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Archive for May 8, 2009

ETHICAL ISSUES IN OBESITY TREATMENT: ETHICAL DESICION MAKING

Friday, May 8, 2009 | 7:44 am

The client. Your clients, like you, are hurhan beings with complex motives and needs. Some of these will be well-understood by the clients and some will be more apparent to others than to themselves. It is not usually ethically acceptable to take clients at face value, especially when you are dealing with potentially very complex issues.

What is this client asking for? Why does he or she want that? With personal issues such as health, fitness and appearance the client’s expression of his or her needs can easily be distorted by anxiety.

The woman in the above example who wishes to get a satisfying relationship by losing fat is unlikely to give this initially as her reason for seeking help. If she is partially aware of and embarrassed about her insecurities, she may deny this even if you ask directly about it. You need to take some care in considering what the initial request for help really represents.

What are his or her strengths and weaknesses? Consider what the client is and is not capable of achieving. Sometimes you can teach the skills and knowledge required. Sometimes the client already has these, so they can be left out of the program. Sometimes you can refer them to someone else who can offer better help or modify your approach accordingly.

What are the probable consequences of this client successfully losing fat? Of staying the same? You should consider whether the gains that can be reasonably expected would be a worthwhile return on the effort and cost involved. You should specifically take into account potential unwanted effects, particularly if the fat loss efforts are unsuccessful. This should include some thought about how the client and other important people in her life are likely to respond to the client losing fat and how they would respond if she regained it. The responses will not always be entirely positive.

What is this client’s history of obesity management? How have these past efforts affected them? Most clients have already made many efforts to lose fat. This history of efforts to lose fat makes up a powerful set of learning experiences that shape what clients expect of you and of themselves. Unless there is good reason to expect a different outcome, it may be unethical to repeat things that have been unhelpful in the past. It is almost certainly unethical to re-expose the client to something that has already been found to be harmful.

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(posted in Weight Loss)

THE G.I. FACTOR: THE CARBOHYDRATE/G.I. FACTOR LINK

Friday, May 8, 2009 | 6:44 am

Newer studies are revealing that the physiological responses to food (how food acts in the body) are far more complex than was previously appreciated. What is true is that different carbohydrate-containing foods do have different effects on blood sugar levels.

Only in recent years have scientists begun to study the actual blood sugar responses to hundreds of different foods in real people, healthy people and people with diabetes. They gave them real foods—not solutions of sugars and starches in water. They measured the blood sugar levels at frequent intervals, for as long as two to three hours after the meal. To compare foods according to their true physiological effect on blood sugar levels, they came up with the term ‘glycaemic index’.

The glycaemic index (or G.I. factor as we have called it) is a ranking of foods from 0 to 100 that tells us whether a food will raise blood sugar levels dramatically, moderately, or just a little.

This research has turned some widely held beliefs upside down.

The first surprise was that many starchy foods (bread, potatoes and many types of rice) are digested and absorbed very quickly, not slowly as had always been assumed.

Secondly, they found that moderate amounts of most sugary foods (confectionery, ice cream etc.) did not produce dramatic rises in blood sugar as had always been thought. The truth was that foods containing sugar actually showed quite low-to-moderate blood sugar responses, lower than foods like bread.

So, it is time to forget the old distinctions that were made between starchy foods and sugary foods or simple versus complex carbohydrate. These distinctions are based on chemical analysis of the food, which does not reflect the effects of these foods in the body. The G.I. factor takes us nearer to a full understanding of how the body responds to carbohydrate foods.

The G.I. factor is a ranking of foods based on their overall effects on blood sugar levels. Blood sugar or blood glucose? Blood sugar and blood glucose mean the same thing, although the latter is technically more correct However, we use the term blood sugar in this book because It is more widely understood. ‘Glycaemic’ refers to ‘blood sugar’.

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(posted in Diabetes)

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