Weight Problems & Eating Disorders

First, we should be clear about what is meant by 'obese' and 'overweight'. You are said to be obese if your body weight exceeds 20 per cent more than the average desirable weight for a person of your height and is defined in terms of an excess of body fat. Overweight describes people whose weight is ten per cent greater than the average desirable weight. A rough guide is whether you can pinch a fold of flesh just below your navel: if it is an inch or more than you are overweight.

Of course, a muscular person may be overweight while having a very low percentage of fat, so body weight alone is not an accurate gauge of obesity. The body mass index, or BMI, is a measure of body weight that takes account of a person's height. It is calculated by dividing the weight of an individual in kilograms by their height in metres squared. There are five main levels of BMI: 19 or less is considered underweight; 20-25 is the norm; 2630 is overweight; 31-40 is obese; and 41 and more is severely obese.

On the basis of these categories, it is estimated that about one third of all patients who visit their doctor are overweight. A BMI of more than 30 is considered to pose a significant risk to health.

Are You Overweight?

Obesity is the third most common complaint in the West after tooth decay and coronary artery disease. Results of recent surveys of British adults revealed that there had been a three-fold increase in the number of clinically obese women; that 50 per cent of women were dieting; and that half of those women had abandoned a diet before reaching their target weight.

Other Survey Findings:

• despite a recommendation that the fat content of the diet should provide only 35 per cent of calories - and ideally as little as 30 per cent - the average was 40 per cent and that included an unacceptably high proportion of saturated (animal) fats;
• consumption of cakes, biscuits, sweets and chocolate was increasing, particularly among women;
• consumption of alcohol was increasing, providing 'empty' calories of no nutritional value;
• an increasing number of meals were eaten out and these tended to have a higher sugar content but include less protein and fibre and fewer vitamins and minerals than the daily diet. Of concern was an increased consumption of cheap take-aways with a high saturated-fat content;
• despite a recommended daily intake of 30-35g of fibre, only a sixth of women, for example, were eating as much as 25g;
• the amount of exercise taken daily was decreasing. Half of those 65 and over took no exercise at all. Thirty per cent of adults did some vigorous activity, but only six per cent did enough to benefit their health.

The Risks

The stark fact is that, according to insurance statistics from both the USA and Britain, obesity is related to mortality: a severely obese person is three times more likely to die than a person of average weight. And that risk is greater still if the person smokes. There is also a significantly higher risk of the following serious conditions:

• cardiovascular disease such as heart attack, heart failure, high blood pressure and stroke;
• late-onset diabetes, which affects people over the age of 40 whose body tissues develop a resistance to insulin. Obese people are five times more at risk than those of average weight;
• gallstones, which may be precipitated by a high concentration of cholesterol in the bowel (fatty tissue is a cholesterol reservoir);
• impaired fertility and complications during pregnancy;
• breathlessness on exertion;
• complications under general anaesthetic;
• osteoarthritis of weight-bearing joints, particularly in the back, hips and knees;
• cancers of the breast, uterus, ovary and cervix, and possibly the prostate, which may result from disturbances in the balance between male and female hormones caused by enzymes in fatty tissue;
• accidents that are the result of slower movement, when crossing the road for example.

Possible Causes of Obesity

Obesity occurs over time as net energy intake exceeds net energy output. Overeating and a lack of exercise are the most common causes. Other underlying causes, such as hypothyroidism, are relatively rare, but a number of physiological and psychological explanations have been put forward to explain simple obesity.

• Genetic Tendency
  Studies of adopted children have revealed a link between the weight status of the children and that of their biological parents that cannot be explained by environmental factors. Environmental influences are not insignificant, however, and a family history of obesity doesn't mean that the condition cannot be treated.
• Eating Habits
  Obese people are often said to eat larger, more infrequent meals and to eat their food more quickly than other people, but there is no basis for this in fact.
• Reduced Metabolic Rate
  Also contrary to popular belief, obese people do not have a slower metabolic rate (see below). The body's 'tick over' speed increases, in fact, the greater the weight you are carrying around.
• Inappropriate Response to Hunger
  Children are believed to be able to adjust their intakes of high- and low-calorie foods in order to maintain a fairly constant calorie content in the diet. Adults, on the other hand, seem less able to do this.
• Toxins
  Fat requires a lot of energy to be broken down and it becomes a convenient 'dump' for all sorts of fat-soluble toxins. Fat delays their transit through the bowel so more toxins are absorbed. If there are a lot of toxins circulating in the body, some people believe, more fat may be laid down in order to deal with them. A high-fibre diet, as well as the avoidance of toxic substances, will remedy this.
• Fatigue
  A lack of sleep may also delay the excretion of toxins from the body (see above).
• Emotional Starvation
  Food becomes (subconsciously) a compensation for whatever is missing in a person's emotional experience.
• Fear of Responsibility
  A person's fear of dealing with relationships leads them to become fat or thin, and therefore less attractive, in order to avoid involvement.
• Comfort Eating
  Food is commonly perceived as comforting, when someone has been bereaved for example.
• Taking Control
  This may occur if a person has been following a strict diet and feels the need to break out of the regime to such an extent that they overcompensate and overeat.
• Acquired Helplessness
  This is the attitude that you have little control over your life so, for instance, if you eat in a canteen at work then you cannot control what you eat and neither therefore can you control your weight. Food can thus become a substitute answer for a range of emotional problems and can become the basis for the compulsive eating found in many overweight people.
• Marketing
  Certain groups of people are particularly vulnerable to the power of advertising, especially as food products such as butter and sugar are still marketed as 'natural', and therefore by implication 'good'. The UK has the second-highest consumption of chocolate in Europe.

Fat Storage

How much fat your body stores is largely determined by four factors:

• your appetite and the amount and types of food that you eat;
• the amount of exercise that you do;
• your basal metabolic rate (BMR). This is the energy that is required for the working of all body systems and the maintenance of body temperature when at rest. It decreases with age but increases if you gain weight. It reduces correspondingly if you go on a reduced-calorie diet as the body perceives this as starvation conditions. Vigorous exercise also increases the BMR.
• the amount of heat produced when the body metabolically processes calories. This is also increased by exercise and the consumption of certain food 'fuels'.

What You Can Do

You obviously have a great deal of control over the first two factors listed above and a much lesser degree over the third. It is not known to what extent factor four may be influenced.

In compulsive eaters the trigger for eating is not hunger but emotional need. Eating as a response to an emotional cue is learnt in childhood, when food means comfort in the sense of being looked after. In adults, however, comfort eating brings transitory emotional relief and is often superseded by guilt, self-criticism and attempts at strict dieting. The latter is doomed to failure because of the individual's low self-esteem and the fact that food is associated with an attempt to satisfy an emotional need, not just hunger. Eventually they will rebel against the self-denial imposed by strict dieting and they will binge. Thus starts a cycle.

If you find yourself in such a cycle and you wish to break free, consider the following:

• self-criticism and a punishing dieting regime will not bring about lasting beneficial changes in your eating habits;
• dieting will not satisfy your emotional needs, only your hunger;
• try to think positively about your body and do not feel guilty about your need for comfort;
• try to recognize your problems for what they are rather than disguising them through their association with eating;
• try to relate to hunger as a physiological urge rather than an emotional cue.

A diet is obviously a good start but in order to lose weight over the long term and lose it permanently you must change your basic attitude to food and eating. There are many dietary guidelines for losing weight but they all fall into two categories: exclusion and inclusion diets.

Exclusion Diets

With these, certain foods, such as chocolate, sugar or potatoes, are excluded from the diet. Alternatively, specific food groups, such as fats or carbohydrates, are kept to a minimum.

Many diets used to be of the low carbohydrate variety but they have lost favour because they inevitably mean that higher proportions of energy have to come from proteins and fats. Unrefined carbohydrates are the best available source of energy and they are rich in micronutrients and fibre (unlike refined carbohydrates). These should make up about 55 per cent of your total calories. They are associated with less fat and sugar and they will satisfy your hunger sooner.

The Importance of Fibre

Fibre, or non-starch polysaccharide (NSP), is a carbohydrate subgroup. There are two types of fibre - soluble and non-soluble. Insoluble fibre is found in cereals such as wheat bran and fibrous fruit and vegetables. It absorbs water, thus making you feel fuller, and helps to slow down the absorption from the gut into the bloodstream of simple sugars, thus averting hypoglycaemia, and improving the passage of undigested material through the bowel, preventing constipation and helping to rid the body of toxins. Soluble fibre is to be found in many fruits and vegetables, pulses and oat bran. It can be transported in the bloodstream, where it binds with fat and helps to prevent atherosclerosis.

Unless your diet is high in fibre you run the risk of other serious diseases, including bowel cancer, coronary heart disease, diabetes, gallstones, piles and varicose veins. An interesting statistic is that the average fibre intake in the UK is only one-eighth of what it was in primitive hunter-gatherer societies. This may not be down just to fibre, however, and may be influenced by levels of starch, protein and animal fat as well.

Low-Fat Diets

All diets advocate the reduction of fat. You cannot exclude fat altogether because then you would be depriving yourself of essential fatty acids which the body cannot manufacture for itself. The fat content of your diet should ideally provide about 25 per cent, 30 per cent at most, of the total calories. The ratio of polyunsaturated or mono-unsaturated to saturated fats should be two to one.

You can reduce your fat consumption by the following methods:

• reduce the amount of red meat that you eat - eat game or fish instead;
• buy lean meat and trim off any fat and take the skin off poultry;
• use healthy cooking methods such as stir-frying, baking or grilling. If you need oil, use olive oil which is mono-unsaturated and stable at high temperatures. Alternatively, use sunflower or soya oil. A pork chop fried with the fat on contains about 25g of fat: if it is grilled having had the fat removed its fat content is about 8g.
• make casseroles with more beans or lentils and vegetables in them than meat;
• roast potatoes as a special treat, otherwise bake or boil them;
• reduce your consumption of cheese and full-cream milk and substitute yoghurt or fromage frais for cream in recipes;
• make sure you know which foods are fat-dense - meat and meat products (27%); butter or margarine (25%); milk (13%); cooking oils and fat (13%); biscuits and cakes (6%); cheese and cream (5%).

High-Protein Diets

A diet that is high in animal proteins is inappropriate for weight reduction and the promotion of good health generally for a number of reasons:

• it usually contains a large amount of fat - between the muscle fibres of meat, for example, as well as around it;
• it usually has a high phosphate content which contributes to calcium loss;
• it produces a lot of nitrogenous waste, which places strain on the kidneys;
• it is likely to contain pesticide, hormone and antibiotic residues unless it has been reared organically;
• it does not contain much fibre.
• Animal protein provides the complete range of essential amino acids. It is, however, possible to get all you need from combining several vegetable protein sources, such as beans plus rice or vegetables plus rice with nuts or seeds.

Inclusion Diets

These involve a limit being placed on the amount of energy provided by the food you eat, so you constantly have to count calories. This has its drawbacks, especially until you develop a calorie awareness. Fat and sugar are the most calorie-dense foods, while fibre reduces the calorie density of a meal. So, two teaspoons of sugar has the same calorie content as about 100g of peas, and 250g of chocolate the same as well over two kilograms of apples!

When you are eating out and it is more difficult to calorie-count, choose grilled meat or fish with salad (and very little dressing) rather than potatoes, avoid alcohol and pre-dinner nibbles, leave the roll and butter on your plate and don't ask for the dessert menu.

If you aim to follow the basic rules of low fat, sugar and refined carbohydrate but high fibre 90 per cent of the time but allow yourself a few treats then you should remain on target without feeling too deprived.

How Quickly Should You Lose Weight?

A woman needs to reduce her daily calorie intake to about 1,000 - 1,250 kcals and a man to about 1,500 kcals. You should increase the amount of exercise you take to achieve a sustained weight loss. Of course, the body does not just lose fat when you go on a diet since it gets it energy from:

• blood glucose
• glycogen stores in muscles and the liver
• fat
• protein.

When you start a diet, the use of glycogen from the liver releases water, which contributes to your weight loss at first. An obese person's excess weight usually consists of about 75 per cent fat and the rest is fat-free mass, which means other body tissues, such as muscles, that contain protein, glycogen and water. To lose the maximum amount of fat rather than fat-free mass, you need to eat 500 kcals fewer per day than you need for your energy output level. As you lose weight, your fat-free mass and your metabolic rate will decrease, thus reducing your daily energy requirement. You therefore need to reduce your calorie intake slightly and gradually in order to maintain a steady weight loss - about 5 kcal a day for each half-a-kilogram or so lost.

Very-Low-Calorie Diets

These are 'starvation' diets of about 500 kcals or less for women and about 750 kcals for men. They may produce a very dramatic weight loss in the beginning but they do not result in long-term loss for the following reasons:

• if you lose more than about 1 kg a week, a greater proportion of fat-free mass is metabolized. This results in a decrease in your BMR so that, on your return to normal eating, you are more likely to gain weight than before your diet;
• unless the VLCD is specially formulated, you will probably be deficient in a number of micronutrients. This may trigger the appetite mechanism, possibly leading to hypoglycaemia and bingeing;
• specially formulated, 'ready-mix' VLCDs mean that you do not have to control calories for yourself and they do not therefore encourage permanent changes in your eating habits;
• the loss of fat-free mass may rarely be high enough to adversely affect the heart muscle, for example, with the risk of death.

You should only go on a very-low-calorie diet is you are severely obese or you need to lose weight urgently, in order to undergo surgery for example. You should not follow such a diet for more than a month without medical supervision, and consult a doctor immediately if you experience any unusual symptoms. Do not consider a VLCD if you have Gout or porphyria.

Conclusions about Diets

Neither exclusion nor inclusion diets are very successful in achieving permanent weight loss. Dietary rules on their own do not produce results unless they are accompanied by dietary self-control. Strict deprivation is likely to bring about a 'backlash' of binge eating which is followed by guilt and another attempt at dieting. For some people this becomes a lifelong pattern. What they need to do is learn to recognize true hunger and therefore be able to establish dietary self-control. They may still have periods of comfort eating but they will be less likely to crave the foods that make dieting difficult, such as cakes and chocolate, if those foods are less restricted.

Developing Better Eating Habits

Consider how you view food and eating it.

• Analyse your reasons for overeating. Is it because you are bored, or because you feel angry or frustrated in some way, or is it just habit? Eating can be a person's way of dealing with a whole range of emotions. If you keep a food diary for about a month, recording what you eat and how much and when, how you were feeling at the time, and what exercise or activities you did, you will be able to assess how balanced your diet is and how your emotions may be reflected in your eating patterns.
• Learn to appreciate the difference between eating to satisfy genuine hunger and comfort eating.
• Eat at least three meals a day because otherwise the body reacts to what it thinks is starvation and fat storage increases.
• Make eating a relaxing experience and don't rush your meals. Don't be distracted by other things, such as the television, during a meal, and relish all aspects of the food you are eating - its colour, texture and aroma as well as the taste.

Eating Disorders

Anorexia Nervosa

This is usually thought of as a disease of modern times, associated as it is with Western society's obsession with a slim body shape. It was, however, first described as a condition in 1874. The incidence rose dramatically in the last 30 years or so of the 20th century and may now affect as many as one in a hundred women aged between 15 and 25 years of age, a good many of them from a middle-class background and about a third of them with a history of being overweight. Anorexia can strike at any age between 12 and 35 and, in extreme and very rare cases, it is fatal. There is a relatively high incidence among those women who have diabetes.

Anorexia nervosa has the following characteristics, although other disorders show some of the same symptoms so you should consult your doctor:

• a self-imposed, strict eating regime that results in dramatic weight loss and is associated with a morbid fear of being fat and a distorted body image. A woman suffering from anorexia will see herself in the mirror as being much fatter than she is in reality;
• an abnormal reproductive cycle, and very often the absence of periods altogether;
• dry skin and excessive hair growth. The latter is fine, dry, rather brittle hair and it covers the nape of the neck, cheeks, forearms and thighs (and is known as lanugo);
• cold hands and feet with swelling;
• disrupted heart rhythm and low blood pressure;
• constipation.

Anorexia tends to be associated with adolescence and a fear of growing up, hence an attempt to keep the body in a child-like shape. The condition may also be linked to personality disorders arising from family dysfunction or to a family history of eating disorders or obesity, which gives rise to anxiety. Many patients conceal their self-doubt and worries beneath a veneer of conformity, good behaviour and high academic achievement. The onset of the condition may coincide with changed circumstances, such as starting at a new school, or the influence of a particular sociocultural group, for example models or dancers.

The attitude of parents is significant. They may consciously or unconsciously try to influence their daughter's choice of friends or keep her close to home. She may therefore experience conflicts of loyalty and, given a changing body shape that is beyond her control, she may make the control of her weight the focus of her anxiety. All this is against the backdrop of a society that believes thin is all that is desirable.

The consumption of food begins to resemble a battle in that it is the object of desire but is at the same time the cause of anxiety and fear. Dieting may start in a fairly inconspicuous way, perhaps just missing lunch or eating 'slimming' foods. Refusal of food and obsessive calorie counting gradually develop. The anorexic may be very keen to cook for others but will not eat herself, and her mood will veer from shame when she's eaten something 'fattening' to exhilaration as she starts out on a new diet. Self-criticism of her body is inevitable.

The desire not to eat on many occasions eventually develops into an inability to eat. There may be periods of intensive exercise and bingeing, which will be accompanied by great anxiety. The anorexic will never achieve a degree of thinness that is acceptable because her perception of her body is distorted. Dieting becomes increasingly strict and severe emaciation may ultimately be life-threatening.

Treating Anorexia Nervosa
Gone are the days of force-feeding and appetite stimulants. Treatment now takes the form of behaviour therapy, often involving the family or a partner. The aim will be to reach a normal weight range (a BMI of 19), to re-establish normal eating habits and eliminate vomiting, purging and excessive exercising. The patient needs to acknowledge her problem and deal with the fear of losing control of her body by putting on weight. Food has to be disassociated from fear and the body accepted more readily for what it is.

For support, contact the Eating Disorders Association (go to Information).

Bulimia

This condition is closely related to anorexia nervosa, and between 40 and 50 per cent of those with anorexia may develop this as well. First described in 1979, it also has social, psychological and cultural origins, relating to anxiety about appearance and sexual attractiveness. Patients tend to be concerned about their ability to handle responsibility and to be liked or loved, and their desire to please others results in a lack of identity and purpose. Some studies in the USA link this condition to low levels of beta endorphins, which are the body's natural opiates.

Bulimia is, like anorexia, about a fear of fatness and a great urge to overeat. A cycle of bingeing and dieting is again the pattern together with induced vomiting and purging and often the use of diuretics. Bulimia is estimated to affect about two per cent of women under 40, but as many as 20 per cent are believed to have eating disorders that involve occasional bingeing that is related to emotional problems such as tension, feelings of inadequacy, repressed anger, indecisiveness or just plain boredom. Those suffering from bulimia do all they can to hide their condition.

What are the Warning Signs?
These may include:

• the avoidance of meals, often with an excuse such as "I'll eat something later";
• the patient disappears to the toilet or bathroom immediately after having eaten;
• self-criticism of the body;
• the patient appears withdrawn, apathetic and pessimistic;
• inexplicable disappearance of food or keeping of strange hours.

Eating and vomiting become part of the same process to the bulimia sufferer, and a lack of opportunity to vomit induces great anxiety. Bingeing - usually with refined carbohydrates - produces a transitory high but is usually followed by symptoms of hypoglycaemia - weakness, sweating, confusion and erratic behaviour. Vomiting brings relief, as if the body is getting rid of its emotional problems, but it is also a form of punishment for being weak-willed and taking food. It also provides the security of the knowledge that it is possible to overeat and not gain weight. Some nutrients are absorbed before the patient vomits, however, so a bulimia sufferer rarely becomes as emaciated as an anorexic.

The Side Effects
Depending on just how many nutrients are absorbed, how often vomiting occurs, and how well the body copes with chemical imbalances, the effects of bingeing may include:

• abdominal distension and pain;
• swollen salivary glands;
• tiredness, nausea and breathlessness;
• tooth decay and gum disease.

The side effects of vomiting, in addition to Hypoglycaemia, include:

• electrolyte imbalance. When you vomit you lose potassium chloride and hydrogen ions. This can cause a number of complications -
  muscle weakness and tingling or numb fingers and toes,
  tiredness,
  headaches, confusion and an inability to concentrate,
  palpitations and low blood pressure,
  damage to the kidneys.
• swollen face and ankles as a result of a lack of protein;
• damage to tooth enamel due to stomach acids being vomited;
• damage to the oesophagus (bleeding and abrasions) caused by vomiting.

Other problems include depression, alcohol abuse and drug dependency, carbohydrate craving before a period and food allergy. There may also be a link between bulimia and polycystic ovarian syndrome. Mood swings are common. The emotional roller coaster that accompanies the cycle of bingeing and dieting can only be dealt with if the patient recognizes that eating is being used as a means of dealing with stress and that alternatives have to be found.

Self-Help for Bulimia
Much the same sort of treatment is needed as for anorexia. A food diary may be helpful. You must learn to be kind to yourself. Accept that occasionally you will eat for comfort and understand the reasons. Psychotherapy will help to build up self-respect, self-confidence and self-discipline. Above all, honesty is necessary for recovery: take care that your desire to please does not mask your actual level of progress. Develop new eating habits. Don't feel you have to finish everything on your plate; make sure that you have lots of non-fattening snacks to hand; and don't deprive yourself of the occasional treat.

Preparing for a weight-loss programme

Think carefully before embarking on a diet.

• Keep and study a food and exercise diary for a number of weeks and assess its implications.
• Look at several diets before choosing one that suits your needs.
• Be realistic when it comes to setting targets.
• Make it easier for yourself by joining a support group or getting yourself monitored by a doctor or another practitioner.
• Change your attitude to food. Do not think of it as a security blanket. Improve your calorie consciousness so that you have the confidence to choose wisely. And allow yourself the odd treat without thinking you have to be punished.

To Exercise or Not?

Exercise alone is not enough to make you lose weight. You would have to walk for 38 hours to lose 1kg of fat. But exercise will help a weight-loss programme by burning some calories and increasing your BMR (see above) as long as it is vigorous enough. Ideally you should do aerobic activity for 20 to 30 minutes every day. (Build up the amount of exercise you do gradually if you have not done it for a while.) There will be other benefits:

• it encourages the production of heat by metabolic processes (thermogenesis), therefore using calories;
• it suppresses appetite for a hour or so afterwards;
• it shapes and tones the body's muscles;
• it increases muscle strength and stamina;
• it is a natural antidepressant and de-stresser and it encourages good-quality sleep;
• it improves circulation and cardiac capacity, lowers blood pressure, lowers cholesterol levels and helps to prevent osteoporosis.

The Use of Drugs

The artificial control of hunger by appetite suppressants, which are only available on prescription, does not provide a long-term solution to the problems of being overweight, although it might help a severely obese person get started.

Homeopathic Treatment

Constitutional treatment may well be necessary, but in the meantime you could try the following specific remedies, which should be taken in the 30c potency weekly for up to eight doses.

• Calcarea
  For eating when worried; panic attacks; depression; dizziness; itchy scalp; craving for sweets; cramping abdominal pains; stress incontinence that is worse for coughing; thrush; vaginal discharge before a period; swollen breasts before a period; chest pain; stiff neck; clumsiness; eczema.
  
  Generalities: hot flushes; weakness that is worse for not eating regularly; tendency to arthritis.
  
  
• Lycopodium
  For eating when anxious and therefore increased weight when under stress; increased weight even if small quantities of food are eaten; tearfulness before and after a period; difficulty in concentrating; irritability before a period; dizziness; itchy scalp; hair loss, painful eyes; craving for sweet things; bloated abdomen before a period; cramping abdominal pains; stress incontinence that is worse for coughing; breathlessness; stiff neck; sciatica; swollen fingers; hot feet.
  
  Generalities: tendency to arthritis; fatigue that is worse before a period.
  
  
• Sepia
  For increased weight when under stress and during the menopause; irritability before a period; difficulty in concentrating; hair loss; chronic sinusitis; craving for sweets; stress incontinence that is worse for laughing or coughing; thrush; vaginal discharge before a period; stiff joints; hot sweats.
  
  Generalities: hot flushes; fatigue that is worse before a period; tendency to arthritis.
  
  
• Sulphur
  For increased weight when under stress due to a marked increase in appetite; increased weight during the menopause; itchy scalp; hair loss; chronic sinusitis; craving for sweets, especially before a period; itching in the back passage; stiff joints; swollen fingers; hot feet; hot sweats; eczema.
  
  Generalities: hot flushes; fatigue that is worse before a period; tendency to arthritis.
  
  
• Pulsatilla
  For increased weight due to a marked increase in appetite; increased weight even if small quantities of food are eaten which is worse during the menopause; indecisiveness; tearfulness and irritability before a period; dizziness; migraines; craving for sweets; bloated abdomen before a period; cramping abdominal pains; stress incontinence that is worse for laughing or coughing; thrush; breathlessness; chest pain; swollen fingers; hot feet.
  
  Generalities: marked fluid retention; hot flushes; fatigue that is worse before a period; tendency to arthritis.
  
  
• Phosphorus
  For increased weight due to a marked increase in appetite, even if small quantities of food are eaten; difficulty in concentrating; panic attacks; tearfulness before and after a period; dizziness; fatigue that is worse after a period.
  
  
• Lachesis
  For weight gain during the menopause; difficulty in concentrating; indecisiveness; depression; hair loss; sensation of a lump in the throat; bloated abdomen before a period; breathlessness; stiff neck, painful legs, hot feet; clumsiness.
  
  Generalities: hot flushes; fatigue that is worse before and after a period and for not eating for a while.
  
  
• Natrum mur.
  For increased weight when under stress due to a marked increase in appetite; increased weight even if small quantities of food are eaten; tearfulness and irritability before a period; dizziness; itchy scalp; hair loss; sore eyes; sensation of a lump in the throat; stress incontinence that is worse for laughing or coughing; thrush.
  
  Generalities: fatigue and weakness before a period; tendency to arthritis.
  
  
• Kali carb.
  For eating when anxious and therefore increased weight when under stress; increased weight even if small quantities of food are eaten; panic attacks; hair loss; migraines; chronic sinusitis; craving for sweets; swollen breasts before a period; stiff neck.
  Generalities: PMS; symptoms worse for not eating for a while; tendency to arthritis.
  
  
• Arsenicum
  For eating when worried; depression; panic attacks; craving for sweets; thrush; breathlessness; chest pain; stiff joints; swollen fingers; eczema.
  
  Generalities: marked fluid retention; weakness.
  
  
• Causticum
  For eating when worried; depression; difficulty in concentrating; irritability before a period; migraines; stress incontinence that is worse for laughing or coughing; breathlessness; chest pain; stiff neck, stiff joints; hot feet; clumsiness.
  
  Generalities: hot flushes; tendency to arthritis.
  
  
• Mercurius
  For increased weight when under stress; increased weight even if small quantities of food are eaten; panic attacks; painful eyes; craving for sweets; thrush; swollen fingers.
  
  Generalities: marked fluid retention; fatigue; tendency to arthritis.
  
  
• Belladonna
  For eating when worried; increased weight even if small quantities of food are eaten; dizziness; cramping abdominal pains; chest pain; stiff neck; painful legs; clumsiness; hot sweats.
  
  Generalities: marked fluid retention; weakness before a period.

See Appetite Changes, Weight Loss, Weight Gain for more information.

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