Wed, 06 Sep 2000

How to get rid of ugly flab around the waist?

Dear Ms. Urwin,

I am 50-year-old man, and exercise four to five times a week, running on a treadmill for 45 minutes at speed 9, level 2. I also lift heavy weights, and have a great physique for a man of my age, but it is almost impossible to eliminate the slight belly.

If I reduce my food intake, my physique suffers because my muscles shrink and I cannot work out. If I eat normally, I can do exercises quite well, but the slight belly persists.

What do you think I should do? I do not eat fried foods, chocolates, ice cream or even take sugar with my tea or coffee. Often I eat only the breast part of chicken for dinner. How to get rid the belly without compromising the muscles? Can you answer this?

Kind regards

C. Dadlani

Answer:

Dear Mr. Dadlani,

Congratulations on your regular exercise and the deserved success with your physique. But be prepared, that flat stomach you want takes patience and discipline. If you are already "lean", please don't reduce your food or overtrain, but try to "fine tune" both diet and exercise.

I suggest cutting down on rice, wheat and other starchy foods, which can cause bloating. At the same time, increase your lean protein and have extra vegetables and fruit. Continue to avoid fried foods and simple sugars.

Drink more plain water. Muscles are made up of almost 80 percent water and if you don't take in enough, they can't work at their best. Your body also needs water to flush out the toxins that are made when fat is used as an energy source.

Training for five hours a week is enough. Do your aerobic work on three alternate days, for no more than an hour, and vary the treadmill periodically. Weight train twice a week on the other two days, using your whole body each time with slow, precise, correct, movements.

To make your belly look as flat as a washboard, here is an excellent exercise using the transverse abdominal, the deepest stomach muscle. It works with the other abdominals in holding in your stomach.

Lie on your back, legs straight and arms extended on the floor, behind your head. Exhale and concentrate on attempting to draw your navel to your spine while stretching your fingers further away from your body. Hold the contraction as you breathe in and out 20 times.

Carry on with your good work Mr. Dadlani and that belly will disappear, but also try to accept yourself as you are. Maintaining the right balance, by keeping both mind and body in good shape, is what real fitness is all about. Good luck.

Question:

Dear Clare,

I am a pharmacist, living in Jakarta.

I was interested in your articles about obesity and weight management in two editions of The Jakarta Post. Thus, I would like to ask you these related questions:

1) How can we motivate obese patients to be strict with their diet?

2) Do you think that pharmacotherapy can play a role in obesity management?

3) What do you think about Xenical (a new popular antiobesity drug) in terms of efficacy and safety?

Regards,

Dewiyani

Answer:

Dear Dewiyani,

Obesity is a complex and frustrating condition which is on the increase.

However, terms such as being fat, overweight or obese can mean different things to different people. A teenage girl may describe herself as obese when she is only two kilos heavier than her friends, while an adult male might blame poor stomach muscles on an obvious thirty kilo excess.

There are several methods of working out your "acceptable weight" for your height, but the one used by most professionals is the Body Mass Index (BMI). To be above the fairly wide BMI range means you are overweight; below is underweight. With this formula, being classed as "clinically obese" requires you to be considerably heavier than "clinically overweight".

In other words, being obese is 20 percent or more above your acceptable weight. This means a real risk to health, including an increased incidence of early death. So, assisting weight control by sensible and realistic means is very important.

1) Motivation and commitment can be strengthened by exercise. Numerous studies highlight the importance of increased physical activity in the treatment of obesity. Besides, exercise makes people feel good about themselves.

Positive personal motivators are far more effective than pressure from others about starting and sticking to a diet. Keeping a detailed food and activity diary or joining a support group can work. Praise, recognition and encouragement from family and friends also helps.

2) In obesity management, reducing calorie intake and increasing exercise is the most successful approach. However, drug treatment under medical supervision may sometimes be advised and required.

3) Xenical, also known as Orlistat, is a new kind of medical treatment for obesity. This drug interferes with the digestive enzymes that break down fat in the diet. Consequently, about 30 percent of the fat you eat passes through your system undigested.

Xenical can be effective under certain circumstances and typical weight loss is about 10 kg in one year. Stomach upsets are the most commonly observed side effects, which may include flatulence with discharge, oily spotting and faecal incontinence. However, these symptoms are generally mild and short lived. Xenical also decreases the absorption of fat soluble vitamins, so a daily multivitamin supplement is recommended.

-- Clare E. Urwin