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get smart, be fit

Go on, admit it. You have already abandoned most of your New Year resolutions including the pledges to get fit and eat healthy. If you are sticking to them then you are the one in 10 exception to the rule. Bulletin looks at the two extremes of losing weight - the diet and exercise route and the more drastic surgical route.

Steve McIntosh is managing director of Fitnut Ltd, an Aberdeen company which provides advice to businesses on how they can help improve employee health.

According to Steve the key to healthy and well being success is to measure it - know exactly where you are starting and set attainable goals.

"You have to treat your proposed lifestyle change as a project with you as project manager," he said. "Do some planning - make a written statement of intent - set SMART goals and refer to them daily or weekly. "

Keep a food and exercise journal for a week
Identify vulnerable times for eating junk food or avoiding exercise and develop a coping mechanism.
Reward yourself for reaching milestones with small non-food treats
Observe the habits of successful people around you
Find out what your ideal weight is and be realistic about your actual weight.

You also need to be aware of what you eat and when.

"Recent research shows that people who eat four or more times a day are 45% less likely to be obese than those who eat three or fewer times a day," he said.

"Also if you think you're hungry you are probably dehydrated so increase your intake of water. You need to replace two litres of fluid a day lost through respiration, perspiration and urination - and beer and wine don't count."

It also helpful to calculate the level at which you exercise.

"Rate your level of exercise by perceived exertion," said Steve. "Use a scale of one (lying in bed) to 10 (so exacting that you can only manage for two minutes or less).

"To improve fitness and reduce body fat you should exercise around level seven or eight which means you should be able to talk but not sing, you should be sweating lightly and breathing faster throughout the activity.

"Recent studies showed that three 10-minute walks a day and one 30-minute daily walk had equally good effects on blood cholesterol levels and stress and mental tension. In one study over 12 weeks, women who exercised three times a day averaged nearly 10 pounds of weight loss and also improved their cardiopulmonary fitness scores."

You can also take control of your own energy levels by maintaining a 50/20/30 ratio of carbohydrates/proteins/fats each day, and make your evening meal the smallest of the day.

For further information, sign up for a free health and fitness newsletter at www.fitnut.co.uk

But for some people the diet and exercise approach is just too difficult and for those considering following the surgical route to a new figure there is some sobering advice from surgeon Ken Park of Aberdeen Surgical, a consortium of experienced general surgeons who provide a fast track surgical care service for patients.

"If we can get to people before they reach the stage they require surgery and modify their diet that is the best possible solution all round," he said. "However once you get to a BMI of 35+ (body mass index, a calculation of weight over height) being completely pragmatic about it, diets don't normally work. People won't stick to a diet long enough and rigid enough to get their weight down over a satisfactory period. Then you have to do some form of weight reduction surgery."

An increasing number of patients are being tempted abroad for this type of surgery but Mr Park warns that the long term health costs may far outweigh any financial savings.

"There are some really brilliant surgeons overseas but there are also an awful lot of guys who have set up who are not regulated. They say they can do the surgery but they are not selecting the patients properly and not following them up properly."

He said that when he first became a surgeon he thought most obese patients could be helped simply by getting them eating less and exercising more but now realises it is not as simple.

"Once you get a BMI above 35 there is a significant risk from health problems and if you have developed diabetes or hypertension there is an indication to do surgery. Above 40 there is a definite indication irrespective of whether you have any of these because the risk of developing them is very high."

He said many people going overseas were not being effectively screened or advised about the implications of the surgery.

"They will not be able to eat properly and they have to accept that. It is not an easy option and there are lots of problems which, if you don't select properly, will arise. We select very carefully with a standard protocol and they are all seen by a surgeon, a dietician and perhaps a psychologist and a physician."