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Obesity

Claims of an obesity 'epidemic' are largely driven by media hype and are not supported by the evidence, but for individuals entering late middle age in particular, weight management can be a serious problem.  Increasing weight from middle age has been associated with an increased risk of heart problems, diabetes and even dementia, and excess fat is often associated with decreased mobility and even physical disablement.
Sadly, no ‘magic formula’ has yet emerged for avoiding weight gain as you get older, although the new drug Rimonabant (see below) may be an early indication of the way ahead. The non-drug strategies for maintaining a healthy weight at any age remain the same: Watch what you eat and get moving.
The most effective approach to reversing weight gain in middle age include a combination of the following:

Exercise
Increase your level of physical activity. Aerobic exercise boosts your metabolism and helps you burn fat. Strength training exercises increase muscle mass, boost your metabolism and strengthen your bones. It has recently been discovered that short bursts (just 15 seconds or so) of intense physical activity are highly effective in promoting weight loss.
You can be more physically active even without starting a formal exercise program (which not many people stick to, anyway). Just spend more time doing the things you like to do that also get you moving. Gardening can be surprisingly physical, and taking walks in the country (especially over rough terrain) is a very enjoyable way to get some exercise. Or you might just take ‘Rover’ for some ball play in the park, and maybe get there on your bike! Make it your goal to be active for a total of 30 minutes or more a day on most days.
Increased physical activity, including strength training, may be the single most important factor for maintaining a healthy body composition — more lean muscle mass and less body fat — as you get older.

Improved diet
Because of changing hormone levels, your metabolism slows as you get older. This means that you need fewer calories a day to maintain your weight as you get into your mid- to late 40s. However, because we all develop rather fixed eating habits, this can mean that we are eating 200 calories or so per day more than we need from middle age onwards - with the inevitable consequences.
Aim to reduce your calorie intake by just a few percent. Increase the proportion of fruit and vegetables and cut back the fatty biscuits and cake. There is no need to go on a ‘diet’ and in fact this would probably be counter-productive because your body is likely to respond by reducing your metabolic rate to conserve energy, making it much harder to lose weight.
Increase your protein intake at the expense of dietary fat and ‘high GI’ carbs such as sugar or starch. Proteins satisfy hunger, help build muscles and promote hormone production, and take a lot of energy to digest. Eggs are an excellent and cheap source of protein (the advice you will sometimes come across about the ‘dangers’ of cholesterol in eggs is nutritional nonsense). Try to introduce some saturated plant fats such as cocoa butter or palm oil into your diet. Contrary to much ill-informed advice, such fats and oils are nutritionally excellent and may even assist weight loss.

Psychological factors
The need for calorie control and exercise are obvious, yet many people have immense problems making the changes automatically. The reason for this is that to make changes of this kind requires changes of habit, and this is profoundly difficult for most people. After four or five decades of adult life (the time when many people realise the need to make urgenbt changes if they are to live to see old age), habits are deeply engrained and enormously difficult to alter by ‘willpower’ alone.

This means that there is a need to bypass the conscious mind in some way and access the ‘subconscious’, where habits are stored. Commonly adopted approaches to this include use of affirmations, either consciously spoken, or recorded, and self-hypnosis using recordings. Both approaches can produce good results.

Diet pills
Generally speaking, ‘diet pills’ tend to represent the triumph of hope over experience. In particular, the idea of ‘thermogenesis’, while sounding convincing, is simply a non-runner, as tens of thousands of disappointed buyers will testify (with the possible exception of dangerous ephedra-based drugs whose side effects outweigh the possible advantages). Appetite suppressants such as Hoodia gordonii extracts may be more effective, but there is some danger of triggering the ‘starvation response’ if you fall below a minimum calorie intake - and it doesn’t work for everyone.
The new drug Rimonabant, sold under the brand names Acomplia (Europe) and Zimulti (US), went on sale during summer, 2006 and is nominally only available on prescription at present (in fact it can be purchased online for around £120 for a 4-week, 20 mg/day course).

This drug, manufactured by Sanofi-Aventis, reduces the craving for food by targeting the same part of the brain that is stimulated by cannabis. A review of four controlled trials of the drug found it helped people shed a limited amount of weight (typically less than 5kg (11lb) in one year)  when they were given a course of 20 mg/day. However the most useful effect of Rimonabant was that most of the weight loss occurred around the waist, where an accumulation of fat is known to be particularly dangerous to health. The review noted some side effects, including nausea, dizziness, headaches, joint pain and diarrhoea.
The drug costs £55 per patient per month, and it is likely that financial constraints will prevent large-scale prescription by GPs. It is likely that Rimonabant will herald the introduction of a number of similar and perhaps more effective drugs in the near future, and if they are not fairly easily available on prescription, a ‘black market’ will become inevitable. Until more effective and cheaper anti-obesity drugs become available, Hoodia gordonii extracts remain a better and more easily available alternative.
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