Yeshiva World News

With our constantly changing medical system, how does one choose a primary care physician?  What does one take into account when making this very important decision?

• 44,000 to 98,000 deaths annually from medical errors (Institute of Medicine)
• 225,000 deaths annually from medical errors including 106,000 deaths due to “nonerror adverse events of medications” (Starfield)
• 180,000 deaths annually from medication errors and adverse reactions (Holland)
• 2.9 to 3.7 percent of hospitalizations lead to adverse medication reactions
• 7,391 deaths resulted from medication errors (Institute of Medicine)
• 2.4 to 3.6 percent of hospital admissions were due to (prescription) medication events (Australian study)

Given these facts, and given that we all tend to put our health in the hands of our physicians, it is incredibly important that we pick the right professional.  Here are a few criteria to consider when picking your primary care doctor.  Primary care doctors can be either:

• Family practitioners – doctors who have completed a family practice residency and are board certified, or board eligible, for this specialty. The scope of their practice includes children and adults of all ages and may include obstetrics and minor surgery.
• Pediatricians – doctors who have completed a pediatric residency and are board certified, or board eligible, in this specialty. The scope of their practice includes the care of newborns, infants, children, and adolescents.
• Internists – doctors who have completed a residency in internal medicine and are board certified, or board eligible, in this specialty. The scope of their practice includes the care of adults of all ages for many different medical problems.
• Obstetricians/gynecologists – doctors who have completed a residency and are board certified, or board eligible, in this specialty. They often serve as a PCP (Primary Care Physician) for women, particularly those of childbearing age.

Be sure that they:

• Provide preventive care and teach healthy lifestyle choices
• Identify and treat common medical conditions
• Assess the urgency of your medical problems and direct you to the best place for that care
• Make referrals to medical specialists when necessary
• Is the office staff friendly and helpful? Is the office good about returning calls?
• Are the office hours convenient to your schedule?
• How easy is it to reach the provider? Does the provider use email?
• Do you prefer a provider whose communication style is friendly and warm, or more formal?
• Do you prefer a provider focused on disease treatment, or wellness and prevention?
• Does the provider have a conservative or aggressive approach to treatment?
• Does the provider order a lot of tests?
• Does the provider refer to other specialists frequently or infrequently?
• What do colleagues and patients say about the provider?
• Does the provider invite you to be involved in your care? Does the provider view your patient-doctor relationship as a true partnership?

In addition to all of this, when you first visit you doctor, he will be interested in your health history and family history.  This is all very important.  However a good contemporary doctor who is up to date on what keeps people healthy and understands that drugs and surgeries alone are very often not the best answer will want to know your weight, your Body Mass Index and should ask you how often and what types of exercise you do.  He should also be interested in the basics of your dietary consumption.  Although he is not an exercise specialist or a dietician, he should look for lifestyle deficiencies in terms of lack of proper exercise/activity and if you are getting the necessary nutrients in your diet (Does your eating include vegetables, fruits, whole grains, and lean proteins?).  Does your doctor encourage you to make lifestyle changes to better your state of health and is he as interested in preventing illness as much as treating it?

Also just as important.  Does your physician try other means before drug therapy?  Proper diet and exercise with weight loss can often times solve problems like high blood pressure, high cholesterol, and a pre-diabetic or type 2 diabetic conditions.  Drugs have side effects; every one of them.  Lifestyle changes generally don’t.  And, just as your doctor understands that he or she must refer out to specialists when necessary, are they willing to refer out to exercise specialists and registered dieticians?  Will they insist that you come back for a follow up 8 weeks after starting an exercise program to see if you have lost weight and if your vital signs and blood work have improved?

One of the unfortunate outcomes of Kupat Cholim, or HMO medicine, is that you may not get the kind of time with your doctor that you need and deserve.  It isn’t their fault–that is the system as opposed to private medicine.  You must use your allotted time well.  Come in prepared with intelligent questions and if your doctor does prescribes something for you, ask if there is a non-medicine alternative and if you do indeed need to take drugs, be sure you understand the side effects.  Although doctors are very busy, you should be able to contact him when necessary.

Please remember that your health is your responsibility.  Leading a life that includes healthy habits is crucial, but choosing the right doctor to be a partner and work together with you in that endeavor is an important step. Please remember that doctors have some knowledge of nutrition and exercise, but not extensive knowledge.  Personal Trainers, Exercise Physiologists and Dieticians do have extensive expertise.  Choosing a doctor interested in preventative health measure that will hopefully keep you OUT of his office will “add hours to your day, days to your year and years to your life.”

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 17 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il  Check out the Lose It! web site - www.loseit.co.il    US Line: 516-568-5027

For the last 17 years as a health professional, I have spent a great deal of time trying to educate and motivate others to make the necessary changes to improve their health and quality of life. But as we all know, it is up to the client to take the information and decide to make the necessary changes. It takes courage, time and a lot of hard work to make those changes and when clients are successful we celebrate! Personally, I get a lot of nachas and inspiration from past and present clients and I would like to share some of that nachas with you.

Y. is a 48 year old mother who has to travel quite a distance to see me. She started her journey to good health with our Lose It! program. Although she lost an amazing 20 kilo, there was more work to be done in order to reach the range of healthy weight. Now she has become a daily exerciser. Her husband got a one-time bonus from his job and offered to buy her a gift. She asked for the only thing that she really wanted—to go to Personal Training. Y. was an insulin dependent type 2 diabetic and Baruch Hashem, the amount she now takes has been lowered by 900%! She is also coping with some of her life’s stress much better.

S. is a 24 year old currently learning at a Baal Tshuva yeshiva. He has a past history of obesity as well as addictions. He did the Lose It! program originally and lost over 30 kilos. But he too still had a long way to go. He began a combined program where he was seeing our therapist for an hour a week and began Personal Training as well to up his intensity in exercise. This past week, he had to return home for a week to attend a wedding of an old friend. He exercised on his own, was polite to his old friends without engaging in dangerous and destructive behaviors, seemed to have enjoyed himself and has really “passed the test”.

A. is 20 years old. She has always wanted to be a normal weight but getting there caused disordered eating. She hasn’t finished Lose It! yet, but she is eating healthfully and ordered, and she is exercising on her own. But that isn’t all. This past week, we were talking about career planning. She is so turned on to her new-found health and wellbeing that she is considering this as a career…to be continued.

B. is a Rav who is very involved with the needs of the community, particularly with our youth. He needs to be in good health and to have the energy it takes to do his job. He was a type 2 diabetic, on the verge of getting medicated. It isn’t just the 25 kilo he lost. He exercises, drinks far more water everyday than he used to, eats well and most of all, he can stay up late nights to deal with all of his cases and handle his phone calls from times zones abroad 10 hours away. That enables him to save precious Neshomas in Klal Yisrael.

M. is a Yeshiva Bachur, who’s eating was truly out of control. That was coupled with almost no activity or exercise. His parents got him to come to Lose It! when his weight was approaching 150 kilo. He has lost over 25 kilo, and has more to go, but he is going down. More than that; he is learning better than he has ever learned before and he has control over his life in general.

A divorced mother of 2 takes medication for mental health problems as a result of a bad marriage. Now that she has completed our intense 3 month program combining Exercise, Behavioral Therapy and Dietetics, her new Psychiatrist (whom we recommended) has cut her medication in half and is hoping to halve it again next month. She is coping with life much better and continues to improve.

5 Years ago, a 37 year old man came to me totally unfit, with blood sugar almost twice the acceptable level and his triglycerides were “through the roof”. He has an impossible schedule, learning a full seder every morning, running a high pressured business in the afternoon and evening, and spending his evenings tending to Chesed cases. He started slowly but was determined to get his health back, especially at such a young age. After 12 months, there was a drop of 205 points in his triglycerides and 98 points in his blood sugar. He lost more than 30 kilo of weight. He hasn’t been with me for a couple of years now, but continues to exercise and has given himself a whole new lease on life.

Yes, I could go on and on and on. There are countless people with whom I have dealt in all of my programs over the last 17 years who have come out as the new and improved editions Even those who don’t reach all of their goals, usually have improved their lives in some positive way. Thank you readers for sharing in my Nachas. Sharing helps me “add hours to my day, days to my year and years to my life.”

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 17 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il Check out the Lose It! web site – www.loseit.co.il US Line: 516-568-5027

In last week’s column, we discussed the fact that more than two thirds of the American population is now overweight, obese or extremely obese.  Our youth, ages 2-19 have an overweight-obese rate of just over 50%.  And with this (and the sedentary lifestyle that accompanies most overweight and obese people) comes a myriad of diseases such as type 2 diabetes, high blood pressure, high cholesterol, fatty liver disease, sleep apnea, and emotional issues such as depression.  As we get older, just getting around from place to place can become a challenge as the chances of arthritis begin to increase from all the extra weight we lug around.  We end up paying far more money than we normally would have on doctor’s visits and medicines.  In short, being overweight or obese will take away the quality of life we should be enjoying.

It is clear that we need to make some serious lifestyle changes. In this column, we present a 16-point plan developed by Mathew Caddy, MS, RD, for cutting our calories though portion size reduction.

• Downsize   Research proves that downsizing plates, bowls and drink glasses can play a big role in portion control. A 2012 Journal of Nutrition Education and Behavior study found that when participants were given a large-sized bowl, they served themselves 77% more pasta than when they were given a smaller bowl (Van Kleef, Shimizu & Wansink 2012). In a separate study, nutrition experts served themselves 31% more ice cream when given a 34-ounce bowl than when armed with a 17-ounce one (Wansink, van Ittersum & Painter 2006). Further, their servings increased by an additional 14.5% when they were using a larger serving spoon.
• Size It Up   You can’t scale back your portions until you come to grips with how much you’re really eating. Flip food packages over, read nutrition information and pay close attention to how serving sizes are defined. Case in point: A brand of granola may look rather harmless at 130 calories per serving, but upon closer inspection this is just a quarter cup, less than almost anybody would eat in one sitting nowadays.

• Rise and Dine   A recent University of Missouri study demonstrates that eating breakfast can help control appetite and regulate food intake throughout the day (Leidy et al. 2011). For 3 weeks, subjects either skipped breakfast or consumed a 500-calorie meal. Consuming breakfast led to increased fullness and reductions in hunger throughout the morning, an outcome that could assist with portion control later in the day.

• Scale Back   Most people can’t grasp what 4 ounces of chicken breast or 1 ounce of cheese looks like—yet these portions are considered appropriate for a calorie-controlled diet. “Adding a digital food scale to the kitchen can help people understand what real portion sizes look like,” notes Young. “It may come as a shock to learn that your typical steak serving is 8 ounces or more, a lot more than what most people should eat.” Using measuring cups for items like cereal can also help keep portions in line with what is stated on product nutrition labels.
• Stave Off Snack Attacks   A recent study by scientists at Yale University showed that falling glucose levels can trigger a reward region in the brain that leads to heightened cravings for high-calorie fare such as cakes, pizza and ice cream (Page et al. 2011). Take back control by making sure you eat something every few hours; include healthy snacks such as yogurts with fruit; hummus and raw veggies; or whole-grain crackers with 1 tablespoon of almond butter or Tehina.
• Pay Attention   Eat your meals and snacks in the kitchen or dining room, not on the couch.. A review of studies published in the American Journal of Preventive Medicine found that TV viewing, with all its other problems, was strongly associated with higher consumption of calorie-dense drinks and foods and lower consumption of fruit and vegetables in both adults and children (Pearson & Biddle 2011).  In a study at the University of Bristol, England, people who ate lunch while playing a computer game felt less full by the end than those who noshed undistracted, and gamers consumed about double the number of calories 30 minutes after the meal compared with the other group (Oldham-Cooper et al. 2011). If you eat while distracted, you’ll likely remember less about the food you consumed, which can leave you feeling hungrier later on.

• Chew on This   In today’s fast-paced world, many of us wolf down our food. Well, it’s time to eat at a snail’s pace. A 2011 American Journal of Clinical Nutrition investigation discovered that subjects consumed 12% fewer calories when they chewed each bite 40 times than when they chewed just 15 times (Li et al. 2011). Additional chewing also slows down the rate at which you take in food, which New Zealand scientists found can keep weight down (Leong et al. 2011).
• Start Right   The right appetizer can keep calorie intake within reason. A 2012 study by researchers at Pennsylvania State University showed that people who ate a 100-calorie salad 20 minutes before digging into a pasta meal reduced their total caloric intake for the meal by 11% (Roe, Meengs & Rolls 2012). The same laboratory found that eating a raw apple 15 minutes before a test meal cut caloric intake by 15% (Flood-Obbagy & Rolls 2009). Preceding meals with low-calorie, fiber-rich items like vegetables and fruits can boost satiety, making it less likely you’ll dole out copious amounts of spaghetti or ask for second helpings of meatloaf. But don’t expect the same benefit when you high-calorie foods like dips or fish.

• Slice Away Calories   Cutting calories could be as simple as cutting up your food. A 2011 study published in Journal of the Academy of Nutrition and Dietetics found that subjects who ate whole pieces of candy while participating in a computer task consumed about 60 more calories than those who nibbled on candies that were sliced in half (Marchiori, Waroquier & Klein 2011). Both groups consumed the same total number of candy pieces—six to seven whole candies or six to seven candy halves.

• Sleep Tight   Here’s another reason to get a good night’s sleep: An investigation by scientists at New York Obesity Research Center found that subjects fed themselves about 300 more calories when sleep-deprived than they did after sleeping normally (St-Onge et al. 2011). Why does lack of sleep lead to the munchies? A 2012 American Journal of Clinical Nutrition study reported that subjects who slept only 4 hours showed more brain activity in response to food stimuli than those who got 9 hours of shut-eye (St-Onge et al. 2012). So a poor night’s sleep could cause the concept of portion control to go awry.

• Choose unrefined, hight fiber foods   Fiber-rich foods slow down digestion and minimize blood sugar fluctuations. Incorporating these foods into snacks and meals will boost satiety and tame hunger. A study in the journal Appetite found that volunteers felt fuller after consuming high-fiber bread than they did when they consumed the same number of calories from fiber-poor white bread (Keogh et al. 2011).

• Keep Your Distance   At your next meal, try this suggestion from Cornell University: Keep extra food away from the dining table. Cornell scientists found that when subjects kept pasta and pudding serving-dishes off the table, obliging the subjects to serve themselves from dishes on the kitchen counter or on the stove, they ate an average of 20% fewer calories (Payne et al. 2010). The study authors surmised it was a case of “out of sight, out of mind.”

• Eat Your Calories   It’s okay to have a glass of orange juice with breakfast or a post-workout protein shake, but it’s important that most of your daily calories come from solid food. A study conducted by scientists at the University of Kansas Medical Center found that post-meal hunger and desire to eat were greater when subjects consumed liquid calories than when they consumed the same amount of energy from solid food (Leidy et al. 2010). The investigation found that the solid meal led to a greater drop in ghrelin, the hunger-producing hormone, than the liquid meal.

• Be the Chef   Portions doled out at restaurants have been growing over the last several decades. When you leave the food prep to someone else, you always raise the risk of getting more calories than you bargained for. “Cooking more of your meals allows you to become better aware of appropriate portions and often leads to eating higher amounts of healthful foods,” Young says. But make sure to use measuring spoons, scales and other devices to keep sneaky excess calories out of your meals.
• Know the Real Deal   The low-fat version of an item like peanut butter may have calories on par with the higher-fat version, since ingredients like sugar often replace the fat to make the product taste better. “Low-fat items can trick you into thinking you’re eating less than you are,” A Journal of Marketing Research study found that people ate 28% more chocolate candies when they were portrayed as “low-fat” than when they were described as “regular” (Wansink & Chandon 2006). The researchers concluded that low-fat labels cause people to underestimate calorie consumption, increase what they think is an appropriate serving size and temper feelings of guilt after polishing off a box of reduced-fat treats. The upshot is that “reduced-fat” versions of products like crackers, cookies, fruit yogurt and peanut butter need the same dietary constraint as their higher-fat counterparts.

So here you have read 16 suggestions; suggestions to eat less.  Because when we get down to it, we need to get back to basics, eat less and be more active to use more calories.  Because in the end of the day, without that important ingredient, nothing else will matter.  Don’t compromise your nutritional needs, but finding the right tools to eat less will, “add hours to your day, days to your year and years to your life.”

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 17 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il  Check out the Lose It! web site - www.loseit.co.il    US Line: 516-568-5027

Since the obesity and overweight epidemic began, there has been no shortage of articles written speculating as to why we are more overweight and sicker than any previous generation and there has been tens of millions of dollars spent trying to find the answer. More than two thirds of the American population is now overweight, obese or extremely obese. Our youth, ages 2-19 have an overweight-obese rate of just over 50%. And with this (and the sedentary lifestyle that accompanies most overweight and obese people) comes a myriad of diseases such as type 2 diabetes, high blood pressure, high cholesterol, fatty liver disease, sleep apnea, and emotional issues such as depression. As we get older, just getting around from place to place can become a challenge as the chances of arthritis begin to increase from all the extra weight we lug around. We end up paying far more money than we normally would have on doctor’s visits and medicines. In short, being overweight or obese will take away the quality of life we should be enjoying.

With all of the studies we have produced and all the money spent of research, perhaps it is time to take a look backwards at the very basics of how we gain and how we can lose weight. We have all heard of a calorie. By definition, it approximates the energy needed to increase the temperature of 1 kilogram of water by 1 °C. What we need to know about calories is that it is the measure of food intake. 3,500 calories is one pound, 7,500 is one kilogram. We gain weight when we consume more calories (energy) than we expend, we lose weight when we expend more calories than we take in, and finally, we maintain weight by keeping our consumption and expenditure even. We expend calories through our metabolism, activity and exercise. Keeping this in mind, here are a few facts that can help us size up how we have gotten to this regrettable point.

In the last three decades, the size of portions has increase by 2 to 5 times. “Unfortunately, waistlines have followed suit,” says Lisa R. Young, PhD, RD, adjunct nutrition professor at New York University and author of The Portion Teller Plan (Three Rivers 2006). When researchers at the University of North Carolina analyzed data from food surveys conducted in the 1970s, 1980s, 1990s and the past decade, they concluded that the average daily energy intake of a U.S. citizen increased from 1,803 kilocalories (kcal) in 1977–78 to 2,374 kcal in 2003-06 (Duffey et al. 2011)—a rise of nearly 32%, and more than enough to contribute to our expanding collective girths. Let’s go back to our basic math. If our daily consumption has increased by 572 calories per day and there are 365 days per year, that increases our yearly caloric intake by 208,780 calories over where we were 35-40 years ago. Now let’s go back to our 3,500 calories per pound. We can gain almost 60 pounds per year (28 kilo) before taking calorie usage into account. Again, this is the basic mathematics of the situation. We eat more, we burn less, and this is the result.

For the most part, Young says, large quantities of cheap food have distorted our perceptions of what proper portions are supposed to look like. That is, our brains have become accustomed to large and oversized portions. “We also view a heaping serving of food as a bargain,” she adds. The overload is happening everywhere—in fast-food restaurants, fine-dining establishments, coffee shops and even cherished cookbooks. In examining 18 recipes published in every edition of the iconic Joy of Cooking since it first appeared in 1936, Cornell University scientists found that average calories per serving have jumped 63% in the past 70 years (Wansink & Payne 2009). Changes in serving sizes were determined to be a leading factor behind the increases.

Making lifestyle changes in order to reduce caloric intake is definitely a daunting task. Where do you start? What are the changes that will yield the best results? Mathew Caddy, MS, RD, has developed 16-point plan for cutting our calories though portions size reduction. Next week’s column will guide you through the process, step by step. Stay tuned!

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 17 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il Check out the Lose It! web site – www.loseit.co.il US Line: 516-568-5027

The world has changed greatly in the last 40 years.  I am sure that there are many of you who recall a time when everyone ate three meals a day and it was likely that you ate breakfast and dinner with your family together at the table.  But that was when the world was a different place.  Today’s world is more demanding of our time and no matter what we do in life, we are expected to produce more and be more efficient.  This creates time-pressures that didn’t used to exist, and as a result, eating right can present new and unusual challenges.  In addition, with two thirds of society either overweight or obese, simple calorie cutting programs that involve eating traditional meals may be impossible.  So, what are the alternatives?  The latest craze is meal replacements.  Let’s take a look at what they are and how to use them effectively for weight loss or weight maintenance.

Both the electronic and print media have inundated us with advertisements for different types of meal replacements or meal systems.  Even some major universities, who have instituted programs as part of major research projects use replacement meals for weight loss.  What exactly is a meal replacement?  They come in a variety of forms.  They can be beverages, shelf stable or frozen entrees, breakfast cereals, and meal/snack bars that may be eaten by themselves or in conjunction with real food.  A recent study by Levitsky and Pacanowski in 2011 looked at using one small-portion meal substitute per day instead of lunch.  The subjects in the study ate a normal breakfast and supper.  This combination cut 250 calories per day.  That can result in about a 1 kilo or 2 pound loss of weight in a month’s time.  This same study also found that over time, there was no increase in hunger using the replacements meals.  Unfortunately, like any “diet” the rate of relapse from eating replacement meals is no better.  The 95%-97% rate of weight regain still holds to be true.  Still, the best predictor of not regaining weight remains to be consistent physical activity and exercise.

Dr. Len Kravitz and Michelle Kulovitz M.S. have come up with some criteria for selecting meal replacements:

• Meal Replacements should have 200-300 calories
• Products with 12-20 grams of protein  keep some people fuller for longer
• Avoid high sugar shakes and bars
• Products should be fortified with a third of daily vitamin and mineral requirements

The most aggressive form of meal replacements for people who need to lose a lot of weight are known as medical-grade products.  They are formulated specifically to provide all recommended macro- and micro- nutrients in a reduced-calorie diet.  These are only available through a physician or a medically supervised weight loss center.

People using one replacement meal per day can use this indefinitely, however, if you are using two or more replacements, you should seek the advice of a clinical weight loss specialist or dietician familiar with replacement meals. Also, if you take medications and you are planning on losing substantial weight quickly, speak to your doctor. Dosages of your medicine may have to be adjusted throughout.

Even meal replacements, just like eating meals, should be planned and made part of your overall food plan.  There may be days where you need two replacements instead of one but on the other hand, if you see that you have an opportunity to eat real food, do it.  Remember, there is no shake, bar, or other packaged product that can give you the vitamins and nutrients that real, whole foods can give you.  We also lose the pleasures that come with sitting and eating a meal slowly and mindfully.

As a Personal Trainer and the co-director of a weight loss center, I can tell you that for over 17 years, I have seen many people try to us replacement meals in their various forms exclusively to lose weight and they all failed.  Not only have they failed, they have gained back more weight afterwards.  Research has determined that willpower pretty much always runs out at some point.  And people who use shakes and the like are usually relying on willpower to battle hunger that can come along with this method of weight loss.  So again, to use a replacement once a day surrounded by real meals and real snacks can be an option.  And adding a balanced and efficient exercise program will certainly help you have a successful outcome in the long term.  But I discourage the lure of rapid weight loss through replacement meals only.  It is a challenge for all of us in the new and hectic world in which we live to learn how to eat right and eat ordered.  But combined with exercise, it is the best path to good health and achieving and maintaining normal weight.

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 17 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il  Check out the Lose It! web site - www.loseit.co.il    US Line: 516-568-5027

Part I of this article covered child and adolescent obesity –  the fact that it’s reached epidemic proportions both in the United States and Israel, and the broad steps we can take to help stem the tide. Part II focuses on the specific ways in which we can help ensure not just our children’s future good health, but our as well.

As much as bad eating habits play a role in childhood obesity, the first positive step for children is to get them to be active and exercise. We live in a sedentary world, and computers and hand held video games have not helped our cause.  Dr. Debi Pillarella, M. Ed., developed a plan of ae-based activities for children.  Here are her tips and advice:

2-5 Years of Age

The Scoop

“Kids between the ages of 2-5 need social, physical and intellectual interaction and development. These years are called the building block years, as they lay the foundation from which subsequent skills will grow. Free play, exploration, creativity, song and exposure to a variety of experiences are critical. Ever wonder why kids at this age can’t seem to sit still? They’re learning about their bodies and how to control them within the space they live. Instead of restricting this, confining them to a couch with a video playing, or enrolling them in extensive structured activities, channel the energy in a positive way (see below) and watch your young ones soar. They will tire out and eventually need a rest. (Don’t worry.) “

To Do

• Free play
• Catching objects (beanbags, scarfs, playballs, etc.)
• Rolling objects
• Bouncing a ball
• Kicking a ball
• Tossing/throwing a ball
• Hitting a larger stationary ball (on a T) with a bat
• Jumping
• Running
• Walking (forward, backward, sideways)
• Hopping
• Galloping
• Skipping
• Introduction to swimming/water
• Walking a line (low balance beam)
• Pedaling a bike
• Using imaginative or thematic play
• Following simple directions (Simon Says)
• Cooperative games
• Non-competitive relays and sports
• Emphasis on fun and play
• Positive, motivating, encouragement

Not to Do

• Restrictive play
• Sitting still for long periods of time
• Overuse of motorized toys (e.g., battery operated jeeps, etc.)
• Competitive team sports
• Emphasis on winning and hard play
• Negative comments, criticizing, comparing skills of children

5-8 Years of Age

The Scoop

“At this age, kids are building on the foundations that were created in the previous years and are moving on to more complex movements and skills. Moving from hitting a stationary ball to one that is thrown, bouncing a ball with two hands to bouncing it with one, and progressing from a bike with training wheels to one without, are all milestones that are accomplished here. Kids at this age can play longer and harder than those at the earlier stage of development. They can actually follow multi-task directions (e.g., run to the cone, jump up and down three times, then run back to me) and enjoy playing in a group more.”

To Do

• Bike riding
• Skating
• Scooters
• Skateboarding
• Swimming
• Running around
• Non-competitive sports
• Trying out a wide range of fitness/movement activities (not just those Mom and Dad like or want them to play)
• Introduction to youth sports (basketball, soccer, baseball, etc.)
• Following more complex directions
• Cooperative games
• Non-competitive relays
• Emphasis on fun and play
• Being positive, motivating, encouraging

Not to Do

• Choosing your kids’ sports
• Forceful participation
• Competitive play
• Weight lifting
• Negative, non-encouraging comments

8-10 Years of Age

“According to Dr. Ken Cooper, this is a critical age for kids’ fitness. Decline in children’s physical activity occurs during this time frame. Increased computer game use occurs, leaving less time to get up and move. At this age, kids are self conscious about themselves and how they are viewed by and compared to their peers. The athletes of the group start to become labeled, just as those who aren’t as athletic get shunned from team play. Giving kids a lot of successful, fun activity and fitness options in addition to sports will prove valuable as they grow.”

To Do

• Fun, play
• Successful activities and sports
• Biking, hiking, swimming, skating, rollerblading, skateboarding
• Walking, running, tennis
• Games and relays
• Partner sports
• Group activities (kid’s fitness classes, martial arts for kids, etc.)
• Being positive, motivating, encouraging

Not to Do

• Watered-down adult fitness programs
• Long duration, high intensity activities (running five miles non-stop)
• Intense competition
• Negative, non-encouraging comments

10-12 Years of Age

The Scoop

“Kids this age are ready for team play as well as individual fitness activities. Youth-sized equipment works well with this age as well. (E.g. low weight dumbbells, low height steps, BOSU, etc.). They are also into music, so tap into their music choices (lyric appropriate, of course) to provide motivation while working out. Getting stronger is also important to this age range. The American Academy of Pediatricians (AAP) suggests introducing resistance training to this age group. Research conducted by Wayne Westcott, Ph. D. as well as Avery Faigenbaum support resistance training and state it is safe and effective for youth as long as it is highly supervised and the programming developed by a qualified professional. Lower weight, higher rep programs that focus on overall strength improvements, functional exercise, balance and flexibility set in a supportive, fun environment work well. Boys and girls strength will be relatively similar until their early teens. Peer acceptance is important at this age and can influence a child’s decision to participate in activity and sport.

To do

• Sports
• Biking, walking, running, skateboarding, rollerblading, swimming, etc.
• Any activity based on what kids enjoy
• Success, feeling good about performance
• What peers are doing/participating in
• Self selection of activities
• Support, motivation, and positive feedback from parents/family

Not to Do

• Parent selecting activity/sport
• Forceful, nagging from parent/family
• Bodybuilding, power lifting, weight lifting
• Negative feedback from others

When your child is overweight, take action, but do it smartly.  Remember: educate your child through example and by letting them read material about a healthy life. Gently let them understand what happens a little later in life to those who can’t get this under control. Too many “adult” diseases are now manifesting themselves in our youth.  But just as important, your relationship with your son or daughter should not be about their weight, their eating habits or their exercise.  Be sure to praise and compliment them on any little iota of progress they make in any area.  To succeed, they have to feel good about what they are doing.  The health of your child may be dependent on tackling these issues early.  Dealing properly with weight loss and healthy life habits early in life will “add hours to your day, days to your year and years to your life.”

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 17 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il  Check out the Lose It! web site - www.loseit.co.il    US Line: 516-568-5027

If one of more of your children is overweight or obese, you are in good company. In the United States, approximately 17% (or 12.5 million) of children and adolescents aged 2-19 are obese. In Israel, about 13% are either overweight or obese. Since 1980, the prevalence of obesity among children and adolescents has almost tripled. Today, about 1 in 3 American kids and teens is overweight or obese – nearly triple the rate since 1963. With good reason, childhood obesity is now the #1 health concern among parents in the United States, topping drug abuse and smoking.

Among children today, obesity is causing a broad range of health problems that previously weren’t seen until adulthood. These include high blood pressure, type 2 diabetes and elevated blood cholesterol levels. This past May, Israeli researchers were able to establish a link between childhood obesity and cancer. Those who are obese have a 42% greater likelihood to develop cancer. There are also psychological effects: obese children are more prone to low self-esteem, negative body image and depression. Parents can be frustrated and often at times, feel helpless. The question is, what changes can you can implement that will make a lasting difference and help ensure your children’s future health?

One thing that will surely fail with children and adolescents is attempting to force them to change habits. Children are not home most of the day to begin with, and whether it is a party in the classroom for finishing a Parsha of Chumash, a Chanukah celebration in school or spending time with a friend, most of this is not under your control. They will find a way to find the food they want and certainly can use it as a form of rebellion. Instead try to remember two basic rules: 1) arrange the environment in the home for success, and 2) set a proper example.

Don’t try to control things that you can’t control but absolutely DO control what is available in your household. When your children come home from school, leave cut vegetable sticks and fruits out on the table. At the beginning, they may still come home and look for an unhealthy snack such as a bag of chips or a candy bar, but slowly, over time, they will begin trying the healthy items also. They may even prefer it. Try introducing some whole grain products into their meals. For instance, mix some whole grain pasta into the white flour pasta to get started. Eventually, try to use brown rice and whole grain breads. Make sure you serve fresh salads and cooked vegetables at your meals, and even though you may have cakes and cookies for dessert, try to have a fresh fruit choice as well. Keep a limited number of unhealthy snacks in your home, and make one unhealthy treat a day the limit. This way you are giving them what they want but in limited amounts. Drs. Jennifer L. Miller, M.D. and Janet H. Silverstein, M. D. wrote in a 2007 paper on Childhood Obesity that it is important to introduce lifestyle changes instead of fad diets for your overweight children.

Here is a rule not just for weight loss, but for healthy living as well. Don’t expect your child to do things that you aren’t doing yourself. If you and your spouse are overweight, it is time to take control of your life so your children will learn that positive behavior from you. So many parents come into our offices with their adolescents and expect them to learn a healthy lifestyle in some type of vacuum. YOU ARE YOUR CHILDREN’S MOST VISIBLE AND IMPORTANT ROLE MODEL! Make this a family project and you are more likely to see favorable results.

Now that we’ve defined how you can help in abroad way, stay tuned for Part II to learn about age-specific activity plans that will benefit not only your child, but your whole family.

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 17 years of professional experience. In addition to his private consultations and personalized workout programs, Alan is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc . Lose It! now features special programs for Seminary Girls and Yeshiva Boys. Alan can be reached at 1-516-568-5027, 972-2-651-8502 or his cell phone 972-50-555-7175. Email: alan@loseit.co.il

Visit the Lose It! website www.loseit.co.il