Tuesday, November 16, 2010

Obesity....'Modified Cambridge Diet'

Obesity is ubiquitous. Nowadays it is the norm to have one or two in the family who are saddled by the problem of obesity. I have mine. Two of my grown up children are obese. It is an epidemics brought about by a multiple change in our life style: Internet connectivity, a hundred and one TV programme, general increase in affluence and a blugeoning fast food industry. Above all also, to a significant extent, 'bad food habit' behaviour exhibited by one or two parents [ my wife will skin me alive for this last comment!].

The 'wives' put the food on the table and if it is excess food on a daily basis, the children had it. Infact my Endocrine and Diabetologist colleague in my hospital joked that having a wife who 'is a good cook' or thinks she is a good cook, in 2010, can be considered a 'high risk behaviour'. I cannot agree more, seeing what happened to my two boys.

As in my earlier articles,the medical conditions that follow obesity are very well known but to reiterate the most troublesome and 'mother of all evil', as a cardiologist, I would put DIABETES as the highest on the list...THE MOTHER OF ALL EVIL.
From here one get increased incidence of stroke,coronary artery disease, ED, high blood pressure, vision problem and blindness,general debility and ill-health etc etc and etc.

Other conditions not related and effected through Diabetes but are related direct to Obesity are Musculoskeletal ie increase incidence of debilitating joint problem at early age due to increased wear and tear as a result of 'Absorber problem'; increased incidence of CANCER amongst obese individuals; and not to under-rate also the important aspect of psychological impact of a net decrease in self esteem related to obesity.

I have a very simple formullae for estimating ideal body weight: Your height in centimetres[ say 165 cm for eg ] minus 100. In this case your ideal body weight is 60 kg. Give yourself 3 kg on each side. Therefore for a man of height 160 cm, his ideal weight range is around 57 to 63 kg. If you think you are the 'muscular' or the 'big boned' types give yourself a 5 kg allowance, so your ideal range should not exceed 65 kg!...Beyond that is obesity. For woman ,despite popular belief , their allowance should be less rather than more! If you weigh above 90 kg and your height is 160 cm, you are already considered to be Morbidly Obese.

There is no short cut to it's solution and the short answer to obesity is really very short: EAT LESS, BURN MORE.....on a daily, regular basis indefinitely. Nothing beats an active lifestyle of regular 3 to 4 time of exercise a week; healthy balanced , high vege, high fibre-low-fat-low calorie diet; with plenty of fluid daily.
There is no two way about it unless one do not mind a "SHORT FUSE".
[ see my LONGEVITY articles, the common denominator of these long living, population s across the world are: continuous physical activity, low weight, low calorie diet and an uncomlpicated, spiritual lives ].

A short life is not an option, therefore DIET, EXERCISE and watch your Weight is the only option. It is I am afraid a lifelong proposition. Unless one does not mind a 'SHORT FUSE'!

Having said that, for the morbidly obese, one may need to kick start one's weight loss programme with something drastic: A loss of say 6 to 8 kg a month for several months to give the necessary 'turbo boost' towards a long term programme of sane eating and living. This is where the commercially prepared Cambridge Diet comes in.

It is a fluid diet which come in commercially prepared sachets to be added to cold water. Very spartan. The extreme end is just 3 sachets a day, one for breakfast , lunch and dinner with a total of only 450 kcalories!! If one is strict about it and combine with daily exercise, the Cambridge people promise a weight loss of 2 to 3 kg a week. Important amino acids and vitamins are already present in the sachet.

Personally I think this is too drastic, and to lose weight is NOT AN ISSUE in any programme. The most important issue is how to maintain the loss. Added to this is the high cost of sachet per month in excess of 1500 RM...too high.

My Modified version is meant to be kinder to the patient and cost less than 100 Rm . No sachet involved. Just two very small breakfast and lunch aided by a glass of ENSURE, and a third of your normal dinner....Losing weight is about discipline.

Just buy a can of ENSURE at 55RM :
4 scoups of ENSURE in 250 mls of cold water[ one full glass], drink slowly,enjoy the taste....total 160kcalories
Plus one small slice of pineapple/water melon/one whole guavas/...certainly not bananas[ high calories]....25-40 calories.
Your usual coffee or tea without sugar , creamer or milk....almost zero calories
and one or 2 glasses of plain water
Total calories ...200 kcalories

Repeat the same.
Total calories.....200 kcalories

Have your normal dinner with your children and Mrs, but only take only HALF or just ONE THIRD of your normal ration, more like one third would be better...be truthful to yourself. If your dinner is pretty heavy, just a third.
Fluid, just plain water or coffee or tea without calories[ plain, no sugar!]
Total calories.....let us assume 600 kcalories

Total calories for the whole day: 1000 kcalories.

If you add exercise daily to your regime it may be possible to lose 5 to 6 kg per month. If you lose 10 kg in two months, you may go back to your normal diet, just half the 'volume'. CARRY ON THE EXERCISE...

At the end of the day it is all about a LIFESTYLE change..the sharp weight loss in the 1st initial 2 months is just to give you the necessary boost to your spirit!!!

I have been talking like this to my 2 boys for years, but they have yet to take up the challenge.My only consolation is that even much much mega 'people' like Prophet Noah and Ibrahim and some others faced the same problem millenium back, on much more important issues of 'Akidah' and even they were not successful...so who is Nik Isahak to complain about?

[ again I have to re mention that this is only for the very obese to kickstart a lifelong habit of judicious eating habit and a life of continous activity and movement. For the rest, a lifelong habit of a balance , high fibre diet with a lot fruit, vege and reasonably low to moderate fat diet with plenty of fluid with no added calories to it, generally suffice. In Malaysia with 'warongs' and 'mamak' stalls opening 25/7, I know it is not easy to diet! I ususally address specific problems like for example 'high cholesterol issues' with low dose statins. To compound the problem of obese chaps here is our habit and kind hospitality of having all occasions celebrated with a 'makan' etc etc.

Having said that, the secret to a long and healthy life is no really no big secret: The elixir of youth is:.. still in being able to continue a lifestyle of daily exercise and maintaining one's weight within the ideal range! The best general rule of thumb is , stick the weight that you were at when you first entered college or when you were in the 'sixth Form'. A tough order! Even I am struggling to achieve that...and one more ingredient I forget to add to the 'elixir' story: add a 'teaspoonful' of spirituality, minimum five times a day, to your life to complete the 'asam garam' for longevity. This would, like Vitamin C in the case of reducing oxidative stress, reduce the complex issues of life's multi-faceted stress, its disappointment, pain etc etc and etc. I will deal with Stress in my blog next month insyaallah....Huwallahualam. ]


If you wish to stick to your present diet, just do MODIFIED CAMBRIDGE on 2 days a week.
Fast the non obligatory Muslim fast on Monday and Thursday every week with just a glass of ENSURE for sahur and one or two dates/ a slice of your favourite fruit and a few more glasses of plain water with no calories inside it. At Breaking Fast time do the same.
This 500-600kcalories diet two days a week will somehow 'play' havoc with your internal 'obesity' humoral signals or hormones and will ensure you significant weight loss. This has been studied in the UAE and some Muslim countries in the Middle East.

Dont forget your exercise though on your non fasting days !



Araman Amru said...

Salam Dr Nik, Sir..
Araman here.. your patient.. we meet today morning, 20/11/2010 on following up of my cholesterol issue..
Finally found your blog.. Yes you were right.. I mistyped you link.
I'll target to lower my LDL.. near to 3.. for our next meet.. 8 weeks from now..
While listening to you today.. I do noticed what you were saying... about the western people.. who takes care of what they eat..
Going thru some of your blogs.. I think I'm beginning to understand what you mean...
Thanks for the advice and the medicine Sir..


Anonymous said...

Salam Dr Nik,

Im Rifqi, one of your patient, we meet last Saturday. You sure remember the big guy which you give me straight 15 kilo to loose to overcome my obesity and fatigue dilemma. Read your blog. A very good stuff indeed. Well, insyallah we'll meet again, next year for my health screening, and pray for me, the next time i come to visit you, i will be on my ideal weight. Salam and God Bless you Dr.

Cabaran Size M said...

Terima kasih Dr.Nik.

Cara modified cambridge diet ini berjaya ke atas pelan diet saya.
Berjaya menurunkan berat badan sebanyak 15kg (dari 79kg ke 64kg), dari BMI >30 ke 24.

Sekarang sedang menghadapi masalah weight loss plateau. Masih ada 4kg lagi sebelum mencapai BMI unggul 23.

Pearls and Gem said...

Size M. Tahniah !
You can....try combine it with daily exercise.
Read 'Mixing the profane and the sublime' under section, Exercise.

You can.............

Anonymous said...

Thank you for your great post. I've learnt some important things from your blog. I'll bookmark your blog for future visit. keep posting good contents please. Thanks again.


Cabaran Size M said...

Looking back my last comment on 15th November 2011 and realized that i have been on modified cambridge for the past 4 years.

successfully achieved size S with weight of 59 to 61kg (BMI<23), purely using diet control without exercise.

but as for any behavioral change, i encountered relapse phase (eating unhealthy) and have weight gain till 65kg (max). range 62-65kg

last 2 weeks decided that i need a healthy lifestyle and add on exercise on my daily routine on top of my meal replacement. Cycle to work (1.5km per trip), doing home cardio workout (20mins). No weight loss but tummy appeared to be smaller.

Hopefully can get back to BMI<23