Weight No Longer: The Prescription for Amazing Fitness & Living

WEIGHT

NO LONGER

The Prescription

for Amazing Fitness & Living

Philip Caravella, M.D.

Copyright © 2015 Philip Caravella, M.D.

All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means---whether auditory, graphic, mechanical, or electronic---without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

ISBN: 978-1-4834-3057-7 (sc)

ISBN: 978-1-4834-3059-1 (hc)

ISBN: 978-1-4834-3058-4 (e)

Library of Congress Control Number: 2015906904

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

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Lulu Publishing Services rev. date: 04/06/2016

Contents

Forward

Preface

Introduction

Chapter 1: The New Exercise/Diet Paradigm: From Victim to Victorious: Looking at the world of preventive health in a different and new format

Do You Want the Truth?

The Time Has Come

Chapter 2: How Can Weight Problems Be Solved?

Long-Term Survival Demands Change

Dieting's Biggest Taboos and Mistakes

Your Role in Addressing Obesity

Chapter 3: How Serious Is Our Problem?

Do You Want to Live?

Chapter 4: The Challenge of Long-Term Health

Is Weight Gain a Social Disease?

Chapter 5: Beginning at the Beginning to Understand Primitive Man

Primitive Man and His Dietary Wisdom

What Happened?

Paleolithic Human Stature

The Paleolithic Diet

Chapter 6: Searching for the Truth

Defining the Problem

The Deafening Roar

The Psychology of Overeating

Relatives Who Love Too Much

Teenagers

Chapter 7: Weight Problems and Challenges

It's Not All about You

Will Health-Care Rationing Be in Our Future?

Chapter 8: Obesity, the Greatest Health Hazard of Our Day

Who Is Most Likely to Be Obese?

Definitions

BMI

Women's Basal Metabolic Index (BMI) and Health

What About Men?

Obesity and Disability in Women

Disability and Disease

How Serious is the problem of obesity as it relates to our health?

Chapter 9: The Disease Debacle

Type-2-diabetes Mellitus

Other Conditions

Pre-diabetes is the precursor of T2DM

Type-1-Diabetes

Diabetes, Diet, and Exercise

What effect does exercise have on insulin and blood-sugar levels?

The Metabolic Syndrome (Syndrome X)

Cancer

Breast Cancer

Endometrial Cancer of the Uterus

Ovarian Cancer

Pancreatic Cancer

Cardiovascular, Heart, and Blood-Vessel Diseases

Hypertension

Heart Failure

Stroke

Fragile Bones

Degenerative Arthritis aka Osteoarthritis

Obstructive Sleep Apnea

Polycystic Ovary Syndrome

Obesity and Mobility Disability

There is no Comfort for the obese!

Chapter 10: The Real Secret to Weight Control

Exercise or Else

What about Children and Teens?

Your Exercise Program Today

A Little Story from 2013

Chapter 11: Separating Fact from Fiction: Deceptive Advertising Lives On!

Lean Body Mass

Lower Abdominal Fat or the Dreaded Midriff Bulge

Visceral Fat (Lower Abdominal Fat Deposits)

Here Comes the Good News: You Can All Have It Your Way!

Aging, Metabolism, and Weight

Exercise: Resting Metabolism

Does Research Have the Answer?

Aerobic vs. Anaerobic Activities

Aerobic Exercises

Anaerobic Exercises

Energy Utilization

Chapter 12: Medications for Weight Loss: Pros and Cons

See Your Physician

Chapter 13: Exercise with a Purpose

Chapter 14: Setting Up a Daily Exercise Format to Lose Weight

Beginning

Lack of Time for Exercise

Losing Weight Requires Commitment, Melting Away Fat Requires Exercise Time

Friends and Exercise

Chapter 15: Exercise Frequency, Duration, and Intensity

Frequency

Duration

Time in Action

Intensity

Health Over Weight Loss

What Is Best for Most People?

Chapter 16: Exercise Prescriptions That Will Work

Preparation Protocols

Calculate Your BMI

Outfit Yourself

Arrange Your Exercise Time, Place, and Conditions:

The Exercise Prescriptions

Normal-Weight Adults with a BMI of 18.5--24.9

Pregnant Women

Grade 1 Overweight Adults with a BMI of 25.0--29.9:

Grade 2 Overweight Adults with a BMI of 30.0 and Greater

Adults with Diabetes

Adults with Heart Disease, High Blood Pressure, or Chronic Obstructive Pulmonary Disease (COPD)

The Classic Protocol for Health

Chapter 17: Alternative Sports and Options Provide Many Opportunities

A Potpourri of Activities and Sports Open to You and to Your Family

Badminton

Biking

Cross-Country Skiing

Downhill Skiing

Golf

Handball

Hiking

Inline Skating or Roller-skating

Jogging

Rope Jumping

Rowing, Canoeing, or Kayaking

Swimming

Tennis, Racquetball, Squash

Chapter 18: Resistance Training

Fitness and Flexibility

Equipment

Free Weights or Machines?

What About Speed?

Sex Differences in Muscle Development

The Error of Over-Training the Wrong Muscle Groups for a Specific Activity

Chapter 19: How Do You Become Overweight? The Real Nitty Gritty

The Effect of Dieting on Metabolism

Chapter 20: The American Diet Circus

The Gorilla Diet

The Western Lowland Gorilla Diet

The Eastern Lowland Gorilla Diet

Chapter 21: The Natural Diet: God's Choice for Us

The Crux of a Good Diet

The Basics of Losing Weight and Keeping It Off

There are times when we all need special indulgences.

Choosing Foods: the Good, the Bad, and the Better

Magical and Amazing Foods

Avocado

Apricot

Apples

Asparagus

Beans

Beets

Blueberries

Broccoli

Brussels Sprouts

Cabbage

Cauliflower

Carrots

Celery

Cranberries

Cucumber

Fish

Grapes

Lettuce

Mushrooms

Oranges

Peppers (Green, Red, and Yellow Varieties)

Pineapple

Prunes (Dried Plums)

Tomatoes

Wild Game

Good Foods Sometimes Misunderstood

Eggs

Chocolate

Flax Seed

Nuts

Honey

Olive Oil

Good Snacks

Blacklisted Foods

Brown-Listed Food (the only one)

Remember ...

The Food Diary

Chapter 22: Advanced Information Directives

How to Eat

Grocery Store Shopping

Vacations and Business Trips

Relaxation

Hobbies

Chapter 23: Lose Weight by Burning More Calories than You Ingest

Chapter 24: Understanding Carbohydrates, the Good and the Bad

Why Eat Carbohydrates at All?

Modified Carbohydrate Diet

Alcohol

The Role of Exercise on Carbohydrates

Ideal Carbohydrate Composition of the Diet

Chapter 25: Understanding Protein

Protein and Muscle Mass

Chapter 26: Understanding Fats

Various Forms of Fat

Important Points Regarding Fat Consumption

The Role of Exercise in the Makeup of Our Lipids (Fats)

Dietary Fat Content

Chapter 27: Dietary Cultural Differences

The Rest of the World

The Mediterranean Diet

Individual Food Nutrients

Chapter 28: Understanding Dietary Fiber in Fruits, Vegetables, and Nuts

Nuts

Fiber

Chapter 29: Fad Diets

Restaurants

Travelers

Chapter 30: Revamping the Food Pyramid

Chapter 31: Where's the Fat?

Fat and Fat-Free Mass---a Critical Distinction

Weight-Bearing Exercises

Footwear and Exercise Equipment

A Caveat for Health Risks

Injuries

Terrain and Environment

Wind Resistance

Walking

No-See-Ums

Treadmill Exercises

Swimming

Clothing

Pregnancy and Exercise

Factors to Consider when Selecting Your Fitness Program

Chapter 32: Is Childhood Obesity the Beginning?

A Trip Back in Time

Chapter 33: Breast-Fed Versus Bottle-Fed Babies: Is One Method Better?

Bonus Observation for New Mothers

Chapter 34: Toddlers and Children: How Are They Doing?

Sports

Relationships

Lifespan of the New Generation

Chapter 35: Are Our Schools Missing the Mark?

School Cafeterias

Elementary School

Do Psychological and Emotional Issues Play a Role in Obesity?

Chapter 36: Freedom from the Scourge of Obesity

Family and Friends

Chapter 37: You Are the Author of Your Own Life

The National Weight Control Registry

Inflation and Health-Care Costs

A Love Story

Chapter 38: Testimonials by My Patients in Their Own Words

Robert Myers

Julie D. In her 50's when this was submitted to me in August, 2004.

Len M. age 51 received via snail mail in August of 2004.

N. H. A woman.

Donna P. a 60 year old woman:

Dennis Lekan

Janice Sergi, RN

Disclaimer

Medical knowledge, diagnostic techniques, and treatment strategies while generally improving are in a constant state of flux. Though every effort has been made to ensure accuracy and to offer to you the best possible guidance, you must consult your physician before making any decisions concerning your level of exercise, diet, use of medications, or any other modalities mentioned in this book that may affect your health one way or another.

Dedication:

To the sick and less fortunate who have not found refuge in the field of medicine despite the best intentions of all professionals who have been involved in their health care.

And Especially

To my dear and loving wife Debra and to my father,

Louis Philip Caravella, an immigrant from Sicily, who entered America through Ellis Island at the age of twelve.

Forward

I first met Dr. Caravella more than 30 years ago, when referred by friend who really liked him for his thoroughness during his office visits and his strong emphasis on preventative medicine. I quickly made an appointment and was surprised on my first visit by the amount of time he spent asking details about my health and lifestyle before he even began his physical examination.

Having just started to run regularly, Dr. Caravella encouraged me to continue and recommended a routine that I was comfortable with including walking, running and resistance training. I became quite a fanatic. In addition we talked about life style, eating habits, family life, and the necessity for general well being as a part of staying healthy for a lifetime.

In addition, blood pressure and Cholesterol were dogged family problems and while others might have seen these issues as borderline Dr. Caravella saw them as a trend because of my family history and he watched them closely.

With exercise and diet I was doing well though as time went on he added low doses of medicine to my regimen. I truly believe that because we dealt with these issues early and because he considered all aspects of my health habits, my medical issues have been under total control my entire life.

From the time I met Dr. Caravella in private practice and than followed him to the Cleveland Clinic, he became even more interested in total health, diet, exercise, attitude, etc. as it pertains to the whole person. I know he studied, practiced and continued to learn, and this book is a result of years of success in working with patients of all ages and stages of health. It is as complete an encyclopedia on getting and staying healthy as one can find; necessary reading for all adults, and more importantly worth following, and keeping by your side as a permanent reference.

Dr. Caravella served as a Captain in the Army early in his career and after retirement from The Clinic, served as a physician in the Army with the rank of Lt. Colonel. He is a graduate of St. Louis University School of Medicine and served his residency at the University of Illinois Peoria School of medicine. He is a Fellow of the American Academy of Family Medicine.

Dennis F. Lekan, MBA, Ed. D.

President

Corporate Leadership Associates, LLC

Preface

My fifty-six year old father, Louis P. Caravella, died unexpectedly from a heart attack one night when I was a junior medical student at Saint Louis University School of Medicine. The horrible and unexpected news came from a phone call during the night, tearfully recounted from my twin sister, Phyllis. His death shook me to my timbers and I have still not recovered from the shock of it, though with time I have learned that his demise was fully preventable. My interest in preventive medicine therefore grew over the decades from my father's unexpected death inspiring me to study and practice in the fields of preventative and family medicine.

Over the years it has become apparent to me that weight problems, obesity, and related diseases such as type-2-diabetes are the cause of most common and serious medical problems we face in America and for that matter in most developed countries worldwide. My research in this area has spanned many decades and differs from many authors in that I have noted the progressive increase in obesity among most Americans regardless of what book or books they have read in the past or which opinions they have chosen to follow. Every diet plan of every form has nearly universally failed most followers or we would not be facing the problems we now have due to obesity. Researchers have confirmed that as our daily calorie count has gone down over the past two hundred years, our weight continues to escalate. In 1985 about thirty-five percent of our population was overweight or obese and now it is more than two out of three people. We are losing the battle. At our current rate of increasing obesity nearly one hundred percent of the population will be obese by 2050. A Stanford study reported in the August 2014 issue of The American Journal of Medicine confirms my research about obesity being closely linked to inactivity rather then overeating.

It is time to get a grasp of this problem once and for all. This book clearly educates, informs, and directs the reader on how to achieve and maintain a normal weight for life. These are not theories. My principles work. The information when read and followed by you will result in success and will turn your life around and the lives of others who will follow your direction.

I can think of no greater health challenge facing Americans and I can think of no better way for you to achieve success other than following the principles explained clearly in this book.

From Victim to Victorious!

Philip Caravella, MD, FAAFP, Lt. Col. US Army Medical Corps, (RET)

Introduction

Do Americans have a weight problem that is contributing to so many of their health care problems? The statistics are terribly horrifying, as you will find out in forthcoming chapters. The problem continues to escalate regardless of what diets people follow, whose advice they glean, or what they do. The stampede of weight problems proceeds with abandon not halted by anything anyone has done to date. The problem is so far out of control that it touches nearly every life through some unfortunate victim that you and I know.

This book sets the stage for learning what it takes to solve this tenacious problem and more importantly will result in achieving success by the believers, the performers, the people who take this advice, and those who will run with it. It works. It has worked for many of my patients. It can change your life. It could save your life. It will give hope to your children, their children, and all who want to turn their lives around.

Obesity, weight problems, and all of their related diseases including cancers, heart disease, mobility disability, and especially diabetes are preventable or improvable under most circumstances. Read this book. Follow what you read and you will be the better for it.

This is not a book about half-baked theories, concepts, or lame principles that have failed before and will continue to fail since they have not been properly researched or understood. This is a book you can take to the bank. It will serve you. You will achieve success by following it. It eliminates excuses and failure while promoting wellness, happiness, goodness, success, and a new way of life.

This book is for everyone that has followed and failed at any diet or effort to lose weight. This book is for the victim who will become victorious by learning what is required to achieve a better if not a normal weight. You will become an athlete within the framework of your abilities. You will learn about proper and natural nutrition. You will learn proper exercise techniques and habits. You will eat a correct diet. You will be successful. You will win. I want to congratulate you on your future success. This book will not provide excuses for failure but will give you the building blocks and information required to succeed when you place into practice the advice that has been written in this text. By following the principles of this book well into your future, you will become an amazing picture of remarkably improved health. You will likely enjoy a better and a longer life. As my father would often say to me, Philip. The harder you work, the luckier you'll get.

Fall in love with yourself and someone else will fall in love with you.

Dr. Philip Caravella

CHAPTER 1

The New Exercise/Diet Paradigm:

From Victim to Victorious: Looking at the world of preventive health in a different and new format

Do You Want the Truth?

This is not another book of recipes for you to master or one of incomplete exercise programs that permeate so many diet books flooding the bookstores and libraries. Recipes are not the answer. Knowledge is the answer, and from there, you will be the judge on whether any recipe, diet, or exercise formula is appropriate to achieve the goals of losing weight, becoming fit, and most important, achieving your best overall health. A solid understanding and resolution of the ubiquitous problems of being overweight or obese engulfing our society lie within these pages. Eventually, the solutions for these problems and how to extend your life will become intuitive. In the meantime, you will find the answers to the problems and their related diseases lying within specific exercise prescriptions and nutritional guidelines, which will save the day as well as your life. You will not be told, as we sometimes tell our children, This is the way it is, because I say so or because I'm your mother, that's why. I am offering you hard facts and principles to acquire nearly perfect health, fitness, grace, form, and beauty, which will become second nature as you put them into practice.

Magazines, media, and many other sources of information are laden with confusing and usually incorrect concepts and theories. My research indicates the misinformation available to the public is more extreme in the areas of obesity, its causes and related conditions and diseases than in almost any other area of health. There is very little accurate information available to patients or to professionals who hope to successfully manage weight problems in their patients or clients. Misinformation, in my opinion, plagues many books associated with weight problems, and this travesty has provided more of a disservice than a help to those who have read many of them.

For example, Frances Berg's Underage and Overweight: America's Childhood Obesity Epidemic---What Every Family Needs to Know is one of these offenders. Berg claims, We need to shift to a new Paradigm. I call it 'Health at Any Size,' and it means focusing on health, not weight, and helping all people be healthy at the size they are.

This type of twisted thinking may be accommodating to the growing numbers of expanding human beings, but it will not solve the serious health problems linked to childhood obesity, much less overweight adult conditions such as type 2 diabetes, breast cancer, uterine cancer, high blood pressure, degenerative arthritis, and other obesity-related diseases facing us and our children. Obese individuals cannot and will not be healthy without reducing their weight, regardless of whatever paradigm is attempted to sugarcoat their problem.

Physicians generally lack the time or knowledge to successfully help with weight loss and will often say things like Follow a better diet and try exercising. Have you heard that before? This insufficient advice will not carry the day. Weight problems continue to escalate from involving 35 percent of adults in 1985 to now, harming an astounding 65 to 69 percent (depending on sources) of the population. Childhood obesity is even exploding at a greater rate.

This book succeeds where other books have failed in preparing you for successful weight loss and improved fitness. The information presented here is based on my own research at the Cleveland Clinic, my practice of medicine for over forty years, and from the analysis of several professional resources available primarily to physicians such as UpToDate.com, an online evidence-based clinical-decision support resource to physicians from Wolters Kluwer Health, and other respected medical journals in the fields of family medicine, preventive medicine, internal medicine, and general surgery.

Like many of us, UpToDate has been concerned about the inaccuracy of information about health-related problems available to the general public on the Internet. As a test case, they decided to evaluate the data for inflammatory bowel diseases, including Crohn's Disease and ulcerative colitis. Their experts determined that information about these conditions on fifty different websites lacked accuracy and quality. UpToDate concluded, Few websites provided high quality information.

This brings us to the topic of obesity and its related diseases. How good is the available information about these complicated conditions? How good is the current research about obesity?

Almost all current books about weight problems are flawed and will lead to failure by those who follow their suggestions. As proof of this, the statistics on the percentage of overweight individuals in America over the past thirty years has grown worse rather than better.

This book is based on solid facts that can be understood by anyone intent on solving their weight and health-related problems. Everything written in this book is based on research, solid evidence, and it will stand on its own. It is not based on conjecture or misplaced thinking that sounds good but is false, misleading, or ineffective. By applying the principles found here, you will be successful in obtaining normal weight while becoming fit in the process. Your risk of developing most weight-related health problems and diseases will be reduced and your life expectancy extended, allowing you the opportunity to enjoy life to its fullest.

The Time Has Come

Thomas Edison said, The doctor of the future will give no medicine, but instead will interest his patients in the care of the human frame, in diet, and in the cause and prevention of diseases.

The future is now. What will you do to make a difference? How will you perform?

The problem isn't really the problem. Your reaction to your problems and the solutions you chose will determine the outcomes you will have.

How will you react to the challenge? Will you chose the correct road to follow. The road that appears the most difficult at first becomes the road that eventually yields the best outcomes. My father often said to me, Philip! The harder you work, the luckier you get.

CHAPTER 2

How Can Weight Problems Be Solved?

You must look into a mirror if you want to know where your problems lie. You must look into your heart when you wish to solve them.

Long-Term Survival Demands Change

Real change is not easy because we are creatures of habit, influenced by our friends, surroundings, and upbringing. We become used to a certain lifestyle, whatever it may be. Over time, we come to believe that what we are doing is right, because of such psychological processes as justification and rationalization. We convince ourselves that it's working for us. Long-term survival requires us to follow the natural order of being, but survival is not instinctual when it comes to diet or exercise. We are easily misled by a softer, less physically demanding way of life. Following a life of leisure often leads to misery and eventual self-extinction as many unfortunate beings before us have already found out. It is time to evolve.

Due to a lack of knowledge, one can lose sight of doing the correct thing for health and happiness by forfeiting opportunities, following bad habits, being too lazy, or worshipping our excuses. Faith in yourself and in self-preservation is a must if you wish to be successful in the battle against weight problems. All battles can be won, once you know how to do so. But you have to understand the facts.

When finished with this book, you will have the facts straight. You will be an expert in the area of weight loss and weight control. To defeat this tenacious foe, you must know what to do and, what's more important, you have to do it. You have to know where you are and where you are going.

This will become easier once you get started. Remember the old Chinese proverb, a trip of a thousand miles begins with the first step. Well, you will begin the first steps toward victory as early as today. Winning becomes easier as you learn how to win. The most