I've tried all sorts of slimming diets and nothing seems to work -what can I do now?

Trying a slimming diet is not the right way of tackling weight reduction - it is a lifestyle change that is needed. If you cannot do it on your own, don't give up. Join one of the groups such as Weight Watchers and attend regularly. Remember why you need to lose weight: your blood pressure will benefit and you will reduce your chances of a stroke or heart attack.

Is it safe for heart patients to try the Atkins diet?

he Atkins diet is high fat, high protein and low carbohydrate. The theory is that when we eat carbohydrates and sugar the body responds by making insulin to burn them off. Too much intake equals too much insulin and then too much fat is stored and therefore we gain weight. In the short term it works for many people but there is a tendency towards constipation and bad breath. Heart patients with high cholesterol levels are usually protected by statins but control can be lost. My view is that if there is significant weight loss, this is good in the short term - say 2-3 months - but for long-term protection a switch should be made to the Mediterranean Diet, which is proven to cut the risks of a heart attack and is the programme described in this chapter.

We have a local Weightwatchers group in our area. Are slimming groups any good?

Any group like this can be helpful because of the supportive role and the sensible advice they offer. They reinforce the following basic rules.

• Eat less fat and sugar.

• Avoid nibbles.

• Do not miss meals.

• Eat more fruit and vegetables.

• Fill up on low-fat high fibre foods.

• Take regular dynamic exercise, e.g. walking, cycling, swimming - any strong movement exercise.

You have mentioned before that Asians have a higher incidence of coronary disease and diabetes - what dietary changes can they make?

It is true that Asians in particular are vulnerable to coronary disease and diabetes, and have a tendency to abdominal obesity. Try the following tips.

• Fried foods should be avoided.

• Eat low-fat yoghurt, semi-skimmed or skimmed milk and reduced fat cheeses instead of full-fat versions.

• Try casseroling, boiling, grilling, steaming, poaching or microwave cooking instead of adding fat or oil. Some vegetables, such as fenugreek (methi), aubergines and karelas, soak up more oil in during cooking.

• Try to make minced meat dishes and dhals without fat and avoid using oil in the cooking.

• Remove visible fat from meats.

• Do not spread fat on chapattis and do not add oil or ghee to the chapatti dough.

• Reduce deep fried snacks, e.g. chevdon, sev, samosas, puris, pakoras and chips.

• Switch from creamy salad dressing to low-fat yoghurt based dressing.

There is an excellent information sheet on this website: heartuk.org.uk (number 03).

We have a full social life and I am often out during the week at business lunches. How can I avoid fatty foods when I am out?

If you are going to family or friends, tell your host that you have been told to lose weight and what you need to do about it. They will understand and because they will now know that you don't eat fatty foods or sweet desserts, any embarrassment will be avoided. The following tips apply to eating in restaurants.

• Avoid the cocktails (tomato juice and mineral water are just as fashionable these days).

• Avoid fried appetisers or cream soups - select minestrone or gazpacho soups.

• Choose a fresh fruit starter such as melon.

• Look for the grilled fish or poultry and ask for any sauces to be left off.

• Grilled Dover sole and a salad are a good standby

• Remove the skin from poultry and don't eat fatty meat.

• Take a salad with vinegar and oil instead of mayonnaise.

• At a salad bar, avoid cream dressings, cheese, olives, bacon bits and croutons.

• Have fresh vegetables such as spinach or carrots. Ask for sauces or butter to be left off vegetables or put 'on the side'.

• Order baked or boiled new potatoes in their skins.

- At Oriental restaurants, have a stir-fry of chicken or fish and vegetables. Steamed rice is better than fried. Resist sweet 'n sour dishes and banana or apple fritters.

• In Italian restaurants, avoid creamy sauces.

• In Indian restaurants, have plain tandoori or tikka with a salad and steamed or boiled rice, rather than those dishes which come in thick sauces. Indian cooking involves a lot of fat and sometimes coconut so, in general, menu options should be very carefully selected. Ask if you are not sure how certain dishes are cooked.

• Dessert can be fresh fruit or sorbet - try to avoid cream.

• Enjoy a glass of wine and perhaps finish with black coffee (decaffeinated if you are prone to palpitations - see Chapter 6).

Some restaurants now have items marked as being low in fat. Airlines also often offer this when meal options are presented.

If you are the host, you can choose the restaurant. If you are a regular at a particular restaurant, tell the owner about your preferences so that you will be able to eat without drawing attention to any question mark over your health.

 
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