CDS02757_Healthy_Living_Reprint_FINAL

Healthy Living
Your guide to a
healthy lifestyle

Contents
BMI Healthcare – Intelligent Health
2
Introduction
Healthy Living –Your guide to a healthy lifestyle
3
With everyone leading busy
lives, finding time to devote to
spending hours in the gym and
following complicated diets is
simply impossible for most.
No wonder you may feel
daunted. Of course you want to
live a long, fit life, and you may
well have particular health issues
you want to address following
your assessment, but how on
earth are you supposed to
know what to do to be healthy?
The fact is that by making small,
realistic and achievable changes
to your everyday life, you can
make a genuine difference to
your health,not only giving yourself
a vastly improved feeling of
vitality,but also reducing your risk
of diseases like cancer, heart
disease, diabetes, depression
and osteoporosis. For instance,
30 minutes of moderate exercise
– like a brisk walk – every day can
significantly reduce the risk of
having a heart attack.
In this book, we’ve tried to give a
clear, simple and comprehensive
guide to what you can do to
make a real difference to your
health, with sensible advice, so
you don’t have to worry about
faddy diets or health regimes.
Take small steps
Making small lifestyle changes
doesn’t have to take a lot of
time or cost megabucks – for
example, you can fit exercise
into your normal routine and
you don’t have to make every
change for the better at once.
Cutting down on alcohol and
fatty, sugary foods, for instance,
are significant changes which
will have a huge impact on your
chances of living well into a
healthy old age – but breaking
these old habits can be tough, so
it’s OK to take baby steps.
The key to making long-term
changes is to be realistic. If you
can be ‘good’ most of the time,
you can still enjoy cakes and
glasses of wine – just in
moderation! (Though smoking is
one habit to stop altogether,
right now.)You might not ever
manage to lead the ‘perfect’
healthy lifestyle, but simply by
reading this book you’ll increase
your awareness of the need to
protect your health and the fact
that you can do so by making
certain changes.This awareness
will help motivate you to make
the right choices, whether it’s
eating more fish or allowing
yourself a few moments to relax
each day. Gradually, you’ll build
up good habits and start to
enjoy them and being healthy
will become second nature.
So, read on. In every chapter
you’ll find out how you can
make a difference by making
basic changes like quitting
smoking, drinking less alcohol,
staying active and eating sensibly.
All of these are common risk
factors for diseases like cancer,
heart disease,strokes and diabetes
and you’ll see them cropping up
again and again in this guide.
Whether you tackle lifestyle
changes one by one or, even
better, in combination, you can
actively protect yourself against
illness – and you’ll feel fantastic.
Thank you for choosing BMI Healthcare for your health
assessment – we really hope you enjoy this guide to
healthy living. And yes, being healthy can be enjoyable!
In modern life we’re constantly being told to ‘get
healthy’: eat this, not that; do this exercise, not that;
worry about this, not that. All these different messages
can be extremely confusing.
Healthy Living
p3 Healthy living
n Introduction
p4 Heart health
n What is heart disease?
n Know your risk factors
n Blood pressure
n Cholesterol
n Reducing my risk
p11 A healthy diet
n A healthy size
n Making healthy changes
n Losing weight
n Food problems
p23 Fitness and exercise
n Why bother?
n Excuses, excuses
n What to do
and how much?
p29 Stopping smoking
n Top ten reasons
n The benefits of stopping
n How to stop
p35 Sensible drinking
n Units
n The dangers of overdoing it
n Drinking more safely
p41 Dealing with
stress and worry
n Why is stress bad?
n Problem solving
and prioritising
n Lifestyle changes
n Work – life balance
n 5-minute relaxation
p48 Cancer
n What causes cancer?
n Testicular cancer
n Skin cancer
n Bowel cancer
n Prostate cancer
n Cervical cancer
n Breast cancer
p64 Women’s health
n Menopause
n Osteoporosis
n Chlamydia
“Making small, realistic and achievable changes to
your everyday life can make a genuine difference
to your health, not only giving yourself a vastly
improved feeling of vitality, but also reducing
your risk of diseases.”
your guide to
a healthy lifestyle

Heart health
4
Heart health
5
Heart health
The heart is a muscular pump that moves blood
around the body, transporting oxygen and nutrients
to specific parts of the body through the arteries
and taking away unwanted carbon monoxide and
waste products by the veins. This system is called the
cardiovascular system.
Cardiovascular disease (CVD) occurs when this
system is faulty and is the number one cause of death
in the world.The heart beats around 100,000 times
a day, but if a blockage stops the circulation, a heart
attack or stroke can suddenly strike and the heart or
brain can be permanently damaged.
Condition becomes worse when the plaque is so thick, it
prevents the arteries from supplying enough oxygenated
blood to the heart.
Coronary heart disease: Build up of plaque (fatty materials)
in coronary artery walls.This makes the walls thicker and
makes it harder for oxygen and blood to pass through.
Angina
Heart
Attack
An area of the plaque can rupture causing a blood clot to
form on top of the plaque.This can block the artery and
stop the heart from getting blood and oxygen.
Narrowing of artery
Plaque
Abnormal
blood flow
Narrowed
artery
Plaque
CVD is actually an umbrella
term for a whole group of
conditions caused by blockages
of the blood vessels and heart,
cutting off the flow of oxygen.
The main types of CVD are:
n Coronary heart disease
– when the blood
vessels supplying the
heart are blocked.
n A stroke – which relates
to the supply of blood to
the brain.
n Peripheral vascular disease
– when circulation in the
legs is impaired.
The commonest cause of a
blockage is when fatty deposits
– often called ‘plaques’ – build
up inside the walls of the blood
vessels which pump blood around
the body through arteries.
The plaques can suddenly and
unexpectedly rupture, causing a
blood clot to form,obstructing the
blood flow. This blockage can then
cause a heart attack or stroke.
More than one in three deaths
(35%) are from CVD each year
and CVD accounts for around
one fifth of all deaths before
the age of 75.
What is heart disease?
What is CVD and why should I be concerned?
Everyone who comes for
a BMI health assessment is
screened for their risk of
cardiovascular disease – tests
may have included measuring
blood pressure, body weight
and fat, cholesterol levels,
blood sugar, kidney function,
thyroid function, and an
electrocardiogram.These tests
– the need for which will vary
according to your age, medical
history and gender, among
other factors – help distinguish
who is at a high level of risk.
Falling into one of the groups
listed here, or a combination
of them, means it’s essential
to take action to reduce your
risk of heart disease and stroke.
n People who have already
got some form of
atherosclerosis (thickening
of the artery wall due to
the build-up of fatty material
like cholesterol).This includes
angina (heart pain), a heart
attack or stroke, a transient
ischaemic attack (mini-
stroke) or peripheral artery
disease (narrowing of
blood vessels outside the
heart or brain).
n People with a history of
symptoms such as chest pain
when exercising, shortness
of breath, fainting, leg cramps
or palpitations.
n People with diabetes type
one or two.
n People who have high
cholesterol and/or those
who have a family history of
high cholesterol.
n People with a history of
hypertension (elevated
blood pressure).
Other factors make your risk
higher too:
n Having a family history of
premature cardiovascular
disease (affecting your father,
brother or son under the
age of 60 or your mother,
sister or daughter under 65).
n Having another medical
condition like chronic kidney
disease or autoimmune
disorders such as
rheumatoid arthritis.
n Being of south Asian origin.
n Men are at greater risk than
women of cardiovascular
disease (three times as many
men have heart attacks), and
for both genders, the risk of
heart attacks increases with
age (being over 45 for men
or 55 for women).
n Having a premature
menopause.
Leading a dangerous lifestyle?
80% of coronary heart disease
and stroke cases are thought to
be caused by ‘behavioural’ factors
which lead to risk by raising blood
pressure, blood sugar and levels
of fat in the blood:
n Being overweight (a BMI
over 25), and/or not getting
enough exercise, especially
people who tend to store
fat around their stomach
and/or who don’t eat many
fruits and vegetables (see
chapters on diet and fitness).
n Smoking,or being a passive
smoker (see p.29).
n Drinking excessively (p.35).
n Being under psychological
stress (see p.41).
Overall,the higher the number of
these factors which apply to you,
the greater your risk – but
because lifestyle plays such a big
role,the good news is that you
can dramatically downgrade your
risk by eating sensibly,not smoking
or not drinking excessively and
reducing stress levels.
What are my cardiovascular disease risks?

Heart health
6
Heart health
7
How often do I need to get it checked?
n If it’s under 130/85 that’s within normal limits. Do follow
the guidelines in this chapter for keeping blood pressure
healthy and have your blood pressure checked again in
three-five years.
n If it’s between 130/85 to 140/90, have your blood pressure
checked again in one year.
n If it’s over 140/90, have your blood pressure checked in
four weeks time by your GP or practice nurse after
following the guidelines mentioned in this chapter.
n If it’s over 160/110, see your GP as soon as possible.
Normal flow Restricted flow
Cholesterol
CVD prime suspect #1: high blood pressure
42% of British people between
35 and 64 are thought to have
hypertension, or high blood
pressure. So what is blood
pressure and how can you
keep it under control?
You may have been told that
the ideal blood pressure is
120/80 and medications may
be needed for blood pressures
above 140/90 (though if you’re
at high risk of cardiovascular
disease already, the numbers
to aim for might be lower
– under 130/80).But what does
that mean? Blood pressure is
the strength with which the
blood pushes against the walls
of the blood vessels. If that
pressure becomes too high,
extra strain is put on the heart
and arteries. Over time, the
heart may beat less effectively
and the risk of having a heart
attack or stroke increases.
Blood pressure is measured
with two numbers; the first,
the higher number, is a measure
of the highest level of pressure
your heart reaches during a
beat and is called systolic
blood pressure.The second,
lower number, is the lowest
level of pressure the heart
experiences, as it relaxes in
the pause between beats.This is
called diastolic blood pressure.
The higher each of these numbers
are, the higher your blood pressure
and the greater the risk of disease.
What causes high blood pressure?
All the usual ‘lifestyle’ suspects:
being overweight, not being active
enough, taking in excess salt or
alcohol, or not enough fruit and
veg – plus a family history of high
blood pressure can be a factor.
Are there any symptoms?
Not usually – you may feel
perfectly well with high blood
pressure.That’s why it’s essential
to keep getting your blood
pressure checked.
CVD prime suspect #2: high cholesterol
It is thought that as much as
two out of three adults may
have high cholesterol levels in
the UK.You might think
cholesterol is bad, but in fact
there are good and bad kinds.
What is cholesterol?
It’s a fatty substance made as
the liver breaks down fat from
the foods we eat and it plays
many essential roles in the
healthy functioning of the body,
from the hormones to the
nervous system to digestion.
What are the ‘good’ and ‘bad’
types of cholesterol?
Cholesterol is carried from the
liver to cells by molecules called
low density lipoproteins (LDLs).
If there’s too much LDL
cholesterol for the body to use, it
builds up in the blood, and starts
to line artery walls, damaging the
circulation – so this is the‘baddie’
we all want to have less of.
There’s another type of fat in the
blood, called triglycerides, which
is another baddie.The more foods
containing saturated fat or sugar
you eat, the more overweight
you are and the more alcohol
you drink, the higher your blood
triglyceride will become.These
also lead to an increased risk of
cardiovascular disease.
The ‘good’ cholesterol is the
kind carried from cells to the
liver to be broken down or
expelled as waste from the body
– this is done by high density
lipoproteins (HDLs). The higher
the level of HDL cholesterol,the
better,as they prevent too much
fat building up in the blood vessels.
If you have high levels of LDL and
triglycerides and low levels of
HDL, that’s especially unhealthy.
What affects my levels
of HDLs and LDLs?
Women tend to have higher
levels of HDLs than men, and
for some people, high cholesterol
runs in the family and isn’t much
affected by what they eat, but
everyone will benefit by watching
their cholesterol levels through
daily diet.
As well as taking exercise,drinking
less alcohol and losing weight,one
of the main ways to lower‘bad’
cholesterol is to eat less of the
saturated fat which is one of its
main causes. It’s not about eating
a purely‘low-fat diet’– we all need
some fat in our diet;so it’s more
about eating the right sort of fats.
Saturated fat is a villain which is
easy to recognise. It comes from
animal fats and it’s more solid or
hard in appearance than healthier
monounsaturated fats,which
tends to come from vegetables
and nuts. Butter (contained in
cakes,biscuits and so on),red
meats (often marbled with white
fat) and hard cheeses should be
avoided,and replaced with
healthier fats like those found in
oily fish,olive oil,nuts and seeds.
A lot of people assume that
foods which contain cholesterol
– which include eggs, prawns,
liver and kidneys – are bad for
you, but in fact these foods are
perfectly healthy, so long as you
eat a balanced diet and cut
down on saturated fats, which
are far more harmful.
In particular,eating plenty of
soluble fibre can lower levels of
bad cholesterol too – go for fruits,
veg,oats,pulses and beans.

Heart health
8
Heart health
9
What does my reading mean?
In general, a healthy target to aim for is a total cholesterol level
under 4 mmol/L and an LDL level of under 2 mmol/L. However,
targets vary depending on your overall risk for CVD.A total
cholesterol level of 5 mmol/L may be nothing to worry about if
you are in good health and have an overall low risk for CVD.
However, if you have diabetes or high blood pressure with a
total cholesterol level of 5 mmol/L, it becomes more important
to reduce cholesterol levels.
Although there are no recognised targets for HDL or good
cholesterol, the ratio between HDL and total cholesterol levels is
important.If your HDL level is low in comparison to your total
cholesterol levels,it can be another sign that you are at risk from CVD.
A total cholesterol level above 7.5 mmol/L might mean that high
cholesterol levels run in your family, an inherited form of high
cholesterol levels called Familial Hypercholesterolaemia.
Food type Eat more Eat in moderation Eat less
Cereals Wholegrain cereals e.g. oatmeal
porridge, wholegrain/seeded bread,
wholegrain (brown) rice or pasta
White rice and pasta, brown
bread (can be dyed white bread)
and white bread
Fruits vegetables All fresh, frozen and dried fruits
and vegetables, baked potatoes
Olives, oven chips Fried potatoes, chips and other
fried or oil-roasted or buttered/
cheesy vegetables, crisps
Nuts seeds Pistachios, walnuts, poppy seeds,
sunflower seeds, pumpkin seeds
Pecans, hazelnuts, brazils, almonds,
cashews, pine nuts, sesame seeds
Coconut, roasted peanuts
Meat pulses Chicken or turkey (skin removed),
lentils, beans, soya/tofu,
chickpeas/falafel
Lean red meats and liver Visible fat on meat, burgers,
kebabs, sausages, patés, duck,
goose, gravy made from fat
Fish Oily fish – tuna, salmon,
sardines etc (preferably not tinned
in oil) all other fish
Shellfish Fried/battered fish, caviar
Dairy products Low fat soft cheese, e.g. cottage
cheese, mozzarella, semi-skimmed
or skimmed milk, low-fat yogurt,
egg whites
Up to 3 egg yolks per week,
Edam, Camembert, Parmesan
Butter, other hard cheeses, full-fat
milk and yogurt, cream, whole
milk, chocolate, cream cheese
Fats Cholesterol-lowering/low-fat
spread, sunflower, rapeseed,
flaxseed, sesame, olive oils,
peanut butter
Lard, butter, dripping, suet, ghee,
coconut oil, palm oil
Drinks Water, fruit juice, tea Coffee, alcohol Fizzy and sugary drinks
A cholesterol lowering diet
How can I bring my risk of cardiovascular disease down?
The good news is that
because behavioural factors
play such a big role in
causing CVD, making lifestyle
changes can have a major
impact on lowering blood
pressure and cholesterol,
reversing the likelihood of
circulatory problems.
n Don’t smoke.
n Maintain an ideal body
mass index of 18.5-25
and keep your waist
measurement within
healthy limits (see p..12).
n Don’t let more than 30%
of your calorie intake
come from fat – and
don’t let more than 10%
come from saturated fat.
Check labels and choose
foods with less than 3-5%
saturated fat per 100g.
n Keep your intake of
cholesterol to a minimum
– follow the suggestions for
a cholesterol-controlling
diet in the table.
n Replace saturated fats with
unsaturated fats, choose fish
and poultry over red meat.
Trim off visible fat and skin
from meat before cooking
and/or eating, and opt for
extra-lean cuts. Eat fewer
biscuits, cakes, chocolate, etc.
Bake, steam or boil rather
than frying and when you
do fry, choose olive, walnut,
flaxseed or sunflower oil
over butter. Replace butter
on your bread with low-fat
spread and use it sparingly.
Choose low-fat dairy
products over full-fat.
n Eat at least five portions of
fruit and vegetables per day.
n Ensure you get your ‘good
fats’ – omega 3 fatty acids,
which you can get by eating
oily fish once a week or
other sources like walnuts
and soya products.
n Eat fish overall twice a week,
it’s a healthy source of protein
without the fat in meats.
n Limit your alcohol intake to
under 2 to 3 units per day for
women, or 3 to 4 units per
day for men and have 2 free
alcohol days per week (see
chapter on sensible drinking).
n Eat less than 6g or about
a teaspoon of salt per day
(replace with herbs, spices,
lemon juice, chilis).
n Aim to do at least 30
minutes of aerobic activity
per day, most days – fast
walking is a good example
(see pages 23-28). Exercise
increases the amount of
HDL ‘good’ cholesterol in
the blood.
n Maintain a healthy blood
pressure and have it
checked regularly.

Heart health
10
A healthy diet
11
What now?
The primary method of reducing your risk for
cardiovascular disease is to make healthier lifestyle
changes as described in this book. In some cases, where
lifestyle changes are not enough, or where you have
underlying medical conditions that increase your risk
significantly, it may be appropriate to get treatment.
Cholesterol and blood pressure lowering drugs are
the most common treatments used to reduce your risk
or treat established cardiovascular disease. In these
cases, it is best to discuss it with your doctor.
To find out more about lowering your risk of
cardiovascular disease,The British Heart Foundation’s
website (www.bhf.org.uk) is full of helpful
information, as is that of the Stroke Association
(www.stroke.org.uk) and the Heart Research UK
website (www.heartresearch.org.uk).
A healthy diet
Eating sensibly sounds like the simplest thing in the
world, yet for many, it’s one of life’s toughest challenges.
It’s likely that you already know if you could lose a few
pounds to improve your overall health and that you are
fully aware that the average western diet is lacking in
fruit and veg and overloaded with fat, salt and sugar.
But making changes can seem daunting. It doesn’t
help that every day, we’re bombarded with hundreds
of mixed messages from the media and in shops and
restaurants.There’s all the pictures of skinny models
contesting with shelves packed with double choc chip
muffins and books trumpeting the latest diet, it’s hardly
surprising that you may not know which way to turn.
The good news is that healthier eating is not about dieting or
deprivation – sensible, small and subtle tweaks to give your body
the nutrients it needs, long term, will have a great effect. It’s all about
finding your own healthy balance where food is concerned – going
from overweight to a healthy size will not only make you look and feel
fantastic, but will reduce your risk of type two diabetes by as much as
40 times and coronary heart disease and stroke by two or three times.
“To eat is a necessity, but to eat intelligently is an art.”
– La Rochefoucauld

A healthy diet
12
A healthy diet
13
What’s a healthy size?
There are several ways to
determine whether your
size is healthy, all of which
are included in a BMI Health
Assessment and all of which
should be looked at together
to get a more accurate picture.
Body Mass Index
One method healthcare
practitioners use to assess a
patient’s weight is by calculating
their Body Mass Index (BMI).
You can do this by dividing your
weight in kilograms by your
height in metres, and then divide
the result by your height again
– use this BMI table to find out
what range you fall into. Body
weight isn’t always a reliable
indicator of being unhealthy
since muscle weighs more than
fat. People who are muscular
may be wrongly categorised as
overweight using this method.
It’s also unsuitable for children,
people over 60 or women who
are pregnant or breastfeeding.
Apple or pear?
Some people are ‘apple’ shaped
– they store excess fat around
the tummy – while others are
‘pears’ whose fat accumulates
around the thighs and bottom.
Apple shapes are more at risk
of health issues linked to obesity,
like heart problems, strokes and
type two diabetes.
So another way to measure size
is to look at the measurement
of your waist (around your tummy
button) – you should ideally aim
Body Mass Index table
If your BMI is less than 18.5, you’re underweight, you should look at your body fat percentage and think of doing more exercise to build
muscle mass.
If your BMI is between 18.5 and 25, this suggests your weight is ideal.
If your BMI is between 25 and 30, this suggests your weight is over the ideal. Look at your diet and exercise to see where your calorie
imbalance is occurring. Start making changes now before things get worse.
If your BMI is between 30 and 40, you’re obese and need to change your lifestyle without delay. See your doctor to help plan how
you’re going to do it.
If your BMI is over 40, you’re very obese and making a change is even more urgent: again, do this with your doctor’s help.
for it to be under 37 inches for
men or 32 inches for women
(again, this is a generalisation and
isn’t applicable to everyone, in
particular some Asian body types,
which can have a higher inherited
risk for problems or tend to be
smaller).If it’s over 40 inches (men)
or 35 inches (women), taking
action to reduce it is essential.
The danger values for Asians are
above 35 inches for men and
above 32 inches for women.You
can also divide the measurement
of your waist by that of your hips.
The waist-hip ratio you end up
with should be under 1 (for men)
or 0.85 (for women).
Body fat
Your body fat percentage is another
useful way to assess whether your
size is healthy because, as noted
earlier in this chapter, weighing
alone doesn’t take the proportion
of fat into account.Your assessment
will have included a measurement
of your body fat,and if it’s outside
the recommended ranges shown
here,it’s advisable to try to reduce
it – regular exercise will turn
fat into lean muscle (see fitness
chapter).Your overall body weight
may not change much,but you’ll be
doing your health a big favour.
Males Females
Age
1–30
31–40
41–50
51–60
61+
Low High Low High
12
13
14
16
17
18
19
20
20
21
20
21
22
22
22
26
27
28
30
31
Apple shaped Pear shaped

A healthy diet
14
A healthy diet
15
Making healthy changes
Whether you need to lose weight
for medical reasons, such as
managing diabetes or lowering
your risk of heart disease, or
you just want to look and feel at
your best, eating a balanced diet
is crucial for good health.The
best way to reach and maintain
a healthy size is simply to follow
sensible eating guidelines in the
long term to give you all the
vitamins and minerals you need.
Sugar and fat are both high in
calories, so by eating sugary and
fatty foods only in moderation,
you’ll be well on your way to a
trimmer waistline.
Overall
n Eat at least five 80g portions
of different vegetables (not
including potatoes) and fruits
each day to make you glow
from the inside out, fill you
up and reduce your risk of
disease. Eating more veg
doesn’t mean platefuls of
boiled broccoli – it’s about
making your diet more varied,
flavourful and satisfying.Add
salad to your sandwich, chop
some vegetables into your
bolognaise and snack on
berries at your desk – the
portions will soon add up.
n Eat foods from the main food
groups in the right proportions:
starchy foods, fruits and
vegetables should form the
bulk of the diet,with moderate
consumption of dairy and
meat products, and sparing
use of fats and sugars. Use the
eatwell plate picture as a guide.
n Cut down on saturated fats,
found in butter, sweet baked
goods and red meat, which
raise cholesterol, and replace
with‘good’fats like those found
in nuts, seeds, olive oil and
oily fish like salmon and tuna.
(Aim to eat at least two
portions of fish each week,
one of which should be oily
fish). Cut the fat off meat,
choose leaner cuts, go for
low-fat spreads or cooking
sprays over butter, grill,
steam or bake rather than
frying, and turn to lower-fat
dairy products.
n Avoid high fat foods (check
the label – if it has more than
20g of fat per 100g, or more
than 5g of saturated fat per
100g, think twice). Overall,
fat should account for no
more than 30% of your total
energy intake.
Sugar and diabetes
If your assessment has shown
that you are at a high risk of
diabetes (fasting blood sugar
between 6 and 7 mmol/L) or
that you may already have it
(fasting blood sugar level above
7 mmol/L), it’s recommended
that you go and see a doctor.
Even if your results are normal,
it’s a good idea for everyone to
moderate the levels of sugar in
their diet. By reducing the
amount of sugar in your cooking,
snacks and sugary drinks, you
help keep your blood sugar
steady so your energy levels
don’t dip and you don’t suddenly
feel desperately hungry. Opting
for satisfying foods which release
sugar slowly into the body and
keep your blood sugar at optimal
levels, will make you feel fuller for
longer. These include fibre-filled
fruits and vegetables, wholegrain
complex carbohydrates, and pulses
– so your daily starches should
come from foods like porridge,
brown rice and wholegrain bread,
as opposed to PopTarts, white
rice and white bread. Check labels
and avoid foods with more than
15g of sugar per 100g.

A healthy diet
16
A healthy diet
17
Losing weight
The only proven way to lose
weight is to burn more calories
in energy than you eat. It’s easy
to create this energy deficit by
reducing the number of calories
you eat – by cutting down on
highly calorific food and eating
regular moderate sized meals.
Exercise is also important.
The average woman needs
around 2,000 well-balanced
calories per day,or 2,500 for the
average man – though the
number of calories will vary
for children, older adults, if your
daily life is unusually active
or inactive.
1lb of fat is gained for every
3,500 calories you eat, and equally
1lb of fat is lost for every 3,500
calories you burn and don’t
replace, so eating 500 calories
per day less than you burn in
energy will result in weight loss
at a sustainable rate of around
1lb in seven days. If you lose
weight much more quickly than
this, you’ll be losing water and
muscle weight, not fat.
If you’re already overweight,
your body needs more than the
standard number of calories to
maintain its weight, so just by
eating the normal recommended
amount of calories (2,000 or
2,500), you’ll lose weight. But if
you’re only overweight, not obese,
you could aim to eat around
1,500 – 1,800 calories a day to
lose weight at a realistic pace.
Weight loss surgery or slimming
pills are not usually recommended
except in extreme cases where
someone is unable to make
changes to their diet and exercise.
Always consult with your doctor
about any weight loss plans
before you start to cut back.
Guideline daily amounts for
health and average weight maintenance
Men
2,500
55g
300g
120g
95g
30g
24g
6g
Energy (kcalories)
Protein
Carbohydrates
Of which sugars
Fat
Of which saturated fat
Fibre
Salt
Women
2,000
45g
230g
90g
70g
20g
24g
6g
What is a portion?
Michael Fogarty recommends
sticking to the following
portion sizes:
portion of
hard cheese
portion
of rice
portion
of meat
portion of
potatoes
size of a
matchbox
2 tennis
balls (women)
3 tennis
balls (men)
size of a deck
of cards
2-4 egg sized
Salt
Eat less than a teaspoon
(6g) of salt per day (ready
meals are one of the
worst offenders when it
comes to large quantities
of hidden salt).
1,500 calories IN
2,000 calories IN
3,000 calories IN
2,000 calories
USED =
2,000 calories
USED =
2,000 calories
USED =
decrease in
body weight
no change in
body weight
increase in
body weight
The expert’s top tip
Michael Fogarty, BMI’s Senior Dietician, says:
“If you’re eating sizeable meals, eating between meals
or snacks should be avoided; it’s such a potent source of
calories and fat. You can eat little and often if all your
meals are small enough, but if you’re eating large main
meals for breakfast, lunch and dinner, just have a fruit-based
snack and only if necessary. Avoid processed sugar, too
– it has such a fundamental effect on insulin levels and if
your insulin levels are very high, excess calories are likely
to be stored as fat.”
Take care with portion sizes
Just because you can buy food in
large portions at a restaurant or
in the supermarket, that doesn’t
mean the portion is considered
‘normal’ and in fact, your body
will probably be satisfied with
much less. In general, ready meals
and other highly processed foods
are less filling and nutritious for
the number of calories they give
you than home cooking.

A healthy diet
18
A healthy diet
19
TopTips:
n Avoid ‘empty’ calories.These are often
contained in fatty or sugary foods, which
don’t fill or satisfy the body. (Don’t just
check labels for fat and sugar – look out
too for chemical sounding ingredients
like corn syrup, fructose, dextrose, invert
sugar and hydrolysed starch – and avoid
foods containing them).
n Small changes make a big difference
over time. You can calculate roughly how
many pounds you can lose in a year by
dividing the number of calories you’re
saving by 10. One less 270 calorie
chocolate bar a day will result in 27 pounds
of weight lost in a year.If you can cut down
by just 100 calories a day – a two-finger
kitkat – you’ll hardly notice the difference,
but you’ll lose 10lbs in a year.
n Don’t crash diet. Overall, focus on the
quality and proportion of foods you eat
for optimum nutrition rather than
obsessing about counting calories and
weighing yourself. Don’t be unrealistic
or tell yourself you can’t eat certain
foods – fad low-calorie diets or diets
which almost eliminate a whole food
group (like the low-carbohydrate Atkins
diet) deprive the body of essential
nutrients, sending it into shock.
These diets only work in the very short
term;as soon as you start eating normally
again,the body quickly replaces all the
weight lost,along with added cravings and
a slower metabolism.For some people,it’s
easiest to buy a‘portion plate’which has
lines showing how much protein,starch,
fat and vegetables to place on it.(You can
buy one from www.thedietplate.com).
n Change your mindset about eating.
As soon as you forbid a food, you can’t
help but crave it, and many dieters only
end up bigger and unhappier, or struggling
with an eating disorder. Instead, think
about enjoying food and being healthy:
focus on feeding your body the nutrients
it needs,and don’t be too hard on yourself
when you have the occasional treat.
n Conscious eating. Be conscious of what
you are eating – many people don’t
think about what they are eating as they
are often too busy, watchingTV or
working at the same time.Take control
of what you’re eating, notice your
portion size, eat slowly, enjoy your meal
and savour it, if you do this you are
more likely to know when you have
eaten enough and you are less likely to
pick at food later.
You can eat healthily when you eat out too...
If you usually have this... ...try this for a healthier option
Indian
Korma, passanda or massala with lamb Tandoori or madras with chicken, prawns or vegetables
Pilau rice and naan Plain rice and chapatti
Onion bhajis and samosas Vegetable side dishes and a dhal
Italian
Meat feast pizza with pepperoni and extra cheese Pizza with lower fat toppings such as vegetables, ham, fish or prawns
Pasta with a creamy sauce such as carbonara Pasta with a sauce based on tomatoes or other vegetables
Garlic bread Bruschetta with fresh tomatoes and herbs
Chinese
Sweet and sour pork or prawn balls. Remember anything in batter
will be high in fat
Chicken chop suey or Szechuan prawns
Egg fried rice Steamed or plain rice
Prawn crackers, dim sum and spring rolls for starter Chicken and sweetcorn soup
Thai
Green and red curries contain coconut milk, which is high in saturated
fat, so if you do choose a curry, try not to eat all the sauce.
Try to stick to stir-fried dishes or steamed dishes containing chicken,
fish or vegetables.And have some steamed rice with your meal
Fish
and chips
Large cod and chips
Have a portion of baked beans or mushy peas and bread with your
fish and chips
Don’t eat all the batter, because it soaks up a lot of fat. If you can get it,
fish coated in breadcrumbs soaks up less fat
If fish and chips are cooked in oil at the right temperature, they won’t
only taste better, but they absorb less fat. So watch out for soggy batter
and chips because this is often a sign that the oil wasn’t hot enough
Kebab Doner kebab Chicken shish kebab served with pitta bread and salad
Sandwiches
White bread
Brown or wholemeal bread, granary rolls, brown bread with added nuts
or seeds, rye bread, bagels, tortilla wraps or wholemeal pitta bread
Bacon and fried egg
Lean meats (this includes ham, beef, turkey and chicken without the skin),
tuna, smoked mackerel, hard-boiled egg and don’t forget to add some salad
Cheddar
Edam, Emmental, Gruyère, mozzarella and low-fat cream cheese and
add some salad
Jacket
potatoes
Tuna and mayonnaise Baked beans, cottage cheese or ratatouille
Puddings
Chocolate cakes or
desserts with cream or chocolate fillings
Fresh fruit salad or tinned fruit with yoghurt
Fruit flan, tart or pie – the healthier option is pie with just one crust,
either a top crust or a flan with a pastry base
Fruit crumbles
Steamed puddings

A healthy diet
20
A healthy diet
21
Want to know more?
Visit the NHS’s healthy eating
pages to learn more about good
nutrition and safe weight loss:
www.nhs.uk/livewell/goodfood
Or visit Diabetes UK for
helpful information on foods
and recipes for diabetics:
www.diabetes.org.uk
Food problems
Irritable Bowel Syndrome (IBS)
As many as 20% of people in
the UK suffer from this common
long-term gastrointestinal
disorder. It typically develops
between the ages of 20 and 30
in women, though it can appear
at any age and affect men, too.
Although there is no known cure,
if you’ve been diagnosed with
IBS, there are ways you can
manage the condition and relieve
the symptoms.
What is IBS?
IBS typically causes symptoms
after eating, including abdominal
pain and cramping, constipation
and/or diarrhoea, a bloated
stomach or excess wind, an
urgent need to use the toilet
and a feeling that you haven’t
been able to empty your bowel
fully. Nausea, bad breath,
burping, tiredness, headaches
and aches and pains are also
associated with it, and it can
cause feelings of embarrassment,
anxiety and depression.Your
doctor can advise you if you
have IBS if you suffer from
these types of symptoms.
Causes and help
n Keep a food diary and
note down when the IBS is
triggered,then avoid the foods
which seem to set it off.
n Discuss the level of fibre in
your diet with your doctor –
eating less may help if irritable
bowel syndrome is diagnosed.
n Eat regularly and slowly.
n Drink plenty of water,
around 8 cups of fluid
per day.
n Avoid fizzy drinks, alcohol
and too much fruit.
n Keep your coffee/tea intake
to three or fewer cups
per day.
n Avoid processed foods and
artificial additives.
n A 4 week trial of probiotic
dairy drinks can show if
these would be helpful for
the condition.
n Increasing physical activity
can help.
n While it’s not known what
causes IBS,it’s known to
flare up at times of stress or
depression,or in people who
have experienced trauma
in the past – it’s thought
difficult emotions can in turn
affect the digestive system,so
counselling to improve stress
can make a real difference.

See your doctor to discuss
whether medicines to reduce
the pain of cramping, laxatives,
anti-diarrhoea medicines or
antidepressants can help.
You can also visit
www.theguttrust.org to
find out more about IBS.
The Big Question: Do I need to take food supplements?
It’s believed that antioxidants contained in vitamins and
minerals keep our bodies healthy: vitamin C, vitamin E and
carotene, a form of vitamin A, are found in fruits, vegetables,
and vegetable oils, and foods like tea, red wine and even
chocolate have been hailed as having healthy properties
thanks to the antioxidants they contain.Antioxidants prevent
the harmful effects of particles in the body called free radicals,
which cause cell damage, leading to ageing and diseases like
cancer. Because eating antioxidant-rich foods like fruit and
vegetables has been linked to staying in good health, recent
scientific research has tried to establish whether taking
antioxidant supplements can prevent disease. However, no
conclusive results have yet been found, so the jury is still out
on whether taking vitamin supplements has any beneficial
effect on health.The bottom line is that as long as you’re
eating a balanced, healthy diet, with 5 portions of fruit and
vegetables a day you’ll be getting all the antioxidants you need
directly from your food.

A healthy diet
22
Fitness and exercise
Lines or wrinkles on
the face, particularly
at corners of the eyes
Smoking both
dehydrates and
deprives your
skin of oxygen
Why bother?
We all know exercise is good for us, but how exactly?
Physical activity…
n strengthens the muscles, including the heart
n reduces cholesterol and high blood pressure, lowering your
chances of developing cardiovascular disease and stroke
n helps avoid respiratory problems by strengthening the lungs in
the case of aerobic exercise
n makes you happier – fact. Exercise releases endorphins and
serotonin, brain chemicals which act against depression, stress
and anxiety. The achievement and independence gained
through doing exercise and taking care of the body are also
well known to improve confidence and self-esteem
n has a massive impact on boosting energy levels
n strengthens bones, reducing the risk of osteoporosis (thin and
weakened bones)
n may help protect against the chances of developing certain cancers
n protects the immune system
n helps to keep you slim by burning body fat
n helps you sleep better
n improves skin-tone by delivering more oxygen to body tissue
n helps regulate appetite
n increases life expectancy.
Fitness and exerciseFood allergies and intolerances
Allergy or intolerance?
About one in five people
in Britain think they have a
food allergy, but only around
one in 70 do.
If your symptoms flare up
within an hour of eating a
certain food (shellfish and
nuts are some of the main
foods some people are
allergic to) and if they include
an itchy or swollen mouth,
throat or skin, a rash, or a
runny nose, wheezing or
coughing, it’s likely you have
a food allergy which blood
tests will pick up – your body
is mistaking a certain food
as harmful and the immune
system’s response is causing
unpleasant symptoms. Some
food allergies can even
cause the body to go into
anaphylactic shock, which
can be fatal – if an allergy is
serious, you should discuss
with your doctor how to
make sure you’re kept safe,
for example by letting people
around you know about it.
If the symptoms occur more
than an hour after eating or
are different, it’s likely you
have a food intolerance, which
is thought to affect up to15% of
the population.
Food intolerances include:
n Lactose intolerance
– an intolerance to dairy
products caused by a
deficiency in the lactase
enzyme in the body.
n Gluten intolerance
– which makes it hard
to digest wheat.
n Sensitivity to caffeine.
The causes of most food
intolerances aren’t understood
beyond the fact that they seem
to stem from an abnormal
immune response. Others may
be psychosomatic – in other
words, they originate in the
mind, perhaps because of an
eating disorder or a traumatic
association with a certain food.
Testing for food intolerances
usually relies on eliminating the
problem food from the diet
then reintroducing it to see if
the symptoms change.
Getting help
If you do have any kind of allergy
or intolerance, the treatment is
simply to avoid any trigger foods.
Your doctor will be able to help
you plan your diet to make
sure you still get the nutrients
you need even if you have to
eliminate certain foods.
Visit www.allergyuk.org to
find out more about food
allergies and intolerances.
23

24
25
Excuses, excuses…
So, if we all know the vast benefits, why is it so hard for people to
exercise more? One reason is because they think they don’t have
the time. For many working people the idea of going to a gym or
for a run in the early hours of the morning or the dark hours after
work stays just that – an idea. The UK has the longest working hours
in Europe, and it can also be difficult in our workaholic culture to
take an hour at lunchtime to go to the gym.
Lifestyles have also changed dramatically as technology has
developed.We drive instead of walking or cycling, we spend hours
sitting watching screens fromTVs to DVDs to computers and games
consoles. Furthermore, we eat processed ready-made meals in front
of theTV rather than foraging and hunting for food and actively
preparing fresh meals as our ancestors did. Our bodies still have not
adapted to our lack of physical exertion and increased food intake,
so the excess calories we eat and don’t burn off are stored as fat.
It can be extremely difficult in this society to say no to all the junk
food and turn down sedentary nights in front of the box.
‘I hate sport and gyms! Help!’
The fact is that you don’t
have to join a gym or be
‘sporty’ to become fit.
Getting off the bus a stop
earlier, parking the car
further away from the shops
or work, going for a brisk
walk at lunchtime, walking
or cycling to work or the
shops, gardening, housework
and climbing stairs instead of
taking the lift are all simple
ways to increase your level
of physical activity without
breaking the bank or
devoting hours to a serious
workout regime.
At work,get out of your chair to
move around the office regularly
– go and see colleagues in
person rather then emailing and
stand up when you’re on the
phone.Encourage your employer
to make it easier to cycle to
work, or why not motivate
your colleagues by starting a
sports team or taking part in
a sponsored run for charity?
At home, surely you can’t get
fit watchingTV?Yes you can!
Buy an exercise bike, or simply
practise strengthening and
stretching exercises (like squats
or pilates) while watching your
favourite shows.
Expert top tip: walk your way to fitness
Walking is free, provides
an ideal cardiovascular and
weight-bearing workout,
is easy to incorporate
into everyday life and
comes as second nature
to most people – plus,
by getting outside in
daylight you’ll be topping
up your vitamin D and
taking valuable time out
to refresh your mind and
body. Buy a pedometer
and aim for 10,000 steps
per day, around five miles,
or between one and two
and a half hours’ walking,
which will burn off around
3-400 calories (most
people walk between just
3,000 and 5,000 steps per
day). Build up gradually by
adding an extra 500 steps
a day at a time.

26
27
Exercise for weight loss
So we need to do more exercise if we want a
trimmer tummy. But how much do you really
know about the art of burning calories through
exercise?Take our quick fitness quiz to find out…
1.Which type of exercise should you choose to
burn the most calories – walking briskly, jogging
or cycling?
A) Jogging
B) Cycling
C)They all burn the same amount
2.Walking one extra mile a day will burn around
an extra 100 calories each day – how much
weight loss could this translate to over a year
(assuming your calorie intake remains the same)?
A) 2lbs
B) 5lbs
C)10lbs
3. If you are a 10 stone woman and you live a
sedentary life (you largely spend your waking
hours at a computer, in the car/on the train or
on the sofa), you will burn around:
A) 1,500 calories per day
B) 2,000 calories per day
C) 2,500 calories per day
How much exercise to do
According to the Department
of Health, only around 1 in 3
men and 1 in 4 women in the
UK reach the recommended
level of exercise – which is at
least 30 minutes of moderate
exercise at least 5 days per week.
It should be a reasonably
challenging activity, which raises
your heart rate and makes you
feel a little out of breath, yet it
doesn’t need to be intense –
you shouldn’t be in any pain,
and if you start to feel sick or
dizzy, stop and see your doctor.
What do you like?
The key with exercise is to
find activities you love, so you’ll
keep coming back for more.
Think back and ask yourself
what you used to like doing
when you were younger
– did you go ice-skating every
Saturday with your friends,play
footie in the park,or go dancing
on Friday nights? Maybe it’s
time to rediscover old pleasures.
Or perhaps a daily walk in the
park would be a chance for some
precious‘me-time’?
Even if a particular exercise is,
admittedly, hard to enjoy while
you’re panting away and your
muscles are aching, the rewards
can also be addictive – sitting
on the sofa considering a 30
Always consult your doctor first
if exercise is going to be a shock
to your system, and always warm
up and cool down and take time
to stretch.Any increase in activity
will be of benefit, so don’t give
up trying if you can’t quite manage
a brisk walk or 30 minutes a day.
A good way to begin if it’s been
a long time since you did any form
of exercise is walking, building
up from slow to moderate to
fast walking; or swimming – both
of these are relatively gentle but
still very good for you.You can
minute run, it’s natural to want
to stay where you are, but it’s
practically guaranteed that if
you go, you’ll come back
glowing with vitality and feeling
so much better for it.
Variety is also important to
keep you interested.Try a dance
class for a couple of months,
and then try out martial arts, go
do your daily exercise in one go,
or in shorter blasts if you prefer
– though to burn fat, you need
to keep up the intensity for more
than 20 minutes at a time.This is
because the body uses energy
stores from recently digested
food for the first 20 minutes and
it is only once these are running
low that it starts to call on your
body’s fat stores.
Aerobic exercise – like jogging,
cycling, or football – is the type
which gets your heart pumping
and gets you out of breath
rock-climbing, or learn to ski.
If you keep learning new
skills, you won’t get bored.
And whenever possible,
make activity sociable – if
you can chat to a friend as
you pound the treadmill at
the gym, the time will fly by.
– your heart and lungs work
harder than usual, you burn
plenty of calories and your
whole cardiovascular system is
strengthened. Strength training
– like weight-training, sit-ups or
yoga – builds and tones muscles
(which burn more calories than
fat), as well as strengthening
joints and bones. Do some of
both types of exercise, and
you’ll be getting the full range
of health benefits.

28
Stopping smoking
29
Exercise
Calories burned per
hour (based on a
150lb/68kg person)
Notable benefits
Cycling – 5mph/13mph 174/612 Aerobic fitness and see how fast your thighs and bottom tone up
Yoga 178 Flexibility, balance, toning, posture and core strength; plus relaxation
Housework – light/heavy
eg scrubbing floors
246/440 Flexibility and strength (and a job well done)
Walking – 3.5mph brisk
speed
271
Strength (especially when carrying heavy shopping!) and the faster you walk, the better your
aerobic training
Swimming – crawl,
slow/fast
288/522 Strength without stressing joints and when fast, aerobic fitness
Tennis – doubles/singles 312/450 Strength, flexibility, coordination and aerobic fitness in a social setting
Golf – carrying clubs 324 One study found regular golf playing can increase life expectancy by 5 years
Football 498 Great for building aerobic endurance and strength and the social aspect means regular practice
Dancing like there’s no
tomorrow
546
A whole body aerobic workout that doesn’t feel like one; there’s an endless variety of dancing styles
to try, from belly-dancing (great for the tummy) to fast and furious bhangra
Boxing (sparring) 642 Stress-busting aerobic and strength workout
Jogging
(10 minute mile /6mph)
654 High impact whole body aerobic workout, great for heart and lungs as well as weight control
Cross country skiing 690 Adventurous aerobic and strength workout
Circuit training 756 Strength, toning, stamina and endurance
For general information on getting more active, visit www.nhs.uk/livewell
Answers:
1. C –The type of exercise doesn’t make a difference to the number
of calories burned, only how quickly you burn them. If you particularly
enjoy a certain activity and can participate with friends while doing
this, you are more likely to do this more often and for longer periods.
Therefore, the total amount of calories burned overall will be greater
than participating in an activity that can burn calories faster which you
resent doing. Exercise should and can be fun. (Of course, different forms
of exercise can benefit the body more or less than others – for example
jogging or fast walking will be a better aerobic workout for your heart
and lungs than slow walking).
2. C – burning just 100 calories extra per day means you can lose a
staggering 10lbs a year without having to change your eating habits.
Use a simple calculation trick of dividing calories burnt per day by 10
to work out how many pounds you can lose per year, assuming you’re
otherwise in energy balance.
3.A – A sedentary daily life may mean you only burn 10% more calories
than your resting metabolic rate.This works out at around 66 calories
burnt per hour for a 10 stone woman: if you sleep 8 hours a night, and
are sedentary all day, that means you’re only burning 1,500 calories per
day, so to eat the average 2,000 calories of food per day without putting
on fat, you need to be more active!
Smoking
Stopping smoking is one of the most important ways
to prolong your life and health, especially safeguarding
against illnesses like cardiovascular disease and cancer.
Smoking is highly addictive because of the nicotine in tobacco, which
causes powerful withdrawal symptoms, and also because it becomes
a behavioural habit, so smokers feel they ‘need’ a cigarette to keep
their hands and mouth busy. Many people may try and fail to quit
several times before they succeed, but get there in the end.The good
news is that both the physical and the psychological habits can be
broken, and the health benefits you’ll enjoy in return, from within
hours of quitting, are tremendous and lifelong.
“One in two smokers
will die from a smoking
related disease”

Stopping smoking
30
Stopping smoking
31
The benefits of quitting smoking after:
20 minutes: Pulse and blood
pressure return to normal.
8 hours: Oxygen level in the
blood returns to normal as
levels of carbon monoxide and
nicotine significantly decrease.
1 day: The heart and lungs
start to repair themselves as
the body starts to clear out the
harmful tar and the thousands of
chemicals in cigarette smoke like
ammonia and hydrogen cyanide.
2 days: Nicotine, which
increases blood pressure, heart
rate and the narrowing of
arteries, all of which make the
heart work harder, is eliminated
from the body; smell and taste
are re-sensitised.
3 days: Breathing capacity
improves and energy levels go
up – the rise in oxygen allows
higher concentration levels
to be achieved and improves
general mental wellbeing.
1 week: The cravings and
restlessness caused by nicotine
withdrawal should now begin
to ease.
3 months: Circulation improves,
so it’s easier to walk and run,
and the voice is less hoarse.
9 months: Lung function
improves by 10% and coughing
problems heal.
1 year: Risk of a heart attack
falls by half.
10 years: Risk of lung cancer
falls by half.
15 years: Risk of heart attack is
now that of someone who has
never smoked.
20minutes
8hours
1day
2days
3days
1week
3months
9months
1year
10years
15years
Smoking both
dehydrates
your skin and
deprives your
skin of oxygen
Smoking adds lines
or wrinkles on the
face, particularly at
corners of the eyes...
...and a subtle
gauntness of the
features, with
prominence of the
underlying bony
contours

Stopping smoking
32
Stopping smoking
33
Live longer
Smoking accelerates the ageing process – and we’re
not just talking about wrinkles. Life-long smokers can
expect to have their life expectancy reduced by 10 years.
The risk of cardiovascular disease and lung damage is
related to the amount smoked daily and how long you’ve
smoked for. So the sooner you quit, the better.
Protect your family’s health
Those who have to live and work around smokers are
at serious risk of the same illnesses because they breathe
in the smoke too – and it’s especially unfair to expose
anyone, especially children, to these risks, not to mention
the unpleasant smell of smoke.
Feel stronger
Stopping smoking improves the body’s ability to fend off
colds and flu.
Save cash
If you smoke 20 cigarettes a day, you’ll save over £2,000
a year or, in 10 years, over £20,000. That’s quite a rainy
day fund.
Feel happier
Smokers tend to think that smoking calms them down,
but in fact, this is only in the short term immediately
after a cigarette is smoked. Studies have shown that in
the long term, ex-smokers’ stress levels are lower than
those of smokers.
i
C
i
i
C
C
i
C
i
C
i
C
i
C
i
C
10 top reasons to stop smoking
What’s my risk?
Smoking is bad for everyone, but the risks
associated with smoking are further increased if:
nYou’re pregnant, or your partner is pregnant,
because first and second-hand smoke harm
the baby in the womb.
nYou take the contraceptive pill – the
combination heightens your risk of heart
disease to 30 times that of a non-smoker.
nYou have high blood pressure, diabetes, asthma,
other existing or past heart or lung problems, or
suffer from other medical conditions.
The nicotine in cigarettes tends to speed up your
body’s process of removing (or metabolizing) other
drugs from the blood stream.
Asthmatics who give up smoking find that their
inhalers work more effectively. Many ex-smokers
find the effects of caffeine to be increased, so that
a cup of coffee or tea becomes stronger.
If you have a mental health condition that is helped
by anti-psychotic or neuroleptic medications it is
important that you talk to your GP and/or psychiatrist
before quitting. People who stop smoking may
need a different dose of this type of medication.
Be more confident
Once you no longer rely on a cigarette in your hand as a
social crutch, you’ll find you never really needed it.
Improve fertility
Quitting is not only essential if you or your partner are
pregnant to protect the unborn baby, but will also raise
your chances of conceiving.
Look and smell better
Smokers are notoriously unconscious of how they smell
to others, but the fact that non-smokers have been
found to be three times more appealing to the opposite
sex than smokers tells you everything you need to know.
Stop and see how much whiter your teeth become, how
your skin brightens and clears, and how non-smokers no
longer avoid sitting next to you.
Heighten your senses
Once your ability to taste and smell return in full, you’ll
realise how much you’ve been missing.
Enjoy better sex
Both women and men who stop smoking improve their
blood flow and this means it’s easier to get sexually aroused.

Stopping smoking
34
Sensible drinking
Help me stop!
Lines or wrinkles on
the face, particularly
at corners of the eyes
Smoking both
dehydrates and
deprives your
skin of oxygen
Sensible drinking
An age-old, delicious way to relax, laugh and socialise
– or, a depressant drug which, apart from the often
embarrassing or aggressive way it makes people
behave when it takes away their inhibitions, can
become addictive and which in large quantities can
cause severe damage to the body? Drinking alcohol
is both of these things – but so long as it’s done
in moderation, you need never worry about the
negative side of drinking.
Get ready…
Decide to quit when you have a relatively
un-stressful week ahead, and make a
promise to stop smoking on a particular day.
Marshall your resources. Pre-warn friends,
colleagues and family that you will be
irritable and that you’ll need their support.
Bin all cigarettes and avoid other smokers
from the moment you quit and stock up
on inspiring books.
As a preparation for quitting for good, over
a week or two, see if you can reduce the
number of cigarettes you smoke to just a
couple per day – then when you do quit, it
will be easier. Don’t use this as an excuse
not to stop smoking completely, though!
Get set…
Hypnotherapy or visualisation focusing on
how good you’ll feel when your body is free
of smoke and how you’ll ride cravings can help.
You can also find stop-smoking CDs or ask
friends for recommendations for therapists.
People who wean themselves off nicotine
using medication have been found to be
two times as successful in quitting.With
Nicotine ReplacementTherapy you can
use patches, nicotine gum, lozenges or
even an inhalator resembling a cigarette –
ask your doctor or pharmacist what NRT
product would be best for you.
Other medication is available on prescription
including Brupropion (trade name Zyban)
andVarenicline (trade name Champix) which
help to curb cravings for cigarettes. However,
these medicines should only be considered
after discussion with a doctor.
The NHS offers a variety of counselling
or group support services for quitters, in
person, by phone and online. People have
found that this support in combination
with medication makes them four times
more likely to quit. Call the NHS Smoking
Helpline on 0800 022 4332.
Go!
Cravings for a cigarette only last a few
moments at a time. Once you have got
through one, you can get through them all.
Make quitting part of a wider bid for good
health. Go for brisk walks or jogs in the first
days of quitting to feel how much fitter you
have become almost immediately; eat plenty
of fresh fruits and vegetables; and indulge
in a massage or go to a spa for a day to
heighten the sense of cleansing the body
and increase your motivation.
Give yourself substitutes to keep the
mouth and hands busy like chewing gum
and fresh fruit.
Find out more:
visit www.smokefree.nhs.uk
35

Sensible drinking
36
Sensible drinking
37
When calculating units, guesswork can be
very flawed. One common myth is that
so long as you don’t mix your drinks, you’ll
get less drunk – In fact, although mixing
drinks may upset your stomach, it has no
effect on the level of intoxication: alcohol is
alcohol. Just because you don’t feel drunk
and you’re not an alcoholic doesn’t mean
you’re not drinking too many units.
Regular drinking builds up tolerance and
prolonged heavy drinking is enough to
cause serious health problems as well as
withdrawal symptoms like anxiety. Plus,
we’re drinking stronger drinks than we
used to – for instance, strong continental
lagers, as opposed to milder ale, or ‘new
world’ wines, which can be stronger than
those from France or Spain and we’re
also drinking more wine – we all know
the current fashion for wine-glasses the
size of soup bowls!Those wine glasses
hold a third of a bottle of wine each.
“10 times as many people in
Britain die of alcohol-related
causes each year as the number
who die in road accidents”
A single 25ml measure of spirits or a small ‘shot’ (vodka, gin, rum, whisky, tequila etc) = 1 unit (be aware
that many bars now routinely use larger measures as ‘singles’)
A pint of ordinary strength beer or cider = 2 units
A pint of continental lager = 3 units
A ‘small’/ ‘standard’ 125-175ml glass of wine or champagne =1.5/2 units
Large glass of wine or champagne (often the standard size unless you ask for a ‘small’) = up to 3 units
Bottle of wine or champagne = 7.5–10.5 units depending on strength
1 bottle of 5% ABV alcopop =1.4 units
Zombie cocktail = 4 units (contains 4 measures of rum and apricot brandy). Cocktails are deceptive as you often
can’t taste the alcohol in them, yet they routinely contain at least 2 units, if not more.
Evidence shows that in Britain, eight out of ten people don’t
know the recommended number of units. Every drink contains
a different level of pure alcohol, so you can’t assess how much
you’re drinking by simply totting up how many drinks you’ve
had. To make understanding how much you’ve drunk easier, the
safe amount to drink is calculated in units – a unit is 10ml or 8g
of pure alcohol.This is the amount an average person in good
health can break down in an hour.
Q: Which has the most units, a gin and tonic, a cocktail, a pint of beer or a glass of wine?
A unit is worked out using the percentage of alcohol by volume
(ABV) of a drink.The percentage of alcohol equals the number of
units in one litre. So, for example, beer labelled 6% ABV is strong:
it equates to 6 units in every litre – which is just under 3 units in a
pint.You can check the units in every drink by looking at the % ABV
on the label.
Every drink has a different ABV, but here is a rough guide:
TopTip: visit this site to find out how many units are in your
favourite cocktail: www.in-the-spirit.co.uk/cocktails
You can also visit www.drinkaware.co.uk to use a unit calculator
to add your daily units up online.The government recommends
setting yourself an upper limit of 2-3 units per day, a maximum of
14 units per week for women and 3-4 units per day, a maximum
of 21 units per week for men.
The most important number is the units per day – as it’s definitely
not healthy to ‘save’ all your units for one day and binge. If you do
overdo it one day, make sure you give yourself at least 48 hours
without drinking alcohol, to allow your body to recover.

Sensible drinking
38
Sensible drinking
39
The Big Question
Isn’t drinking red wine good for me?
Sadly, the jury’s still out on this one.Although red wine
contains resveratrol, an antioxidant substance linked to
having preventative effects when it comes to illnesses
like cancer and heart disease, it also contains many
other harmful substances.Although studies have found
light to moderate consumption of alcohol can raise
levels of good cholesterol and reduce levels of bad
cholesterol to protect the heart, there’s no evidence
so far that drinking any particular type of alcoholic
drink is directly linked to health benefits. Sadly, drinking
causes many more deaths than it prevents.There are
far more positive ways to make an impact on health,
like eating more fruit and vegetables and giving up smoking.
Effects
n Heart disease: 6,000 male
deaths each year in the UK
from coronary heart disease
are caused directly by drinking.
n Liver damage, like cirrhosis
and liver cancer. One in three
British adults drinks enough
alcohol to be at risk of liver
disorders, and sufferers are
increasingly younger.
n Cancers, notably breast cancer,
liver cancer and mouth cancer.
Drinking is responsible for
one in four cases of mouth
cancer in the UK.
n Brain damage, from memory
loss to dementia.
n Depression, and in some
cases even psychosis.
n Stomach damage.
n Fertility problems – low
fertility, loss of periods or
irregular periods.
n Smaller genitals.
n Chronic pancreatitis
which can lead to type
two diabetes.
n Loss of body hair.
n Bad skin.
What increases risks?
n Being older – the older you
are, the less easily your body
processes alcohol.
n Being female or being light
in weight (hence the term
‘lightweight’) – alcohol has a
greater effect on someone
who weighs less because
of the higher concentration
of alcohol in their blood, so
don’t even think about trying
to match a 15-stone man
drink for drink!
n Drinking on an empty
stomach – this increases the
rate of alcohol absorption.
n Being on medication
– drinking is not advisable
when you’re on most types
of medication because of
possible adverse reactions.
n Being pregnant – if you drink
while pregnant, the baby
is exposed to the alcohol
through the placenta and this
can have serious effects on
their development and raises
the risk of miscarriage. It is
advisable to avoid drinking
alcohol completely when you
are pregnant.
So why exactly is too much alcohol such a bad thing? Apart from
encouraging you to singTinaTurner songs, drinking too many
units, has a serious effect on health.
Alcohol is a drug that has the potential to harm every organ in
the body. Short-term effects can include being sick, dizziness,
dehydration, headache, saying and doing things you don’t mean,
The dangers of overdoing it
behaving out of character, hangover, sleep disruption, impotence, loss
of consciousness, potentially fatal alcohol poisoning and of course an
increased risk of accidents and injuries.
Your BMI health assessment may have highlighted health issues
possibly linked to drinking too much.
Alcohol can significantly increase your weight due to the high
calorie count in drinks (especially cocktails, and particularly
creamy ones, which are fatty as well as sugary). Drinking 4 pints
of beer at around 250 calories is equivalent to eating 4 chocolate
bars in terms of calories – no wonder people talk about having a
‘beer belly’!These are ‘empty’ calories which don’t fill you up or
play a nutritional role.
Top Tip: if you’re watching your weight, opt for lower-calorie drinks,
like a 175ml glass of wine at 125 calories, or a gin and slimline tonic
at 55 calories.
Long-term effects of drinking above the recommended number of units over time can include:

Sensible drinking
40
Dealing with stress and worry
41
Dealing with
stress and worry
Stress is hard to define and means different things to
different people. It is thought that the number of people
who feel stressed and overwhelmed in the UK is on the
rise – Job related stress and relationship stress being the
most cited reasons for it. The charity MIND reported
that half a million people in the UK experience work-
related stress at a level they believe is making them ill.
Twelve million adults see their GP with mental health
problems each year, much of it stress related.
Drinking safely
Ask yourself if the following
situations sound familiar:
n Not wanting to socialise
without a drink.
n Needing a drink at the end
of the day to wind down.
n People regularly telling you
you’ve done something
embarrassing,argumentative
or upsetting while drunk.
n You can’t just have one drink.
n Drinking secretly or lying
to others about how much
you drink.
n Not being able to
remember what happened
the evening before.
n You’ve started shaking,
sweating, having blackouts
or loss of appetite.
n You’re already thinking
about your next drink.
If they sound familiar, now’s
the time to cut down on your
drinking before it affects your
health and life even more. Here
are some simple ways to reduce
your units.
n Ask for a small (not standard)
glass of wine or single (not
standard double) GT.
n Drink spritzers to dilute
your drink.
n Ask for low-alcohol drinks,
– or why not try a non-
alcoholic cocktail?
n Have a glass of water or soft
drink for every alcoholic one
to slow you down and ease
the load on the body.
n At home, use measures, as
it’s easy to over-pour.
Also,did you know that
we tend to pour as much
as 30% more into a wide
glass than a tall,slender one?
This is because of an optical
illusion in which our brains
underestimate the volume in
a low,wide glass compared
to a tall flute.So getting rid
of your tumblers for drinking
alcohol is a good move for
cutting down.
n Have at least two alcohol-
free days each week and
keep track of the number of
units you drink.
n Realise that you don’t become
more interesting or fun to be
with when you drink – it can
be a relief to find you can still
have a good time on a night
out without using alcohol as a
social crutch!
n Don’t feel obliged to buy
yourself an alcoholic drink
when it’s your turn to get
the rounds in.
n Eat a meal rich in protein
and carbohydrate (such as
meat and potatoes) before
drinking, to slow down
alcohol absorption (though
it won’t prevent it!).
n If you know you have a
drinking problem, get help.
Speak to your doctor, or call
Drinkline (0800 917 8282)
or Alcoholics Anonymous
(0845 769 7555).
Find out more
Visit www.drinkaware.co.uk for
all the facts on how much is too
much when it comes to drinking.
Why is it bad for you?
It is thought that stress effects our
body through the phenomenon of
“fight or flight”which results in
changes both physically (due to a
release of adrenaline) and mentally
(gearing yourself up to face the
danger head on or to run away).
This is meant to be a temporary
state that the body needs to carry
out the necessary survival
mechanisms.However in stress,
particularly chronic stress,the body
is always on this constant state of
alert.This can have serious medical
outcomes including coronary heart
disease,high blood pressure,some
cancers,obesity,a low-functioning
immune system and lead
to psychological effects of
depression and anxiety.
Your BMI assessment will have
included a lifestyle consultation
which may have identified any
areas of stress in your life. Many
people are aware that they are
stressed but not sure what would
help whereas others don’t know
the impact stress is having on
them and therefore assume this
is normal. It is only when they
stop and their body returns to
a relaxed state do they realise
how stressed they were.

42
43
n breathlessness
n feeling sick or dizzy
n headaches
n constant tiredness
n fainting spells
n restlessness
n chest pains
n sleeping problems
n tendency to sweat
n constipation or diarrhoea
n nervous twitches
n craving for food
n cramps or muscle spasms
n indigestion or heartburn
n pins and needles
n lack of appetite
n high blood pressure
n sexual difficulties.
You may have these feelings:
n aggressive
n depressed
n irritable
n neglected
n fearing you are ill
n dreading the future
n dreading failure
n taking no interest in life
n believing you are bad or ugly
n lacking interest in others
n losing your sense of humour
n having no one to confide in.
How you may behave:
n difficulty making decisions
n inability to show true feelings
n problems concentrating
n avoiding difficult situations
n denying there’s a problem
n frequently crying.
Some of the symptoms of stress would include:
If a problem is beyond your
control then it may need to
be dealt with in other ways
or left alone.
There are different types of
problem solving. Active problem
solving looks at what can be
actively undertaken to reduce
the stress. Methods include
making a pros and cons list of
what would be good about taking
a certain action or reducing the
number of demands on oneself
by saying“no”.Whereas emotional
coping strategies focus on how
someone is feeling and base
judgements on that. It is thought
that active problem solving is
better for health and generally
allows you to feel more in
control and empowered whereas
being governed by feelings
alone can sometimes increase
the sense of being overwhelmed.
Therefore, getting better
organised, making a list of jobs;
tackling one task at a time;
alternating dull tasks with
interesting ones are positive
coping strategies. Similarly,
sorting out your worries can
help. Divide them into those
that you can do something
about (either now or soon)
and those that you can’t.There’s
little point in worrying about
things that you can’t change.
Also try to be kinder to yourself:
accept that you can’t stay on
top of things all of the time and
that you cannot always make
things perfect. Let go a little. If
you’re working with someone
who’s simply impossible, or you’re
being made redundant, there’s
little you can do, so instead of
fighting the issue, it would be
less stressful to accept the
situation and look for a new job.
You can’t change what others
say or do but you can change
your own response.
Changing the
meaning of things
One of the classic thought-
patterns of stress is to think about
the worse thing that could happen.
People who are stressed often
think unrealistically ‘catastrophic’,
black and white, worst-case
What can help with
overcoming stress?
Life is stressful and a certain
degree of stress is entirely
normal, perhaps even
necessary to keep things
interesting! But high stress
levels are associated with
poor health both
psychologically through
exhaustion, depression,
anxiety and even total
burnout, as well as many
physical health problems.
According to Professor Cary
Cooper, an Occupational
Health expert from the
University of Lancaster, the
most unhelpful response to
stresses is to ignore them
and hope they will go away:
‘Not taking control of the
situation and doing nothing will
only make your problems
worse.’ Instead, he advocates
taking control of whatever you
can, training yourself to be
more emotionally robust and
building a strong social network
for support.
Problem solving
and prioritising
It is important to evaluate which
problems need to be done,
which could wait and which are
problems that are beyond your
control.Those problems that can
be solved and are immediate are
important to focus on.
scenario thoughts.These
thoughts are unhelpful and
have a negative impact on
our emotional wellbeing.
Cognitive Behavioural
Therapy (CBT) has been
used as one form of talking
therapy to help with these
unhelpful thoughts and try
and balance them with more
helpful and useful ways of
thinking that will promote
coping and wellbeing.
Mindfulness
There is some recent evidence
to suggest that Mindfulness
Cognitive BehaviouralTherapy
(MCBT) helps to treat stress
and depression.This form of
therapy is a type of CBT but
incorporates a lot of principles
on breathing and focusing of
attention. MCBT is based on
the practice of Buddhism.
It suggests that most worries
and stresses are based on
fears about something that
might happen in the future
and how you might react, or
concerns about something
that’s already happened.
Therefore, focussing your
attention on the moment
you’re in, either you’ll
probably find that there’s no

44
45
reason to be stressed, or
that even if there is, the
actual experience of stress
itself is not as bad as the fear
of stress in future or regrets
about the past.
Mindfulness is essentially
about learning to slow down
and stay in the moment, and
not to get carried away by
thoughts and feelings. Mark
Williams, Professor of Clinical
Psychology at the University
of Oxford, says that people
who practice MCBT ‘begin
to see thoughts and feelings
as a temporary weather
pattern… and realise they
don’t have to judge themselves.’
Labelling
When we are upset, we
sometimes think things like
‘nothing can make me happy’,
‘I should have done things
differently’,‘I mustn’t get
angry’, or ‘will I always be a
failure’? Or some people say
sorry for everything, even for
things other people do
wrong.These are all mood-
lowering ways of talking to
oneself and other people, and
changing your language can
really make a difference, says
psychotherapist Philip
Hodson. He suggests that it’s not
what happens to us which
causes us misery – it’s how we
see what happens and the
language we use to think about
what happens.
If your thought is ‘I mustn’t get
upset,’ challenge it! Ask yourself
‘Must I really never get upset, or
can I allow myself to feel the
way I feel?’
Acceptance is the key
– believe you’re OK
Thinking that one is okay and is
trying their best even if things
don’t work out can have a positive
influence on how you feel. It will
help to make you feel better.
There have been studies that
have given people who had mild
or moderate depression a
placebo (a ‘fake’ antidepressant
or ‘sugar pill’ containing no
active chemicals).These people
said they felt better and their
brains even changed physically.
In fact, the number of people
who were given placebos for
depression who felt better was
almost the same as the number
of patients who felt better on
antidepressants. The human
brain believes the messages we
give it. So, if you can tell
yourself you are doing well, it’s
likely you will do well.
Lifestyle changes
If you are feeling “out of sorts”
it is important to make the
connection with stress. Could
the fact that you’re feeling
overwhelmed be a response to
too much pressure? If so, it
would be helpful to improve
your lifestyle.
Nutrition
Junk food diets can bring on
depression.We all need at least
five servings of different fruit and
vegetables every day to keep
our minds feeling fresh and
energetic, able to concentrate
and think clearly.We also need
protein (meat, fish, eggs, soya) for
strength, and slow-burning
carbohydrate (wholegrain rice,
wholemeal pasta, wholegrain
bread, boiled potatoes) for
energy. Oily fish like mackerel,
brazil nuts, bananas, and leafy
vegetables all contain nutrients
proven to keep the mind healthy.
Cut down on ready meals,
artificial additives, and naughty
pick-me-ups like sugary snacks,
caffeine and alcohol.This will
have a positive impact on your
mood. Stressed people often
turn to smoking, alcohol, and
caffeine to feel better. However,
self prescribing in this way only
seems to help with stress in the
short term and invariably makes
the stress worse.
Physical activity
Physical activity has a proven
effect on helping to alleviate stress
and depression.Some studies
have shown that regular exercise
can help and be as powerful as
antidepressants in treating mild or
moderate depression.Therefore,
that cosy night in on watching
DVDs on the sofa is, indeed,
tempting.But doing some exercise
– especially somewhere green
– is proven to make us happier
than sitting around.
One scientific study found that
a walk in the park reduced
depressive feelings in roughly
three out of four people, while
walking through a shopping
centre made at least one in
five people more depressed.
When we get our hearts going
with a bit of exercise, our brains
release chemicals which uplift
the mind, called endorphins.
We feel happier with our
bodies, and we release tension
and stress and feel refreshed.
Another important change is to
take regular breaks. Maybe give
yourself a brief break whenever
you feel things are getting on
top of you.
Sleep patterns
Worrying about work and
money are the main reasons
for insomnia among two-
thirds of us, a recent survey
found. Poor sleep has been
linked to higher levels of stress,
anxiety and depression, yet we
still work among the longest
hours in Europe. If you can’t
get the recommended seven
or eight hours’ sleep at night,
a 15-20–minute powernap in
the afternoon is increasingly
acceptable among British
companies and has a beneficial
impact on your productivity and
helps decrease stress levels.
Social support
Social support is considered
to help to buffer the effects of
stresses. It’s generally accepted
that loving relationships and
seeing friends and family
regularly do make people
happier. Many studies show
that high levels of community
and social togetherness play
a significant role in wellbeing.
Therefore, confiding in
someone, not keeping
emotions bottled up and
focussing on the positive
aspects of your life can
help reduce stress. Putting
thoughts and feelings into
words does help to soothe
us. So share your worries
and listen to advice from
those who know and care
about you.

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47
Putting it into practice
– work-life balance
Our culture of working long
hours is one of the major
causes of stress and depression.
Over half a million British
people report that work-
related stress makes them
ill every year, with common
problems including bullying and
exhaustion from overwork.
It is important to also say no
to unreasonable deadlines
and crazy hours and make
time to relax on your own or
with your family or friends. If
necessary, tell your employer
something needs to change.
Employers are duty-bound
under the Health and Safety
at Work Act 1974 to protect
the health, safety and welfare
of their employees.
Organise and prioritise at
work and home: decide on an
order of tasks and a realistic
timescale and then do one
thing at a time.Writing a list
(as above) can often help get
worries out of your mind and
under control. Change what
you can. Look at the problems
that can be resolved, and get
whatever help is necessary
to sort them out. Look at
your long-term priorities. Step
back and examine what it is
about your life that’s giving you
too much stress.What can you
off-load, or change? How can
you introduce a better balance
between work, social life and
home life? Is it time to reassess
your priorities?
Further help
If you’re unhappy and it’s
persistent, you’re not alone.
More than one in every five GP
appointments is about stress,
anxiety or depression. So make
an appointment with BMI or
your GP and talk it all through.
There are all kinds of therapies
available,from cognitive behavioural
therapy to help identify and
change your thinking errors (like
catastrophic thinking) to relaxation
classes, as well as prescribed
medications from your GP.
Learn to relax
Simple relaxation is increasingly
believed to be one of the best
treatments for stress, anxiety
and depression, and even five
minutes can have a dramatically
positive effect. Follow this simple
routine to relax your muscles
and slow your breathing.
Simple five-minute relaxation exercise
from Dr Seema Quraishi, Clinical Psychologist at BMI London Independent Hospital
1) Sit comfortably in a chair
with your arms on your
knees at rest. Make sure
there are no draughts or
distractions and the chair
is comfortable.
2) Raise and elevate your shoulders
towards your ears and whilst
doing this tense them and hold
them in this position for ten
seconds and then relax.
3) Clench your hands into fists and
hold them in this position for ten
4) Clench your stomach in but
keep breathing.Tense it and
hold in this position for ten
5)Tighten your bottom and
keep it tense for ten seconds
and then relax.
6) Clench your toes and hold
them in this position for ten
seconds and then relax
7) Finally,tense all these parts of
your body simultaneously and
hold them in this position for
ten seconds and then relax.
www.mind.org.uk

Cancer
48
Cancer
49
Cancer
It may sound silly, but when was the last time you took a
few minutes to look for any changes in your breasts, skin
or testicles? Health awareness and screening for certain
cancers is hugely important. If cancer is discovered at
an early stage, before it spreads, there’s a better chance
of successful treatment and recovery. In some cases,
there are no symptoms and only a clinical examination
will show signs of a tumour but in the cases of breast,
skin and testicular cancer, your own awareness can also
help you spot developing problems.Although medical
screening reduces risk, it doesn’t eliminate it. So it’s worth
being vigilant, knowing how your body normally looks
and feels and knowing what changes you can look out for.
Men Women Overall
1. Prostate cancer 1. Breast cancer
1. Breast cancer:
45,000 new
cases a year
2. Lung cancer 2. Bowel cancer
2. Lung cancer:
39,000 new
cases a year
3. Bowel cancer 3. Lung cancer
3. Bowel cancer:
38,000 new
cases a year
Cancer screening with BMI
BMI offers specific screening for breast, cervical, testicular, bowel
and prostate cancer as part of its health assessments and the doctor
will also assess your risk of other cancers as part of an overall check
up. If your BMI assessment identifies any causes for concern, your
BMI doctor will discuss these with you and can refer you on to a
specialist for treatment, either from BMI or via your GP.
Want to find out more about all types of cancer? Visit Cancer
Research’s website at www.cancerhelp.org.uk
Most common types of cancer in the UK
What causes cancer?
In cancer, a cell’s DNA mutates to make it grow abnormally and
reproduce excessively – these damaged cells don’t work properly
and form a lump of tissue known as a tumour. Some tumours are
benign tumours, which do not actively destroy surrounding tissue
and remain at the same site of the body. However, malignant
tumours are more aggressive and cause illness by destroying
surrounding tissues or spreading to other sites in the body where
they implant and cause new growths.There are more than 200
types of cancer, associated with different parts of the body, all
of which behave in their own way.The causes of cancer vary
depending on the site of the body where it develops. Causes
range from a weak immune system, to ageing, to environmental
The behaviour of cancerous cells
A normal row of cells
lining an organ
The DNA in one
cell mutates
Disorganised cell growth
produces a tumour
...or by travelling to
other parts of the body
A malignant tumour causes
problems by growing into
local tissues...
exposure, to harmful chemicals, to viruses, to leading an unhealthy
lifestyle.The exact cause of some cancers is still unknown.The rest
of this chapter will go into more detail about the more common
types of cancers.
Some people are born with a genetic predisposition to inherit
certain cancers – like breast or bowel cancer. If you have a higher
risk of cancer because of your family history, it’s important to
discuss this at your BMI assessment or with your GP as you may
be eligible for extra screening.

Cancer
50
Cancer
51
Follow a sensible lifestyle
Leading a healthy lifestyle will lower your risk of all
types of cancer.
In terms of lifestyle changes, you can help protect yourself
against cancers in general by:
n Quitting smoking.
n Maintaining a healthy weight.
n Eating a low-fat diet with at least five portions of
nutrient-rich fresh fruit and vegetables everyday.
n Exercising for 30 minutes most days of the week.
n Sticking to the recommended limits on alcohol.
What if there’s a problem?
Thankfully, testicular cancer is highly curable even at its advanced
stages. Still, of course, the earlier it is caught, the less treatment
needed and the better the chances of stopping it spreading.
Around 1,960 men in Britain are diagnosed with testicular cancer
each year but 95% make a full recovery.
If a swelling, lump or any other cause for concern has been found
at your BMI assessment, your GP will be informed and you’ll be
urgently referred for a specialist ultrasound to identify the problem
and/or treatment.
To find out more about testicular cancer, visit
www.cancerresearchuk.org
Testicular cancer
Testicles create sperm for reproduction and the male sex hormone
testosterone, to give men their secondary characteristics (like a
deep voice or facial hair). Cancer of the testicles is the commonest
cancer in British men between the ages of 20 and 35.
Am I at risk?
Your assessment and examination will have identified your risk
factors for testicular cancer – these include:
n Testicular tumours are commonest in young Caucasian
men between the ages of 18 and 45.American research
shows that white men are 5 times more likely to develop the
condition than black men and these research findings have
been confirmed in UK studies which show that testicular
cancers are rare in those from ethnic minorities.
n The most common symptom is a lump or swelling in part of
one testicle which is usually not painful but can have a dull
ache or dragging sensation associated to it.
n A past medical history of an undescended testicle has shown to
increase your risk. If you’ve had a cancer in the opposite testicle
before, your risk of a second cancer is increased by 12 times.
n A family history of a brother with testicular cancer increases
your risk. It is thought that 1 in 5 (or 20%) of testicular
cancers are due to an inherited gene.
Lowering your risk – what you can do
Be aware – as well as getting your testicles clinically examined,
check your testicles once a month and get to know what looks
and feels normal in your testicles. Report any changes like swelling,
discomfort or pain without delay. Most testicular cancers are
first detected by the patient, who may have noticed a change just
by chance or through self-awareness.
How to check your testicles
1. Check them after a bath or shower when the skin is at its
most relaxed.
2. Holding your testes in your hand, examine them with your
thumb and fingers. First check they feel as heavy as usual and
are the usual size. It’s normal to have one ball larger than the
other and for one to hang lower.
3. Then feel each one in turn, checking that it is smooth and
not swollen with no lumps.
Cancer in both testicles is rare so it can be helpful to compare
each testicle to the other to know what’s normal for you.
4. If you notice anything unusual, tell your doctor as soon
as possible.

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52
Cancer
53
Checking your moles
Use the ABCD checklist
to tell what’s normal and what isn’t:
If you notice one or more of these signs, report them to your
doctor without delay.
A for Asymmetrical: a suspect mole has
an irregular shape compared to a normal
mole which is round or oval.
B for Border: a melanoma’s border is
uneven and irregular, perhaps appearing
ragged or notched.
C for Colours: a melanoma has two or
more colours, compared to a normal
mole which is just one colour. It may
bleed or be itchy, too.
D for Diameter: normal moles are less
than 6mm from side to side; melanomas
tend to be larger.
More than 6mm
Skin cancer (malignant melanoma)
Malignant melanoma is just one type of skin cancer, but it’s
the most serious, as it easily spreads around the body. It causes
the most deaths of all types of skin cancer – 1,500 each year
in England and Wales. It’s the sixth commonest type of cancer
in Britain, but overall, cure rates for skin cancer are very high,
between 70 and 90% depending on the type.
Am I at risk?
Overexposure to UV light (from the sun or sunbeds) is the main
cause of malignant melanoma as it damages skin cells – in other
words, not using sunscreen and not covering up in the sun puts you
at risk, as does using sunbeds.
Certain people are especially at risk – take special care if:
n You use sunbeds.
n You are fair skinned, have light coloured hair, or have freckles.
n You have a lot of moles.
n You’ve had skin cancer before.
n You’re on medication or are using beauty products which
increase your skin’s vulnerability to sunrays.
n Your immune system is vulnerable – for example if
you have certain autoimmune diseases or a medicine
is lowering your immunity.
n You are spending time in a hot country or work outdoors.
Lowering your risk – what you can do
Check your skin regularly – ideally every 3 months. If caught at an
early stage, the chances of curing malignant melanoma are much
higher.A melanoma’s first sign is often a new mole appearing or
changes to an existing mole, often in size or colour.A malignant mole
can be anywhere on the body, but the most common sites are
the legs in women, the back in men and the face in older people.
Avoid over-exposure to the sun, in winter as well as in summer.
Everyone needs a few minutes of sun exposure a day since it gives
us the essential nutrient vitamin D, but protecting the skin against
cancer by wearing sunscreen and covering up should be your
priority – enough vitamin D should still be absorbed because no
sunscreen provides total protection. Avoiding sun damage also helps
skin stay looking younger for longer, so using sunscreen is one of the
best beauty treatments you can give yourself.
Here’s what to do when you’re in the sun
n Use SPF of 15 or higher (check it protects against UVA and
UVB rays). Factor 15 protects against around 93% of UVB rays,
factor 30 against 97% and factor 50 against 98%, so factor 15 or
30 will give the best value for money
n Use liberal amounts (at least a handful per adult body) of
factor 15 or higher sunscreen on exposed parts of the body
30 minutes before going outside (don’t forget the face is always
exposed in winter) and reapply around every two hours or
after towelling or sweating (waterproof sunscreen may need
reapplying after 40 minutes in water). Research found that not
applying enough sunscreen could reduce the SPF from 80 to 3!
n Wear a hat (large brimmed if possible), use a parasol, cover up
with long sleeved clothes, wear sunglasses and so on
n Avoid the sun at its peak (usually between 10am and 2pm
or whenever you feel it is strong)
n Don’t use sunbeds, ever. Use of sunbed before the age of 35
is associated with a 75% increase in the risk of melanoma
n Don’t let yourself get sunburnt or go sunbathing with
the intention of getting a tan – a tan is the skin’s
response to being damaged.
What if I find something?
If your assessment has identified any problem mole(s), or
you find one yourself at any stage, you’ll be referred to a
dermatologist for further examination and, if necessary,
treatment. If skin cancer can be identified early, before it
spreads, it can be dealt with by simply cutting it out of the
skin, resulting in no further problems.

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