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Should pregnant obese women control their weight?

Should pregnant obese women control their weight?

Pregnant women who are obese or overweight are at an increased risk of complications, such as needing caesarean sections, developing gestational diabetes, and even dangerous high blood pressure known as preeclampsia.

Diet and exercise, researchers say, can help them safely control their weight gain during pregnancy.

But there is a catch. The women in a recent study who lost weight – about 1.8kg on average – after they were at least nine weeks into their pregnancies did not have fewer obstetric complications.

Researchers are concluding that to lower their risk of complications, women may have to change their behaviours before or immediately after they conceive.

“We think that by the time these women are already in the second trimester, it may already be late to change important outcomes,” said Dr Alan Peaceman, lead author and chief of maternal foetal medicine at Northwestern University Feinberg School of Medicine in the United States.

Seven US clinical centres, including Brown and Columbia universities, recruited 1,150 pregnant women for the trial and split them into a control group and an intervention group.

The second group focused on reducing calories, increasing physical activity and incorporating behaviour changes such as self-monitoring.

The trial, funded by the US National Institutes of Health, followed participants between nine and 15 weeks pregnant through to the birth of their child.

The study was published in the journal Obesity.

Most American women of childbearing age are overweight or obese. These women are more likely to gain excess weight in pregnancy and to retain those pounds after childbirth.

Their children too, are more likely to be obese than the children of thinner women.

The US National Academy of Medicine recommends that women who are not overweight limit their pregnancy weight gain to 11.3kg to 15.9kg (25lb to 35lb).

Women who are overweight should gain no more than 6.8kg to 11.3kg (15lb to 25lb) and obese women should not gain more than 5kg to 9kg (11lb to 20lb).

Advice from doctors on weight gain during pregnancy has varied over the years.

In the 1950s, the standard advice was not to gain more than 6.8kg. But expectant mothers weren’t gaining enough, and that led to low birthweight babies that were at higher risk for developmental problems.

By the late 1970s, mothers were told to “eat for two”. When pregnant women began to gain more weight, the thinking was that it was not a medical concern and they would be able to lose it after they gave birth.

But by the early 2000s, doctors found the extra pounds contributed to high blood pressure, gestational diabetes and more caesarean sections. The infants also faced more risks.

“Excess maternal weight gain was not just associated with bigger babies, but those babies ended up with an increased risk of obesity and childhood diabetes,” Dr Peaceman said. – The Philadelphia Inquirer/Tribune News Service

What to eat when you’re on the 5:2 diet

What to eat when you’re on the 5:2 diet

I have decided to embark upon the 5:2 diet because it is easier for me than going on the ketogenic diet. But I am struggling with the two days in which I am required to eat 500 to 600 calories a day. I learned that even one plate of wantan mee is 450 calories! Do I have to skip two meals for those two days that I am doing intermittent fasting then?

You are right. One plate of wantan mee is around 450 calories!

You can imagine that one plate of nasi lemak, which people usually eat for breakfast in Malaysia, together with sambal and one piece of fried chicken, as well as one egg, will be around 850 to 1,100 calories!

Actually, you don’t have to skip any meal at all for those two days in which you are required to take in less.

How do I do this?

Okay, this is what you can do in a typical day to get below 500 calories.

Remember, if you are a man, you can eat up to 600 calories. If you are a woman, you have to do 500 calories.

In general:

5:2 diet, intermittent fasting, fasting diet, diet, losing weight, sample menu, corn on the cob, Star2.com

Corn on the cob, as seen in the above filepic, can be part of a dinner during this diet.

• Eat a lot of vegetables.

Green leafy vegetables are bulky and make you feel full. Also eat vegetables like cauliflower and broccoli because those give your stomach a sense of bulk.

• Eat small portions of lean meat, fish or eggs.

Protein will make you feel full. Remember to choose lean meats, rather than fatty ones, because fat contains a lot of calories.

Unlike the ketogenic diet, you are trying to restrict calories and not take too much fat.

• Bake and roast something, rather than fry.

We advocate that you prepare your own meals so that you can control your calories better, instead of eating out for these two days.

• Drink a lot of soups.

They will make you feel full.

• Do not eat a lot of carbohydrates like bread, pasta or rice.

You certainly cannot have cakes on fast days! If you must eat something sweet, try fruits.

• Drink plenty of water.

5:2 diet, intermittent fasting, fasting diet, diet, losing weight, sample menu, turkey sandwich, Star2.com

Paired with corn on the cob for dinner would be a turkey sandwich, which would come up to about 328 calories in total. — Visualhunt.com

You can also drink black coffee or tea without any added sugar or milk.

You should also avoid artificial sweeteners as these will spike your insulin.

Remember, you are trying to get your insulin levels to go down – the main reason why you are even doing intermittent fasting!

• Yes, you can skip a meal.

Some people advocate skipping breakfast entirely in order to get more hours of fasting in, and only start eating lunch at 2pm.

If you do that, you can add those calories back to lunch or dinner.

Give me an example of a diet on a fast day together with the amount of calories per meal.

Okay, this is an example of a one-day meal plan:

Breakfast – 1 sachet of mixed oats (255 calories)

Lunch – skip

Dinner – Beetroot, spinach and feta cheese salad (125 calories)

Supper – 1 apple with some butter (145 calories)

Total calorie count: 525 calories

Here is another:

Breakfast – skip

Lunch – 1 soft boiled egg and asparagus (90 calories)


Snack – A few grapes (60 calories)

Dinner – Turkey sandwich (172 calories) with corn on the cob (156 calories)

Total calorie count: 478 calories

Wow! You can hardly eat anything at all! I tried this, and I was so hungry that I could not focus at work during fast days.

When you start this for the very first time, it is normal to feel hypoglycaemic (low blood sugar) or unwell, with a lack of concentration.

You should also not plan to exercise during fast days unless you are already comfortable with the diet. (No, you cannot add calories to your food based on how many calories you think you burned during exercise! You must stick to the calorie restriction!)

But if you keep busy, such as being hard at work, you will be surprised that time passes quickly and you won’t realise that you are hungry anymore.

Some people also feel cold or have headaches. Again, this is common with any new diet, and it will pass.

If you really cannot take the hunger, just keep one small snack available with you at all times. I recommend half a large banana, which is around 60 calories.

Pregnant women, teenagers and children should not fast.

If unsure, you should consult your doctor before trying this, or any, diet.

How much weight can I lose on this diet?

It depends on how long you keep at it. A lot of people have reported losing anything from a few kg to 40kg.

You will usually lose more weight at the start of the diet than in the middle of it.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Here’s why you can’t keep that weight off

Here’s why you can’t keep that weight off

Losing weight is, for most people, the easy part. The bigger challenge is trying to keep it off for more than a year.

New research helps explain why people in this second stage are so much more prone to failure.

In a nutshell, people who have shed a significant chunk of their weight are hungrier and have a stronger desire to eat for at least a year after transitioning from weight loss to weight-loss maintenance.

And even when their hormones send loud satiety signals to the brain after a meal, they still don’t feel full.

The new study, published on Feb 1, 2018, in the American Journal of Physiology-Endocrinology and Metabolism, falls in line with a growing field of research that explores the body’s tenacious and multi-pronged response to weight loss.

In a bid to ensure that lost weight is regained, the human body has been found to reset its thermostat to burn fuel more efficiently, to economise in calorie-burning movements, and to rev up the impulse to find and eat food.

Researchers believe these responses evolved to protect humans against wasting away during times of famine.

But in societies where calorific foods are never in short supply, these adaptations have worked to the detriment of dieters.

Moreover, in people who have become obese, there’s growing suspicion that these responses become harder to override.

In recent years, researchers have found evidence that obesity makes the brain more “deaf” to some of the gut’s satiety signals, and more keenly attuned to signals of hunger. The new research offers some validation for that surmise.

More hungry, less full

To study the effects of weight loss in 35 severely obese subjects, Norwegian researchers helped them lose close to a tenth of their weight.

They provided dietary advice, exercise coaching and psychotherapy during several three-week stays at a wooded retreat in eastern Norway.

All the subjects had a body mass index greater than 42 (a BMI over 30 is considered obese) at the outset of the study.

At one year, when subjects had lost an average of close to 11kg (24 pounds), they returned to the retreat to map out maintenance plans.

Every six months from enrolment to two years out, researchers checked in to conduct a series of tests.

Before and for three hours after meals, they gauged subjects’ subjective feelings of hunger, fullness and desire to eat, and asked how much food they planned to consume.

And they measured circulating levels of five separate hormones that regulate appetite to see how they responded to the prospect of a meal or a meal just eaten.

What they found was that the body’s reaction to weight loss shifted over time.

In the short run – four weeks after their exercise-and-weight-loss regimens got underway – the subjects had lost an average of 3.5% of their body weight.

Their levels of appetite-boosting hormones had risen rapidly – probably a response to their getting roughly three-and-a-half hours of exercise per day while at the retreat.

But they did not report increased hunger or desire to eat. And with rising levels of satiety hormones, they were feeling more full in the wake of eating a meal.

As they met their weight-loss goals, however, things changed.

At the end of a year of dieting and exercise, the study’s participants had lost about 7.4% of their weight and had improved their fitness considerably.

But they reported to researchers a significant increase in their hunger and desire to eat. And the sensations of fullness they reported after meals had plummeted.

Two years after enrolling in the study – and a year into their weight-maintenance programs – the subjects had, on average, successfully kept the weight from coming back.

But they continued to report levels of hunger and desire to eat that were just as high or higher than at the end of Year One. And they reported feeling no more full after a meal.

At both time points, their hormone levels continued to show increases in appetite-stimulating compounds, as well as those that would signal fullness.

Though they lost the weight and – with the study’s unusual level of support – managed to keep it off, they were hearing the loud cries of their hunger-boosting hormones.

The fullness ones, not so much.

The good news, according to the researchers: A sustained and supportive program of dietary restriction and physical activity does induce weight loss and can help very obese patients keep the weight off.

The bad news: “Patients with severe obesity who have lost significant amounts of weight… will have to deal with increased hunger in the long term.”

If these patients are to beat the odds and sustain their weight loss, professionals working with them will have to find ways to help them cope with that, they added. – Los Angeles Times/Tribune News Service

Interested in the ketogenic diet? Here’s how to start

Interested in the ketogenic diet? Here’s how to start

I read that the Journal of the American Medical Association (JAMA) has published that they will be conducting a study on the ketogenic diet. Does this mean they will make it a legitimate medical diet?

It does mean the medical world is taking the ketogenic diet seriously.

Basically, the study will run in 2018. Twenty-five overweight and obese adults will be secluded at a lakefront centre in Massachusetts, United States, for three months. (I know, it sounds like a dream holiday.)

But before they check in, they have to lose 15% of their body weight on a diet that restricts calories. Once they do, they go to the lakefront centre where they will be randomly assigned to one of the following diets:

1. A low-fat, high-carbohydrate diet with high added sugars.

2. A low-fat, high-carbohydrate diet with low added sugars.

3. A very low-carbohydrate, high-fat ketogenic diet.

After three months, they will be followed up regularly, while another group takes their place.

There will be five groups over the span of three years.

JAMA has also published a meta-analysis of 13 randomised controlled trials (the highest degree of medical evidence to push for a treatment or diet) that suggested people on ketogenic diets lose more weight and keep off that weight compared to people on low-fat diets.

How do I begin a ketogenic diet? I’m not used to eating fats. Our Malaysian diet has a lot of rice, noodles and breads in it. I suppose those would constitute a high carbohydrate diet, correct?


To be on a ketogenic diet, you might have to prepare or cook a lot of your own foods, or at least be very mindful of what you eat when you eat out.

You can even plan how fast you get into the ketogenic state (fat burning). The more you restrict your carbohydrate intake, the faster you will get into ketosis.

However, you are also more likely to get the side effects.

In the very carbohydrate-restrictive sort of ketogenic diet, you are supposed to eat only less than 15g of carbohydrates a day. That is equivalent to 1.5 slices of bread!

You basically have to limit all carbohydrates so that your body will start to burn calories from fat.

Give me a list of foods to eat and to avoid.

You can eat:

• Meats – chicken, fish, beef, lamb, poultry, pork, eggs, etc.

• Leafy greens – kangkung, kailan, lettuce, spinach, kale, etc.

• Vegetables that grow above the ground in general (because they are not starchy) – broccoli, cauliflower, brinjal, bitter gourd, etc.

• High fat dairy products – cheese, high fat cream, butter, etc.

• Nuts and seeds – kacang putih, macadamias, walnuts, cashews, kuaci, etc.

• Certain fruits – avocado, raspberries, blackberries, and other low glycaemic impact berries. A ketogenic diet does not advocate fruits other than these because most other fruits contain a lot of fructose (sugar)

• Sweeteners – if you really must sweeten your coffee!

• Other fats – coconut oil, high-fat salad dressing, etc.

However, don’t eat:

• Grains – rice(!), wheat (bread, roti), noodles, corn, cereal, etc.

• Sugars – any added sugar to sweeten your coffee or tea, honey, maple syrup, honey etc.

• Fruits – apples, bananas, oranges, papayas, watermelon, ciku, etc.

• Tubers – potatoes, yams, etc.

I realise this is going to be difficult to incorporate in a Malaysian diet. But if you really want to go full keto, you have to make the effort.

Plenty of Malaysians have done this and lost a lot of weight.

Does this mean then that I can eat all that I want within the range of what I can eat?

You should keep your meal ratio at 70% fats, 25% protein, and 5% carbs. It is not that easy, trust me – especially on the fats.

But opt for fatty meats like chicken with skin and fat on, steaks with a lot of fatty marbling such as the rib eye, etc.

A lot of people supplement their fats by taking coconut oil or cheeses as a snack. The fat will keep you from feeling hungry and make you feel energised.

No, you cannot eat how much you like. If you want to lose weight, you have to restrict your calorie intake too, but in the ratio mentioned above.

What are the side effects of the ketogenic diet?

Now this is what causes most dieters to drop off.

That’s why when you start keto, you should not do a severe version of it, but ease yourself gradually into that ratio.

And always make sure you properly hydrate yourself with liquids and minerals, because most of the side effects are from poor hydration.

The side effects are:

• Keto flu (the commonest) – flu-like symptoms.

• Dizziness and drowsiness

• Inability to sleep

• Heart palpitations

• Frequent urination and diarrhoea

• Muscle cramps

Side effects are usually the worst in the first week or so. Then, it usually improves.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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