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WEIGHT (kg) / HEIGHT (m2)




belly fat, abdominal obesity, truncal obesity, visceral obesity, skinny fat, thin outside fat inside (TOFI)


Waist to Hip ratio > 0.8 women, > 0.95 men)


Waist to Height ratio: > 1 : 2


Central Obesity is an important consequence of Dietary Risk and is independent of weight as a risk factor. High fat intake may manifest as steatohepatitis (fatty liver). The liver is a filter for what you eat and is located in the right upper quadrant of the abdomen. The liver is important for glucose metabolism and diabetes prevention.




You are beautiful.  We are without judgment and fully supportive.
Do what makes you happy.  Start where you are.



see also sections on Nutrition, Lipid, and Exercise 

Quality Nutrition

Hydrate: we are 70% water, ensure your intake is proportionate

fruits, vegetables, whole grains, protein, legumes, greens, seeds, nuts

Fiber: more wholesome, less processed foods


Nutrition and Exercise Log (cognitive therapy)

Research indicates that the most effective strategy for achieving a weight goal is using a simple nutrition and exercise log (see below)

Stimulus Control (behavioral therapy)
Make healthy eating easy and unhealthy eating difficult

Environment trumps willpower.  Think about what you would likely do in a library or gym.

Keep water bottle at home, work, transit.  Get good groceries.  Meal prep.  On-the-go healthy snacks.

Avoid Prolonged/Intermittent Fasting

no significant difference compared to calorie restriction with consistent mealtimes

Some fasting is good such as when you are sleeping and when you are not hungry.  Prolonged fasting breaks down vital tissue including muscle, slows metabolism, and decreases repair.  Prolonged starvation mode may paradoxically lead to increased storage of fat for long term energy.  This is why it is not uncommon for extremely thin people with anorexia to have cholesterol that is actually high.  Consider Bear vs Horse; Bears hibernate for prolonged periods (bears in Alaska hibernate for up to 4 months) therefore store more fat versus Horses that graze throughout the year during the day and are lean yet strong.

Adjust Portion Size by 5% and periodically reassess based upon results.

Avoid Fad Diets

- Avoid Very Low Carb / Very High Fat (Ketogenic)

not recommended, not good long-term strategies because the preferred fuel is glucose.  Ketogenic diets are catabolic so burns fat, yet also burns muscle and consumes more water and energy to convert to glucose.  People lose weight, but usually yo-yo up and down with these diets and there a considerable amount of weight lost is from water.  We are relatively ketogenic when we are sleeping.  Excess fasting can put you into starvation mode so you store more fat when you eat.  For this reason, it is not uncommon for anorexics to have high cholesterol.  Atherosclerosis risk.

- Avoid Low Carb / High Fat (Atkins, South Beach, Zone):

not recommended because limits fruits/vegetables, atherosclerosis risk (Dr. Atkins had a heart attack)

- Avoid Paleolithic: wholesome, less processed, restricts grains/legumes, coconut oil is still highly processed and high in saturated fat, this combined with more meat may pose higher atherosclerosis risk

Healthier Fad Diets:

+ Low Fat / High Carb (Ornish, Rosemary Conley)

moderate-low evidence of effectiveness

+ Points Based (Weight Watchers)

moderate-low evidence of effectiveness

Positive Reinforcement (behavioral therapy)

Set a goal with a reward.  Do not give yourself the reward without achieving the goal.  You may inform the doctor so we can write this down and check back on the progress,  This is super powerful and we have seen phenomenal results with this.


Lose Weight -> increase Aerobic with limited Strength training

Gain weight -> increase Strength training with limited Aerobic

Enjoy your food. 

Small bites.  Chew carefully (certain foods digest better with saliva than in stomach).  Limit talking while drinking, chewing, swallowing.

Meal Replacement Shake

especially if high Body Mass Index (overweight/obese), also great after exercise

convenient (just add water)

example:  Sprouts Vegan Protein (20g protein, 4g carbohydrate, 2.5g fat without saturated fat so lean high quality protein with some carbs and low fat): Pea, Organic Brown Rice, Natural Vanilla, Flax Seed, Stevia, Chia Seed, Sprouted Black Rice, Organic Hemp Seed, Sea Salt, Potassium Chloride, Grape Seed/Skin, Blueberry, Raspberry, Cranberry, Prune, Cherry, Bilberry, Strawberry, Broccoli, Spinach, Tomato, Carrot, Onion, Monk Fruit, Alpha-Galactosidase, Prodigest Enzyme


Calories Count

500kcal per day: decreased intake or increased activity -> lose 1 lb per week

less processed food and more wholesome food promotes even more weight loss


When eating, it is best to eat during the day you are active.  Eat a substantial breakfast and lunch and if you want to go lighter, do so in the evening and this way you will be more likely to burn excessive calories.

Community Supported Agriculture

Order a CSA bag/box full of groceries are fresh, healthy wholesome, economical, and supports the local farmer

Yasukochi Family Farms (<$30, free delivery)

 Other CSA programs

Bariatric Surgery

does NOT reduce all-cause mortality in 60-70%, average life span increase only 2.4 years longer and has considerable risk, most weight loss is just after surgery with regain over time if lifestyle is not optimized

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