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    The socio-cultural macro environment represents the values, expectations and attitudes of the wider social environment. Community attitudes to convenience foods and leisure saving technologies are examples. A hedonistic and materialistic atmosphere where moderation is considered unfashionable is common in many sectors of Western societies. Where this is coupled with easy access to palatable, high-fat foods and reduced necessity for energy expenditure, obesity levels are likely to increase. In Australia, an advertising expenditure of $1 million per day on food stuffs, confectionery and soft drinks is combatted by an equivalent amount per year spent on public health education, some of which is presumably aimed at eating for reduced body fatness.

    With increased affluence there is also an increased opportunity for over-indulgence through the social processes of dining out, business lunches, social festivities and celebrations. There are also cultural and ethnic differences in food preferences and exercise availability: European-style food is usually higher in fat, for example, than Asian foods; some foods, such as pork, have traditionally held a higher social status than vegetables or fruit in different cultures; opportunities for exercise are reduced for some ethnic and religious groups such as Middle Eastern and Muslim women.

    Male attitudes to health are known to differ from those of females. Men have typically been less responsive to health messages, attend doctors less often, but suffer more from most forms of illness than women. This has been attributed to social and attitudinal differences between the sexes—men feel more isolated and vulnerable if they admit any concern about their health. Overcoming these attitudes is a major obstacle to providing acceptable fat loss programs for men. Cultural attitudes in some ethnic groups also mean that partner support for fat loss practices, particularly by males for females, is low or non-existent.

    Social attitudes to physical activity can influence participation. Increased interest in jogging in the 1970s for example, followed by aerobics and then weight training in the 1980s, formed the pattern of a social ‘trend’. It is doubtful, however, if these have compensated for the decreases in physical activity that have occurred at the workplace or the decreases in other ‘incidental’ activity in day-to-day life. Multi-event sports like triathlons have become popular, but this is usually only amongst the very fit. Fun runs and community activities, however, have the potential to attract large numbers of people who may otherwise remain inactive. Socially acceptable forms of activity differ according to ethnic group, nationality, age and gender. Being fat carries a negative status, but more so for women, and being inactive also carries a negative status, but more so for men.

    The influence of the socio-cultural macro environment has been particularly noticeable in countries like the UK and the Netherlands. The overall nutrient intake in the food in both countries is similar, but the obesity rate in Britain is increasing at a much greater rate than in Holland. According to Dr Wim Saris, from the University of Limburg, this might be put down simply to the fact that only 3 per cent of British transport involves the bicycle, whereas the equivalent figure is over 30 per cent in the Netherlands.

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    Although fat moves continuously through the fat cycle, at times lipogenesis dominates and at other times lipolysis dominates. The overwhelming factor influencing the balance is the state of feeding, with fasting favouring lipolysis and feeding favouring lipogenesis, as already discussed. These directly correspond to the demand for fat as fuel.

    Another condition which favours lipolysis is stress, either physical or psychological, such as exercise or a fearful situation. Adrenalin causes an increase in lipolysis with FFAs being released into the bloodstream anticipating a demand for fat as fuel. If the situation passes without the need to use the extra energy, such as with exercise, the fat returns from the fat cycle back to the fat cell In other words, an increase in lipolysis does not always correspond to an increase in fat utilisation for energy.

    A number of other factors can influence the balance of lipolysis and lipogenesis. A large fat mass tends to increase the amount of lipolysis and thus the amount of FFAs available for energy needs. Insulin, catecholamines, Cortisol and sex hormone levels can also alter the balance. Fat cells in the hips, buttocks and breast are more responsive to female hormones than the fat cells on the abdomen, which are more prolific in men.

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    Pete Falk never sets foot in a grocery store without a plan—a menu plan, that is. Writing down exactly what he needs to prepare each week’s meals keeps him away from all of the high-fat, high-calorie temptations that line supermarket aisles. It’s the key to how he lost 63 pounds.

    Pete, a 35-year-old computer engineer from Denver, got in the menu-plan habit while attending a medical clinic specializing in weight loss. At the time, he weighed 257 pounds, too much even for his 6-foot-1 frame. “I had been heavy since I was a kid,” he explains. “I wanted to slim down, and I had tried numerous times on my own. I didn’t get really motivated until my allergies and asthma started getting worse. Then I knew that I needed help.”

    At the clinic, Pete went on a physician-supervised eating plan for the first couple of months. Then, he worked with the doctor and a nutritionist, learning how to make smart food choices on his own. “They gave me sample menus, which I took to the supermarket with me so I’d know what to buy,” he says. “Eventually, I realized that by sticking with the menus, I was filling my cart with healthy foods, not the junk that helped me gain in the first place.”

    The menus encouraged Pete to make other healthful changes in his eating habits. He stopped skipping breakfast, he started packing his lunch on workdays, and he tried to have dinner at about the same time every evening. “Because of my job, I had been eating really late some nights—around 10 o’clock,” he says. “I was so hungry by then that I’d stuff myself.”

    As Pete’s eating habits improved, his waistline shrank. He joined a local gym, where he worked out 6 days a week. Within 4 months he was 63 pounds lighter.

    That was more than 2 years ago. Pete has since started lifting weights, which has added some bulk—all muscle—to his physique. He’s holding steady at a fit 200 pounds.

    While exercising regularly has helped Pete get in shape, eating healthfully has kept him trim. These days, he writes his own menus, but he still takes them to the grocery store. “My menus help me shop conscientiously,” he says. “I get the right ingredients and buy only what I need—no junk food.”

    WINNING ACTION

    Get a plan. If you’re prone to straying down the wrong supermarket aisle, like Pete, get a plan. Decide on your meals for a full week. Write down what you need to make each meal. Use that as your shopping list. This

    way, you’ll leave the supermarket with exactly what you §. went in for, and you’ll minimize impulse buys.

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