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Question: Are there any diets tailored for people with Hypopituitarism? I have hypopituitarism due to a tumor. Are there any diet/exercise plans out there that are adapted to this condition? Specifically, that take into consideration cortisone balance.

Answer: Being overweight is associated with a risk of developing a variety of illnesses that can cause symptoms and interfere with a person's quality of life. Whether a person would benefit from weight loss can be determined from their BMI (Body Mass Index), which is calculated by measuring their height (in metres) and weight (in kilos), squaring the height and dividing the weight by the result. If the BMI is greater than 25 the person is overweight. The cornerstone of obesity treatment is changing lifestyle factors and this includes changes to diet and physical activity. In cases where weight loss is particularly difficult to achieve using lifestyle changes alone, there are drugs that are effective in promoting weight loss. These have potential side effects however and require medical supervision. Physical activity may be more important than diet in promoting fitness and controlling weight. To be effective the physical activity should be undertaken at least five times a week, for at least half an hour. It needs to be sufficiently strenuous to make the participant slightly out of breath (but still able to talk to a companion). Suitable forms of exercise include brisk walking, swimming, cycling and using a treadmill. Those with complaints such as arthritis should choose low impact activities such as swimming. Participants in higher impact activities need to ensure they have appropriate, impact-absorbing footwear, which is replaced when it deteriorates. Exercise also provides an immense feel-good factor, and is now often used in the treatment of depression. On the diet aspects of controlling weight, it is best for overweight people to aim for gradual weight loss: rapid weight loss can result in loss of muscle mass. In addition to being intrinsically harmful, this will lead to a reduced Basal Metabolic Rate (BMR), which will reduce the effectiveness of subsequent attempts to control weight. Gradual weight loss, combined with exercise to maintain muscle mass, is therefore the preferred option. The quantity and quality of the diet is important. A diet can result in weight loss but still have a bad effect on health, e.g. fashionable 'high protein, high fat' diets can have negative effects on health (low carbohydrate levels can lead to low blood sugar levels resulting in light-headedness and dizziness, and the resulting high levels of ketones (chemicals produced in the body by the metabolism of fat) can often be detected on the dieter's breath.) A low fat, relatively high carbohydrate diet is a more healthy option. The diet needs to contain a sufficient (but not excessive) amount of protein - 60 grams per day is generally sufficient. However, the relatively high carbohydrate intake should not be in the form of eating concentrated forms of sugar as this can result in impaired glucose tolerance and reactive hypoglycaemia (low blood sugar levels as a result of the body trying to cope with sudden increases in sugar intake) with associated light-headedness and dizziness. Those wishing to lose weight would often benefit from the support of a dietician or practice nurse providing long-term follow-up. Medical supervision is also advisable for those whose condition can make weight loss more difficult, e.g. those needing hydrocortisone replacement therapy. Sibutramine and orlistat, the drugs available for weight control, both have significant side effects and should only be taken under medical supervision and in conjunction with lifestyle weight-control methods. The only way to lose weight is to consume fewer calories than we expend (about 600 fewer each day usually results in steady weight loss). After initial success with weight loss, we will actually expend fewer calories each day, and so will need to further reduce our intake to maintain weight loss. This is the difficulty in maintaining a weight loss plan!

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