SO YOU WANT TO FIT…

LET's face it: exercise can feel like drudgery if you don't spice up your routine with some variety after a while. And that's a big concession for a health nut like me to admit. So that is why I'm always on the prowl for hot new trends in exercise. We all could use a little motivational boost now and then. And by fat, the hottest and latest exercise trends are all in the mind/body genre.

Here's a round-up of what moves are keeping the very fit even fitter. Pilates is one of the most popular exercise systems going today. Developed in the 1930s by New York-based physical trainer Joseph Pilates, the system involves a series of stretching and strengthening types of exercises designed to keep ballet dancers limber and strong, with a non-bulky, elongated look. Migrating out of the ballet world to the fitness scene, Pilates is taught by certified instructors at clubs and spas that promise that latest, greatest ways to maintain sculpted perfection.

The emphasis is on posture, breathing and a confounding number of verbal cues to "rotate your pelvis", "move from your core", and "tuck your tailbone a centimetre more". Performed either on medieval-looking equipment, ominously given names like the "Reformer", or on cushy floor mats, Pilates may just tighten areas of your body that you thought had long ago lost the battle to gravity. Look for Pilates-trained instructors near you, or ask if they have learned any specialised forms of "core conditioning" work, a similar approach that aims to develop that sleek and toned look.

What else is capturing the attention of the fit crowd? Yoga maintains its first-place standing as the fastest growing exercise system in the U.S., parts of Europe and Asia. Depending on what lineage is followed, yoga is viewed as the superior method for restoring health and wellness, gaining fitness, and developing unity of mind, body and spirit. But the quality of instruction in most international cities varies widely. Most Westerners fasten onto the notions of control and discipline of the body without focussing on the inner-directed skills of unburdening the mind and directing the spirit.

Much of the clarity of mind and freedom from stress that is emphasised in various hatha yoga schools in India somehow gets lost in the translation by the time it reaches yoga studios in Los Angeles or Buenos Aires. Some classes, highly popularised in urban centres, lack the calming effects of yoga, while they feature the heated, strength-training aspects of Ashtanga or "power yoga", as it is called in Germany and the U.S. The celebrities Madonna and Sting swear by this approach, believing that it gives them the stamina necessary for their high-energy performances.

Then there are the hybrid trends that attempt to combine popular classes. For example, Pilates has just been combined with yoga to form Yogilates. Created in 1997 by Johnathan Urla, Yogilates is described as "an alternative path to optimal fitness and health" in his new book. Urla recommends you start with a beginner series at least three times a week, allowing your body time for recovery and "for the changes in your neurological pathways to be absorbed".

# You need enough floor space, a yoga mat to protect your back, a rolled towel to place under your head, and a firm pillow to sit on. Urla also recommends a yoga strap, two or three-pound dumb bells, and a foam yoga block. Wear loose clothing, remove dangling jewellery, shoes and socks. Start with a spine stretch and hip hinge by sitting up on the floor, and opening the legs slightly wider than your hips. Place your hands on the floor for support. Then hold your legs in parallel, flex your feet and allow your knees to bend slightly as you inhale and stretch your spine up straight.

Next, exhale and round your spine over, curling from the top of the head toward the ground. Use your core (abdominal and back) muscles to round your spine and feel the stretch in your spine. Inhale and roll your spine back up to sitting straight. Then exhale and hinge forward from the hips, keeping your back straight as you lean forward. Press your hands into the floor to brace your back and push yourself forward. You should feel the stretch in the back of your legs.

Inhale and bring your back up straight.

In the beginning, you may find that you are very inflexible in your hamstrings, the muscles in the back of your thigh. Be very careful with this exercise. Do not overstretch or try to grab your legs and pull beyond any strain, or you may risk an injury.

All exercises must be practised over and over to create any lasting change in your physique or performance. Start out very slowly with any routine you are learning, and perform the movement with control and ease. Never do any bouncing or jerky motions or you could strain or tear muscles, ligaments or tendons.

Developing the physical skills will certainly help you improve your health; however, developing the skills of awareness that accompany mind/body workouts may prove to be an even greater boost to your overall sense of well-being.

THEY ARE NOT HANDICAP

Though there are situations that can lead to the loss of an eye, such victims needn't despair. They can undergo rehabilitation for aesthetic, functional and psychological reasons.

IT is not infrequent to come across people who have sustained permanent damage to one of the paired structures of the body like the lungs, the kidneys and the eyes. Once we see them, it does set us thinking about what it is like to carry on leading a normal life. The fact is that the body's ability to cope with such situations is amazing.

As regards vision, while people who are monocular are able to perform almost everything that a binocular person does, there are a few functional and other limitations, some of which can be overcome. For example, even simple acts like threading a needle or pouring a drink into a cup can become a challenge. Likewise, getting used to limited peripheral vision especially in situations like when there is heavy traffic or the industrial work place with fast moving equipment can not only become unnerving but at times also hazardous.

Commonplace situations that can lead to a loss of an eye include intentional surgical removal of the eye for intraocular tumours, severe irreparable trauma to one eye which may pose a threat to the normal eye, infections when vision is irreversibly lost, and when a blind eye is disfigured or results in chronic irritation and pain. Such persons, once considered the end of the road cases as far as the ophthalmologist was concerned, can now undergo further rehabilitation for aesthetic, functional and psychological reasons.

The individual who is blinded in one eye undergoes an adaptational process to resume leading a normal life. This includes a relearning of spatial orientation, depth perception at near and far using various visual cues and greater movement of the working eye and head to cover a larger field, etc. From the medical point of view, given that there is only one eye, ophthalmologists recommend the following:

Wearing protective eye wear at all times, preferably made of polycarbonate lenses which are shatter proof, especially when outside the home environment, be it while driving, at school or at work. This is because, when exposed to injury, it is the "seeing eye" which is more likely to be injured.

That the only "seeing eye" be subject to periodic and complete ophthalmic evaluations to recognise early diseases.

Potential traumatic situations including contact sports and hazardous situations should be avoided, even if it means a review of the person's job description.

Physical rehabilitation of the patient includes various modalities. The most simplistic, and common, form is to place an artificial eye (prosthesis) in the eye socket. While this is frequently done by fitting a "stock eye" from a box, much like selecting a shirt from a clothing store which may or may not fit well, in the developed world and in a handful of centres in India, a "customised prosthesis" is tailored to suit the person's needs with much superior cosmesis.

When an eye is removed surgically, an implant is placed in the socket, usually at the same sitting, to act as a foundation on which the prosthesis rests and moves to a certain extent.

For any reason if a primary implant is not placed, secondary implants may be used. Choices of these implants are varied and the current generation of implants are designed to integrate with the orbit such that the overlying prosthesis may be coupled to the underlying implant for better movement. However, the latter is not without certain limitations and hence used in a limited way.

Finally, in the Indian environment we do come across patients who have had their eyes removed several years earlier before they finally seek attention. More often than not, due to the delay and lack of adequate care of the socket, a ready fitting of the artificial eye is impossible.

In such situations, major reconstructive surgery may be required either using synthetic materials or the patient's own tissues before fitting him with an acceptable prosthesis.

WHERE IS THE FAMILY PHYSICIAN ?

There is nothing inevitable about the decline in general practice's fortune but if this trend is to be halted and reversed, it can be only through consistent and constructive leadership. Before a series of tests, try and see the family physician first.

"Professions arise in response to the recognition of a social need, and their continued existence is dependent on their success in satisfying the expectations raised by the state of knowledge which they proffer."
-Sir Harold Himsworth

MR. S, 28, a worker in a pappad manufacturing unit, suddenly complained of chest pain, sweating and mild body ache, while working. The proprietor immediately fixed up an appointment with a cardiologist, Dr. X. In the evening, Dr. X saw him after an ECG evaluation and advised him to come the next day with the results of his blood tests, to rule out cardiac problems.

Mr. S developed high fever the same night. After completing the tests the next day, he again met Dr. X and brought to his notice the fever that he had had. Dr. X after going through the reports suggested that he consult another senior physician after adding that he had no cardiac problem to worry about. On contacting the senior physician, it was learned that he saw only a limited number of cases per day and that he could see Mr. S only after two weeks. On the third day Mr. S came to my clinic with his reports. On clinical evaluation after eliciting a good history, I did a simple blood test, which revealed malaria. He was given tablets for three days and he recovered.

I have narrated the case to explain that a primary care physician or family physician should be the physician a patient must see first. The message here is that similar physical complaints may be manifestations of different diseases like malaria, heart problems or lung diseases. In this case, the choice of specialist was made by a lay man. Hence, the patient had to suffer for three days before a diagnosis was made and suitable treatment was given, not taking into account the monetary loss incurred by the individual.

By tradition, the doctor first consulted in an illness is known as a GP. He is also called the family physician or the primary care physician. By practice, even today the doctor responds to a patient's call either by treatment at his office or by visiting the home. The family physician will be a doctor to all the members of a family and will look after them throughout his practicing years, being involved in many important events in their lives, including births, marriages and deaths. He acts as a friend, counsellor as well as a doctor, especially in rural areas, and is an honourable member of the family. After qualifying, a new doctor must immediately forget most of what he has been taught or has learned about medicine and start again. It is found that more than 50 per cent of them eventually go into family practice, but it is unfortunate that the medical curriculum, even now, tends to concentrate on the diagnosis and treatment of obscure illnesses which a family physician may rarely encounter in the course of a long career. The present day hospital and medical college environment is too refined and unrealistic to be of continuous use to the prospective family physician.

Moreover the attributes which go to make a family physician do not appear in any text book. It is astonishing to note that for long, hospitals have failed to impress students with the fundamental attributes to enter family practice. The great qualities of a family physician are compassion, sympathy, understanding, faith, hope and affection.

GOING into a little bit of history of this speciality, the term GP came into use at about the beginning of the 19th Century in England. Prior to that, only three categories were present — physicians, surgeons and apothecaries. A hundred years ago a doctor was not a gentleman and was expected to enter through the back door, whereas his veterinary counterpart entered through the front door as he looked after the gentleman's horse. In 1827, the President of the Royal College of Physicians held that midwifery was an act foreign to the habit of a gentleman! In 1830, a Metropolitan Society of General Practitioners in medicine and surgery had been instituted. The GP at that time did everything. By the late 19th Century, teaching hospitals came up and were staffed by physicians, surgeons and obstetricians. But for the GP, hospital privileges were of little importance as he could do his surgery over the kitchen table or his obstetrics in the family bedroom much more safely than in the institution. As the hospital system developed, it was not really the possession of skills or a higher qualification that began to divide the profession but the question of whether or not the doctor had access to hospital beds. In 1948, the National Health Service of England formalised the separation of domiciliary and institutional services. Once the GP was excluded from the hospital, a marked deterioration in his status began. But later in March 1965, a Charter for the Family doctor services appeared and was produced by the British Medical Association. And now the real backbone of the NHS in England is the services of the general practitioner.

Meanwhile in the U.S. in 1962, the Association of American Medical Colleges noted that from 1900 to 1962, American medical graduates choosing general practice fell from 33 per cent to 18 per cent and projections for the following decade predicted the demise of the general practitioner. However, in a leading article, "End — or Beginning?" in The Lancet (July 24, 1965) it was stated that "there is nothing inevitable about the decline in its (general practice's) fortune; but if this trend is to be halted and reversed, it can be only through consistent and constructive leadership". During this period, a group of 10 general practitioners in the U.S. saw this rapid decline of general practice and were eager to keep up with the times yet preserve those precious attributes of the old generalist. They hastened to establish a movement to create the new specialty of family practice through an American Board of Family Practice (ABFP).

FAMILY practice is a horizontal specialty, much like paediatrics and internal medicine, and shares large areas of content with other clinical disciplines. It incorporates this shared knowledge and utilises it in a unique way to deliver primary medical care. It draws most heavily on internal medicine, paediatrics, obstetrics and gynaecology, surgery, psychiatry and preventive medicine. This establishes a cohesive unit, combining the behavioural sciences with the traditional biological and clinical sciences.


The ABFP defines the family physician to be one who serves the public as a physician of first contact and as means of entry into the health care system; assumes responsibility for his patients' comprehensive and continuing health care, acts as coordinator of his patients' health services; and accepts responsibility for his patients; total health care, including the use of consultants, within the context of their environment, including the community and the family or comparable social unit. The family physician performs two major functions which may be related entirely to individual patients but usually concern the family as a group. They are primary assessment and continuing care.

Primary assessment refers to the patient presenting to the doctor with previously undifferentiated, unknown illnesses or symptoms. The task of the family physician is to decide upon the severity of these symptoms, their prognosis and the way in which they affect the person's socio-economic conditions. This is one of the most difficult aspects of family practice. Assessment is made not only upon the information the patient presents to the family physician but is also related to the family physician's knowledge of the patients environment, his family, his work, his past medical history, his pattern of behaviour and the culture of the neighbourhood. Thus the roots the doctor develops in his community become important. After this assessment, the management of the problem is discussed with the patient and a mutually acceptable course of action is agreed upon. The term continuing care, is based on the knowledge of the social background of the patients over many years and for the chronic sick. It also means that the long term problems of people which may persist for months, years and sometimes for a whole lifetime can be managed.

Why do patients see a doctor? All patients consult doctors for some reason. Yet, it is very common to hear doctors speaking of unnecessary consultations, and patients who waste their time. Evident in all such phrases is the feeling that there was no reason for the patient's visit to the doctor. The truth lies either in the doctor's inability to discover that reason or because the patient has not learnt how to use the doctor. In most cases, the fault lies more often with the doctor than the patient. Thus a patient goes to a doctor for two reasons — to obtain recognition of his sickness, and to seek help in order to get better.

IN conclusion, the role and function of the family physician was described by Sir Theodore Fox, Editor of The Lancet in these terms: "his essential characteristic... is that he is looking after people as people and not as problems. He is what our grandfathers called `my medical attendant' or `my personal physician' and his function is to meet what is really the primary medical need a person in difficulties wants, in the first place, the help of another person on whom he can rely as a friend. Someone with knowledge of what is feasible but also with good judgment on what is desirable in a particular circumstance and an understanding of what the circumstances are".

CATARACT SURGERY

Cataract is an opacity in the lens of the eye. The normal lens is transparent and allows light to reach the retina. When it becomes opaque (cataract) light does no reach the retina and the patient is unable to see clearly.

Till date there is no proven cure of cataract. The only available treatment is surgery. And so the method and technique of surgery is of importance. Earlier surgery was done only when the cataract was mature and vision was impaired to the extent that daily activities were hampered. But today no one waits so long. Cataract surgery is done electively. This is possible because of the new techniques and developments in surgery
Past techniques

There was a time when cataract was removed through a 12mm large opening. Now with the latest technology we remove the lens through a small opening of 2.8mm with the help of ultrasonic aspiration technique called phacoemulsification. A foldable intraocular lens is then implanted in the eye.

The success rate is close to 99.5 per cent. The present options in phaco surgery are Standard phaco or the first generation phaco surgery using simpler machines and an incision size of 3.2 mm . This was first conducted in late 1970s. In Cold phaco or the second generation surgery, the incision size reduced to 2.8mm but it was much safer since the amount of heat being delivered to the eye was reduced significantly thus reducing the trauma.

Now there is Microincisional (Mini Keyhole) Cataract Surgery. Introduced by Bausch and Lomb this is a revolutionary technology that enables cataract surgery to be done through the a 1.6 mm to 1.8 mm incision.

A new intraocular lens has been devised which can be inserted through this small incision and gets unfolded inside the eye. This is called a micro intraocular lens (MIL). The advantages of this are quicker surgery (sutureless); faster recovery; minimal post–operative restrictions; better vision quality and astigmatism neutral.

After effects

Most people do not need to wear glasses for distance vision but will need them for reading. This can be avoided if a multi-focal lens is placed in the eye. Then glasses may not be required for most work. A few may require glasses to refine their vision.

About five per cent of people get a thickening of the posterior capsule after the surgery, which is called after cataract. This can be easily dealt with by a laser procedure done as an out patient procedure.

The authors are Chennai-based Ophthalmologists.

Causes

Ageing, UV light, Deficiency in protein and vitamins, Intrauterine Infections leading to congenital cataract, Developmental cataract seen in adolescents, Injury and Systemic factors like diabetes mellitus.

Symptoms

Blurring of images, Double images, Image distortion

FOR HEALTHY HEART

One Sunday morning a 24-year-old executive went to a fitness centre for the first time. After working for half an hour, he complained of pain in the left shoulder. The trainer asked him to continue, as it was his first day.

After about 20 minutes this young executive suffered severe chest pain when he was rushed to hospital. He collapsed and cardiac resuscitation was done. His ECG showed Extensive Heart Attack for which an emergency angioplasty was done and patient survived. After investigations his LPA levels were 130mg.

Hence a word of caution for all fitness freaks. Heart disease and heart attacks have assumed epidemic proportion in India over the past two decades. It is one of the leading causes of death and long-term disability. Based on the evidence, heart diseases will double by 2015 and become the single largest contributor to mortality, accounting for almost one-third of all deaths.
Early manifestation

Not only is the incidence of heart attacks increasing significantly, but the blockage of coronary arteries manifests at least a decade earlier. Every sixth patient with heart attack is below 40 years of age. Young Indians have a five to 10 fold higher rate of heart attacks and deaths as compared to Western population. Indians all over the world have the highest rate of mortality and morbidity for heart attacks whereas the incidence of heart attack have halved in the West during the past 30 years. Irrespective of gender, religion and social class, the high rates of heart attacks in Indians are in sharp contrast to very low rates in other Asians such as Japanese and Chinese.

The most important reason is a combination of nature and nurture — genetic pre-disposition (nature), urbanisation with affluence (nurture). Genetic pre-disposition is reflected by levels of Lipoprotein–A (LPA), which is higher in Indians. Sedentary habits and western lifestyle leads to decreased physical activity, increased consumption of junk food results in obesity, insulin resistance and atherogenic lipid abnormalities. High LP (A), high triglycerides, high levels of bad cholesterol and low levels of good cholesterol predispose heart diseases and heart attacks.
What you can do

Lifestyle modification is of prime importance. One should walk about five kilometres in 45 minutes at least five days a week. Unaccustomed exercises should be avoided. Preventive measures should be undertaken in those with risk factors but without established disease i.e., counselling for tobacco use, early diagnosis and treatment of high blood pressure, diabetes mellitus and dietary measures to treat lipid abnormalities. All these are important in those individuals who have a family history of heart diseases.

The family physician should be trained to recognise signs and symptoms and ECG evidence of heart attacks and institute first aid measures and prompt referral to a hospital where definite therapy can be given.

SAVE YOUR KIDNEYS

The twin bean-like organ located on either side of the spine is better known as the biochemist of the body. The kidneys filter about 200 litres of fluid every 24 hours and return it to the blood stream. Approximately 1.5-2 litres is eliminated from the body in the form of urine, and the rest is retained. The production of urine involves highly complex steps of excretion and re-absorption, which is necessary to maintain a stable balance of body chemicals.

Kidneys perform crucial functions, which affect all parts of the body. But the kidneys are also vulnerable to a range of problems from a minor urinary tract infection to progressive kidney failure. Advances over the past three decades have improved the ability to diagnose and treat those who suffer from kidney disorders.

Kidney diseases usually affect both kidneys. If the kidney’s ability to remove and regulate water and chemicals is seriously damaged, waste products and excess fluids build-up, causing severe swelling and symptoms of kidney failure.
Different kinds

The different types of kidney diseases are characterised as Hereditary, which can be transmitted to both males and females and generally produce clinical symptoms from teenage years to adulthood; Congenital, which usually involves some malformation of the genitourinary tract leading to obstruction; Acquired, also known as nephritis or inflammation. The most common is "glomerulonephritis".

Kidney failures are not always permanent. Some get better after treatment. With acute kidney failure, dialysis may be needed until the kidneys get better. In Chronic or End Stage Kidney Failure, there is no improvement and dialysis is a must for the rest of the patient’s life. If the patient is in a fit condition, kidney transplant can be one treatment option.

Unfortunately, many kidney diseases are still of unknown cause. Some can be successfully treated while others progress to advanced kidney failure, or End Stage Renal Diseases (E.S.R.D) requiring dialysis and/or transplantation.

Dialysis is performed routinely on persons who suffer from acute or chronic renal failure, or who have ESRD. It involves removing waste substances and fluid from the blood that are normally eliminated by the kidneys. Dialysis may also be used for individuals who have been exposed to or ingested toxic substances to prevent renal failure.
Treatment

Haemodialysis removes waste products from the blood by passing it out of the body, through a filtering system (dialyser) and returning it, cleaned, to the body. While in the filtering system, the blood flows through tubes made of membranes that allows the waste products (which are much smaller than the blood cells) to pass out. The waste products pass through the membrane into a dialysis solution (dialysate), then out of the machine. The clean blood is returned safely to the body. This cycle is repeated throughout the dialysis session. It takes about four hours to complete a session and it needs to be done thrice a week.

In Peritoneal Dialysis, instead of being cleaned by an artificial membrane outside the body, the blood is cleaned inside the body, through the Peritoneum (a thin membrane that surrounds the outside of the organs in the abdomen).The peritoneum allows waste products to pass through it and is very rich in small blood vessels. By running a dialysis fluid into the peritoneal cavity through a tube called Catheter, and then out again, waste can be filtered from the blood.
Two types

There are two types of peritoneal dialysis: Continuous Ambulatory Peritoneal Dialysis or CAPD is done without machines. The patient can do it himself, usually four or five times a day at home or at work, while continuing with regular life. Automated Peritoneal Dialysis or APD is a more refined version. In this the dialysate solution is changed by a machine, at night, while the patient is asleep.

In both cases, the patient can travel, as the bags can be delivered to the visiting areas. In APD the small size of the machine makes it easy to travel.

Kidney transplant or renal transplantation is the organ transplant of a kidney in a patient with end-stage renal disease. There are two sources of kidney donors: Living and Deceased. But before opting for transplant one should thoroughly consult his doctor and get a physical examination done.

The writer is a Consultant Nephrologist based in New Delhi.
Warning signs

Burning or difficulty during urination

An increase in frequency of urination, nocturnal

Passage of bloody urine

Puffiness around eyes

Swelling of hands and feet

Pain in back just below ribs

High blood pressure

FOOD FOR YOUR MOOD

There is a deadline at work, you feel the pressure mounting and you haven’t had much sleep. You feel tired, petulant and anxious. You reach for that bag of chips or packet of biscuits as you try and figure out your presentation. You haven’t had lunch so you are ravenous. You finish that bag of chips and the biscuits and a bottle of some sweet syrupy drink. Why are you still hungry?

You go home in the evening and as you work at your laptop you pile up your plate with, you’re not sure what exactly, something greasy and filling. You mindlessly shovel food into your mouth as you try and focus.

Late into the night you eat a big bowl of ice cream as you watch the late night news, while another part of your brain tries to fathom the final touches to your presentation. By the time you get to bed at 2.00 a.m. you are exhausted, disconcerted and strangely, still hungry. Does this sound familiar?

Here’s another scenario. You’re feeling depressed and sad. You try to appease your senses with chocolate; as you keep eating, you seem to feel better, and the gratification of that creamy chocolate helps, temporarily.

An hour later, you reach for a piece of fresh cream cake; somehow it doesn’t seem to stop with a piece. Before you know it, the entire cake is over. Does this sound familiar too?
Connections

Is there a connection between Mood and Food? Apparently, yes.

All too often we find that our longings for food, especially ‘unhealthy’ food, happen to concur with the most vulnerable periods in our life. During emotional low points, we discover ourselves unconsciously seeking solace in food.

Emotional eating however can disrupt our well meaning efforts at weight loss and healthy eating. This leads to a tailspin of weight gain, self recrimination, and plummeting self-confidence, leading to further despair and over eating.

First, we need to understand that nearly all unhealthy eating is motivated by something we’re not always aware of on a conscious level. It is most often the result of unconstructive thoughts, beliefs and attitudes that may be lurking just below our conscious awareness.

This negative thinking is invariably the product of negative programming that we might have assimilated in childhood from parents, teachers, etc. We may have learnt early to soothe unpleasant feeling of a tumultuous childhood for instance with a candy bar, or parents may have used food as a reward for ‘good behaviour’.

The positive sensations that were associated with the food involved may often need to be re-experienced in adulthood whenever one is anxious or unhappy. Major life stressors — such as death of a loved one, unemployment, ill health, divorce, day to day set backs such as bad weather and unwelcome changes in your normal routine can trigger emotions that encourage overeating.

But why do negative emotions lead to overeating? Some foods have seemingly addictive qualities. For example, when you eat beguiling foods, such as chocolate, your body releases trace amounts of mood-enhancing hormones. Eating it may make you feel better, if only momentarily.
Distraction

Food can also be a distraction. If you’re concerned about an imminent event or rethinking an earlier conflict, eating comfort foods may distract you. But the distraction is short-lived. While you are eating, your thoughts may focus on the satisfying taste of your comfort food. Unfortunately, when you’re done overeating, your attention returns to your worries, and you may now bear the additional burden of guilt about overeating.

As you might have realised, "will power" alone is an ineffective tool to address this problem, since our unconscious motivations are much more powerful and persistent than our conscious desire to eat healthy, exercise and so on.

The only valid and permanent solution to our unhealthy eating habits is to get to the heart of the problem, analyse and eliminate the toxic thinking pattern that created our bad habits in the first place. This may require some amount of counselling and a deeper understanding of the issues at hand.

Happy occasions also call for celebration with food as our society is immersed in experimenting with gastronomic pleasures at any pretext possible. So it doesn’t help your resolve to eat healthy when inundated with an array of pleasures for the palate. If on such an occasion, you are stressed, anxious or unhappy, needless to say, the problem is compounded.

Of course, it’s very important to be armed with a healthy diet plan and a well-structured exercise programme that you can sustain. But neither of these things alone can bring about real and lasting weight loss if our own subconscious mind and concealed thoughts are still destroying us.

The writer is a Practising Obgyn, Fitness and Lifestyle Consultant,

NAFC (USA) and Director, TFL Fitness Studio, Chennai. E-mail: drsheela@tflinc.net
How to stop this futile cycle

Learn to recognise real hunger. Studies have found that the body is sometimes unable to distinguish true hunger from just stress or even thirst. (The next time you think you are hungry, drink a glass of water, wait a while and see if you are still experiencing hunger.)

Identify the triggers that lead you to overeat. Maintaining a ‘food journal’ for a week or two is an excellent way of recording your food intake, satiety levels and correlated mood. You may find to your surprise that there is a very definite association between that stressful meeting you need to attend and your reaching for the nearest ‘comfort food’, or your tendency to overeat at lunch when you have had a showdown with the kids or your spouse.

Identify the thoughts and feelings you normally experience before your gluttonous enterprise and those that justify your indulgences.

The best way to circumvent the downward spiral of overeating, self-loathing and then further overeating is to avoid keeping those sinful temptations near at hand. Instead, stock up on healthier options, so if real hunger strikes you are not left feeling frustrated.

Exercise regularly. It has been found repeatedly that exercise acts as a stress reliever. Modalities like Yoga and meditation go a long way in managing stress. Any form of low to moderate intensity cardiovascular activity like a walk or a swim will help relieve stress. Find your favourite mode of exercise and use it to get you through the tough times instead of using food as a way out.

Get adequate sleep. Sleep deprivation has been shown to confuse the body into misreading the body’s signals of fatigue as hunger.

Make a habit of ‘mindful eating’. Taking 10 minutes off for your meal will enable you to focus completely on the food and enjoy it, rather than consuming hundreds of calories without actually registering it.

Find other outlets for your stress. Taking a walk, talking to a friend, watching a movie, pursuing a hobby can all substitute as distractions instead of food during susceptible times.

See a therapist. If after your attempts to gain control of the situation you find there is no progress, it may be time to see a therapist to delve a little deeper into the psychological aspect of the problem.

Upheavals are part and parcel of life. Learning to use the right resources to deal with unpleasant feelings is an important part of staying healthy. If you intend to make meaningful changes in your diet, weight and lifestyle, understanding yourself a little better will go a long way in preventing self sabotage and regret.