2.3 Assessment

An im­por­tant part of your prepa­ra­tion be­fore you start on the SWLL is to as­sess your cur­rent sit­u­a­tion. By do­ing this you will:

  • Record a baseline that you can use to measure future progress.
  • Identify problems that may need correcting before you start on the SWLL.
  • Get an objective idea of the challenge you face.

Physical Exam

Before you start on the SWLL make an ap­point­ment with your doc­tor for a com­plete check­up. There are sev­er­al rea­sons why this is es­sen­tial.

Ask her if there is any rea­son why you can­not start an ex­er­cise pro­gram. If there is, then your first pri­or­i­ty will be to ad­dress the prob­lem. It is also pos­si­ble that she will al­low you to start an ex­er­cise pro­gram, but with re­stric­tions on what you can do.

If you are a smok­er, your doc­tor will urge you to give it up. If you are ready to do this, it is prob­a­bly best to fo­cus on quit­ting and to post­pone the adop­tion of the SWLL. Some high­ly mo­ti­vat­ed peo­ple may be able to do both at the same time. Most peo­ple will have bet­ter suc­cess if they grap­ple with the chal­lenges one at a time.

As part of your phys­i­cal, your doc­tor will or­der a blood test. When the re­sults come back she will tell you if there are any prob­lems, and what to do about them. This is good, but it’s not enough. Ask her for a copy of the test re­sults. Take the re­sults home and store them in a safe place.

The re­sults of the blood test act as a base­line. In years to come, you will get more blood tests and you can com­pare them to ear­li­er re­sults. They may show that some num­bers are im­prov­ing, which is re­as­sur­ing and con­fir­ma­tion that your cur­rent lifestyle is good. Or they may show that some mea­sures are de­te­ri­o­rat­ing, in which case you can take cor­rec­tive ac­tion.

Having a copy of the re­sults al­lows you to study them and get a bet­ter un­der­stand­ing of what they mean. Certain num­bers may be marked as be­ing out of range. This means the re­sult is ab­nor­mal and may sig­nal a prob­lem. For ex­am­ple, if a man finds that his Prostate Specific Antigen (PSA) num­ber is high, then he may have a prob­lem with his prostate. When he re­search­es PSA, he will find that it might point to prostate can­cer, but that the test is no­to­ri­ous­ly un­re­li­able.

Some num­bers are es­pe­cial­ly wor­thy of at­ten­tion be­cause you have it in your pow­er to do some­thing about them.

If your choles­terol is too high then adop­tion of a healthy lifestyle will like­ly im­prove it. For a mi­nor­i­ty of peo­ple this is not true. A per­son may have a liv­er that sim­ply pro­duces too much choles­terol. It is still ben­e­fi­cial for such a per­son to adopt a healthy lifestyle, but for them, drugs are the main tool to con­trol choles­terol.

Before you see the doc­tor, a nurse will weigh you and take your blood pres­sure. If your blood pres­sure is el­e­vat­ed, you may be able to re­duce it through a lifestyle change.

Roughly one third of all peo­ple are salt sen­si­tive. If they in­gest too much salt, they re­tain flu­id and their blood pres­sure goes up. For them, a salt re­strict­ed diet can im­prove their blood pres­sure, some­times dra­mat­i­cal­ly. For more in­for­ma­tion on this, check out http://www.dashdiet.org, the Dietary Approaches to Stop Hypertension web­site.

For more in­for­ma­tion about these tests, see the metabol­ic syn­drome sec­tions of the “Health” chap­ter.

Finally, your doc­tor may pre­scribe drugs based on the re­sults of the exam. Question her and ask if there are any non-drug so­lu­tions to the prob­lem. A good ex­am­ple is a find­ing of high choles­terol. Many doc­tors rou­tine­ly pre­scribe drugs and don’t men­tion that lifestyle change may be a bet­ter so­lu­tion. Show her the pa­per cit­ed in Appendix 4, fo­cus­ing on the re­sults of the Portfolio Diet. She may be will­ing to let you try it.

Calorie Intake

It is al­most uni­ver­sal­ly true that peo­ple who have prob­lems with their weight do not have an ob­jec­tive com­pre­hen­sion of how many calo­ries they in­gest. If you hear a healthy wom­an say­ing, “I sim­ply can’t lose weight. I’m al­ready eat­ing like a spar­row and I still gain,” you can be sure that she doesn’t know what her calo­rie in­take is.

This is also true of peo­ple who are suc­cess­ful weight losers. Doctors Hill and Wing of the National Weight Control Registry re­port that:

Registry par­tic­i­pants al­most cer­tain­ly un­der-re­port­ed their to­tal en­er­gy in­take, al­though this phe­nomenon is not un­com­mon among oth­er pop­u­la­tions of ques­tion­naire re­spon­dents. Registry par­tic­i­pants re­port­ed con­sum­ing 1300 to 1500 calo­ries per day, of which 23% to 24% came from fat.

The val­ue of an ac­cu­rate count of your calo­rie in­take can­not be over­stat­ed. All the oth­er com­po­nents of the SWLL re­volve around it. You need to in­gest enough calo­ries to dis­pel hunger, but no more. Ingest too many calo­ries and you won’t lose weight. Eat too few and you will be hun­gry most of the time and won’t stay with the pro­gram.

You can start mea­sur­ing the calo­ries that you cur­rent­ly in­gest be­fore you adopt the full SWLL. Buy a good diet scale and use it to quan­ti­fy the calo­ries in all the food you eat. Adopt a method­ol­o­gy to track how many calo­ries you in­gest each day. See the “SWLL Diet” chap­ter for a dis­cus­sion of this.

Once you have ac­cu­rate data for, say, a week, you can com­pute a dai­ly av­er­age calo­rie in­take. Compare that num­ber to your to­tal dai­ly en­er­gy ex­pen­di­ture (TDEE). The method to com­pute TDEE is in the “Why Are You Overweight?” sec­tion of this chap­ter


It is use­ful to have some idea of your cur­rent ac­tiv­i­ty lev­el. You can use it as a base­line once you start on the SWLL.

The eas­i­est way to record ac­tiv­i­ty is to wear a pe­dome­ter or fit­ness track­er. All such de­vices record the num­ber of steps you take each day, and some will record ad­di­tion­al in­for­ma­tion, such as how many flights of stairs you climb.

Record the num­ber of steps that you take each day.

Numerous health au­thor­i­ties urge us to take 10,000 steps each day, or the equiv­a­lent in some oth­er form of ac­tiv­i­ty. By wear­ing a pe­dome­ter and track­ing your steps, you can com­pare your­self to this stan­dard.

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