- Fat is oxidised under aerobic conditions.

- Optimal fat utilisation in unfit people occurs at a lower exercise intensity compared to fit people.

- Fat utilisation also increases proportionately with exercise duration.

- Hence, low-moderate intensity, long duration activity is most appropriate for fat loss in those likely to require this most.

- Increasing both ‘planned’ and ‘incidental’ physical activity is important in any fat loss program.

- In general, weight-bearing physical activities are best for fat loss, except perhaps in the initial stages or for the very obese.

Ask anyone what they think is the best way to lose fat and the two sure answers are ‘diet’ and ‘exercise’. And while diet—or at least a change in eating patterns—is well accepted at the scientific level, it is surprising how little scientific support there is for exercise. Most scientists working in the area will agree that some form of exercise (or perhaps more appropriately, physical activity) built into an individual’s lifestyle, is probably more important than food restriction for long term prevention of fat gain, but there is much less agreement on the benefits of exercise in initial fat loss.

Some researchers have pointed to the relatively small levels of energy expenditure involved in significant levels of exercise. It is typical to find popular diet programs, for example, pointing out mat walking a kilometre uses only around 100kcal, which is quickly negated by a glass of beer or small piece of cake. However, the benefits claimed for exercise by its exponents are greater than this. Some forms of exercise have been claimed to increase long term metabolic rate (although this remains controversial) and increase fat oxidation. In addition, exercise is often claimed to be much more psychologically pleasurable than restrictive dieting.

One of the problems in assessing the benefits of exercise in fiat loss has been the large individual differences in response to a given exercise load, and the many different types of physical activities that have been used in scientific research. The effect of a certain type of exercise in one group of people, such as young women, doesn’t necessarily mean that the same type, intensity and duration of exercise will have the same effect on another group, e.g. fat men.

*138\186\4*

Patients often resist change because they have adopted faulty ideas about food and beauty. Our culture creates and spreads many of these ideas. Over time, patients accept these notions as truth and stop questioning whether they are valid. Cognitive therapy identifies and challenges the characteristic thoughts that reinforce disordered eating.

The food diaries are a good place to start, since they record a woman’s thoughts about eating. We can explore these thoughts during therapy sessions.

For example, I recently worked with a patient on the need to eat three regular meals a day. She agreed to try, but at home, alone, she hesitated putting the rule into practice. In her diary she noted that whenever she faced the need to eat on such a schedule, she always thought, “If I eat that much food I will get fat.” Another patient reported that every time she stepped on the scale, she automatically thought, “I am so fat that everyone must hate me.”

Automatic thoughts may strike when a patient feels angry or suffers rejection. Such thoughts usually center on feeling or looking fat, the fear of losing self-control, or the need to diet. Sometimes the thought takes the form of a mental image. One patient said, “Whenever I eat, I imagine I’m a pig wallowing in a mud-hole. Dozens of people stand at a fence watching me gorging on my slop.”

Once we identify these recurring thoughts, we can examine them carefully. The first step is to reduce the thought to its essence. I may ask the patient, “Are you feeling fat because you are afraid that others may see you this way?” Or I may ask, “Do you think that feeling fat is your way of dealing with anger? Does it spring from your belief that you are a worthless person?”

The next step is to gather any evidence that either supports or contradicts the patient’s automatic thoughts. For example, if the patient thinks she is fat, we determine whether she has actually gained any weight recently. If she has, then of course her thinking has some basis in reality. If not, her feelings may represent a kind of substitute for her unacceptable feelings of anger.

Once we’ve identified these characteristic thoughts, the patient and I can begin the search for more valid ways of thinking. For example, we try to turn the false notion “I am fat” into the reality: “My weight is the same, but today I’m wearing a pair of jeans I bought back when I was unhealthily underweight. I’m not fat; my clothes are too small.”

*76/35/5*

But that wasn’t the case just 2 years ago, when Pam carried 145 pounds on her 5-foot frame. She found out that her cholesterol had reached 285, well above the recommended maximum of 200. Worse, her triglycerides—a type of blood fat implicated in heart disease—were 94 points higher than they should have been.

Pam’s doctor warned her that if she didn’t boost her activity level, she could expect to follow in the footsteps of many of her family members, who have histories of heart disease and diabetes. When Pam confided that she hated to exercise, her doctor suggested that she start walking.

“The first day, I started off slow and didn’t go very far,” she recalls. “But every day, I went a little bit faster and a little bit farther.” Soon, she was taking brisk walks every morning and evening. Now, she walks 4 to 6 miles every day around her hometown of Fisher, Illinois.

Pam also made some changes in her eating habits, too. “I had talked to my sister-in-law about my cholesterol problem, and soon after, she surprised me with a copy of The Fat-Free Living Super Cookbook by Jyl Steinback,” Pam says. “I used that book as a guide to eliminating all the fat from my meals. The dessert recipes are especially wonderful.”

The results have been amazing. Pam’s cholesterol level has fallen to a very acceptable 191, and her triglycerides have dropped 30 points below the recommended maximum. “My doctor was thrilled,” Pam, now 47, says. But those aren’t the only numbers that pleased Pam. She’s now 35 pounds lighter, thanks to her walking workouts. “I went from a size 12 to a 6,” she says. “It’s really nice because I got a whole new wardrobe for my efforts!”

WINNING ACTION

Do it for your health’s sake. Maybe slimming down for appearance’s sake isn’t enough of a motivator for you. So do it for your health instead. Research has shown that for someone who is overweight, even a modest amount of weight loss—on the order of 10 to 14 pounds—can lower the risk of heart disease and certain cancers, protect against back and joint pain, boost energy, and improve sleep.

*130\89\8*