-Psychology, Leeds University, UK and Board Member of the International Association for the Study

PROFESSOR TRIM’S QUICK START

PROFESSOR TRIM’S PROFESSORS

Professor John BlundellPhD, C Psychol, MBPS Professor of Bio-Psychology, Leeds University, UK and Board Member of the International Association for the

Study of Obesity (IASSO)

Professor Wendy BrownBSc (Hons), MSc, Dip Phys Ed, PhD Professor of Physical Activity and Health, University of Queensland

Professor Ian CatersonMBBS, BSc (Med), PhD, FRACP Boden Professor of Human Nutrition, Sydney University and

Vice President, IASSO

Professor Terry DwyerMBBS, MPH, MD, FAFPHM Director Menzies School of Health Sciences Hobart, and

University of Tasmania

Professor Garry EggerMPH, PhD, MAPS Director, Centre for Health Promotion and Research Sydney Adjunct Professor of Health Sciences, Deakin University

Professor James Hill PhD Director, Center for Human Nutrition, University of Colorado

Health Sciences Center and Co-Founder, National Weight Control Registry

Professor Kerin O’DeaBSc, PhD Director of Menzies School of Health Research, Darwin

Professor Stephan RossnerMD, PhD Director, Obesity Research Program, Luddinge Hospital, Stockholm, Sweden and Past President of IASSO

Professor Boyd SwinburnMD, MBChB, FRACP Professor of Population Health and Nutrition, Deakin University

Professor Klaas Westerterp PhD Professor of Human Energetics, Head of Department of Human Biology, Maastricht University, The Netherlands

PROFESSOR TRIM’S

QUICK START THE WEIGHT-LOSS PROGRAM

for new mothers and mothers-to-be

Dr Katherine Samaris

MB, BS, PhD, FRACP

Dr Garry Egger

MPH, PhD, MAPS

First published in 2003

Copyright © Katherine Samaris 2003

Copyright © Garry Egger 2003

All rights reserved No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without prior permission in writing from the

publisher The Australian Copyright Act 1968 (the Act) allows a

maximum of one chapter or 10% of this book, whichever is the greater, to be photocopied by any educational institution for its educational purposes provided that the educational institution (or body that administers it) has given a remuneration notice to Copyright Agency Limited (CAL) under the Act.

Allen & Unwin

1 Weight-loss 2 Women–Nutrition 3 Physical fitness for women

I Title (Series: Professor Trim’s medically supervised weight-loss programs).

Introduction

How to use Professor Trim’s Quick Start Weight-Loss Program for New Mothers and Mothers-to-be vii Part 1 Background

1 Obesity and the modern environment 3

2 General nutrition for weight management 9

3 More movement makes mightier mums 20

4 Stressing up for (more) dinner 27 Part 2 Motherhood

Pre-pregnancy

Pregnancy

7 Special nutritional requirements in pregnancy 54

8 Special considerations in pregnancy 60 Post-partum

9 Weight management after childbirth 65

10 Myths associated with pregnancy and

Appendix

Purchasing Professor Trim’s Medically Supervised

ABOUT THE AUTHORS

Garry Egger is Director of the Centre for Health

Promotion and Research in Sydney and AdjunctProfessor of Health Sciences at Deakin University

He has been involved in health promotion for almost

30 years and is the author of more than 25 books

Katherine Samaris is a Consultant Endocrinologist at

St Vincent’s Clinic and St Vincent’s General Hospital,Sydney She is actively involved in diabetes and obesityresearch at the Gavin Institute of Medical Research

INTRODUCTION: How to

use Professor Trim’s Quick

Start Weight-loss Program for New Mothers and

Mothers-to-be

The Professor Trim’s (PT) Quick Start program in thisbook is an introduction to effective weight loss, and a life-time of weight management, for new mothers and mothers-to-be It differs from other pregnancy advice in that it’saimed mainly at mothers—although never neglecting thehealth of the baby Most information for new mums,you’ll find, is focused on the health of the child Andwhile no one would deny the importance of this, theongoing health of the mother often seems to be forgotten.Pregnancy and childbirth are critical periods for weightgain in women and the weight that’s gained at these times

is often difficult to lose over the long term Since excessbody weight can be a health risk, it’s crucial that all thebest available scientific information be put into helpingwomen at these stages in their life This doesn’t meanignoring the needs of the baby Indeed, as we will see,maintaining ideal weight and good health in the mother

is likely to improve childbirth outcomes The ProfessorTrim program is designed to do just that

PROFESSOR TRIM’S—THE HISTORY

Professor Trim’s evolved from the ‘GutBuster’ program,which started as a men’s ‘waist-loss’ program in 1991.GutBusters became the biggest, and most successful,men’s weight-loss program in the world It had an inter-nationally acclaimed scientific advisory board and wasconsistently rated by consumer groups as among the bestweight-loss programs available

Initially designed for men, GutBusters soon oped a program for women Hence the Professor Trim’srange of programs—for men and women, and theseQuick Start versions

devel-Several thousand Australian doctors (see www.professortrim.com) have had special training in weightcontrol as part of a Postgraduate Medical Certificate inWeight Control and Obesity Management from SydneyUniversity These doctors, and the Professor Trim’s Medically Supervised Weight-Loss Program, can help newmums through a shared-care system that provides thebest information available on weight loss and weightmanagement

MORE PROFESSOR TRIM’S ADVICE

More intensive individual programs will continue thequick start to weight loss you’ll get from this program.Information about the full Professor Trim’s programs arecontained in the back of this bookset You can alsopurchase these directly from your PT doctor and workwith him or her through the full twelve months of theprogram, or longer

The way to get the greatest benefit from this QuickStart new mum’s program is first to read the book Youcan then access regular updates on current research and

information from the Professor Trim Internet site atwww.professortrim.com At the end of each chapter inthis booklet you will find an easy-to-follow summary ofits contents, contained in a Professor Trim’s PrescriptionPad Use these summaries as your checklist for puttingthe program into action

STRUCTURE OF THE PROGRAM

The information contained in this book is divided intotwo parts The first part, ‘Background’, provides asummary of general weight loss information—nutrition,physical activity and stress management in particular—

to set the stage for modifications to this with hood The second part, ‘Motherhood’, discusses the specificrequirements for weight management before, during andafter pregnancy The reason that both the ‘before’ and

mother-‘during’ pregnancy periods are considered so importanthere is that taking preventable action in these stages canmake long-term weight control after childbirth muchmore manageable

Best results are likely to be achieved by fully preparingfor weight management in the pre-pregnancy, ‘before’phase Since about half of all pregnancies are unplanned,however, we appreciate this is not always possible Hence

actions taken during pregnancy might represent the first

attempt to deal with a weight problem Where action is

left until after delivery, the problem becomes more

diffi-cult, but not impossible to solve Women reading thiswho have already put on weight after giving birth shouldconsider all of the advice as part of their preparation for any future pregnancies For those who have finishedtheir family, the complete Professor Trim’s ‘BecomingSlimmer’ program for women is another alternative

Professor Trim’s Prescription Pad

• Read this booklet first

• Try to put the recommendations at the end ofeach chapter into action

• Check in at the Professor Trim Website(www.professortrim.com)

• Check in with your Professor Trim doctor forongoing help

• For more specific programs, and a ‘personalweight coach’, see the Appendix on page 77

Part 1

Background

Chapter 1

OBESITY AND THE

MODERN ENVIRONMENT

OBESITY—THE MODERN EPIDEMIC

Through thousands of years of evolution, humans werekept lean by the effort required either to eat or avoid beingeaten The ultimate goal was comfort—food on the table

at the end of the day, without having to toil too hard toget it By the twenty-first century this goal has been largelyachieved But what nature gives on the roundabouts, ittakes on the swings Obesity and overweight are the price

we pay for technological advancement and modernisation

At the turn of the millennium, more than two inevery three Australian men and one in every two womenwere classified as overweight And although we don’t havecomparative figures for historically earlier times, it’scertain that the numbers of overweight would have beenminute, compared with today

Women fare particularly badly in this new worldbecause, biologically, they have been designed to get fatmore easily, and to store fat more efficiently, than men.This is because the survival of the evolving human racemeant it was necessary for a woman to both survive thenine months of pregnancy and to nourish the baby after-wards To do this their bodies had to lay down extraenergy reserves (i.e., fat) as a form of insurance againstfamine, a process which became very effective And whilethe trials of day-to-day life in past ages ensured that the

effects of weight gain were readily counteracted afterchildbirth, the easier way of life in our modern environ-ment makes this weight loss no longer automatic

PREGNANCY AND BODY WEIGHT

Pregnancy is a period of necessary weight gain in a woman,resulting not only from the weight of the growing foetus,but also from the extra reserves required to feed thatfoetus Natural increases in hunger will normally drive theincrease in body weight required for an ideal pregnancy.However, in the modern environment this ‘biologicalhunger’ is often confused with ‘learned appetite’ andhence the desire to eat may not necessarily be biologicallydriven On top of this, there are tendencies in modernsocieties to condone ‘eating for two’ by a pregnantwoman, even if this amounts to over-eating, and to beover-protective of a woman being too active during herpregnancy As a result, pregnancy and motherhood havebecome almost synonymous with permanent weightgain Yet a glance back through history tells us that thisneed not be inevitable Women in hunter-gatherer andother subsistence existences rarely, if ever, gained perma-nent weight as a result of childbirth Hence the problemcan be seen to be associated with lifestyle, in particular,the nature of modern technological societies

PREGNANCY AND THE HEALTH OF THE MOTHER

Traditionally, recommendations for weight gain duringpregnancy have been based on the health of the child

In the modern environment, inadequate weight gain toensure a healthy baby is rarely the problem (except, of

course, in the case of special circumstances or pre-termdelivery) The mother’s health, and the difficulty ofregaining a healthy body weight after childbirth, nowneed to be taken into consideration in making recom-mendations for pregnancy weight gain As post-partumweight retention is partly dependent on the amount ofweight gained in pregnancy, it would seem illogical tosuggest a greater gain in pregnancy than is necessary.The good news is that this means permanent weightgain doesn’t have to occur after childbirth If lifestylechanges are the key to weight gain in women in moderntechnological societies after they give birth, the answer topreventing the problem lies in becoming aware of thesechanges and making the necessary adjustments to reducetheir impact This doesn’t mean going back to haulingwater from the nearest freshwater spring or washingclothes by hand But it does mean considering a long-term plan for weight management

The table below shows the factors that appear to bemost associated with weight gain in new mothers andmothers-to-be

Factors identified as tending to increase weight gain inmotherhood

Pre-pregnancy weight Excess weight before pregnancy increases the risk of greater weight retention after giving birth.

Gestational weight gain The bigger the gain during nancy, the greater the difficulty of shedding the excess weight.

preg-Number of pregnancies The difficulty in returning to ‘normal’ weight appears to increase with more births.

Lower educational level Less educated women have more trouble losing post-pregnancy weight (suggesting that weight maintenance can be learned).

Later return to work or activity An earlier return to work or high activity levels can decrease the risk of weight retention.

Not breastfeeding Although not always a factor, feeding offers a ‘window of opportunity’ for long-term weight maintenance in the mother, as well as a reduced risk of later excess weight gain in the child.

breast-Extreme dieting Trying to diet excessively can lead to outs’, or bingeing, when things go wrong, which result in even greater weight gain.

‘break-Overeating, or ‘eating for two’ For many women, pregnancy

is an excuse to eat whatever they like to satisfy their cravings And while genuine cravings are an indication of need, these are often confused in an environment of unlimited foods.

Post-partum depression This can lead to ‘comfort eating’ and reduced activity, both of which increase the prospects of weight gain

BEHAVIOUR CHANGE FOR WEIGHT LOSS

Because weight control programs are a dime a dozen, itshould be apparent that most don’t work If they did,why would there be so many? It would also seem logicalthat one of the best ways to find out what does work is

to ask those who have successfully lost a lot of weight andmanaged to keep it off for a long period

Researchers in the United States have done this

Dr James Hill from Colorado State University and his colleagues have established a National Weight ControlRegistry (NWCR) of a large number of people who havelost a minimum of 14 kilograms and kept this off for

at least five years These people have been subjected to arange of different forms of research, which has shownconsistently similar conclusions about the best tech-niques for long-term loss Five main factors stand out:

1 A lifestyle built around a high level of physical activity This doesn’t mean a regular commitment

to an exercise regime (although this can help).Accumulated movement, or physical activity builtinto the lifestyle (adding up to at least 60–80minutes a day for women), has the best effect

2 A lifetime pattern of low-fat eating This doesn’t

imply a ‘diet’ as such, but an ongoing reduction offoods that are high in fat and energy (calories)

3 Established techniques for managing stress Stress

can be an issue in causing compensatory ‘comforteating’ Ability to deal with day-to-day stresses isassociated with better long-term weight manage-ment

4 Self-monitoring This includes measuring such

things as the number of steps taken daily (using apedometer), the amount of fat in the daily foodintake, the number of servings of fruits and vege-tables eaten each day, etc Self-monitoring isknown to be one of the most effective methodsavailable for making a range of behaviour changes

5 Eating breakfast This is the most important meal

of the day Eating breakfast helps reduce food take, and hence total energy, over the rest of the day.Other factors that seem to be important, particularly forwomen either contemplating pregnancy or about tobecome mothers, are:

in-• Unlearning old habits These often die hard, but

habits such as eating for comfort, or being passiveinstead of active, are often the cause of significantweight problems The good news is that if they can be learned in the first place, they can also beunlearned

• Learning new habits Replacing negative ways

of thinking with more rational, positive ways ofthinking, is often as good as, or better than, anydiet program for weight loss

Professor Trim’s Prescription Pad

• Weight gain is normal and healthy in nancy—but it can be too much in the modernenvironment, as well as too little

preg-• A number of factors are predictive of partum weight retention

post-• Behaviour change—mostly reduced physicalactivity—is the main cause of weight gain afterchildbirth

• Long-term weight loss maintenance is bestachieved through a low-fat, reduced-energyeating plan, regular exercise, self-monitoringand establishing ways of dealing with stress

NUTRITION FOR WEIGHT LOSS

In general, nutrition for weight loss or weight ment is the same as nutrition for good health In essencethis means:

manage-• Not eating too much;

restric-• Limiting rich, high energy dense foods

These principles apply generally throughout the stages ofmotherhood, from planning a pregnancy to after delivery

FOOD VOLUME AND WEIGHT LOSS

Despite the hype about different types of diets for weight

loss, the issue basically boils down to the volume of food

consumed in terms of total energy (calories or kilojoules),which can be expressed as:

Volume = Energy density (kcals/g) × × Portion size (g)

There are many different ways in which volume can bedecreased, some of which are associated with the type oramount of foods eaten, and others with the management

of hunger

New mothers and mothers-to-be do need to eat morethan most other women But for many women inmodern Australia, the problem comes with eating notjust enough more, but eating too much more It may

be quite unnecessary to drastically increase food intakeduring pregnancy—particularly for those who are alreadyoverweight More important is a varied diet and anadequate volume of food for the long-term benefits ofboth mother and child Here we consider the mainfactors accepted scientifically as influencing food volumeand quality

REDUCING DIETARY FAT

There’s been a lot of controversy recently about whetherfat or carbohydrate is the most important nutrient inweight control The answer should be clear; it’s totalenergy (calories or kilojoules) that is important, irrespec-tive of where these come from However becausethere are 38 kJ per gram in fats and oils (remember oil

is just a liquid form of fat) and only 17 kJ per gram

in carbohydrate and protein, it’s much easier to take inmore calories through fat

The long and the short of it is, if you can reduce fats

in your diet (including those commonly regarded asgood fats, such as olive oil), even throughout pregnancy,

you’ll go a long way to preventing a long-term weightproblem Here are some simple ways to do this:

• Don’t use spreads like butter and margarine (or at

least spread them thinly) While some of the new

designer margarines may help your cholesterol,they’re still up to 80 per cent fat (at 38 kJ) and justadd to your weight woes

• Take the skin off chicken Birds store fat underthe skin Animals store it more throughout themuscles Take the skin off before cooking, soyou’re not tempted to eat it afterwards

• Don’t fry food in oils or butter Grill, bake, boil,steam whatever you like Frying in oil results

in the 38 kJ being soaked up by the food and, mately, stored on the body

ulti-• Cut all visible fat off meat Fat on meat is easy tosee It’s the white bits around the outside of the T-bone or the grainy white bits throughout otherforms of red meat Go for the low-fat meats,which are generally whiter meats like veal, porkand spring lamb Otherwise trim all the fat offbefore cooking—it’s too tempting after it’s beencooked

In case you’re wondering, it’s not necessary toeat meat for a healthy pregnancy—unless youwant to If you don’t like meat there’s no need toforce it down, as long as you are eating a widevariety of foods, including some rich sources ofprotein (like beans and lentils) The addition of amulti-B vitamin and a folate supplement (from

a reputable supplier) is advisable

• Avoid cream dairy products Cheese and

full-cream dairy products are large sources of fat Milk

can be modified by going for the low-fat versions(preferably one containing added calcium), but it’shard to get a true low-fat cheese For this reasoncheese should be eaten in moderation.

WHAT IS LOW FAT?

To take the low-fat issue further than just the five tipsabove, you’ll need to understand a bit about fat Thereare a couple of simple rules to work by The ProfessorTrim program stipulates that you should:

• Avoid foods with more than 10 per cent fat

How do you know if a food is more than 10 per

cent fat? Look for Professor Trim’s Ultimate Food

Energy Guide at any bookstore (a copy is supplied

with each full Professor Trim program) This willtell you the number of grams of fat per 100 grams

in a stack of different foods If a food has morethan 10g/100g (i.e., 10 per cent) fat, avoid it

In fact, ban it from the house

• Reduce your daily fat intake Again, from your

Ultimate Food Energy Guide you can check on

just how much fat you are eating in your diet.Check the quantity of each food eaten and thenumber of grams of fat it contains Then try toreduce your daily fat intake to around 30g a day

or less

INCREASING DIETARY FIBRE

Fibre is mostly the ‘stringy’ part of foods, like the bits of

an orange that hold it together, or the bran on the outside

of a grain There are different types of fibre, but for ourpurpose here we’ll consider them all together and make

the assumption that most high fibre, low energy densefoods, such as fruits and vegetables, come from plants.However fibre also exists in some manufactured foods,such as bread, pasta and cereals

Through increasing your fibre intake you’ll decreaseyour fat intake, and thus have a double effect on yourexcess body weight A simple formula is to eat at leastthree different fruits and four different vegetables a day,and to increase your intake of pasta, breads (withoutspreads) and cereals

INCREASING THE PROPORTION

OF PROTEIN

Protein is muscle food It comes mainly from the muscles

of the animals we eat, but other good low-fat sources arebeans, legumes and some other vegetables Protein is ofparticular importance during pregnancy because of theneed to create new body tissue

Because protein goes into muscle in our bodies, andmuscle is active, it helps to increase metabolic rate—provided this is combined with exercise (see Chapter 3).Protein is also generally not turned to fat, because anyexcess is lost as heat or passed out through the urine It’s

important that the proportion of protein in your diet is increased, not necessarily the total amount This doesn’t

mean eating more food, as protein is a significant source

of food energy It’s also important to make sure anincrease in protein comes from low-fat sources Thetable on the next page lists some good sources of suchprotein

Seafood is a good source of protein and also has fits for blood fats like cholesterol Recent research hasshown that eating more fish can improve birth outcomes

bene-in pregnant women and hence eatbene-ing two or threeseafood meals (not fried or raw) per week should be astandard recommendation for good health and weightmanagement.

DECREASING ENERGY DENSITY

‘Energy density’ is a relatively new term that refers to thenumber of calories (kilojoules) per gram of food Thereason it’s now used is that sometimes it’s not just fatwhich adds to total calories, but high quantities of sugarand/or fat Energy density is calculated by dividing thenumber of kilojoules in a food by the number of grams

of that food Where this turns out to be less than 12.5kJper gram of food (3cals/g), it implies a high energy densefood that should be avoided Between 7.5 and 12.5kJ/g

is medium and below 7.5kJ/g is low energy density andcan be eaten in (almost) unlimited quantities (For asummary of foods and their energy density see Professor

Trim’s Ultimate Food Energy Guide) The energy densities

of some well-known foods are given in this table

Some low-fat sources of protein

Fish (most kinds) Legumes Kangaroo

Oysters (cooked, not raw) Chicken breast

Lean beef

Some low-fat but high energy dense foods

Food Fat ED kcals/g

(g/100) (kJ/g)

Biscuit: savoury crispbread,

puffed and toasted 3.8 3.8 (16.1) Biscuit: fruit, polyunsaturated, wholemeal 9.9 3.9 (15.9) Bread: melba toast 4.9 3.8 (16.0) Breadstick: hard 3.8 3.9 (16.3) Breakfast biscuit, wholewheat, bran 7.6 3.5 (14.9) Cereal (mixed grain, sugar more

than 35%, fortified) 4.2 3.8 (16.1) Confectionery, carob coated, sugar 9.9 4.2 (17.5) Cornflakes 0.5 3.7 (15.6) Fudge, not chocolate, plain 4.2 3.8 (16.1) Muesli, toasted 9.8 3.9 (16.2) Mousse, low-fat, chocolate, artificially

sweetened 5.0 3.9 (16.3) Popcorn, air-popped, no added fat 4.2 3.5 (14.8) Pretzel, regular 7.2 3.8 (15.8) Rice cake, natural, brown 3.4 3.7 (15.6) Rice cake with corn and sesame 2.5 3.9 (15.0) Turkish delight, chocolate-coated 9.8 4.0 (16.6)

REDUCING TOTAL ENERGY (CALS)/kJs

Whether we’re looking at fat, carbohydrate or protein, atthe end of the day it’s still the total amount of energy(calories or kilojoules) that causes a weight problem Ifyou’ve cut back on fatty foods and high energy densefoods it’s almost impossible to eat too much food—almost! But eating the right sorts of food for some peoplecan still be a problem, for while food quantity may need

to be increased during pregnancy, it does not need to be

increased greatly In women who are already overweight,the actual quantity of food eaten may not need to beincreased at all On the other hand, it is vital that apregnant woman does not diet, or excessively restrict herfood intake Moderation is the key to a healthy preg-nancy and pregnancy outcome.

INCREASING VARIETY

This may not sound right, given the above and that itimplies eating more food But that’s not necessarily thecase By eating a wide variety of even small amounts offoods, you are guaranteed to get all the vitamins,minerals and nutrients you need for having a healthybaby—even if this food is low in energy Try to eat at least

40 different types of (good) food a week Rememberthough, this has to tie in with the rules outlined above,which means foods which are low-fat, low energy denseand low in total energy So you’ll be looking for variety

in fruits, vegetables and other unprocessed foods—evenspices

EATING REGULARLY

Eating regularly doesn’t mean eating more It can meaneating less, because it helps to satisfy hunger better.Research suggests that eating several small meals,instead of one or two large meals a day, will decreasecholesterol in the blood; it will also lead to less reduc-tion in metabolic rate, which is what happens whenpeople skip meals In particular, don’t go without break-fast If possible, try to eat at least every four hours—butmake sure it’s something healthy, like fruit or a low- fat snack

MANAGING HUNGER

When we talk about managing hunger, we’re not cerned with genuine biological hunger What we are

con-interested in is managing learned appetite Few of us these

days eat when we are genuinely hungry We eat when it’stime to eat, when we are with friends, when we have acup of tea, when we feel sad or need to relax, or whensome other learned stimulus tells us we should eat Manymothers-to-be eat extra not because they are hungry, butbecause they feel they have to, or because they are pres-sured by those around them to eat ‘for the good of thebaby’ We all need to recognise genuine hunger again.Many stimuli in the modern environment, such as fastfood takeaways, food packaging, the layout of shoppingcentres, to mention but a few, are designed to make us eat

at times of the day when we don’t really need to Havingeaten once in association with some other normalactivity, the chances are that we will do it again the nexttime that situation occurs For example, having a piece

of cake with a cup of tea can end up always meaning ‘cup

of tea = cake’ Stopping ourselves doing this means: (a)first of all recognising the link between behaviour andfood, and (b) making changes to break this link

A lot of what we consider to be hunger could be called

‘pseudo-hunger’ Often what we consider as having a ‘bigappetite’ is merely having learned to eat too much It’simportant to differentiate between the two, particularlyduring pregnancy when biology may be confused withpsychology So here are some tips to help you:

1 Deal with those situations where ‘pseudo-hunger’

is making you over-eat

2 Recognise the difference between real hunger and

learned appetite

3 Don’t eat treats (e.g., chocolate) when you are

hungry—it makes you learn that only treatssatisfy hunger

4 Fill up with high fibre, low-fat foods.

5 Don’t get hungry—eat small, eat often.

6 Respond to your genuine food cravings during

pregnancy, but make sure these are genuine

7 Don’t be pressured to over-eat during pregnancy

by well-meaning friends and relatives

8 Don’t diet or overly restrict your food intake.

9 Be flexible, not rigid in your food habits

10 Eat a wide variety of foods to guarantee a

suffi-cient nutrient intake

Professor Trim’s Prescription Pad

• Try to reduce the total volume of food energy

in your diet

• Do this firstly by reducing fats and sugars andincreasing fibre

• Increase the proportion of low-fat protein

• Increase the variety of foods to more than 40different foods a week

• Eat small, eat regularly

• Don’t miss breakfast; don’t go for longer thanabout four hours without something to eat

• Don’t use butter and margarine (or spreadthem thinly)

• Take the skin off the chook or turkey—beforeyou cook it

• Don’t fry foods in oils

• Cut the fat off meat.

• Avoid full-cream dairy products

• Avoid foods with more than 10 per cent fat;check labels for fat content

• Eat more low energy dense foods and less highenergy dense foods

• Eat less total food

• Recognise genuine hunger and don’t respond to

‘learned appetite’

Chapter 3

MORE MOVEMENT MAKES MIGHTIER MUMS

THE IMPORTANCE OF BEING ACTIVE

Most weight control programs begin with a ‘diet’ Exercise,

is then often added as an afterthought But recent researchhas shown that this may be the wrong way round Alifetime program of planned and ‘incidental’ movement,particularly in a technological environment where dailymovement has been ‘engineered’ out of most lives, islikely to have the best long-term effect on weight loss.The type of activity required, however, may be quite different to that which is often considered In pregnancy,the type and intensity of movement will also change asthe pregnancy progresses; this aspect will be consideredlater In this chapter we’ll look at the requirements forexercise in general for weight maintenance

MOVEMENT TYPE AND INTENSITY

New findings suggest it is not necessary to follow the oldconcept of vigorous exercise at high intensity for weightloss Energy use is the main requirement, and this comes

from all forms of accumulated movement (that is,

move-ment not necessarily done all at the one time) In essence,

as with food intake, the issue with physical activity is

volume, which can be expressed as:

Volume = Frequency × × Intensity ×× Duration

If intensity of activity is increased, frequency andduration can be decreased But where it is potentiallydangerous or disadvantageous to increase intensity,benefits can be gained from increasing frequency andduration This is good news for new mothers, for whomintense activity is not only difficult but can also be dangerous The more you move your body, however, irrespective of how this is done, the less chance it has ofstoring unused energy as fat The main goal of a weightmanagement program therefore should be to increasemovement This can be done in two ways: (1) by increas-ing the ‘incidental’ activity that would otherwise be done

by machines in day-to-day living, and (2) by planning forextra (accumulated) activity throughout the day

INCIDENTAL ACTIVITY

Incidental activity includes:

• walking instead of driving;

• not using remote controls (e.g., for the TV);

• reducing the use of effort-saving machinery (e.g.,leaf-blowers) and doing things by hand;

• standing instead of sitting;

• not using emails where walking to give someone amessage is easy (in an office);

• doing things yourself instead of asking others; and

• using the stairs instead of lifts or escalators

It helps to consider all the things you do each day andplan to make your day more physically active It’s a bit of

a mind shift: we have all been trained to be efficient withour use of time and effort for the past 50 years You’llneed to turn this around and think of how you can

‘waste’ physical effort in performing your daily tasks

Is it possible to take public transport? Could you getoff the bus a couple of stops earlier than you have to, parkthe car some distance from where you are going (or leavethe car at home), take a walk during lunch? Consideryour social activities Could they be made more effort-intensive? How and where do you see your family andfriends? Usually we meet over food; this is fine, as it’s part

of our culture to celebrate life events with food But canyou change this slightly so that, as in many Europeancultures, you meet friends for a walk (or ‘promenade’)and a coffee? Or plan a picnic where some walking is necessary instead of going to the movies Look at yourlocal area and find out where the parks and recreationalareas are Take the kids for a walk on weekends, fly a kite,teach them any kind of ball game, play with them your-self There are endless possibilities It all starts by hidingthe remote control and getting out the front door (prefer-ably leaving the car keys behind)

PLANNED ACTIVITY

Planned movement for weight loss involves accumulating

as much activity as possible What is the minimumamount? Unfortunately, for women living in a modernindustrialised society, it can be quite a lot The USWeight Control Registry, for example, has found that inthe modern environment a woman may need between

60 and 90 minutes of being active daily in order to loseweight, and up to 60 minutes just to maintain herweight The good news is that this doesn’t have to be all in one go

How can you measure activity? One way is by ing the number of steps you take each day using a devicecalled a digital pedometer, which is worn around the

record-waist As part of the full Professor Trim program you’llreceive one of these in your at-home weight loss kit.You’ll also be given a table to set your stepping rate toachieve weight loss at different levels For the purposes ofthis Quick Start program, however, it’s important to saythat any amount of walking will be helpful

COUNTING STEPS

A minimum level of 7500 steps a day just to maintainbody weight will require about 60 minutes of an activitysuch as walking (extra to any activity which younormally carry out in your daily life) The good news isthat it doesn’t have to be done at one time For weightloss you can accumulate 5 lots of 1500 steps, or even

7500 lots of 1 step at a time The main thing is that it

is carried out

For best weight loss results, research has shown thatwomen need more planned activity than men, amount-ing to around 80–90 minutes of accumulated activity aday This would amount to over 10 000 steps, or walking

a total of 4 or 5 kilometres, as well as regular dailyactivity Because volume of physical activity is the issuehere, however (where volume = frequency × intensity ×duration), you may decrease the duration by increasingthe intensity or frequency, if you are fit enough (at leastbefore or after pregnancy; as you’ll see, we don’t recom-mend this during pregnancy) Doing an aerobics class,for example, at a relatively high level of intensity mighthelp compensate for the time spent doing lower intensityactivity, meaning that only 30 minutes a day could beenough (provided you don’t fall into the trap of beinginactive the rest of the day to ‘compensate’)

WHAT TYPE OF MOVEMENT?

The best forms of weight loss activity are those which areweight-bearing, that is, where the body’s weight is notsupported, as in the water or a on a bicycle Some forms

of movement are better than others But in general wecan say that it’s the weight-bearing activities, those whereyou have to carry your own body weight, that use up themost energy These include simple, natural movementslike walking For the average person, walking is one ofthe best types of weight-loss activity, as in the averageweight person it burns up roughly 1 kilocalorie for every20–30 steps walked It doesn’t matter whether this is inthe form of a planned walk, going out to the shops, orjust walking around the house or office While walkingshould be the basis of all weight-loss activity, any form ofmovement is useful However, as a pregnancy progresses

If you are able, also carry out some regular vigorous activity Put together at least 30 mins of moderate intensity physical activity

on most days

Be active every day in as many ways as you can

Think of movement as an opportunity, not an inconvenience

3–4 days/week

Most days

Daily Always

National Physical Activity Guidelines

it may be necessary to do less weight-bearing activity andturn more to weight-supportive movements like cycling,swimming or aquarobics

Before and after pregnancy, the key is to carry outactivities in line with the National Physical ActivityGuidelines illustrated in the pyramid During preg-nancy, however, some changes may need to be made The two guidelines at the bottom of the pyramid still apply, but the upper two, more active, guidelines need to bemodified by the restrictions imposed by your physicalcondition

While putting together ‘at least 30 minutes ofmoderate intensity physical activity each day’ is feasiblethroughout pregnancy, the intensity of activity should bedecreased as the pregnancy progresses Small amounts

of walking, however, can be accumulated right up todelivery without adverse effects

The top-level guideline, however, should be sidered more carefully If vigorous activity has been regularly carried out before pregnancy, there is littlereason (given the provisos listed above), that this cannot

con-be continued, although at a decreasing level and ing medical advice, well into the pregnancy However, it

follow-is not recommended for women who have not been regularly active before pregnancy to become so duringpregnancy Mild increases in movement at the level ofthe bottom three guidelines is unlikely to be harmfuland will be helpful for long-term weight maintenance.Vigorous activity is not necessary except in mothers whowish to maintain a competitive level of sporting fitness,which is an area outside the scope of this booklet andrequires specialised professional supervision

Professor Trim’s Prescription Pad

• Move more for weight loss—as part of yourdaily lifestyle—even during pregnancy

• Increase incidental exercise as much as possible

• Carry out weight-bearing movement (e.g.,walking) for weight management

• Try to accumulate (put together) a minimum

of 30 minutes of ‘planned’ activity a day

• If possible try to accumulate at least 10 000steps or 80 minutes of moderate intensityactivity per day for best results—although notnecessarily all at one time

• If you are reasonably fit, the duration of activitycan be decreased and intensity increased

• Think of movement—any movement—as anopportunity and not an inconvenience

STRESS AND ENERGY BALANCE

It’s not stress itself that is the issue Indeed, stress canincrease your metabolic rate, cause increased nervousfidgeting and result in other stress-related activities which can all help to burn energy and therefore fat But in many people, women especially, it’s the reaction

to stress that makes them gain weight—comfort-relatedeating in particular If you’re like most women, you maywell have been given food as a source of comfortwhenever anything went wrong as a child The generalpattern goes: ‘There, there dear, everything will be allright Here, have a lovely piece of cake (biscuit, choco-late, sweet ) That will make you feel better.’

If this happened to you as a child, it’s quite easy tounderstand why you’d tend to reach for the feedbag inadulthood when you’re faced with disruption to normaldaily life

STRESS AND BINGE EATING

For inveterate dieters, the situation is worse Around

50 per cent of strict dieters, or ‘overly restrictive eaters’,are also binge eaters That is, they not only eat when confronted by stress—they over-eat! Critical life events,such as marriage, divorce, job changes, childbirth, grief,and many other situations, can all lead to temporarystress and hence over-eating among binge eaters

If you react to stress in this way, learning new ways

of coping with stress is important for you If, on the otherhand, you eat less and become more active when stressed,you have no real need to consider stress management forweight loss But because chronic or extended stress inpregnancy can have an effect on birth outcome, you maywant to know more about how to deal with it and thusincrease your chances of a healthy pregnancy

Obviously in a short publication like this we can’t dealwith the problem extensively Here we provide the basics,

so that if you are interested you can follow up on thetopic in more detail, possibly through the full ProfessorTrim program for women, ‘Becoming Slimmer’

WHAT IS STRESS ANYWAY?

The term ‘stress’ is actually a misnomer because it implies

a process rather than an outcome In engineering terms

a better word may be ‘strain’, or the effects of ongoingexposure to a stressor

Like strain on an engineering structure, stress willhave little effect if the object being stressed is strongenough to withstand that stress On the other hand, itcan cause total collapse if the object of the stress is weakerthan the severity of the stressor

A similar thing happens in people Strain in this casehas its effect on the psychological ‘structure’ of the indi-vidual, the ‘stressee’ If the capacity of the stressee isgreater than the severity of the stressor, stress or strain

is not an issue In fact if the stressor is too weak it caneven lead to boredom If, on the other hand, the capacity

of the person being stressed is less than the severity of thestress being applied, anxiety and its consequences (such

as over-eating) are the outcome

The implications of this is that everyone has theirown ‘red line’, above which stress becomes an issue Thismay differ for different kinds of stressors Your red linefor stressors in the family, for example, such as your rela-tionship with a partner, may be low, whereas your redline for work stresses may be much higher

The first lesson of stress management therefore is torecognise your own red line and try to keep just below it

to get the benefits without the costs, in what Americanpsychologist Mihaly Csikzentmihalyi calls the ‘flowchannel’ You’ve probably heard this notion expressed inseveral different ways—for example: ‘If you can’t standthe heat, get out of the kitchen’, or ‘Don’t sweat the smallstuff—and remember it’s all small stuff ’ Recognisingyour red line can help you go a long way to dealing withstress

STRESS AND CONTROL

The term stress is synonymous with ‘lack of perceivedcontrol’ If you think you have control of a situation,

stress is unlikely to be an issue Where you think you have lost control however (whether you actually have or not),

stress can start to play havoc with your psyche Again,

if you are a typical dieter, or ‘overly restrained eater’, the

reaction is likely to be to forget all this and binge—tomake up for lost time!

For this reason, dieting and inflexibility are the twoworst characteristics for a person trying to maintain agood weight-loss program Being too restrictive in youreating habits, and unable to cope with life’s little ups anddowns, will shake the foundations of any weight-lossprogram to the point where over-eating—and consequentweight gain—become the rule rather than the exception.The key, then, is to regain ‘control’ over the situation—

or at least ‘perceived control’ And this can only be done

by instituting some form of ‘escape’, either physical ormental

ESCAPE AND CONTROL

Escape is often regarded as a negative way of dealing with

a situation It’s the coward’s way out But in the sense inwhich we are talking here, escape is not only an effectivesolution, it’s possibly the only solution

Of course this doesn’t necessarily mean physicalescape While this may have been effective as part of the

‘fight or flight’ reaction used by our ancestors when facedwith a frightening stressor, it’s not always the most effec-tive option today In the first place, it’s often not possible

to physically flee an oppressive boss or a bad family situation Most stress today comes not from an outsidestressor but from our way of thinking about things Inthis case escape doesn’t need to be physical—it can comethrough learning techniques of mental escape, such asmeditation, negotiation and relaxation, as well as fromphysical approaches such as exercise or massage, or taking holidays

Finding the best type of escape to enable you to get