Losing weight in 2004

“All this talk of dieting has made me hungry for fish sticks with tartar sauce.”

“I earned 5 points exercising today. Now I can have popcorn at the movies tonight.”

“phaedrus, those studies you cited make me wonder why i haven't heard of any marathoners going on low carb diets.”

“Mostly because most people who run significant distances don't generally need to diet? They burn a lot of calories in their daily running. When I was thruhiking - walking all day every day - I lost weight and was happy with the way my body looked and felt. But I'm not hiking every day, and getting to the woods once a week just isn't enough to make up for sitting in front of a computer all day every day.

If I had time to exercise regularly, I wouldn't have a weight problem. Back when I was walking to work every day, I could eat whatever I wanted. But I don't live in San Francisco any more. I leave the house and get home 11 hours later, too pooped and stressed out to do anything but fix dinner and veg in front of the computer or on the sofa. We bought a treadmill - the big question is whether I can motivate myself to actually walk for an hour in the evenings before I start dinner, or whether it will just gather dust in the corner.”

“i wasn't talking about them going on the diet to lose weight but to improve perfromance.
if a high fat/low carb diet actually improves endurance and total power output over a long period of stress, then wouldn't that be a good diet for endurance athletes, not as a restricted calorie diet, but one satisfying their needs, but with low carb proportions?”

“Phaerus, Inuit and those in the arctic have to work in such adverse environmental conditions that there bodies need anything they can get. Its undeniable that the inuit diet as a whole would be unhealthy for anyone not living under the stresses and demands they encounter daily.

I suggest that the AMA sponsors a study that has middleclass folks form Central Cali eating whale blubber, seal and other game in the quantities a traditional inuit eats. Outta be interesting.”

“Sources: First Nations and Inuit Regional Health Survey (1999) and National Population Health Survey 1994/95 (1996).

Chronic Condition Gender Age Adjusted Prevalence (%) FN&I/Canadian Ratio
First Nations and Labrador Inuit (FN&I) General Canadian Population
Heart Problems Male 13 4 3.3
Female 10 4 2.5
Hypertension Male 22 8 2.8
Female 25 10 2.5
Diabetes Male 11 3 3.7
Female 16 3 5.3
Arthritis/Rheumatism Male 18 10 1.8
Female 27 18 1.5

Diabetes is especially problematic in First Nations populations, where it tends to be predominantly of the non-insulin-dependent type. The age at onset is younger and complications, such as end stage renal disease and cardiovascular risks, are more frequent and appear to develop faster in Native people.10,12-15 Even with no change in the frequency with which new cases occur, the estimated number of diabetic First Nations people in Manitoba will triple by the year 2016 (from 16% to 27%).12,14 The Sandy Lake First Nation community in northwestern Ontario has a diabetes rate of 26%, the third highest rate in the world and four to five times the national average.16,12 A genetic predisposition to fat storage combined with a less active lifestyle and a high-fat diet have been found to play a role in the onset of diabetes in the Ojibway and Cree living in that small community.16 Body mass index was found to be an independent and significant predictor of diabetes17 and a very low fiber intake was associated with newly diagnosed diabetes.18 Moreover, according to the First Nations and Inuit Regional Health Survey, less than two-thirds of diabetic First Nations and Labrador Inuit individuals had attended diabetes clinics or received diabetes education.10

3.2 Mortality

In 1996-97, First Nations and Inuit people from Eastern Canada, the Prairies and the Western Provinces had mortality rates that were up to almost 1.5 times higher than the 1996 national rate.19-25 Although only crude rates are available from the Atlantic provinces and Quebec, aboriginal people from these locations had a mortality pattern similar to the total population, with diseases of the circulatory system being the main cause of death, followed by cancer and injuries and poisonings.19- 20,26

Figure 2



In contrast, the leading cause of death in Native people from the Prairies and British Columbia was injuries and poisonings, followed by diseases of the circulatory system and cancer.21-22,24 However, as Figure 2 illustrates, First Nations and Inuit people were up to about 6.5 times more likely than the total Canadian population to die of injuries and poisonings. The mortality rate attributed to injuries and poisonings was higher in men in both populations.

3.3 Potential Years of Life Lost

Data from the Prairies and British Columbia indicate that in 1997, injuries and poisonings were the leading causes of potential years of life lost (PYLL), almost half of the total PYLL. Premature deaths due to injuries and poisonings in those provinces were up to almost seven times higher than for other causes.21-22,24 In contrast, the main cause of PYLL in the general Canadian population in 1995 was cancer, although injuries were the principal causes of premature mortality in men and the second leading causes of PYLL in women, along with cardiovascular diseases.27

3.4 Life Expectancy

As Figure 3 demonstrates, life expectancy in the Registered Indian population increased by about 10 years between 1975 and 1995.6 This may be partly due to a decrease in the infant mortality rate and to the influx of Bill C-31 registrants who tended to be relatively young. In 1995, the life expectancy at birth was 69.1 years for men and 76.2 years for women, about a 7 year difference between the genders.6 In that same year, the life expectancy in the general Canadian population was 75.4 years for men and 81.3 years for women, a difference of about 6 years between the genders.

Figure 3



Men in the general Canadian population were expected to live 6.3 years more than Registered Indian men. Canadian women in the general population were expected to live 5.1 years more than Registered Indian women. Although the gap between the genders has been slowly narrowing in the general Canadian population since the early 1970s,28-31 it has slightly increased in the Registered Indian population between 1975 and 1980, after which it has remained stable.6 It is interesting to note that in 1995, the life expectancy of Status Indian women exceeded that of non-aboriginal Canadian men.6,31

3.5 Elder Health

In 1997, a little over half of First Nations and Labrador Inuit men aged 45 and older and a little over one-third of elder women reported excellent or good health.8 In contrast, in the previous year, about three-quarters of seniors (the closest available comparison group) in the general Canadian population reported excellent, very good or good health.32 The main health problems reported by older women in the First Nations and Labrador Inuit population were (in order of frequency): hypertension, arthritis/rheumatism, diabetes, and heart problems.8 Women in the general Canadian population suffered mainly from arthritis/rheumatism, hypertension, heart problems, and diabetes, in that order.9 First Nations and Labrador Inuit elderly men reported health problems such as hypertension and arthritis/rheumatism, heart problems, and diabetes,8 in the same order of frequency as men in the general Canadian population.9 However, the prevalence of chronic health conditions in First Nations and Labrador Inuit elders was higher than in seniors from the general Canadian population for both genders.8-9

4. SOCIOECONOMIC ENVIRONMENT

The socioeconomic environment of a population, as expressed by education, employment, and income is a strong predictor of health status.

4.1 Unemployment and Social Assistance

The unemployment rate on the reserves was about 29% in 1997-98, almost triple the official national rate of 10%.7 Moreover, over one-third of FNIRHS respondents saw no progress in employment opportunities between 1995 and 1997.33 In 1997, dependency on social assistance on reserve was 46%, four times the Canadian rate.34 In the previous fiscal year, the average number of recipients of social assistance per month in the on reserve Registered Indian population was 68,790, or about one in five people who lived on reserve.6 In 1997, the estimated number of recipients of provincial and municipal social assistance in the general Canadian population was 2,774,900, or about one in ten Canadians35.

4.2 Education

In 1996, 54% of the Aboriginal population aged 15 and over did not have a high school diploma, compared to 35% of the non-Aboriginal population. Only 4.5% of Aboriginal people had a university degree or certificate, compared to 16% of non-Aboriginal people. However, there was some improvement in the educational attainment of Aboriginal people between 1981 and 1996. The proportion of Aboriginal people in their twenties with a post-secondary degree or diploma climbed from 19% to 23% while those with a university degree or certificate increased from 3% to 4%. During those fifteen years, the proportion of Aboriginal people with less than a high school education decreased from 59% to 45%.36

These improvements in the levels of education among Aboriginal people may be due to the increased number of band-operated schools (from 262 in 1987-88 to 448 in 1997-98),7 increased federal funding for post-secondary education (from $109 million in 1987-88 to $274 million in 1997-98) and the expansion of Aboriginal Studies programs to more than 13 Canadian universities by 1980. In late 1997, 98% of schools on reserves were administered by First Nations themselves and many communities had their own high schools,37 thereby preserving Native traditions in the education system. The responses to the FNIRHS demonstrate that improvement, with over three-quarters of survey participants having perceived progress in cultural programs in school between 1995 and 1997.33 An additional positive outcome of the First Nations control of their education is the observed increase in the percentage of on reserve students remaining until Grade 12 for consecutive years of schooling, from 37% in 1987-88 to 74% in 1997-98.7

4.3 Occupation

In 1995, almost one-third of working Aboriginal people 15 years of age and older worked in sales and service, compared to about one-quarter of the non-Aboriginal population.38 In that same year, occupations in sales and service accounted for a little over two-thirds of the 25 lowest paying occupations in Canada. On the other hand, management accounted for almost half of the top paying fields.39 The proportion of Aboriginal workers in management was about 1.5 times lower than that of the non-Aboriginal workforce.38 Health occupations and jobs in natural and applied sciences represented the second and third most frequent categories in the 25 highest paying occupations, respectively.39 The Aboriginal labour force in those two categories was only half that of the non- Aboriginal population.38 The occupational distribution of Aboriginal people may contribute somewhat to their lower mean employment income.

4.4 Income

In 1995, the average employment income of Aboriginal people was $17,382, about 1.5 times lower than the national average of $26,474.

Figure 4




The average earnings in the on reserve population was $14,055, 24% lower than in Aboriginal people who lived off reserve (see Figure 4). About three-fifths of the difference between the average earnings of Aboriginal people and the total Canadian population can be explained by the lower number of full-time Aboriginal workers, a higher proportion of Aboriginal earners under the age of 35, and a larger number of Aboriginal workers who did not have a high school diploma. In that same year, 44% of the Aboriginal population was below Statistics Canada's low income cut-offs, compared to 20% of the total Canadian population. The rate of Aboriginal children who lived in low-income families was more than twice the national rate, which may be partly explained by the larger number of single-parent families in the Aboriginal population.39

4.5 Single-parent Families

In 1996, almost one-third (32%) of Aboriginal children under the age of 15 lived in a single-parent family, twice the rate within the general Canadian population.1 This increased their vulnerability to poverty since lone-parent families had average family incomes that were half those of all families in 1995.39

4.6 Interaction with the Justice System

In 1996-97, Aboriginal people accounted for 15% of sentences to federal correctional facilities and 16% of total provincial/territorial sentences although they represented only about 3% of the general Canadian population. In Western Canada, Aboriginal people were over represented in custody sentences. In Saskatchewan, they accounted for 74% of sentences to provincial correctional institutions, almost seven times their share of that province's population.40

5. PHYSICAL ENVIRONMENT

The physical environment is an important factor in the exposure to risks such as infectious organisms, chemical and biological contaminants, stress levels, and injury.

5.1 Homelessness

Aboriginal people appear to be the largest population sub-group that is the most at risk of becoming homeless in Canada. Risk factors for homelessness which include high unemployment, welfare dependency, poverty, substance abuse, physical and mental health problems, and domestic and sexual abuse, tend to be more common in Aboriginal communities. Moreover, Native people sometimes face racism and discrimination in the housing market. Many live in poor housing and severely depressed conditions on reserves and in remote communities, leading them to migrate to urban areas in search of jobs, education and better housing. However, because of their attachment to the reserve, indigenous people regularly alternate between living on the reserve (in the Summer) and in the city (in the Winter), resulting in frequent searches for a place to live while in the city. Shelters and agencies which serve the homeless across Canada have reported proportions of Aboriginal clients ranging from about 10% in Ottawa-Carleton women's shelters to approximately 70% in Yellowknife and in runaway youths in Winnipeg. Most estimates hovered around 50%.41

5.2 Housing

In 1991, the average number of persons per occupied private dwelling for the on reserve Registered Indian population was 4.1, compared to 2.7 for the total Canadian population. Crowding was especially prevalent in the Prairie provinces and in Quebec.42 Twenty-two percent (22%) of on reserve dwellings had more than one person per room, compared to only 1% in the rest of Canada.7 Crowding on reserves may be partly explained by a larger average family size in the First Nations and Inuit population and by smaller homes. About 10% of respondents of the FNIRHS lived in families with over 4 children up to 11 years of age living at home,43 compared to none of the respondents of the National Longitudinal Survey of Children and Youth.44 In 1996, band housing was characterized by a lower average number of rooms per dwelling than that for non-band dwellings.45 Crowded living conditions can lead to the transmission of infectious diseases such as tuberculosis, hepatitis A and shigellosis,43 which epidemiological reports show considerably higher rates in provinces/territories with higher concentrations of Aboriginal people.46 Overcrowding can also increase the risk for injuries; mental health problems; family tensions and violence.11,47

In 1997-98, the percentage of adequate houses on reserve was 54%, up from 46% in 1991-92 (see Figure 5).7 Over two-thirds of the respondents of the FNIRHS perceived progress in housing quality between 1995 and 1997.33 However, the condition of band housing is still poorer than non-band dwellings. In 1996, band houses were over four times more likely to need major repairs than non- band dwellings (37% versus 8%, respectively) and more likely to need minor repairs (33% versus 26%).48 The remote location of many First Nations communities leads to higher construction costs because of the delivery of materials from distant building supply centres. The situation is even more striking in the northern regions where higher building standards are required to provide shelter from severely cold temperatures.47

Figure 5



Without efficient ventilation systems, the combination of severe cold, tightly sealed dwellings and the possibility of overcrowding can create high levels of humidity for extended periods of time. Prolonged high humidity can promote the growth of molds which are known to induce a variety of adverse human health effects including respiratory and immune system illnesses.

Mold growth is a recently identified issue in aboriginal housing; the full extent and impact on health is not yet known. A number of federal agencies including Health Canada, Canada Mortgage and Housing Corporation and Department of Indian Affairs and Northern Development are actively undertaking environmental monitoring and human health studies to determine the nature and scope of the risk and to identify effective remediation. In addition, a number of information products have been developed to inform residents109, band management110 and environmental health workers111 on issues and best practices for mold reduction and/or elimination.

5.3 Infrastructure

In 1997-98, 97% of on reserve dwellings had adequate water supply while 93% had adequate sewage disposal systems, up from 82% and 72%, respectively, in 1987-88 (see Figure 6).7 Over three-quarters of the FNIRHS respondents believed there had been progress in water and sewage systems between 1995 and 1997.33

Figure 6



5.4 Tuberculosis

Between 1991 and 1996, the incidence of tuberculosis in First Nations and Inuit communities decreased from 58.1 per 100,000 with an average annual decline of 7%. During this period of time, age standardized incidence rates among First Nations persons on reserve were on average six times higher than the rates for the non-First Nations population (40 per 100,000 vs. 7 per 100,000). The current incidence TB among First Nations persons on reserve are on par with rates seen among the foreign-born in Canada and are 18 times higher than Canadian-born non-Aboriginal population. Rates were similar between men and women and higher rates were seen among the very young (0 to 4) and the elderly (65+). Among MSB regions in 1996, TB rates were highest in Saskatchewan at 105 per 100,000 and lowest in the Atlantic region at 0 per 100,000.

Table II - Age Standardized Tuberculosis Incidence Rates for First Nations on Reserve:1991-1996

Year # of TB Cases among FN on Reserve Age Standardized TB Incidence rate among
FN on Reserve # of TB Cases in Canada Age Standardized TB Incidence Rate in Canada
1991 161 58.1 2018 7.2
1992 204 72.4 2108 7.2
1993 122 42.4 2012 7.4
1994 123 45.2 2074 6.9
1995 124 43.4 1930 7.1
1996 101 35.8 1849 6.5

Source: Numerator data from LCDC, denominator data from INAC.

Age standardization was based on the 1991 Canadian population

Figure 7



The considerable variations in tuberculosis occurrence by population group, MSB Region, calendar year, bacillary status and other factors is detailed in a recent publication108.

5.5 Environmental Contaminants

Environmental contaminants such as polychlorinated biphenyls (PCBs) and mercury can pose health risks to children (especially to the developing fetus and newborn infants), such as developmental problems and toxic effects on the immune system.50-52 First Nations and Inuit people are more at risk of exposure to environmental contaminants due to their traditional diet of fish and marine mammals, in which the contaminants tend to accumulate.51-52 Moreover, the levels of methylmercury in the water systems have increased because of hydro-electric reservoirs, mining operations and the pulp and paper industry.51

Over 60% of Inuit children under the age of 15 and almost 40% of Inuit women of childbearing age on Broughton Island, Nunavut have PCB body burdens exceeding Health Canada's "tolerable" guidelines.53 A study in Quebec found that between 1993 and 1996, the concentrations of PCB in newborn children in Quebec Inuit and the Montagnais of the Lower and Mid Shore of the St. Lawrence River were four times higher than the concentrations in Southern Quebec infants. Moreover, the PCB concentrations in the Quebec Inuit and Montagnais newborns were over the threshold beyond which cognitive impairments are expected to result. The concentrations of mercury in the Quebec and Northwest Territories Inuit were six to fourteen times higher than the levels in the newborn Southern Quebec population and above the threshold for the appearance of neurological impairments.51 However, another study found that the proportion of the Cree population in the James Bay area with mercury levels exceeding 15.0 mg/kg decreased from 14.2% in 1988 to 2.7% in 1993- 94, with wide variations among communities.54 Nevertheless, as Clarkson55 points out, recently revised Health Canada guidelines indicate that there could be health risks with as little as 1 mg/kg of mercury.

The fear of contamination can lead to changes in eating patterns and lifestyles, which can lead to negative health consequences because game meat and fish are important sources of essential nutrients.51,56 Moreover, these changes in the traditional ways of life for Aboriginal people weaken their spiritual bond with the land and adds to the problem of cultural disruption.56 FNIRHS responses show that over one-third of respondents perceived no progress toward a renewed relationship with the land in their communities.33

6. Personal Health Practices

Lifestyle, composed of knowledge, beliefs, attitudes, and behaviours can affect an individual's risk of developing chronic health problems.

6.1 Smoking

In 1997, 62% of First Nations and Labrador Inuit individuals 15 years of age or older smoked,57 a rate that is a little over twice as high as the general Canadian population in 1996-97 (29%).58 The self- reported smoking rate in the FNIRHS was unchanged from the 1991 Aboriginal Peoples Survey.57 The ratio of Aboriginal and non-Aboriginal smokers was similar in the Northwest Territories in 1996.59 In the FNIRHS, the smoking rate decreased with age, just as it did in the 1996-97 National Population Health Survey (NPHS).58 First Nations and Labrador Inuit started to smoke as early as 6 to 8 years of age, with a rapid increase in initiation at ages 11 and 12 and a peak at age 16.57 The general Canadian population has a similar peak age at initiation.58 First Nations and Inuit smokers were more likely to suffer from a chronic condition. Furthermore, smoking rates were negatively associated with educational attainment.57

6.2 Alcohol, Substance and Solvent Abuse

Alcohol and substance abuse is considered a major problem in Aboriginal communities.59-62 In 1996-97, 46% of people in detoxification and treatment facilities in the Regina Health District were of First Nations or Métis descent.60 Information derived from addiction treatment centres, alcohol-related hospitalizations, and deaths due to violent causes (such as suicide) indicate that alcohol is the abused drug of choice and that the negative consequences of alcohol and substance abuse are more severe in indigenous Canadians.62 Aboriginal youth are at two to six times higher risk for every alcohol- related problem than their non-Aboriginal counterparts in the Canadian population. A report by the Canadian Centre on Substance Abuse and the Addiction Research Foundation of Ontario suggest that Aboriginal men may be more apt to abuse alcohol while women tend to abuse drugs alone.61 Binge drinking seems to be a pattern among Native people59,62 which has particular implications during pregnancy.

In 1996, Aboriginal people 15 years of age or older living in the Northwest Territories were almost three times more likely than non-Aboriginal residents to have used marijuana or hashish in the past year and three-and-a-half times more likely to have used LSD, speed, cocaine, crack or heroin.59 The situation in the First Nations and Inuit population does not appear to be improving. More than half of the FNIRHS respondents perceived no progress in the reduction of alcohol and drug abuse between 1995 and 1997.33

The use of solvents and non-beverage alcohol among Native children seems to be widespread.62 One in five Aboriginal youths has used solvents and one-third of users is under the age of 15. Over half began to use solvents before reaching 11 years of age.61 According to the 1996 Northwest Territories Alcohol and Drug Survey, Aboriginal people aged 15 or over were about eleven times more likely to have ever sniffed solvents or aerosols than the non-Aboriginal respondents and almost twenty-four times more likely than the rest of Canada.59

6.3 Problem Gambling

The National Council of Welfare reported in 1996 that indigenous people benefit directly from some casino operations in Saskatchewan, Ontario and Nova Scotia and that charitable gaming takes place on many reserves. It cites two Alberta studies that present a picture of gambling problems in Aboriginal people in that province. In 1995, a report by the Alberta Alcohol and Drug Abuse Commission indicated that almost half of a sample of Aboriginal students from grades 5 to 12 were problem gamblers or at risk of becoming one. The other study examined the problem in Alberta Native people 15 years of age and older in 1994. Twenty-two percent (22%) were considered problem gamblers, 40% were moderate pathological gamblers and 15% were severe pathological gamblers. Problem and pathological gamblers spent almost three times as much per month on gambling than their non-Aboriginal counterparts in Alberta. Over 40% borrowed from a spouse or relative to support their habit and over one-third used money from social assistance or Family Allowance. They also had other addictions. Seventy-three percent (73%) were currently smoking, 60% were recovering from alcohol or drug abuse, while 26% were currently abusing alcohol or drugs.63

6.4 Physical Activity

The erosion of the traditional ways of life among some Aboriginal people has resulted in the reduction or elimination of the need to fish, hunt or trap in order to survive, leading to a more sedentary lifestyle.16,64 A study in the early 1990s found that only 18.8% of Northwest Territories Inuit men between the ages of 13 and 39 and 11.6% of women between the ages of 13 and 29 were physically active. The low fitness level was attributed to acculturation,65 i.e. the social integration and contact of Aboriginals with the non-native population.

6.5 Overweight

Overweight appears to be a major health problem among Aboriginal Canadians, especially among women. A recent study found a higher prevalence of overweight among First Nations people than among Canadians from a European ancestry in Northern Ontario. Twenty-nine percent (29%) of youth between the ages of 5 and 19 and 60% of adult women were considered obese. There was a greater fat centralization among First Nations individuals,66 i.e. fat tended to be primarily distributed in the abdominal area. An earlier study of adult Cree and Ojibwa Indians in Northern Canada found a high proportion of overweight in all age and sex groups, with almost 90% of women between the ages of 45 and 54 having a body mass index of at least 26. They also found a primarily central fat distribution.17 High levels of overweight were also found in Mohawks of Kahnawake, Quebec, with 86% of diabetic subjects and 74% of non-diabetic individuals being obese (Montour, Macaulay & Adelson, 1989).67 In contrast, 19% of the general Canadian population between 20 and 64 years of age were considered overweight in 1996-97.32 Possible genetic factors, in conjunction with diet and physical activity, may explain the findings. Aboriginal people may be genetically predisposed towards overweight, as reflected by a high weight for height growth pattern in Inuit children and youth.68-69 Moreover, the tendency towards a high waist for hip circumference ratio increases the health risks associated with overweight. A review conducted in the mid-90s found that fat centralization increases the risks for coronary heart disease, stroke, diabetes, breast cancer, and gallstones. In some cases, the distribution of body fat played a stronger role than total weight in the predisposition towards various disorders.70

6.6 Dental Health

In 1991, the national total mean Decayed, Missing, Filled Teeth (DMFT) of 12-year old First Nations children was 4.4, ranging from a high of 6.2 in Quebec to a low of 2.1 in the Yukon. This represented a significant improvement over the last two decades.71 However, it was about two to three times higher than the DMFT for non-Aboriginal children in Canada72-75 Moreover, according to the FNIRHS, 22% of respondents reported experiencing dental problems or pain in the past month and about half needed dental treatment at the time of the survey. Dietary changes may have brought an increase in dental problems.76

6.7 HIV/AIDS

While the trend in the reported number of AIDS cases has shown a decline in the general Canadian population since 1994,77 the annual number of Aboriginal AIDS cases has risen dramatically. By the end of 1997, the prevalence of AIDS was estimated at 33.2 per 100,000 Aboriginal people,78 almost eleven times higher than the national rate in 1996 (3.1 per 100,000 population).46 In fact, the proportion of AIDS cases attributed to Aboriginal people has risen from 2% of all cases in Canada in 1989 to over 10% in 1996-97. The age at diagnosis was lower in Aboriginal people than in the non-Aboriginal population, with 29.8% of Aboriginal individuals diagnosed before the age of 30, compared to 18.6% of individuals from the general population. Aboriginal women were more than twice as likely to have AIDS than non-Aboriginal women (15.9% versus 7.0% of total cases, respectively). Aboriginal AIDS cases were more often attributed to injection drug use than were non- Aboriginal cases (19.0% versus 3.2% for men, 50.0% versus 17.4% for women). Aboriginal people are over-represented in groups at risk for HIV infection, such as injection drug users and prison inmates.78

7. INDIVIDUAL AND COMMUNITY COPING SKILLS

The health of a population is also influenced by the capacity and coping skills of its individuals and communities.

7.1 Suicide

Data from Eastern Canada, the Prairies, and British Columbia show that First Nations and Inuit people had a suicide rate in 1997 that was up to almost three times higher than the 1996 rate for the total Canadian population, as illustrated in Figure 8.19-22,24,26 The 1996 crude suicide rate in Northwest Territories Inuit was about six times higher than the national rate.59 Young men were the most common population group to commit suicide.19,21-22,24,59 Alcohol intoxication appeared in 33% of suicides in the Northwest Territories.59

Figure 8



7.2 Family Violence

The National Clearinghouse on Family Violence cites four studies on family violence in Aboriginal communities. The results indicate that at least three-quarters of Aboriginal women have been the victims of family violence, up to 40% of children in some northern Native communities had been physically abused by a family member and the abuse of older adults has been identified as a serious problem in some First Nations communities.79 In contrast, children in the general Canadian population represented less than one-quarter of victims of physical assaults or of all violent crimes reported to a sample of 154 police departments in 1996.80 In 1996-97, 3.6% of Registered Indian children were in the care of Child and Family Services agencies.6

7.3 Residential Schools

Over one-third (39%) of elderly respondents of the First Nations and Inuit Regional Health Survey had attended residential school, with a mean duration of 6 years and a range of 1 to 15 years. Although no statistically significant differences were found in the prevalence of specific chronic health problems between those who had attended residential schools and those who had not, after controlling for age, it is difficult to believe that the severity and duration of physical and mental abuse that has been documented112 did not result in long term physical or mental illness and/or disability. However, it is not easy to determine the long term health consequences of residential schools because of the elders' exposure to other confounding health determinants, such as socioeconomic factors, over time.8

7.4 Traditional Language and Culture

In the last century or so, ten Aboriginal languages have become extinct and at least a dozen are on the brink of extinction. As of 1996, only 3 out of Canada's 50 Aboriginal languages could be considered secure from the threat of extinction in the long run. In the same year, about one-quarter (26%) of individuals claiming an Aboriginal identity reported that an Aboriginal language was their mother tongue, an increase of almost 24% since 1981.81 Cree was the most common mother tongue, followed by Inuktitut and Ojibway.1 However, the number of people who spoke an Aboriginal language at home grew by only 6% between 1981 and 1996.81 Only 15% of the Aboriginal population reported speaking an Aboriginal language at home in 1996.1 Over one-third (39%) of elders in the FNIRHS used an Aboriginal language in their daily life, with the rate of use increasing with age to 60% in those aged 75 years and over.8 Older people were also more likely to be able to carry on a conversation in an Aboriginal language. While 29% of the Aboriginal population could converse in an Aboriginal language in 1996, the proportion was about one-quarter in youth aged 15 to 24 and one-half in those aged 55 years and over. The Inuit were also more likely to be able to speak an Aboriginal language, with almost three-quarters being able to conduct a conversation in Inuktitut.1

According to the FNIRHS, 69% of the informants for the questions on children were "very satisfied" or "satisfied" with the child's knowledge of the Native culture and were significantly more likely to be so if they spoke an Aboriginal language.43 Over 80% of all respondents of the survey thought that returning to traditional ways was a good idea for promoting community wellness. However, more than one-quarter perceived no progress in that area between 1995 and 1997. Furthermore, almost half of survey participants saw no progress in the revival of the traditional roles of women and men while close to one-third perceived no progress in the renewal of native spirituality and traditional approaches to healing. Over one-quarter did not see any progress in the return to traditional ceremonial activities, although a similar proportion of people reported good progress in this area.33

7.5 Disability and Activity Limitations

According to the FNIRHS, one-third of First Nations and Labrador Inuit respondents aged 55 years and older had hearing problems, one-quarter experienced limitation in activities within the home and one-eighth were unable to leave home and needed personal care in the home.8 In contrast, a little over one-third of seniors from the general population who were at least 65 years of age reported needing help with basic or instrumental activities of daily living in 1996.58 The National Advisory Council on Aging recently reported that older Aboriginals generally experience a disability for more than twice as long as non-Aboriginals.82 In the FNIRHS, chronic conditions were associated with activity limitations, regardless of age or gender. Twenty-four percent (24%) of respondents with hypertension, 28% with diabetes, 33% with arthritis, 36% with heart problems, and 38% with cancer reported activity limitations. Fifteen percent (15%) of the survey participants had hearing problem in 1997,11 almost three times higher than the rate in Canadians aged 15 and over in 1991 (5.5%).83 Access to specialized care and housing facilities designed to provide care for people with activity limitations and disabilities may be a problem in First Nations and Inuit communities, as 30% of the FNIRHS respondents with limitations lived in an isolated community while another 13% resided in a community with no year-round road access.11

8. HEALTHY CHILD DEVELOPMENT

Experiences in the prenatal environment as well as in early childhood can have long-term effects on the health of a population.

8.1 Infant Mortality

Data from Eastern and Central Canada, the Prairies and British Columbia indicate that from 1995 to 1997, the infant mortality rate in First Nations was up to 3.5 times higher than the 1996 national rate.19-22,24,84,85 The 1997 neonatal death rate was up to 2 times higher, while the post-neonatal mortality rate was up to almost five times higher in First Nations than in the general Canadian population in 1995.19-22,24,84,86

8.2 Birth Weight

Data from Eastern Canada, the Prairies and the Western provinces indicate that in 1996-97, First Nations infants with low birth weight (less than 2,500 grams) accounted for about 3% to 7% of live births, which is similar to the national rate of about 6% in 1996. On the other hand, about 15% to 23% of First Nations babies had high birth weights (over 4,000 grams).19-24,85 The FNIRHS shows similar findings. First Nations and Inuit babies had low birth weight proportions similar to infants in the 1994-95 National Longitudinal Survey of Children and Youth, but significantly higher proportions of high birth weights. Twenty-two percent (22%) of First Nations and Inuit male infants and 14% of female infants weighed more than 4,000 grams at birth, compared to 16% and 8% of male and female babies, respectively, in the general Canadian population.43-44 High birth weight is associated with gestational diabetes, maternal overweight and prolonged gestation87 and can lead to adverse health consequences. MacMillan et al. report increased neonatal mortality rates, a higher incidence of birth injuries and intellectual and development problems in high birth weight babies.88

8.3 Teenage Pregnancy

Data from the Atlantic provinces, the Prairies and British Columbia show 1997 teenage pregnancy rates in First Nations that were up to four times higher than the 1995 national rate. The rate in younger First Nations adolescent girls (under the age of 15) was especially high, particularly on reserve, where it was about eighteen times higher than in the general Canadian population (11.0 per 1,000 live births, versus 0.6, respectively).19,21-22,24,86

8.4 Smoking During Pregnancy

A recent study of Saskatoon pregnant women found that health risk behaviours during early pregnancy were more prevalent among women with an Aboriginal or Métis background. The risk behaviours (alcohol intake, tobacco use, the use of psychoactive drugs, caffeine intake) were also more frequent in women with lower education and income levels, those not living with a partner, those who had previous births, and in some cases, younger women.89 An earlier study found that smoking, caffeine intake and binge drinking were the most prevalent in Inuit and Indian pregnant women, compared to white women and those with a mixed race. Moreover, smoking was significantly associated with low birth weight and a shorter body length of the newborn.90

8.5 FAS/FAE

The incidence of Fetal Alcohol Syndrome (FAS) appears to be much higher in some Aboriginal communities than in other parts of Canada.91-92 A recent study of a First Nations reserve in Manitoba found that 1 in 10 children was the victim of FAS or FAE (Fetal Alcohol Effects), or roughly 100 cases per 1,000 births on the reserve.93 In contrast, the rate of FAS in western countries is about 0.33 cases per 1,000 births, as reported by McKenzie.91 Alcohol intake, especially binge drinking, during pregnancy seems to be more common in Aboriginal women.89-90 Furthermore, a study which found a higher frequency of alcohol use and abuse in Inuit and Indian pregnant women also found a significant association between alcohol intake, especially binge drinking, and a lower head circumference.90

8.6 Breast-feeding

According to the First Nations and Inuit Regional Health Survey, 54% of children up to 2 years of age had been breast-fed, compared to 75% of children in the 1994-95 NLSCY. However, of the First Nations and Inuit children who had been breast-fed, 39% had been breast-fed for over six months, compared to only 24% of the children in the NLSCY.43-44

8.7 Childhood Health Problems

Children from First Nations and Labrador Inuit communities and from the general Canadian population were rated similarly in terms of overall health status in 1997 and 1994-95, respectively. However, although the order of frequency of health problems was about the same, First Nations and Inuit children had approximately twice the rate of bronchitis, more kidney conditions and heart problems, slightly more psychological difficulties and asthma, but somewhat fewer allergies. Ear problems was the most common health problem mentioned in both surveys.43-44

8.8 Immunization

With the exception of Haemophilus influenzae type b (Hib) data from the Atlantic provinces, Ontario, the Prairies and Western Canada show lower vaccination coverage of two-year-olds from on reserve First Nations communities than in the rest of Canada in 1997. 19,21-23,73,94-95 Furthermore, the coverage levels are generally well below the national immunization targets set for two-year-olds and six-year- olds.19,21-23,73,94,96 However, part of the explanation for these lower vaccination coverage levels may be related to a number of on reserve children who are immunized off reserve.

Table III - Vaccination Coverage of Two-Year-Olds, 1997

Vaccine Canada On Reserve First Nations General National Target
Atlantic Ontario (0-2 years)† Manitoba Saskatchewan Alberta Pacific
Diphtheria 87% 67% 59% 81% 55% 49% 83% 97%
Pertussis 85% 95%
Tetanus 85% 97%
Hib 74% 93% 84% 77% 79% 81% 97%
Polio 86% 67% N/A 81% 59% 72% 83% 97%
Measles 96% 82% 82% 90% 85% 81% 87% 97%
Mumps 96% 97%
Rubella 96% 97%
BCG‡ - 0%* 0-92%** 85% 47% >50%*** 65%§ -

† The collection of immunization data in Ontario has been sporadic and uncoordinated. Furthermore, since most on reserve residents are immunized off reserve, the collection of dates and antigens is incomplete. The data presented here are derived from the average of the four zones/areas in the Ontario region of Medical Services Branch.
‡ The Bacille Calmette-Guérin (BCG) vaccine is administered in Native people because they are considered at high risk of exposure to tuberculosis.97
*BCG is not given in the Atlantic region
**Southern Ontario does not use BCG, mid-Ontario has sporadic use, about 1/3 of Northeastern residents are vaccinated, while at least 85% of Northwestern residents have had BCG.***
In one-year-olds.
§BCG optional offered only. Sources: LCDC (1998; 1997), Ontario MSB Regional Office, Manitoba MSB Regional Office, Saskatchewan MSB Regional Office; Atlantic MSB Regional Office, Alberta MSB Regional Office, Pacific MSB Regional Office.

9. HEALTH SERVICES

Health services play a role in the treatment of illness and in the care of the sick. Accessibility, satisfaction, utilization, and expenditures are important components of health services.

9.1 Unmet Health Care Needs

Almost half of First Nations and Labrador Inuit respondents of the FNIRHS thought that their health services were not at the same level as the rest of Canada. Although the great majority thought that a return to traditional ways was a good idea to promote community wellness, over one-third perceived no progress in at least four of the traditional items specifically measured in the survey.33 Although the 1996-97 NPHS did not measure the same things, it is interesting to note that only about one in twenty respondents felt that they needed health care but did not receive it.32

9.2 Physician Utilization

Data from the Prairies indicate that the main reasons First Nations people consulted a physician in 1996-97 were related to diseases of the respiratory system, followed by injuries and poisonings21,22,23. Respiratory system ailments were the leading reasons for the use of medical services in all age groups, except in those aged 65 and over for whom diseases of the circulatory system were the principal reason for physician consultation. Disorders of the nervous system were also common reasons for the use of medical services in children up to the age of 14.21-22 This may reflect the relatively high prevalence of ear problems and the effects of exposure to alcohol and environmental contaminants in utero.

9.3 Dental Utilization

In 1997-98, over one-third (38%) of clients of Non-Insured Health Benefits (NIHB, Medical Services Branch) received at least one dental service, a rate unchanged from 1994-95. The highest rate was in Quebec at 46% while the lowest was in Manitoba at 29%. Over 44% of all dental claimants were under 20 years of age. Recall examination was the most common dental procedure.98 According to the 1997 First Nations and Inuit Regional Health Survey, about half of the respondents had received dental care in the past year.76 In contrast, almost one- quarter of the 1996-97 NPHS respondents reported a consultation to a dentist or orthodontist.32 However, only 53% of the survey respondents had dental insurance. Over half of those without dental insurance had not seen a dentist in the year before the survey, versus over one-quarter of those with insurance.58 About one-third of First Nations and Labrador Inuit had not received dental care in the previous year.76 The underuse of dental services, in conjunction with a non- Aboriginal diet and inadequate access to fluoridated water supplies, may explain the high prevalence of dental caries in Native children.

9.4 Hospitalization Rate

Data from the Prairies indicate that First Nations had a hospitalization rate that was about two-and-a- half times higher than the general Canadian population in 1996-97.21-22,99 Diseases of the respiratory system were the leading causes of hospitalization in First Nations patients, followed by injuries and poisonings and diseases of the digestive system.21-22 In contrast, the principal causes of hospitalization in the general Canadian population were related to diseases of the circulatory system.

The second and third main causes were diseases of the digestive system and the respiratory system, respectively. Injuries and poisonings represented the fourth leading causes of hospitalization in Canadian male patients.99

9.5 Pharmacy Utilization

In 1996, NIHB clients in the Western provinces had a utilization rate of 991 prescriptions of acetaminophen with codeine per 1,000 people and 656 benzodiazepine prescriptions per 1,000 people, almost 4 times and 1.5 times higher, respectively, than the rates in the Canadian population, but somewhat lower than the utilization rates in recipients of B.C. Social Assistance.100 In 1997-98, central nervous system agents, which include analgesics, antidepressants and sedatives, were the highest category of drug claims, representing 33.7% of prescription claims and 24.8% of over-the- counter claims. In that same year, over two-thirds (69%) of NIHB clients received at least one pharmacy benefit, a rate that has changed little since 1994-95. The highest utilization rate was in Alberta at 83% while the lowest was in the Northwest Territories at 44%, well below the rest of the country.98

9.6 Per Capita Health Care Expenditures

In 1997-98, the national per capita expenditure for all benefits (mainly pharmaceutical, dental, optical and medical transportation services) in NIHB clients totalled $754, with a range of $1,031 in Alberta to a low of $612 in the Yukon.98 A comparable measure in the general population relates to expenses in the private sector, which primarily includes drugs, dental services and vision care. These items are mostly paid out-of-pocket or through private insurance plans.101 The national per capita expenditure in NIHB clients was similar to the per capita private sector health expenditure in the general Canadian population ($792 in 1998). However, the highest and lowest per capita health expenditure were roughly $130 lower in non-NIHB clients ($902 in Ontario and $472 in the Northwest Territories).98,101

10. FIRST NATION AND INUIT CONTROL

10.1 Transfer Agreements

First Nations and Inuit people have worked to gain more self-determination over all areas of their lives for a long time. As a result, community-based health programs are gradually being transferred to First Nations and Inuit control, as decided by each individual Aboriginal community. Environmental health, treatment, and prevention health services, as well as the appropriate Medical Services Branch programs have been or will be transferred. First Nations and Inuit communities which do not want a comprehensive transfer of health services may opt to enter into a more limited Integrated Community-Based Health Contribution Agreement, in which they sign a contribution agreement for all or most of the community health services while setting up their own management structures to directly administer the transferred programs and services.102

As of March 1998, 74% of First Nations communities were involved, at some level, in the transfer of health programs and services. Of these, 31% had signed Transfer Agreements, another 31% were engaged in pre-transfer negotiations and 12% had signed Integrated Community-Based Health Contribution Agreements.102 According to the FNIRHS, 75% of respondents in communities that had completed the health transfer perceived progress in First Nations and Inuit control of programs, 25% of whom saw good progress. In contrast, 72% of respondents in communities that were not engaged in the transfer process perceived progress, 19% reporting good progress. Although the differences were small, they were found to be statistically significant.33

10.2 Aboriginal Health Professionals

In 1997-98, there were almost 2,000 Aboriginal health workers, including nurses, physicians, lab technicians, dentists, optometrists, pharmacists, and health administrators. There were approximately 800 nurses of Aboriginal ancestry103 and in 1997, there were 67 Aboriginal physicians in the country and 33 Aboriginal students enrolled in Canadian medical schools.104 Aboriginal nurses and physicians accounted for less than 1% of all Canadian registered nurses and physicians.105 The responses to the FNIRHS demonstrate that gap with over 40% of the survey participants perceiving no progress in the number or availability of First Nations and Inuit health professionals between 1995 and 1997.33

10.3 Training and Capacity Building

Training and capacity building is part of the transfer of control of health programs and policy to First Nations and the Inuit. Medical Services Branch has various programs to encourage First Nations and the Inuit to pursue post-secondary programs that lead to health careers, such as the dental profession, nursing, environmental health, and health administration. Since 1984, almost 700 bursaries or scholarships (113 in 1997-98) were awarded to First Nations and Inuit students.103 The Department of Indian Affairs and Northern Development provides funding support to the Saskatchewan Indian Federated College which is entirely governed by First Nations people and which offers a Health Studies Program and a Dental Therapy Program.37 A recent survey of all family medicine programs in Canada revealed that although many programs give residents some exposure to Aboriginal health issues, none had formalized curriculum objectives or a strategy to encourage the enrollment of residents of Aboriginal origin.106 According to the FNIRHS, almost one-third of the respondents saw no progress in the training of First Nations and Inuit people in the health field between 1995 and 1997.33

11. CONCLUSION

Despite improvements in many areas, First Nations and Inuit people continue to have a poorer health status than the general Canadian population. This discrepancy in health is, in part, due to the widespread inequities the Aboriginal population faces in the opportunities for health, notably in socioeconomic conditions. Any effort to improve the situation of the Native people need to respect and take into account its cultural beliefs and values and traditional views of the world and offer flexibility in the design and development of programs and services. First Nations and Inuit communities need to be empowered to identify and address their own needs through such means as capacity building, training, and technical and funding support. Although health promotion and disease prevention programs can help some First Nations and Inuit individuals achieve better health, healthy public policies from various sectors need to be developed with the input of Aboriginal communities.

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“I found this quote to be the most telling....

"high-fat diet have been found to play a role in the onset of diabetes in the Ojibway and Cree living in that small community.16 Body mass index was found to be an independent and significant predictor of diabetes17 and a very low fiber intake was associated with newly diagnosed diabetes."

So high fat low fiber (which is not found in meat or fat but foods that are carbohydrates) isnt good for Inuits either...”

“I would bet that the bodies of those living in extremes like the Inuit have adapted to the dietary condition which they live in. In other words, their bodies probably have adapted to a low-carb, high-protien, high-fat diet the same way their bodies have adapted to the cold by becoming shorter and stockier.

You couldn't take the body of someone who was say, descended from Northern Europeans, give it the same diet, and expect it to react the same way, because Northern Europeans ate a lot more carbs. Hell, in the middle ages, often the poorer classes subsisted on nothing but bread during the winter.”

“ask.com rules!”

“bit, please read the above data... It seems the Inuit have adapted by getting heartdisease and diabtetes.”

“Well sure, but really, if you break it down, nature is only interested in getting you old enough to procreate. Once you're too old to have kids, nature doesn't give a damn.

What happens to a Northern European if you eliminate all carbs from their diets? There's a good possibility that they die.

My mom got really sick on the Atkins diet when I was a kid. I'm leaving that fool's advice alone.”

“Bit, my point is that regardless of where you live and the adaptations your body makes we are all still homo-sapiens and still function essentially the same. Though we can survive in the arctic or desert its not ideal and we sacrifce health and longevity for it. The same can be said for eating a scientifically unproven diet. I just dont see the benefits outweighing the risks.”

“My point is that because of adaptation, our bodies don't react the same. Different people's bodies react differently to the diet which we are given. That's why there are some people who can eat junk food and never exercise or diet and don't gain weight, and other people who starve themselves and never lose a pound.

These cookie-cutter diets that pretend that all people's bodies are the same are idiotic.

Here's one diet that will work: Eat less and exercise more. If you burn more calories in a day than you take in, it has to come from somewhere, and eventually it will come from your fat stores, regardless of your genetics.”

“I agree with you hundred percent about excercising more and eating less. I also agree that atkins is not a healthy choice.

"These cookie-cutter diets that pretend that all people's bodies are the same are idiotic." I am not sure if you are referring to atkins or what.

I think we are actually on the same sheet of music.

I mention the Inuit in response to phaedrus example of them eating a low carb diet.”

“eventually it will come from your fat stores, but there's a more precise way of doing it. why not start with your fat stores? why go through a period where you're losing weight from other areas? after all, your fat stores are what you're after.”

“My mother was in Weight-watchers. They told her class to weigh themselves in the morning, becuase, we weigh less in the morning.”

“My point is that because of adaptation, our bodies don't react the same. Different people's bodies react differently to the diet which we are given. That's why there are some people who can eat junk food and never exercise or diet and don't gain weight, and other people who starve themselves and never lose a pound.


These people may not gain but this doesnt translate into health. You can be rail thin with heart disease and diabetes caused by poor nutrition. Your body will operate with what its given.I am talking about treating the body as best as one can since we are fortunate enough to have healthy choices. I am not subscribing to any "diet" rather I am stressing the importance of all the years/decades into health research that groups like the AMA have done. They dont just come up with food guidelines willy-nilly.”

“Referring to atkins and south beach and any fad diet that gives you some sort of "easy way" to lose weight.”

“"Referring to atkins and south beach and any fad diet that gives you some sort of "easy way" to lose weight."


Truer words were never spoken!”

“I really wish you had just posted a link to all that, Birch. Jeeez.

The statistics in themselves mean little to me without something to compare them to, and knowing the diet of the people they were studying. It seems that these were not people living in the traditional manner, and may not, therefore, have been eating the traditional diet.

I say this because, in skimming the vast information above, there is a statistic regarding the percentage of women breastfeeding their children, and it ain't 100%

:)

Also, the study of the high fat diet may leave out the fact that they are also eating a number of highly processed carbohydrates, and it is the premise of many low-carb diets that the carbohydrates in combination with the fats are the problem, not the fats by themselves.

More research needs to be done, no doubt, but intuitively, for me, it makes sense that a low-carb diet can be as healthy as a low-fat diet.”

“http://nutrition.about.com/library/weekly/aa110799.htm

http://images.amuniversal.com/ups/features/coxpages/weekly/healthyliving/heal030602c_web.pdf
(Study of low carb diets... Halfway down first page)

http://www.weightloss.ms/Article52.phtml

There's plenty of evidence for both sides of this discussion. Let's see what the future research turns up.”

“Phaedrus, I woulda posted a link but had trouble getting the URL since my search was done through ask.com. The URL came up as gibberish. My apologies.

Atkins has been around since the 60's I doubt any new breakthroughs in the world of low carbs will show up be we shall see.

I would ask though,why try a "diet" that may someday be shown to be healthy when current research shows adverese side effects (especially for women) like decreased calcium level (up to 65%). It seems awful risky, but hey I am electrician so go figure.”

“I read the first "link" and would say it was right down the middle with a lean away from "atkins" style eating. I noticed something that I think is very valuable which was stressing the importance of quality carbs like whole grains etc...Perhaps I should have mentioned that when I speak of carbs I am not talking aboout candy, "powerbars" and processed foods.I was referring to stuff like rice,potatoes,pasta,whole grains.

I geuss I will err on the side of the majority of the medical community.”

“Yeah, we all make our own choices. I've found, personally, that low-carb diets reduce my appetite to the point where eating is a chore. My stomach shrinks, and after that I can go back to eating a normal diet (just much less of what I was eating previously), and still lose weight. All this comes with my normal amount of exercise.

When I was a manager in Albuquerque, and spent an average of 11 hours a day, six days a week at work, plus incessant on-call interrruptions, I gained close to forty pounds. I lost them in that manner, after trying a number of things. It was comfortable, and I'm pretty sure any risk to my health was less than the forty pounds was causing.

As of now, my weight fluctuates in a range of fifteen pounds, and my low-carb stints are kept to about a week or two, maybe once a year.

It works for me, and others I know, and I'm convinced there's a scientific reason behind it.

BTW, a good deal of the current research was influenced by the sugar lobby. link.

And one additional "by the way", my doctor recommended this diet for me when I started it. That was before I left Albuquerque. My current doctor said he would not recommend it.”

“As for the overall question of the thread, all I can say when I look in a mirror is I darn well better lose weight in 2004, or I'm in trouble. Between diet changes and exercise, I'd lost 28 pounds before my heel pain stopped my hiking and I gained it back (okay, I relapsed on the food, too). With that pain appearing to be gone finally, I have to get rid of those pounds again.”

“Okay, so I am on this stupid diet and I don't lose any weight... exercise and all.

Yesterday I went to the store and bought me the little paperback book by Phil McGraw. I don't like the dude, but after reading it in the store for 30 minutes I thought it was worth it. Walmart has it for only $5.99.

The stuff actually makes sense so I am going to try it. He also has great ideas and easy receipes in it.

I don't think I'll buy the hardcover book, the one that goes into details. This one is good enough for me. It's called "the ultimate weight solution food guide".

i like the list he as on there that tells you how much weight you gain in one year if you exchange your hamburger for a bic mac twice a week... etc...

anyway, the guy gets on my nervs on tv, but the book is really good. Now i just wish his face would not be on the cover.”

“Rice has been a staple in Asia for centuries and how many fat Chinese farmers do you ever see.


OK, someone give me the "skinny" on plain old white rice, potatoes and pasta. Good carbs? Bad carbs? Whole weat bread? Help!!


Signed, the girl who lost 1.5 lbs last week. :)”

“Gem, you're so tiny I can't even imagine why you're on any kind of diet.

I have been on the Atkins diet since last April. I lost 40 lbs. (down from 225 to my fightin' weight of 185). I get my serum lipids/cholesterol checked 2X/year and everything checked out OK. My cholesterol had been borderline high (220) before I went on the diet. It is now 175, which is exceptional for a person in my age group. Atkins has certainly worked for me.”

“FG, I knew someone would make that comment sooner or later....but you have to understand, I gained like 10 lbs because I stopped smoking. I am thinking I rather get rid of it now then later on having to get rid of 30 lbs. I just don't feel good with those extra lbs... it sucks big time. :(

I want to be poor muscle. I lean mean machine lol (okay..so now I am going crazy...)”

“Gem, just substitute screwin' for smokin'. A hot, passionate boffing will burn 150 calories/hour. You'll get rid of the excess weight, feel better and your husband will go out of his mind...”

“lol...I would be screwing (that's how you called it right??) all day long. not possible... even hubby prolly wished it would be possible.”

“Now it takes me all night to do what I used to do all night...I'm not as good as I once was, but I'm still as good once as I ever was...


LOL!!!”

“Sign me up for the weight loss team. I am in my usual cycle of gaining for the holidays, (yum, yum), and now I am going to work it off by running and walking. I'll do a little lifting, but I don't enjoy weights all that much.
Keep on rocking, you weight-losing TT'ers!”

“Dun, just a word about lifting weights. You don't have to lift like Schwartzenegger to benefit. Just lift what you can handle comfortably. It is a clinically proven fact that weight training increases bone density and that it can arrest and even reverse the effects of osteoporosis. Plus, people with higher muscle mass have a higher metabolism.”

“Yeah, you are so right, FG. I do this routine every year. The weights are a good way to burn calories without having to dedicate a lot of time to exercise. I'm addicted to walking and running, though.”

“Aerobic excercise is most important...unfortunately, I have had to give up jogging (again) because my knees just can't take the strain. Now I go for a 5-mile power hike 4-5 days a week on the Huntsville Land Trust at Monte Saneo. Seems to work as well...”

“I've done ok with my exersize, and a little better with eating, but the NFL playoffs really interfered this weekend.”

“My sleeping potion must be kicking in, my spelling ain't worth a crap, LOL!

Beddy-bye time...”

“I feel off the wagon this weekend. :(

Never ever had a BBQ party 5 days into a new diet.

treebeard did good, but I guess I have no self control. So here I sit feeling guilty as hell...

But im getting right back on it!”

“smiley, the foods you listed are fine. They key with carbohydrates is their glycemic index.High glycemic foods release energy quickly and are best eaten while excercising (hiking for example)and for snacks immediately following excercise (for recovery). Low glycemic foods are best eaten with meals as they release their energy slowly to provide energy and the feeling of fullness longer.

Some examples (the nearer to 100 the higher the glycemic index)
HIGH
Glucose 100
gatorade 91
potato,baked 85
corn flakes 84
rice cakes 82
potato,microwaved 82
jelly beans 80
vanilla wafers 77
cheerios 74
cream of wheat 74
graham crackers 74
honey 73
watermelon 72
bagel,white 72
bread,white 70
bread,whole wheat 69
shredded wheat 69
mars bar 68
grape nuts 67
stoned wheat thins 67
couscous 65
table sugar,sucrose 65
raisins 64
oatmeal 61
ice cream 61

MODERATE
bran muffin 60
bran chex 58
OJ 57
potato boiled 56
rice,long grain 56
rice,brown 56
popcorn 55
corn 55
sweet potato 54
banana overripe 52
peas,green 48
bulgur 48
baked beans 48
lentil soup 44
orange 43
all bran cereal 42
spaghetti (no sauce) 41
pumpernickel bread 41
apple juice unsweetened 41

LOW
Apple 36
pear 36
powerbar 30-35
choc milk 34
fruit yogurt,low fat 33
chick peas 33
P R bar 33
lima beans 32
split peas,yellow 32
white milk,skim 32
apricots,dried 31
green beans 30
banana,underripe 30
lentils 29
kidney beans 27
milk,whole 27
barley 25
grapefruit 25
fructose 23

Not a complete list but helpful.

Interms of good VS bad carbs. Bad would probably be highly processed or high sugar foods, Whereas good would be whole grains,rice,pasta,potaoes. Eating foods as near to a natural state is beneficial since processing changes them so much. Even with "added vitamins and minerals" I have read that the nutrients are more readily available in their natural form.”

“"As of now, my weight fluctuates in a range of fifteen pounds, and my low-carb stints are kept to about a week or two, maybe once a year."


Phaedrus, if a low carb diet is so effective why do you need to use it yearly to gain control. It would seem a balanced diet through the year would prevent the 15lb fluctuation you mentioned.”

“I just thought of another thing that was worth mentioning. Proper serving sizes. I would bet that most folks could shed their unwated pounds by simply eating the proper serving sizes. 3oz of meat is the recommended portion which is about the size od a deck of cards. The smallest steak I have seen at a restaurant is a "petite 6oz sirloin".”

“Birch, I'm learning what "full" feels like, since I genreally go from starving to stuffed. I think smaller portions, and less snacking on junk stuff is the key. At least it worked the 1st week! I'm paying less attention to the actual fat content than I am the carbs, but tring to keep everytying in moderation. I know this will take longer, and I hope I've got the willpower to change my eating habits and stick with it.”

“Phaedrus, if a low carb diet is so effective why do you need to use it yearly to gain control. It would seem a balanced diet through the year would prevent the 15lb fluctuation you mentioned."

Well yeah! Any diet, if I stuck to it, should. I tend to gain weight around the holidays and lose it before february. Again, there is evidence on both sides, and I'm not advcating low-carb for everyone. It works for me, though.”

“Okay, I'm starting a week late...I'm going to the gym in a few minutes for workout number one of the day (cardio). I'll post my weight when I get back.”

“Well one week on the Southbeach diet and I am down 10lbs! Man I can tuck in my shirts again. The books says that this diet gets belly fat first, and that is where my fat is.
Most important is that i feel good and the foods are easy to eat. Luch was a chicken breast with all of the broccoli that I wanted to eat,”

“10 lbs in a week? THat doesn't sound too healthy! But hey, I'd love to lose 10 lbs in a week!”

“Normal portion size, exersize and cutting out junk food would largely solve my problem.”

“The first 2 weeks of the South beach diet is a jump start program. After that you double the amount of carbs that you eat. The book says that it is normal to see a large initial weight lose.
I am a carboholic so the elimination of carbs makes a big difference to me.”