Knowledge

Weight Management Position Paper

 

By William Misner, Ph.D.

William Misner, Ph.D.
William Misner, Ph.D.
From 1996 until his retirement in 2006, Dr. Bill worked full-time as Director of Research & Development at Hammer Nutrition. Among his many accomplishments, both academically and athletically, he is an AAMA Board Certified Alternative Medicine Practitioner and the author of "What Should I Eat? A Food-Endowed Prescription For Well Being".

It is well known that Fitness Professionals encounter numerous clients with concern for weight loss. Statistics state that at any one time, 25% of all men, and 45% of all women are attempting to lose weight. Further statistics show that of those who lose weight as a result of temporary caloric restriction protocols 100% is regained within 5 years, with a high percentage of those subjects regaining the weight within 3 months, adding excess fat weight above the former. Simply put, temporal dieting leads to progressive unhealthy weight gain, while a "Lifestyle" weight management protocol is characterized by balanced caloric intake [from a variety of foods] with energy expense [from an active exercise program]. This paper was electronically reviewed by the American Dietetic Association who indicated approval for the ADA's reference link to the Position Paper on Weight Management [#51], and have indicated that they are amenable to including the ADA position reference in the conclusive summary paragraph. We are genuinely encouraged by this response. The intent of this paper is not to specify an exercises or caloric requirements, but rather to enumerate principles upon which to formulate such a program that will result in a permanent healthy "Lifestyle"...

HEALTH RISKS RELATED TO OBESITY Health and fitness are significantly reduced proportionate to the ratio of excessive fat mass to lean muscle mass stores.[1] excess body fat stores result from caloric intake above caloric expense in time and habit dependant fashion. Overweight compromises health as evidenced by a higher rate of coronary heart disease, hypertension, dyslipidemias, diabetes, gallstones, sleep apnea, osteoarthritis, and cancers of the reproductive organs in the obese population. Taken to its absolute endpoint obesity-related degenerative conditions causes 300,000 deaths each year in the U.S.A. [2] in the past 21 years, the total average food intake has increased 6%, while only 22 percent of U.S. adults get the recommended regular physical activity (5 times a week for at least 30 minutes) of any intensity during leisure time.[3, 4]

DEFINITIVE MEASURES OF OBESITY Obesity refers specifically to having an abnormally high proportion of body fat. [5] One can be overweight without being obese, as in the example of a bodybuilder or other athlete who has a lot of muscle. There are 3 measures to consider for identification of fitness-inhibiting, health-degenerative obesity, 1-Waist-to-hip ratio, 2-Waist girth, and 3-Body Mass Index. Not all of these measures will apply to all of your fitness clients. Waist-to-Hip Ratio and/or Waist Girth measurements should be applied to assess obesity in persons with a relatively high lean muscle mass to fat mass ratio. A short person with high muscle mass to fat ratio will record a deceptively high Body Mass Index score falsely indicating a need to seek medically supervised treatment for obesity when a high lean muscle mass to fat ratio may not warrant such actions.

This is indicative for only a small segment of the population. The Fitness Professional is well advised to consider "normal" 15-20% body fat in male clients and 22-30% in female clients separate from their BMI estimate. If body fat percents are less than 20% in males and 30% in females but their BMI is above 25, it should be disregarded as a significant risk factor to their respective health. Persons seeking to lower BMI and/or body fat weight may follow a graduated periodic caloric-restriction protocols preceding entry into a permanent weight management "Lifestyle".[5, 6, 7]

WAIST-TO-HIP RATIO Waist-to-hip ratio measures fat distribution. Pre-menopausal women tend to store fat in the hips, buttocks, and thighs. Postmenopausal women tend to store fat higher in the upper body region [7]. Most men store fat in the abdominal area. Excess fat stored in the upper body is associated with a higher risk of high blood pressure, diabetes, early onset of heart disease, and certain types of cancers than seen in subjects with excess fat stores in the lower areas of their bodies. A waist-to-hip ratio greater than 1.0 in men and 0.8 in women indicates increased health risks, including hypertension, coronary heart disease, and type II diabetes [1].

WAIST GIRTH Waist girth is an excellent means to assess fat distribution. It is an obvious indicator of health risk if above >40 inches (102 cm) in males, and above >35 inches (88 cm) in females [7]. Examples of the relationship of waist girth to fat percent here follow:


GENDER AGE HEIGHT WEIGHT WAIST FAT % BMI LEAN MUSCLE MASS(LBS)
MALE 40 70" 250 45 27.1% 35.9 160 LLM
MALE 40 70" 240 43 25.1% 34.4 158 LLM
MALE 40 70" 230 41 23.0% 33.0 156 LLM
FEMALE 40 65" 180 36 32.2% 30.0 118 LLM
FEMALE 40 65" 175 35 30.9% 29.1 117 LLM
FEMALE 40 65" 165 33 28.3% 27.5 114 LLM

While many formulae may be hand applied to determine male and female body fat, the following may be used in the absence of an automated or computer-generated model:

MALE BODY FAT CALCULATOR[MAN'S Body Fat Formula] %Fat = 100*(-98.42 + 4.15waist - 0.082weight)/weight) FEMALE BODY FAT CALCULATOR[WOMAN'S Body Fat Formula] %Fat = 100*(-76.76 + 4.15waist - 0.082weight)/weight

BODY MASS INDEX Body Mass Index (BMI) may be used to measure both overweight and obesity in adults. It is the measurement of choice for many obesity researchers and health professionals. BMI is a direct calculation based on height and weight and is not gender-specific. Most health organizations and published information on overweight and its associated risk factors use BMI to measure and define overweight and obesity. BMI does not directly measure percent of body fat, but it provides a more accurate measure of overweight and obesity than relying on weight or height-weight tables alone. BMI is found by dividing a person's weight in kilograms by height in meters squared. The mathematical formula is: weight (kg)/height squared (m2).

To determine BMI using pounds and inches, multiply your weight in pounds by 704.5, then divide the result by your height in inches, and divide that result by your height in inches a second time. Or you can use the BMI calculator at: http://www.nhlbisupport.com/bmi/bmicalc.htm The National Institutes of Health (NIH) identifies OVERWEIGHT as a BMI of 25-29.9 kg/m2, and OBESITY as a BMI of 30 kg/m2 or greater. However, overweight and obesity are not mutually exclusive, since obese persons are also overweight.[5] Defining overweight as a BMI of 25 or greater is consistent with the recommendations of the World Health Organization [6] and most other countries.

As indicated, BMI is fat-free muscle mass comparatively calculated against adipose fat mass. A high BMI is contraindicated to predict obesity-degenerative disorders in broad heavily muscle-mass strength athletes or subjects genetically so predisposed. A BMI above 25 or a body fat percent above 20% for males and above 30% for females is however grounds for altering exercise and dietary lifestyle practices which may have contributed to a body composition too high in fat to fat-free lean muscle mass. The causes of poor weight management are multi-factorial, rooted within genetic, metabolic, biochemical, psychological, and physiological origin. Whether the origin of individual weight "mismanagement" can be resolved by the fitness professional depends upon the committed motivation of the client, the positive effect of the relationship attenuated, and the time-generated exercise donated toward reachable goals.

HEALTHY WEIGHT The American Health Foundation's Expert Panel on Healthy Weight has proposed the concept of a healthy weight from a BMI between 19 to 25, and a second concept of "healthier weight goals" for persons above the target (BMI >25). For these persons a more healthful weight goal would be to decrease body weight by 1 or 2 BMI units or 10 to 16 lb below current weight. Programs should, therefore, focus on improving health through small weight losses that are "achievable and maintainable" [1, 8, 9]. The new BMI should remain stable for a minimum of 6 months before further attempts are made to lower BMI. Healthy weight calculations should always include assessment of body fat percent of the client.

GOALS OF THE WEIGHT MANAGEMENT PROGRAM Weight management includes a lifelong commitment change away from problematic habitual practices to a permanent healthful lifestyle. No greater good can the fitness professional do than to persuade the client to make their change "permanent". When a fitness professional enters into an client-professional agreement presenting a Weight Management concern what should be the stated general Goal? The goal of any obesity treatment is adamantly refocused to weight management not weight loss. "Weight management" has been defined as permanent adaptation of healthful eating and exercise behaviors indicated for reduced disease risk and improved feelings of energy and well being. All weight management programs should at the very least include training lifestyle modification with the following goals:

(a) GRADUAL CHANGE to a healthful eating style with increased intake of whole grains, seeds, nuts, fish, fruits, and vegetables, with decreased portions of high saturated fat foods and processed empty-calorie packaged products.

(b) NONRESTRICTIVE EATING based on internal regulation of food, such as permitting hunger satisfaction by regular small-portion meals.

(c) ENJOYABLE REGULAR PHYSICAL ACTIVITY include gradual exercise up to at least 30 minutes daily. [8, 9, 10, 11]

(d) PERMANENT GOAL SETTING should first be: AVOID SETTING UNMAINTAINABLE GOAL WEIGHTS with focus on education on healthful eating and increased activity. Each goal must include helping clients to re-establish tolerable, enjoyable, and stable eating and exercise patterns. Goals may also include halting or reducing the rate of weight gain, stabilizing weight, hence reducing health risks. Small weight losses may be suggested to impact significant effect on health status [11, 12].

THE WEIGHT MANAGEMENT "LIFESTYLE" DIETARY GUIDELINES [13]

1. EAT A VARIETY OF FOODS: Choose most of your foods from the grain products group (6-11 servings), the vegetable group (3-5 servings), and the fruit group (2-4 servings) and (2-4 servings) from the non-animal protein group [nuts, beans, legumes, sprouts, seeds]. Limit amount of foods. Choose sparingly foods that provide few nutrients and are high in fat and sugars.

2. BALANCE THE FOOD INTAKE WITH PHYSICAL ACTIVITY -- MAINTAIN OR IMPROVE YOUR WEIGHT: Do 30 minutes or more moderate aerobic physical activity on most--[preferably all]--days of the week.

3. CHOOSE A DIET WITH PLENTY OF GRAIN PRODUCTS, VEGETABLES, AND FRUITS:These include grain products high in complex carbohydrates -- breads, cereals, pasta, rice -- found at the base of the Food Guide Pyramid, as well as vegetables such as potatoes and corn. Dry beans (like pinto, navy, kidney, and black beans) are included in the beans group of the Pyramid, but they can count both as servings of vegetables instead of meat alternatives.

4. CHOOSE A DIET LOW IN FAT, SATURATED FAT, AND CHOLESTEROL: Some foods and food groups in the Food Guide Pyramid are higher in fat than others. Fats and oils, and some types of desserts and snack foods that contain fat provide calories but few nutrients. Many foods should be restricted completely or limited such as: milk group, meat, eggs, and poultry because they are too high in saturated fat, as are some processed foods in the grain group.

5. CHOOSE A DIET LOW IN SIMPLE SUGARS: Some evidence indicates that diets high in sugars may contribute to hyperactivity or diabetes. The most common type of diabetes occurs in overweight adults. Avoiding sugars alone will not correct overweight. To lose weight reduce the total amount of calories from the food you eat and increase your level of physical activity. 6. CHOOSE A DIET LOW IN SALT AND SODIUM ADDITIVES: In the body, sodium plays an essential role in regulation of fluids and blood pressure. Many studies in diverse populations have shown that a high sodium intake is associated with higher blood pressure. Most evidence suggests that many people at risk for high blood pressure reduce their chances of developing this condition by consuming less salt or sodium. Some questions remain, partly because other factors may interact with sodium to affect blood pressure.

7. IF YOU DRINK ALCOHOLIC BEVERAGES, DO SO IN MODERATION: Alcoholic beverages supply calories but few or no nutrients. The alcohol in these beverages has effects that are harmful when consumed in excess. These effects of alcohol may alter judgment and can lead to dependency and a great many other serious health problems. Alcoholic beverages have been used to enhance the enjoyment of meals by many societies throughout human history. If adults choose to drink alcoholic beverages, they should consume them in moderation. Higher levels of alcohol intake raise the risk for high blood pressure, stroke, heart disease, certain cancers, accidents, violence, suicides, birth defects, and overall mortality (deaths). Alcohol may cause cirrhosis of the liver, inflammation of the pancreas, and damage to the brain and heart. Heavy drinkers also are at risk of malnutrition because alcohol contains calories that may substitute for those in more nutritious foods.

PROHIBITIVE WEIGHT MANAGEMENT PROTOCOLS OUTSIDE OF AFPA JURISPRUDENCE

Certain protocols are prohibited or restrictive in terms of what the AFPA professional is authorized to advise. These protocols include referral of specific clients to other professionals who are trained to assist AFPA clients with specific degenerative disorders. These include protocols that impose physiological imbalances, which may distract from a permanent healthy weight management result.

1. Temporary dietary protocols apart from permanent "Lifestyle" change are prohibited. Hypo-caloric temporary weight loss programs that are not part of a permanent weight management lifestyle should be avoided at all costs. If Weight management techniques fail to induce healthy lifestyle changes within 6 weeks after initiation, services to the client should be abandoned.

2. Planned rapid weight loss protocols above 5 pounds per month is limited to the professional supervisory review of licensed physicians or referred dietitians. Such persons suffering from morbid obesity may have limited options. If a physician or dietitian refers such a client to the fitness professional gradual adaptation to tolerable aerobic exercise protocols must be administered. Rapid weight loss has been implicated in the fast weight regain in the "Yo-Yo" Syndrome. Rapid weight loss is operant in many health-degenerative disorders in both the general overweight and morbidly obese population and is therefore prohibited.[13, 14, 15]

3. Pharmacological use of chemicals such as stimulants, steroids, or diuretics are prohibited. All weight-loss pharmacological agents or surgical intervention are the properly the purview of the appropriate licensed physician.

4. Diets emphasizing excess use of protein above 15% of the individual's total daily caloric requirement, or outside the range of 0.8-1.7 grams protein per kilogram body weight, are prohibited.

5. Excess use of high-saturated fatty foods from dairy, animal, or poultry byproducts are prohibited. [several weight loss schemes currently employ this very unhealthy approach].

6. Excess use of packaged foods at the expense of whole foods from produce origin are prohibited.

7. Supervision of client progress in contradiction to a physician's or dietitian's directive are prohibited.

8. Weight management techniques that fail to accompany regular exercise 30 minutes per day are prohibited.

9. Weight management techniques should refer clients to other health professionals if or when progress fails to occur within 12 weeks of initiation, or if symptoms representing degenerative disorders appear. Weight mismanagement recycling produces the weight "Yo-Yo" syndrome.

10. Clients with suspect psychological disorders such as anorexia, bulimia, or rapid weight gain from binge eating should be also referred to either their physician or the appropriate psychological counseling professional before accepting into a fitness counseling session. After "3 Strikes" or 3 each 3-week attempts at safe effective Weight Management "Lifestyle" changes, the failed client should be referred to a physician for further consultation before being accepted into a return fitness-oriented protocol.

EMPLOYMENT OF WEIGHT REDUCTION PRINCIPLES WITHIN THE WEIGHT MANAGEMENT PROTOCOL Research has examined the prevalence, distribution and correlates of successful weight loss and successful weight maintenance over a three-year period in a community-based sample of 854 subjects aged 20-45 at baseline. More than half (53.7%) of the participants in the study gained weight within the first twelve months, only one in four (24.5%) successfully avoided weight gain over three years, and less than one in twenty (4.6%) lost and maintained weight successfully. The findings underscore the importance of current public health efforts to prevent weight gain by making permanent lifestyle changes or weight control of the prevalence of obesity will continue.[15, 16]

PERIODIC EFFECTIVE WEIGHT LOSS IS PART OF THE PERMANENT LIFESTYLE DIETARY

CHANGE TOTAL CALORIES consumed create excessive weight gain, not simply fat or carbohydrate choices. The following guidelines safely assist clients achieve a permanent, safe, weight loss with in the weight management "lifestyle", avoiding the typical "yo-yo diet syndrome". Success in weight loss is been determined by several principles practically imposed in proportion to commitment and strict adherence to the permanent dietary-exercise "lifestyle" change. Diets employing caloric-restriction typically do NOT work due to the weight loser's return to the original habits that imposed unhealthy weight gain. The fitness professional is authorized to teach gradual, safe, effective weight-loss dietary principles ONLY if the weight loss plan accompanies a permanent dietary healthy "Lifestyle" change. Most clients will migrate to a healthy body weight simply by exercise and amending the appropriate weight management dietary protocols aforementioned.

SEVENTEEN CHARACTERISTICS OF AN EFFECTIVE WEIGHT LOSS PLAN 1. Reduce current refined carbohydrate intake by 50%.[17]

2. Increase raw food vegetable and fruit intake by 25%.[18]

3. Drink a minimum of 10 x 8-ounce glasses of water per day [chose either steam distilled or bottled water that is "chlorine and fluoride free"].[19, 20]

4. Cease eating after 7:00 PM.[21]

5. Reduce or omit meats[excluding salt water cold water fish] and dairy byproducts.[1, 22, 41, 42, 43]

6. Exercise activity is conducted at or below 75% VO2 Max Heart Rate.[23]

7. PERIODIC Short-term weight loss of 2-5 pounds weight loss in 20 consecutive days, followed by seven days NO calorie restriction before repeating a 2nd 20-day protocol.[15, 24, 25, 26] [See explication footnoted* below.]

8. Recommend no more than 1 pound weight loss each week.[15, 24, 25, 26]

9. Do not go below 1,500 calories per day.[27, 30]

10. Refer to the Food Guide Asian or Mediterranean Pyramid and Dietary Guidelines [1, 28].

11. Focus on limiting fat and processed food intake rather than calories. [29, 41, 42]

12. Encourage 30 minutes minimum exercise per day. [30]

13. Include a variety of nutritionally balanced foods. [31]

14. Minimize hunger, no-starve periods. [32]

15. Encourage setting realistic weight loss goals and making slow, moderate changes. [33, 34]

16. Precedes an established lifelong "Lifestyle" protocol, balancing caloric intake with expense. [35, 36, 37]

17. Remove man-made fats [TFA-Trans Fatty Acids-also know as partially or completely hydrogenated vegetable fats]; found in almost all processed baked goods. [52,53,54,55]

*EXPLICATION #7: Mobilization of fatty acids increases the rate of fat metabolism in short-term weight-loss in 20-21 day periods, reducing appetite-induced TOTAL calories, with no more than a 500 calories daily deficit below daily requirement. A 7-day OFF-Diet period reduces the physiological plateaued "Stall" in weight loss from increased appetite, but this is not license to indulge in excessive caloric intake above daily expense. Practice of all 16 guideline's may insure no weight gain during the eat-as-you-please 7-day OFF-Diet period.[38, 39, 40]

INFORMED WRITTEN CONSENT A formal written consent is advised when a fitness professional recommends "Lifestyle" dietary protocol adaptations. The consent should contain the general recommendations that have been established including informing the client of the 10 WEIGHT MANAGEMENT PROTOCOLS OUTSIDE THE JURISPRUDENCE OF THE AFPA PROFESSIONAL [above]. Review of the consent form should detail the importance of permanent "Lifestyle" balances between food intake and exercise expense. The only means to achieving a healthy weight must emphasize the adoption of a healthy balanced diet whose an energy intake that does not exceed expenditure, is low in fat, and provides adequate amounts of all food groups, including whole grains and cereals, fruits, and vegetables, as noted in the Dietary Guidelines for Americans[14].

An informed "CONTRACT CONSENT" form adapted should read as follows:

I,_____________-J. Jones-____________, do hereby acknowledge my understanding agreement to attempt to alter dietary protocols to embrace food choices low in fat, with adequate amounts of all food groups, fish, whole grains, cereals, seeds, nuts, fruits, and vegetables, limiting future intake of processed empty-calorie packaged or fast food products, animal meats, poultry meats, and dairy byproducts. I recognize that I have been instructed to not lose weight any faster than 5 lbs per month, and, if I do lose it faster than that I have been instructed that weight regain excess may occur. I agree to do_________-minutes of aerobic exercise _________days per week for an indefinite period of time in order to establish a permanent healthy diet and exercise protocols as an integral part of this my chosen "Lifestyle". I further agree and understand if any symptom -indicated health disorders appear from the proposed fitness program I will assume all responsibility while informing my fitness professional associate and/or my licensed health care provider. I have reviewed the position statement and understand the 10 WEIGHT MANAGEMENT PROTOCOLS OUTSIDE THE JURISPRUDENCE OF THE AFPA PROFESSIONAL.

Signed_____________________________________


-J. Jones-Client
Signed_____________________________________
-F. Smith-Fitness Professional

CONCLUSIONS Lifestyle habits from choices of food and exercise may result in the incidence of cardiovascular or ischemic heart disease. Diseases of the heart are the number one cause of death while cerebro-vascular stroke is the number three cause of death in the USA. From a multi-country or ecologic approach, a large range of dietary values were implicated in degenerative disease was done inexpensively from data that already exists, thus it is worthwhile to review the history of multi-country studies of dietary links to both ischemic heart disease (IHD) and athero-sclerotic coronary heart disease (ACHD). Yudkin found the incidence of IHD could be correlated with intake of animal protein as well as that of fat.[44] Yerushalmy and Hilleboe did a statistical comparison of dietary macro-nutrients and athero-sclerotic CHD mortality rates for men aged 55-59 in 22 countries.[45] They found animal protein, total calories, animal fat, and fat in general to have the highest rank order correlation coefficients with carbohydrates having a low but positive coefficient in athero-sclerotic CHD mortality rate[ACHD].

RANK ORDER FROM HIGHEST TO LOWEST DIETARY DEATH FROM ACHD[50] DIETARY FOOD ACHD DEATH CORRELATE COEFFICIENT Animal Protein +0.756 = INCREASED RISK Total Calories +0.723 = INCREASED RISK Animal Fats +0.684 = INCREASED RISK Fats +0.659 = INCREASED RISK Carbohydrates +0.305 = INCREASED RISK ------------------------------------------------------------------- Vegetable Fats -0.236 = DECREASED RISK Vegetable Proteins -0.430 = DECREASED RISK

RISK The multi-country approach was also used in the 1960s for studying CHD, with the finding that sugar was also a risk factor.[44, 47, 48, 50] Others[49] have also implicated sugar with the highest statistical association with ISCHEMIC HEART DISEASE (IHD) mortality rate for 30 countries from foods eaten in 1963-1965 related to deaths occurring in 1968-1969, but this finding seems to have been largely ignored:

RANK ORDER FROM HIGHEST TO LOWEST DIETARY DEATH FROM IHD[50] DIETARY FOOD IHD DEATH CORRELATE COEFFICIENT MEN WOMEN Sugar +0.76 +0.69 = INCREASED RISK Animal Protein +0.75 +0.58 = INCREASED RISK Milk +0.72 +0.48 = INCREASED RISK Saturated Fat +0.71 +0.58 = INCREASED RISK Meat +0.65 +0.65 = INCREASED RISK Total Fat +0.59 +0.39 = INCREASED RISK Eggs +0.56 +0.59 = INCREASED RISK Cigarettes +0.41 +0.55 = INCREASED RISK ------------------------------------------------------------------------ Fish -0.19 -0.30 = DECREASED RISK Vegetables -0.39 -0.22 = DECREASED RISK Cereals -0.58 -0.39 = DECREASED RISK

The food categories associated with the least degenerative cardiovascular or ischemic heart disease suggests that the fitness professionals should encourage permanent dietary change toward those foods which appear to support dynamic healthy lifestyle.[50] Combining a balance in food variety with an active lifestyle proportionately contributes to regenerate a healthy weight management profile for the fitness-oriented client. The American Dietetic Association[ADA] position enjoys parallel references quoted throughout the writing of this paper helping to establish clear guidelines for physicians, dietitians, and fitness professionals. This paper also establishes a parallel diet-related interest in health and fitness, and general agreement in principle with the ADA position by favoring only those WEIGHT MANAGEMENT lifestyle protocols known to effect positive role in health.[51]


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[51]-THE POSITION OF THE AMERICAN DIETETIC ASSOCIATION The American Dietetic Association position paper was LAST referenced on January 25, 2001 and and has been throughly included within the composition of this paper in order to establish clear guidelines between the roles of physicians, dietitians, and fitness professionals. This reference has been authorized by the ADA. For more detail on the ADA Weight Management position see: http://www.eatright.org/adap0197.html
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[53]-Weil, A. M.D. 8 Weeks to Optimum Health, Alfred Knopf Pub, 1997
[54]-Barnard, N. M.D. Foods that Fight Pain, Harmony Books 1998
[55]-Haas, E. M.D., The Detox Diet, Celestial Books. 1996
[56]-Adopted and Posted January 28, 2001 @: THE AMERICAN FITNESS PROFESSIONALS & ASSOCIATES WEBSITE http://www.afpafitness.com/articles/AFPAPosWtMg.htm
COPYRIGHT THE AMERICAN FITNESS PROFESSIONALS & ASSOCIATES[AFPA] & HAMMER NUTRITION LTD. © 2001


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