Jogging. Jogging is one of the most effective fat loss physical activities available, but ironically, it is not suited for big or overfat people. It can be quite painful and de-motivating for anyone to carry a large body mass over a distance at speed. It can also be relatively dangerous, not just for the extra pressure put on the cardiovascular system, but because of the possibility of weak joints in the hips, knees and ankles.

Many men, who lose significant body fat, are then often motivated to jog and this should obviously not be discouraged. It is important to make clear, however, that jogging is not necessary for fat loss, as many people think. The ‘no pain, no gain’ philosophy may be true for the elite athlete, but it has no relevance for very unfit fat individuals.

Walking. For most people, walking represents the single most natural, easiest and convenient form of fat loss physical activity. Because it can be carried out at low-moderate intensity over long durations and with low impact, it presents few injury problems or health risks, walking does not have to be brisk, but most importantly, it should be carried out over a set distance, preferably equating to 3-4 km per day. It can also be increased as part of ‘madental’ activity, such as walking up stairs, not using transport, etc. Hence, in the vast majority of cases where injury is not a limiting factor, walking is perhaps the best form of ‘planned’ physical activity for fat loss.

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The most significant changes have occurred in our understanding of measures of body fatness, what causes fatness and appropriate treatment and prevention strategies.

Ideas about measuring fat have shifted with changes in technology, and we have a better understanding of the types and distribution of fat related to disease. In general there has been a shift away from a single fat measure towards a combination, including body mass index, sagittal diameter and waist circumference, that can be used in a practical situation.

The main changes in thinking about the causes of overfatness centre around the type, rather than quantity of food eaten (e.g. the influence of energy from fat on total energy), and the impact of individual factors (particularly genetics) in influencing body fatness. There are, for example, big genetic differences in fat gain and in the extent of fat loss in response to a particular exercise or diet stimulus, and these have not been sufficiently recognised in the past. The interaction of biology with the environment and behaviour also needs to be considered. Understanding the causes of fatness is, of course, vital to the development of correct techniques of coping with it. The implications of all these changes for those interested in fat loss or maintenance of body fat are quite new.

Other changes in orientation have included a re-analysis of the role of fatness in ill-health. Epidemiological studies carried out in the 1960s and 1970s found little correlation between weight and major diseases like heart disease, because the measure of fatness used was generally a measure of body mass (i.e. weight or body mass index (BMI)), which ciiscriminates against healthy, lean, muscular individuals. Epidemiological studies also looked for independent effects of obesity, whereas its effects are largely mediated via other risk factors such as high blood pressure. A re-analysis of these data has now shown that fat distribution is a key factor in ill-health and this explains much of the earlier epidemiological evidence. It’s not only someone is fat that is important in health terms, but also where they are fat.

There has also been an increasing emphasis on gender, race and age and other individual factors on fat gain and loss, to the extent that it’s becoming apparent that any program must be individualised, as stressed throughout this book. However, recognition of the importance of the environment also makes a public health approach imperative.

There has also been a change away from the concentration on ‘diet’ as a form of treatment towards a change in lifestyle which, unlike short term diets, can be maintained over a lifetime. This includes a move away from exercise designed for cardiovascular fitness, towards an increase in the level of total activity—both planned and ‘incidental’—that is carried out within our changing, modem technological lifestyles. To this extent, professionals who deal only in prescribing diets or exercise are unlikely to maintain a primary role in fat loss through lifestyle management in the future.

Finally, a major shift in direction, begun in the 1990s, has been a change in thinking about the psychological aspects of obesity and body fat maintenance. In the 1970s, the use of behaviour modification techniques in weight control began and this has now become standard in most modem programs. More recently it’s been recognised that much more complex, emotional and cognitive (thinking) functions are involved in obesity. This is particularly so in the case of many women, who have suffered much more social and psychological pressure than men to attain an unrealistic body shape, and as a result have often developed counter-productive cognitive cycles of guilt, depression and anger associated with food and food restriction. Modem approaches need to pay more attention to dealing with these issues. Counselling also needs to become more reflective and less directive to empower people to resolve these issues themselves rather than simply replace one dependency (food) with another (a counsellor).

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