Anal cancer and treatment

Anal cancer is an uncommon type of cancer that occurs in the anal canal. The anal canal is a short tube at the end of your rectum through which stool leaves your body.

Anal cancer can cause signs and symptoms such as rectal bleeding and anal pain. Anal cancer symptoms may mimic those of more common conditions, such as hemorrhoids. For this reason, people with anal cancer may not see their doctors right away.

Most cases of anal cancer are diagnosed at an early stage — when treatment provides the best chance for a cure. Most people with anal cancer are treated with a combination of chemotherapy and radiation.

Anal cancer signs and symptoms include:

• Bleeding from the anus or rectum
• Pain in the area of the anus
• A mass or growth in the anal canal
• Anal itching

When to see a doctor
The signs and symptoms of anal cancer aren't specific to this disease. Some people mistake their signs and symptoms for more common conditions, such as hemorrhoids, and don't see their doctors. Talk to your doctor about any signs and symptoms that bother you, especially if you have any factors that increase your risk of anal cancer. Treatment for anal cancer is more likely to succeed if cancer is found at an early stage. 

nal cancer forms when a genetic mutation turns normal, healthy cells into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Abnormal cells grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can separate from an initial tumor to spread elsewhere in the body (metastasize).

Anal cancer is closely related to a sexually transmitted infection called human papillomavirus (HPV). Evidence of HPV is detected in the majority of anal cancers. HPV is thought to be the most common cause of anal cancers. 

Several factors have been found to increase the risk of anal cancer, including:

• Older age. Most cases of anal cancer occur in people age 50 and older.
• Many sexual partners. Men and women who have many sexual partners over their lifetimes have a greater risk of anal cancer.
• Anal sex. Men and women who engage in anal sex have an increased risk of anal cancer.
• Smoking. Smoking cigarettes may increase your risk of anal cancer. Former smokers have only a slightly elevated risk of anal cancer.
• Human papillomavirus (HPV). HPV infection increases your risk of several cancers, including anal cancer and cervical cancer. HPV infection is a sexually transmitted disease that can also cause genital warts. HPV may cause cells in the anal canal to appear abnormal — a condition called anal squamous intraepithelial lesions (ASIL). The abnormal cells associated with ASIL aren't cancer, but they may develop into anal cancer. However, some people with ASIL never develop anal cancer.
• Drugs or conditions that suppress your immune system. People who take drugs to suppress their immune systems (immunosuppressive drugs), including people who have received organ transplants, may have an increased risk of anal cancer. Long-term use of corticosteroids, such as those prescribed to control autoimmune disorders, also may increase the risk of anal cancer. HIV — the virus that causes AIDS — suppresses the immune system and increases the risk of anal cancer.

Anal cancer rarely spreads (metastasizes) to distant parts of the body. Only a small percentage of tumors are found to have spread, but those that do are especially difficult to treat. Anal cancer that metastasizes most commonly spreads to the liver and the lungs. 

Make an appointment with your family doctor or a general practitioner if you have any signs or symptoms that worry you. If your doctor thinks you have anal cancer, you may be referred to a surgeon or a specialist who treats digestive diseases (gastroenterologist). Once a cancer diagnosis is made, you may also be referred to a doctor who specializes in treating cancer (oncologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, you're taking.
• Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For anal cancer, some basic questions to ask your doctor include:

• What is the stage of my anal cancer?
• What other tests do I need?
• What are my treatment options?
• Is there one treatment that's best for my type and stage of cancer?
• What are the potential side effects for each treatment?
• Should I seek a second opinion? Can you give me names of specialists you recommend?
• Am I eligible for clinical trials?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow time later to cover points you want to address. Your doctor may ask:

• When did you begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

ests and procedures used to diagnose anal cancer include:

• Examining your anal canal and rectum for abnormalities. During a digital rectal exam (DRE), your doctor inserts a gloved, lubricated finger into your rectum. He or she feels for anything unusual, such as growths. DRE isn't used to diagnose anal cancer, but it can give your doctor an indication of what further testing might be appropriate.
• Visually inspecting your anal canal and rectum. Your doctor may use a short, lighted tube (anoscope) to inspect your anal canal and rectum for anything unusual.
• Taking sound wave pictures of your anal canal. In order to create a picture of your anal canal, your doctor inserts a probe, similar to a thick thermometer, into your anal canal and rectum. The probe emits high-energy sound waves, called ultrasound waves, which bounce off tissues and organs in your body to create a picture. Your doctor evaluates the picture to look for anything abnormal.
• Removing a sample of tissue for laboratory testing. If your doctor discovers any unusual areas, he or she may take small samples of affected tissue (biopsy) and send the samples to a laboratory for analysis. By looking at the cells under a microscope, doctors can determine if the cells are cancerous.

Staging
Once it's confirmed that you have anal cancer, your doctor works to determine the size of the cancer and whether it has spread — a process called staging. Determining your cancer's stage helps your doctor determine the best approach to treating your cancer. Tests and procedures used in the staging of your cancer may include:

• Images of your pelvis and abdomen. Your doctor may use computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) to make scans of your pelvis and abdomen to assess the extent of your cancer.
• X-ray images of your chest. X-rays of your chest can reveal if cancer has spread to your lungs or the bones in your chest.

Your doctor uses the information from the procedures to assign your cancer a stage. The stages of anal cancer are:

• Stage I. Anal cancer is 2 centimeters (about 3/4 inch) or less — about the size of a peanut or smaller.
• Stage II. Anal cancer is larger than 2 centimeters (about 3/4 inch), but has not spread beyond the anal canal.
• Stage IIIA. Anal cancer is any size and has spread either to lymph nodes near the rectum or to nearby areas, such as the bladder, urethra or vagina.
• Stage IIIB. Anal cancer is any size and has spread to nearby areas and lymph nodes, or it has spread to other lymph nodes in the pelvis.
• Stage IV. Anal cancer has spread to parts of the body away from the pelvis.

What treatment you receive for anal cancer depends on the stage of your cancer, your overall health and your own preferences.

Combined chemotherapy and radiation
Doctors usually treat anal cancer with a combination of chemotherapy and radiation. Combined, these two treatments enhance each other and improve chances for a cure.

• Chemotherapy. Chemotherapy drugs are injected into a vein or taken as pills. The chemicals travel throughout your body, killing rapidly growing cells, such as cancer cells. Unfortunately they also damage healthy cells that grow rapidly, including those in your gastrointestinal tract and in your hair follicles. This causes side effects such as nausea, vomiting and hair loss.
• Radiation therapy. Radiation therapy uses high-powered beams, such as X-rays, to kill cancer cells. During radiation therapy, you're positioned on a table and a large machine moves around you, directing radiation beams to specific areas of your body in order to target your cancer. Radiation may damage healthy tissue near where the beams are aimed. Side effects may include skin redness and sores in and around your anus, as well as hardening and shrinking of your anal canal.

You typically undergo radiation therapy for anal cancer for five or six weeks. Chemotherapy is typically administered during the first week and the fifth week. Your doctor tailors your treatment schedule based on characteristics of your cancer and your overall health. Though combining chemotherapy and radiation increases the effectiveness of the two treatments, it also makes side effects more likely. Discuss with your doctor what side effects to expect.

People with HIV are more likely to experience side effects when undergoing chemotherapy and radiation, since treatments can weaken their already-vulnerable immune systems. Side effects make it more difficult to endure and complete treatment. For this reason, your doctor may recommend lower doses of chemotherapy and radiation if you have HIV.

Surgery
Doctors typically use different procedures to remove anal cancer based on the stage of the cancer:

• Surgery to remove early-stage anal cancers. Very small anal cancers that haven't spread beyond the anal canal may be removed through surgery. During this procedure, the surgeon removes the tumor and a small amount of healthy tissue that surrounds it. Because the tumors are small, early-stage cancers can sometimes be removed without damaging the anal sphincter muscles that surround the anal canal. Anal sphincter muscles control bowel movements, so doctors work to keep the muscles intact. Depending on your cancer, your doctor may also recommend chemotherapy and radiation after surgery.
  
  If your cancer can't be removed without damaging the anal sphincter muscles, your doctor may recommend trying combined chemotherapy and radiation first. Combined treatment may shrink your cancer to a size that allows your surgeon to perform sphincter-sparing surgery.
• Surgery for late-stage anal cancers or anal cancers that haven't responded to other treatments. If your cancer hasn't responded to chemotherapy and radiation, or if your cancer is advanced, your doctor may recommend a more extensive operation called abdominoperineal resection, which is sometimes referred to as an AP resection. During this procedure the surgeon removes the anal canal, rectum and a portion of the colon. The surgeon then attaches the remaining portion of your colon to an opening (stoma) in your abdomen through which waste will leave your body and collect in a colostomy bag.

Tonsillitis Treatments and drugs

Tonsillitis Treatments and drugs

Tonsillitis Treatments and drugs

At-home care
Whether tonsillitis is caused by a viral or bacterial infection, at-home care strategies can make your child more comfortable and promote better recovery.

If a virus is the expected cause of tonsillitis, these strategies are the only treatment. Your doctor won't prescribe antibiotics. Your child will likely be better within seven to 10 days.

At-home care strategies to use during the recovery time include the following:

• Encourage rest. Encourage your child to get plenty of sleep and to rest his or her voice.
• Provide adequate fluids. Give your child plenty of water to keep the throat moist and prevent dehydration.
• Provide comforting foods and beverage. Warm liquids — broth, caffeine-free tea or warm water with honey — and cold treats like ice pops can soothe a sore throat.
• Prepare a saltwater gargle. If your child can gargle, a saltwater gargle of 1 teaspoon (5 milliliters) of table salt to 8 ounces (237 milliliters) of warm water can help soothe a sore throat. Have your child gargle the solution and then spit it out.
• Humidify the air. Use a cool-air humidifier to eliminate dry air that may further irritate a sore throat, or sit with your child for several minutes in a steamy bathroom.
• Offer lozenges. Children older than age 4 can suck on lozenges to relieve a sore throat.
• Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can irritate the throat.
• Treat pain and fever. Talk to your doctor about using ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) to minimize throat pain and control a fever. Aspirin has been linked with Reye's syndrome, so use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.

Antibiotics
If tonsillitis is caused by a bacterial infection, your doctor will prescribe a course of antibiotics. Penicillin taken by mouth for 10 days is the most common antibiotic treatment prescribed for tonsillitis caused by group A streptococcus. If your child is allergic to penicillin, your doctor will prescribe an alternative antibiotic.

Your child must take the full course of antibiotics as prescribed even if the symptoms go away completely. Failure to take all of the medication as directed may result in the infection worsening or spreading to other parts of the body. Not completing the full course of antibiotics can, in particular, increase your child's risk of rheumatic fever and serious kidney inflammation.

Talk to your doctor or pharmacist about what to do if you forget to give your child a dose.

Surgery
Surgery to remove tonsils (tonsillectomy) may be used to treat frequently recurring tonsillitis, chronic tonsillitis, or bacterial tonsillitis that doesn't respond to antibiotic treatment. Frequent tonsillitis is generally defined as:

• More than six episodes in one year
• More than four episodes a year over two years
• More than three episodes a year over three years

A tonsillectomy may also be performed if tonsillitis results in difficult to manage complications, such as:

• Obstructed sleep apnea
• Breathing difficulty
• A peritonsillar abscess that doesn't improve with antibiotic treatment

Tonsillectomy is usually done as a one-day surgery. That means your child should be able to go home the day of the surgery. A complete recovery usually takes seven to 10 days.

Tonsillitis

Tonsillitis

Tonsillitis 

Tonsillitis - Treatment Overview

Tonsillitis is most often caused by a virus, which resolves on its own. But tonsillitis can be caused by strep bacteria, which requires treatment with antibiotics. Watch for signs of dehydration, such as a dry mouth and tongue. Also, watch for signs of complications, such as ear pain, from tonsillitis caused by strep bacteria.

Tonsillitis caused by a virus

Tonsillitis caused by a virus will usually go away on its own. Antibiotics are not effective treatment for viral tonsillitis.

The virus that causes mononucleosis (mono) can lead to tonsillitis that is as severe as tonsillitis caused by bacteria and can take several weeks or more before it goes away.

Home treatments such as gargling with salt water, drinking warm tea, and taking over-the-counter pain medicine (such as acetaminophen or ibuprofen) may help relieve discomfort. Do not give aspirin to anyone younger than 20 because of its link to Reye syndrome.

Many nonprescription remedies such as antiseptic mouthwashes, decongestants, and antihistamines contain extra ingredients that don't relieve discomfort. These remedies are not recommended for children, because they have not been proved to have any benefits in the treatment of acute tonsillitis.2

Tonsillitis caused by bacteria

Antibiotics are prescribed for tonsillitis caused by strep bacteria. A strep infection will usually go away on its own, but antibiotic treatment is needed because untreated strep throat can cause serious complications. For more information, see the topic Strep Throat.

If antibiotics are prescribed, be sure you take them exactly as directed by your doctor. Antibiotics should be taken for the entire duration of the prescription, even if the symptoms disappear completely before the prescription is gone. If antibiotics used to treat tonsillitis are not taken as directed, bacteria can become resistant to them (antibiotic resistance). In these cases, antibiotic treatment of future infections may not work.

Surgery

Surgical removal of the tonsils (tonsillectomy) is still a common procedure, particularly for children. But it is not performed nearly as often as it was in the past. Tonsillectomy may be considered to treat tonsillitis when a child has serious complications, recurrent infections, or chronic infections that do not respond to treatment and interfere with daily functioning. But the risks and benefits of surgery need to be weighed carefully. Tonsillectomy should only be done after you and your doctor carefully consider your or your child's overall health. For more information, see:

The healthy way to lose weight

    The healthy way to lose weight 

   The healthy way to lose weight 

The healthiest way to lose weight is neither crash diets nor bursts of exercise. The body likes slow changes in terms of food and exercise.

For example, someone who hasn't exercised for years shouldn't rush into running miles a day or pounding the treadmill. Not only will the struggle to do so leave you feeling disheartened and demotivated, you're also far more likely to injure yourself and set your fitness levels back further.

The same goes for people who suddenly start starving themselves. Diets that severely restrict calories or the types of food 'allowed' can lead you to be deficient in the nutrients and vitamins that your body needs.

So, if you need to lose weight, what should you do?

Energy needs and weight loss

Your body uses food for energy. It stores any excess energy as fat. This means if you eat more food than your body needs for daily activities and cell maintenance, you'll gain weight.

To lose weight, you need to get your body to use up these stores of fat. The most effective way to do this is to:

• reduce the amount of calories you eat
• increase your levels of activity.

This is why experts talk about weight loss in terms of diet and exercise.

Introduce changes gradually

Small changes can make a big difference. One extra biscuit a week can lead you to gain 5lb a year – cut that biscuit out of your diet and you'll lose the same amount.

You're also more likely to stick to, say, swapping full-fat milk for semi-skimmed or making time for breakfast each morning than a diet that sets rules for all foods.

You should think of weight loss in terms of permanently changing your eating habits. While weight-loss goals are usually set in term of weeks, the end game is to sustain these changes over months and years, ie lifestyle change for life.

Increase your activity levels

Someone who increases the amount they exercise, but maintains the same diet and calorie intake, will almost certainly lose weight.

No matter if you hate gyms – even light exercise, such as a short 20 minute walk, will be beneficial if done most days of the week.

Every single time you exercise more than usual, you burn calories and fat.

There are lots of ways to increase the amount of activity you do. Team sports, racket sports, aerobics classes, running, walking, swimming and cycling will all improve your fitness levels.

Find something you enjoy that's easy for you to do in terms of location and cost. You're then more likely to build it into your routine and continue to exercise, despite inevitably missing the odd session through holidays, family commitments, etc.

• Get out and about at the weekend. Leave your car on the drive and walk to the shops. Try to incorporate longer walks into outings to the park, coast or countryside and take a picnic, so you're in control of what you are going to eat that day.
• Every extra step you take helps. Always use the stairs instead of the lift, or get off the bus a stop before the usual one and walk the rest of the way.
• Use commercial breaks between TV-programmes to stand up and do exercise, or consider using an exercise bicycle in the living room while watching your favourite programme.

Reduce your calorie intake

What is overweight?

Doctors use BMI to assess weight.
A BMI of 18.5 to 25 is healthy.
If you have a BMI of more than 25, you're overweight.
Over 30 is obese.
Over 40 is morbidly obese.
To calculate your BMI, you'll need to know your weight in kilos and your height in metres, then follow the example below.
1. Multiply your height by itself, eg 1.7x1.7= 2.89.
2. Divide your weight (eg 80kg) by this figure.
3. 80 ÷ 2.89= 27.7.
27.7 is the BMI.

If you're overweight, you can't continue with your current eating habits if you really want to lose weight.

It's not possible to reduce body fat while eating lots of food, cakes and sweets. This doesn't mean you can never have any treats, but you need to learn how to limit these foods to small quantities – say, for special occasions.

In terms of weight-loss, you can get your body to use up existing stores of fat by eating less and making healthier choices.

This doesn't mean crash diet (anything less than 1500 calories), which usually ends up with you either getting weaker or giving up in desperation. Quick-fix diets can lead to a yo-yoing effect of drastic weight loss followed by weight gain, resulting in a vicious cycle.

There are no shortcuts to losing weight in a healthy and reasonable way.

Eating 300 to 500 calories less per day should lead to a loss of between one and two pounds per week. This is a realistic target. It may seem slow, but it would add up to a weight loss of more than three stone in a year.

Fat contains the most amount of calories out of all the food types (protein, carbohydrates), so a good way to achieve this is to cut down on fatty foods and eat more wholegrain bread, fruit and vegetables.

Below are ways to reduce calorie intake without having to alter your diet significantly.

• Replace fizzy drinks and fruit cordials with water.
• Swap whole milk for semi-skimmed, or semi-skimmed for skimmed.
• Eat less lunch than usual. For example, make your own sandwich and limit the use of margarine or butter and full-fat mayonnaise (store-bought sandwiches often contain both).
• Stop taking sugar in tea and coffee.
• Have smaller portions of the food you enjoy.
• Avoid having a second helping at dinner.
• Cut out unhealthy treats – such as confectionary, sugary biscuits and crisps between meals.
• Cut down on alcohol intake.

All these things will influence your health in a positive way.

Finally, don't be tempted to skip breakfast – or any meal to lose weight. While skipping a meal will reduce your calorie intake for that hour, it will leave you much hungrier later on.

Not only are you likely to overeat to compensate, but you'll often make bad choices to fill the gap: a cereal bar is not as healthy as a bowl of cereal or as filling, leading you to 'need' something extra for lunch.

Irregular eating habits also disrupt your body's metabolism, which makes it harder to lose weight in the first place.

Write down your plan

Food diary

If you're not sure what's wrong with your diet, try keeping a daily diary of everything you eat and drink.
You can use a notebook or an online diary.
At the end of the week, review your entries for problem areas.
Look out for processed foods, alcohol, fast food, roasts, creamy sauces and fried foods.
If your diet seems largely healthy, look at portion sizes.
If you're not sure what's meant by 'healthy diet', read our series on nutrition.

Once you've decided on what changes you're going to make, write them down. For example:

Week 1

• Exercise: one 20 minute walk every lunch hour.
• Alcohol: none in the week, two small glasses of wine on Friday, Saturday, Sunday.
• Food: no chocolate or biscuits in the week, choose healthy snacks such as fruit, trim all fat from meat, eat no fried or fast food.

My weight loss plan: Week: _____ My weight: _____
Targets	Alcohol	Exercise	Food plan	Mood	Comments
Goals for week
Progress	Alcohol	Exercise	Food plan	Mood	Comments
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Be patient and persevere

It might take a week or two before you notice any changes, but they will steadily appear. After the first month you'll be able to see the results and measure them in terms of looser fitting clothes.

Keeping your motivation up is one of the most difficult aspects of dieting. There will be days when healthy eating goes out the window, and there will be weeks where you may not lose any weight – or put a little back on.

This is normal for everyone – dieters or not – so don't let it undo your plans for a slimmer you. You're not doing anything 'wrong', but you may need to look at your plan. Do you need to increase your activity levels? Make a few more changes to your diet? Put more effort into sticking to your current plan?

The other side of this is to make sure you celebrate your goals. While there's joy enough in stepping on the scales and seeing them dip lower, be sure to mark long-term progress with a reward – such as new clothes or time off from domestic chores.

Celebrating is also a way to involve your nearest and dearest – it's up to you whether you want their encouragement in the form of gentle reminders not to eat certain foods. But support from other people can get you through the bumpy patches.

Health benefits of weight loss

Studies show that overweight women who lose between 10lb and 20lb halve their risk of developing diabetes. For men, the risk of heart problems reduces considerably.

Generally, we gain weight as we age. A few pounds over the years are not a problem, but people who gain more than 20lb compared to their weight as an 18-year-old will rapidly increase their risk of health problems due to that extra weight. In particular, women increase their risk of heart attack and double their risk of dying from cancer.

It may seem like these are problems to worry about in the future, but time flies by and tomorrow becomes today. By keeping your weight in the healthy range, you're less likely to be troubled by illnesses in your later years.

Other people also read:

• Body weight: what determines your body weight and what is a healthy weight.
• Obesity: around one in four men and one in three women in the UK are overweight. Are you one of them?
• Type 2 diabetes: if you are overweight you will significantly increase your risk of developing Type 2 diabetes.

Best ways to weight loss

 Best ways to weight loss

 Best ways to weight loss

You know the drill when it comes to losing weight — take in fewer calories, burn more calories. But you also know that most diets and quick weight-loss plans have about as much substance as a politician’s campaign pledges. You’re better off finding several simple things you can do on a daily basis — along with following the cardinal rules of eating more vegetables and less fat and getting more physical activity. Together, they should send the scale numbers in the right direction: down.

1. Once a week, indulge in a high-calorie-tasting, but low-calorie, treat. This should help keep you from feeling deprived and binging on higher-calorie foods. For instance:

• Lobster. Just 83 calories in 3 ounces.
• Shrimp. Just 60 calories in 12 large.
• Smoked salmon. Just 66 calories in two ounces. Sprinkle with capers for an even more elegant treat.
• Whipped cream. Just 8 calories in one tablespoon. Drop a dollop over a bowl of fresh fruit for dessert.

2. Treat high-calorie foods as jewels in the crown. Make a spoonful of ice cream the jewel and a bowl of fruit the crown. Cut down on the chips by pairing each bite with lots of chunky, filling fresh salsa, suggests Jeff Novick, director of nutrition at the Pritikin Longevity Center & Spa in Florida. Balance a little cheese with a lot of salad.

3. After breakfast, make water your primary drink. At breakfast, go ahead and drink orange juice. But throughout the rest of the day, focus on water instead of juice or soda. The average American consumes an extra 245 calories a day from soft drinks. That’s nearly 90,000 calories a year — or 25 pounds! And research shows that despite the calories, sugary drinks don’t trigger a sense of fullness the way that food does.

4. Carry a palm-size notebook everywhere you go for one week. Write down every single morsel that enters your lips — even water. Studies have found that people who maintain food diaries wind up eating about 15 percent less food than those who don’t.

Plus: 8 Kitchen Cabinet Makeovers for Weight Loss

5. Buy a pedometer, clip it to your belt, and aim for an extra 1,000 steps a day. On average, sedentary people take only 2,000 to 3,000 steps a day. Adding 2,000 steps will help you maintain your current weight and stop gaining weight; adding more than that will help you lose weight.

6. Add 10 percent to the amount of daily calories you think you’re eating, then adjust your eating habits accordingly. If you think you’re consuming 1,700 calories a day and don’t understand why you’re not losing weight, add another 170 calories to your guesstimate. Chances are, the new number is more accurate.

7. Eat five or six small meals or snacks a day instead of three large meals. A 1999 South African study found that when men ate parts of their morning meal at intervals over five hours, they consumed almost 30 percent fewer calories at lunch than when they ate a single breakfast. Other studies show that even if you eat the same number of calories distributed this way, your body releases less insulin, which keeps blood sugar steady and helps control hunger.

8. Walk for 45 minutes a day. The reason we’re suggesting 45 minutes instead of the typical 30 is that a Duke University study found that while 30 minutes of daily walking is enough to prevent weight gain in most relatively sedentary people, exercise beyond 30 minutes results in weight and fat loss. Burning an additional 300 calories a day with three miles of brisk walking (45 minutes should do it) could help you lose 30 pounds in a year without even changing how much you’re eating.

9. Find an online weight-loss buddy. A University of Vermont study found that online weight-loss buddies help you keep the weight off. The researchers followed volunteers for 18 months. Those assigned to an Internet-based weight maintenance program sustained their weight loss better than those who met face-to-face in a support group.

Plus: 15 Foods You Should Never Buy Again

10. Bring the color blue into your life more often. There’s a good reason you won’t see many fast-food restaurants decorated in blue: Believe it or not, the color blue functions as an appetite suppressant. So serve up dinner on blue plates, dress in blue while you eat, and cover your table with a blue tablecloth. Conversely, avoid red, yellow, and orange in your dining areas. Studies find they encourage eating.

11. Clean your closet of the “fat” clothes. Once you’ve reached your target weight, throw out or give away every piece of clothing that doesn’t fit. The idea of having to buy a whole new wardrobe if you gain the weight back will serve as a strong incentive to maintain your new figure.

12. Downsize your dinner plates. Studies find that the less food put in front of you, the less food you’ll eat. Conversely, the more food in front of you, the more you’ll eat — regardless of how hungry you are. So instead of using regular dinner plates that range these days from 10-14 inches (making them look forlornly empty if they’re not heaped with food), serve your main course on salad plates (about 7-9 inches wide). The same goes for liquids. Instead of 16-ounce glasses and oversized coffee mugs, return to the old days of 8-ounce glasses and 6-ounce coffee cups

13. Serve your dinner restaurant style (food on the plates) rather than family style (food served in bowls and on platters on the table). When your plate is empty, you’re finished; there’s no reaching for seconds.

14. Hang a mirror opposite your seat at the table. One study found that eating in front of mirrors slashed the amount people ate by nearly one-third. Seems having to look yourself in the eye reflects back some of your own inner standards and goals, and reminds you of why you’re trying to lose weight in the first place.

15. Put out a vegetable platter. A body of research out of Pennsylvania State University finds that eating water-rich foods such as zucchini, tomatoes, and cucumbers during meals reduces your overall calorie consumption. Other water-rich foods include soups and salads. You won’t get the same benefits by just drinking your water, though. Because the body processes hunger and thirst through different mechanisms, it simply doesn’t register a sense of fullness with water (or soda, tea, coffee, or juice).

16. Use vegetables to bulk up meals. You can eat twice as much pasta salad loaded with veggies like broccoli, carrots, and tomatoes for the same calories as a pasta salad sporting just mayonnaise. Same goes for stir-fries. And add vegetables to make a fluffier, more satisfying omelet without having to up the number of eggs.

17. Eat one less cookie a day. Or consume one less can of regular soda, or one less glass of orange juice, or three fewer bites of a fast-food hamburger. Doing any of these saves you about 100 calories a day, according to weight-loss researcher James O. Hill, Ph.D., of the University of Colorado. And that alone is enough to prevent you from gaining the 1.8 to 2 pounds most people pack on each year.

18. Avoid white foods. There is some scientific legitimacy to today’s lower-carb diets: Large amounts of simple carbohydrates from white flour and added sugar can wreak havoc on your blood sugar and lead to weight gain. But you shouldn’t toss out the baby with the bathwater. While avoiding sugar, white rice, and white flour, you should eat plenty of whole grain breads and brown rice. One Harvard study of 74,000 women found that those who ate more than two daily servings of whole grains were 49 percent less likely to be overweight than those who ate the white stuff.

19. Switch to ordinary coffee. Fancy coffee drinks from trendy coffee joints often pack several hundred calories, thanks to whole milk, whipped cream, sugar, and sugary syrups. A cup of regular coffee with skim milk has just a small fraction of those calories. And when brewed with good beans, it tastes just as great.

20. Use nonfat powdered milk in coffee. You get the nutritional benefits of skim milk, which is high in calcium and low in calories. And, because the water has been removed, powdered milk doesn’t dilute the coffee the way skim milk does.

21. Eat cereal for breakfast five days a week. Studies find that people who eat cereal for breakfast every day are significantly less likely to be obese and have diabetes than those who don’t. They also consume more fiber and calcium — and less fat — than those who eat other breakfast foods. Of course, that doesn’t mean reaching for the Cap’n Crunch. Instead, pour out a high-fiber, low-sugar cereal like Total or Grape Nuts.

22. Pare your portions. Whether you eat at home or in a restaurant, immediately remove one-third of the food on your plate. Arguably the worst food trend of the past few decades has been the explosion in portion sizes on America’s dinner plates (and breakfast and lunch plates). We eat far, far more today than our bodies need. Studies find that if you serve people more food, they’ll eat more food, regardless of their hunger level. The converse is also true: Serve
yourself less and you’ll eat less.

23. Eat 90 percent of your meals at home. You’re more likely to eat more — and eat more high-fat, high-calorie foods — when you eat out than when you eat at home. Restaurants today serve such large portions that many have switched to larger plates and tables to accommodate them!

24. Avoid any prepared food that lists sugar, fructose, or corn syrup among the first four ingredients on the label. You should be able to find a lower-sugar version of the same type of food. If you can’t, grab a piece of fruit instead! Look for sugar-free varieties of foods such as ketchup, mayonnaise, and salad dressing.

25. Eat slowly and calmly. Put your fork or spoon down between every bite. Sip water frequently. Intersperse your eating with stories for your dining partner of the amusing things that happened during your day. Your brain lags your stomach by about 20 minutes when it comes to satiety (fullness) signals. If you eat slowly enough, your brain will catch up to tell you that you are no longer in need of food.

26. Eat only when you hear your stomach growling. It’s stunning how often we eat out of boredom, nervousness, habit, or frustration — so often, in fact, that many of us have actually forgotten what physical hunger feels like. Next time, wait until your stomach is growling before you reach for food. If you’re hankering for a specific food, it’s probably a craving, not hunger. If you’d eat anything you could get your hands on, chances are you’re truly hungry

27. Find ways other than eating to express love, tame stress, and relieve boredom. For instance, you might make your family a photo album of special events instead of a rich dessert, sign up for a stress-management course at the local hospital or take up an active hobby, like bowling.

28. State the positive. You’ve heard of a self-fulfilling prophecy? Well, if you keep focusing on things you can’t do, like resisting junk food or getting out the door for a daily walk, chances are you won’t do them. Instead (whether you believe it or not) repeat positive thoughts to yourself. “I can lose weight.” “I will get out for my walk today.” “I know I can resist the pastry cart after dinner.” Repeat these phrases like a mantra all day long. Before too long, they will become their own self-fulfilling prophecy.

29. Discover your dietary point of preference. If you work hard to control your weight, you may get pleasure from your appearance, but you may also feel sorry for yourself each time you forgo a favorite food. There is a balance to be struck between the immediate gratification of indulgent foods and the long-term pleasure of maintaining a desirable weight and good health. When you have that balance worked out, you have identified your own personal dietary pleasure “point of preference.” This is where you want to stay.

PLUS: 6 Easy Ways to Follow the Mediterranean Diet

30. Use flavorings such as hot sauce, salsa, and Cajun seasonings instead of relying on butter and creamy or sugary sauces. Besides providing lots of flavor with no fat and few calories, many of these seasonings — the spicy ones — turn up your digestive fires, causing your body to temporarily burn more calories.

31. Eat fruit instead of drinking fruit juice. For the calories in one kid-size box of apple juice, you can enjoy an apple, orange, and a slice of watermelon. These whole foods will keep you satisfied much longer than that box of apple juice, so you’ll eat less overall.

32. Spend 10 minutes a day walking up and down stairs. The Centers for Disease Control says that’s all it takes to help you shed as much as 10 pounds a year (assuming you don’t start eating more).

33. Eat equal portions of vegetables and grains at dinner. A cup of cooked rice or pasta has about 200 calories, whereas a cup of cooked veggies doles out a mere 50 calories, on average, says Joan Salge Blake, R.D., clinical assistant professor of nutrition at Boston University’s Sargent College. To avoid a grain calorie overload, eat a 1:1 ratio of grains to veggies. The high-fiber veggies will help satisfy your hunger before you overeat the grains.

34. Get up and walk around the office or your home for five minutes at least every two hours. Stuck at a desk all day? A brisk five-minute walk every two hours will parlay into an extra 20-minute walk by the end of the day. And getting a break will make you less likely to reach for snacks out of antsiness.

35. Wash something thoroughly once a week — a floor, a couple of windows, the shower stall, bathroom tile, or your car. A 150-pound person who dons rubber gloves and exerts some elbow grease will burn about four calories for every minute spent cleaning, says Blake. Scrub for 30 minutes and you could work off approximately 120 calories, the same number in a half-cup of vanilla frozen yogurt. And your surroundings will sparkle!

36. Make one social outing this week an active one. Pass on the movie tickets and screen the views of a local park instead. Not only will you sit less, but you’ll be saving calories because you won’t chow down on that bucket of popcorn. Other active date ideas: Plan a tennis match, sign up for a guided nature or city walk (check your local newspaper), go cycling on a bike path, or join a volleyball league or bowling team.

PLUS: 7 Tricks to Drop Pounds

37. Order the smallest portion of everything. If you’re ordering a sub, get the 6-inch sandwich. Buy a small popcorn, a small salad, a small hamburger. Studies find we tend to eat what’s in front of us, even though we’d feel just as full on less.

38. Switch from regular milk to 2%. If you already drink 2%, go down another notch to 1% or skim milk. Each step downward cuts the calories by about 20 percent. Once you train your taste buds to enjoy skim milk, you’ll have cut the calories in the whole milk by about half and trimmed the fat by more than 95 percent.

39. Take a walk before dinner. You’ll do more than burn calories — you’ll cut your appetite. In a study of 10 obese women conducted at the University of Glasgow in Scotland, 20 minutes of walking reduced appetite and increased sensations of fullness as effectively as a light meal.

40. Substitute a handful of almonds in place of a sugary snack. A study from the City of Hope National Medical Center found that overweight people who ate a moderate-fat diet containing almonds lost more weight than a control group that didn’t eat nuts. Really, any nut will do.

41. Eat a frozen dinner. Not just any frozen dinner, but one designed for weight loss. Most of us tend to eat an average of 150 percent more calories in the evening than in the morning. An easy way to keep dinner calories under control is to buy a pre-portioned meal. Just make sure that it contains only one serving. If it contains two, make sure you share.

42. Don’t eat with a large group. A study published in the Journal of Physiological Behavior found that we tend to eat more when we eat with other people, most likely because we spend more time at the table. But eating with your significant other or your family, and using table time for talking in between chewing, can help cut down on calories — and help with bonding in the bargain.

43. Watch one less hour of TV. A study of 76 undergraduate students found the more they watched television, the more often they ate and the more they ate overall. Sacrifice one program (there’s probably one you don’t really want to watch anyway) and go for a walk instead. You’ll have time left over to finish a chore or gaze at the stars.

44. Get most of your calories before noon. Studies find that the more you eat in the morning, the less you’ll eat in the evening. And you have more opportunities to burn off those early-day calories than you do to burn off dinner calories.

45. Close out the kitchen after dinner. Wash all the dishes, wipe down the counters, turn out the light, and, if necessary, tape closed the cabinets and refrigerator. Late-evening eating significantly increases the overall number of calories you eat, a University of Texas study found. Stopping late-night snacking can save 300 or more calories a day, or 31 pounds a year.

46. Sniff a banana, an apple, or a peppermint when you feel hungry. You might feel silly, but it works. When Alan R. Hirsch, M.D., neurological director of the Smell & Taste Treatment and Research Foundation in Chicago, tried this with 3,000 volunteers, he found that the more frequently people sniffed, the less hungry they were and the more weight they lost — an average of 30 pounds each. One theory is that sniffing the food tricks the brain into thinking you’re actually eating it.

PLUS: 15 Fat-Burning Foods

47. Order wine by the glass, not the bottle. That way you’ll be more aware of how much alcohol you’re downing. Moderate drinking can be good for your health, but alcohol is high in calories. And because drinking turns off our inhibitions, it can drown our best intentions to keep portions in check.

48. Watch every morsel you put in your mouth on weekends. A University of North Carolina study found people tend to consume an extra 115 calories per weekend day, primarily from alcohol and fat.

49. Stock your refrigerator with low-fat yogurt. A University of Tennessee study found that people who cut 500 calories a day and ate yogurt three times a day for 12 weeks lost more weight and body fat than a group that only cut the calories. The researchers concluded that the calcium in low-fat dairy foods triggers a hormonal response that inhibits the body’s production of fat cells and boosts the breakdown of fat.

50. Order your dressing on the side and then stick a fork in it — not your salad. The small amount of dressing that clings to the tines of the fork are plenty for the forkful of salad you then pick up.

51. Brush your teeth after every meal, especially after dinner. That clean, minty freshness will serve as a cue to your body and brain that mealtime is over.

52. Serve individual courses rather than piling everything on one plate. Make the first two courses soup or vegetables (such as a green salad). By the time you get to the more calorie-dense foods, like meat and dessert, you’ll be eating less or may already be full (leftovers are a good thing).

53. Passionately kiss your partner 10 times a day. According to the 1991 Kinsey Institute New Report on Sex, a passionate kiss burns 6.4 calories per minute. Ten minutes a day of kissing equates to about 23,000 calories — or eight pounds — a year!

54. Add hot peppers to your pasta sauce. Capsaicin, the ingredient in hot peppers that makes them hot, also helps reduce your appetite.

55. Pack nutritious snacks. Snacking once or twice a day helps stave off hunger and keeps your metabolism stoked, but healthy snacks can be pretty darn hard to come by when you’re on the go. Pack up baby carrots or your own trail mix made with nuts, raisins, seeds, and dried fruit.

56. When you shop, choose nutritious foods based on these four simple rules:
1. Avoid partially hydrogenated.
2. Avoid high fructose corn syrup.
3. Choose a short ingredient list over long; there will be fewer flavor enhancers and empty calories.
4. Look for more than two grams of fiber per 100 calories in all grain products (cereal, bread, crackers, and chips)

57. Weed out calories you’ve been overlooking: spreads, dressings, sauces, condiments, drinks, and snacks. These calories count, whether or not you’ve been counting them, and could make the difference between weight gain and loss.

58. When you’re eating out with friends or family, dress up in your most flattering outfit. You’ll get loads of compliments, says Susie Galvez, author of Weight Loss Wisdom, which will be a great reminder to watch what you eat

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