Many people resolve to get in shape and lose weight at the start of a new year. However, studies indicate that approximately seven weeks into the resolution, most people give up due to a lack of visible results or boredom with monotonous workouts. This article explores various strategies and insights, including the use of boxing as a fun and effective fitness method, to help maintain motivation and achieve weight loss goals.
The Role of Texture Modification in Swallowing and Weight Management
Texture modification is a common intervention for dysphagia, which is considered important for promoting safe and efficient swallowing. Dysphagia often requires modifying the properties of normal foods and liquids to make them easier and safer to swallow.
Understanding Dysphagia and Texture Modification
In managing dysphagia, health professionals modify food textures and liquid consistencies. Thin liquids pose safety challenges for people with dysphagia because they flow quickly. The rapid bolus flow from the mouth into the pharynx may not allow enough time for airway closure before the bolus reaches the larynx and airway. Thickened liquids are often recommended to slow down the flow, providing more time for airway closure. Very thick liquids and solid food materials may require greater tongue propulsive forces to move material through the oropharynx. People with reduced tongue or pharyngeal muscle strength may experience residues remaining in the pharynx after swallowing. Similarly, solid foods that require chewing can be challenging for people with dental issues or weakness in the masticatory muscles.
The Need for Standardized Terminology
The widespread use of texture modification calls for clear terminology to describe target consistencies for patients with dysphagia. Different countries have developed different classification systems in the absence of clear terminology and definitions to guide the production, preparation, and clinical use of modified food textures and liquid consistencies. The International Dysphagia Diet Standardisation Initiative (IDDSI) was established to address the need for agreed-upon terminology.
Evidence-Based Approach to Texture Modification
The IDDSI project aims to consider current empirical evidence when determining the number and characteristics of terms used in a recommended taxonomy of thickened liquids and texture-modified foods for clinical use. A systematic review of the literature was conducted to identify scientific evidence regarding the influence of bolus consistency on swallowing function and/or physiology in healthy or impaired participants.
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Methodology of the Systematic Review
The term "swallowing function" refers to swallowing safety (i.e., swallowing without aspiration) and swallowing efficiency (i.e., swallowing material in a reasonable timeframe without residue). The term "swallowing physiology" refers to biomechanical components of swallowing behavior, such as hyoid and laryngeal movement, tongue function, or upper esophageal sphincter opening, which contribute to functional swallowing outcomes.
Terminology for Texture-Modified Liquids
The labels "thin," "nectar-thick," "honey-thick," "pudding-thick/puree/paste," "soft solids," and "hard solids" are used to categorize texture-modified liquids, as these were the terms most frequently encountered in the research literature.
Review Objectives and Inclusion Criteria
The review aimed to identify and examine articles describing eating and swallowing in humans of any age, in which at least two different consistencies of food and/or liquid had been tested, and in which objective measures of swallowing function or physiology were reported for different bolus consistencies. The review included articles describing measures of interest in healthy people and/or people with oropharyngeal dysphagia, without restrictions related to diagnostic etiology. Articles in all languages were accepted.
Literature Search Strategy
A comprehensive literature search for literature published between 1985 and January 2013 was conducted using multiple search engines, including Ovid MEDLINE(R), Ovid MEDLINE(R) In-process and other non-indexed citations, AMED (Allied and Complementary Medicine), EMBASE, Health and Psychosocial Instruments, and PsycINFO. The search was also conducted in Scopus using subject area limits such as medicine, agricultural and biological sciences, pharmacology, chemistry, nursing, neuroscience, chemical engineering, engineering, health professions, psychology, materials science, multidisciplinary, and dentistry.
Search terms included MeSH Headings of "Swallowing," "Deglutition," or "Dysphagia," along with keywords such as "Visco," "Bolus," "rheo," "dens," "yield," "fluid," "mechani," "elastic," "Newton," "carbohydrate," "colloid," "starch," "gum," "alginate," "cohes," "thick," "consisten," "nectar," "honey," "puree," "pudding," "thin," "spoon," "liqui," "textur," "smooth," "mince," "soft," "dice," "chop," "fibr," "fibe," "bread," or "solid."
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Validation of Search Strategy
To measure construct validity and confirm that the search was finding important articles from the dysphagia and food processing research literature, members of the IDDSI working committee generated a list of known articles that they expected should have been found in the course of the search. A cross-check of these nominated articles with the search results revealed gaps in the search results with respect to articles describing swallowing in children or arising from the food oral processing literature. Consequently, two additional searches were conducted using the same search engines, seeking articles under the MeSH search term "eating and feeding disorders of childhood" and specifying the additional MeSH term of "food texture" in combination with the original search terms.
Article Screening and Review Process
The initial screening review involved a team of three research assistants who screened the titles and abstracts of 10,147 non-duplicate articles to determine relevance, defined as an article describing a measurement of human swallowing using more than one consistency of food or liquid. Articles were included if they were identified as relevant by at least one reviewer, leading to a set of 488 articles selected for more detailed full-text review. These 488 articles were assigned to an international team of 10 raters who each reviewed between 40 and 70 articles for relevance and quality using a questionnaire administered using SurveyMonkey®. The questions addressed during the full-text review led to a final subset of 36 articles selected for qualitative synthesis.
Qualitative Synthesis and Data Extraction
The qualitative synthesis included extraction of trends from the data both within and across specific participant subgroups (e.g., healthy, stroke patients) and critical appraisal of the risk of bias at both the study level and the outcome level based on the food and liquid consistencies and the measurement instruments used in each study. Due to the wide variety of instrumental methods used to measure swallowing behaviors and the wide variety of foods and liquids used in the selected studies, it was not possible to undertake a quantitative analysis of results across studies. Studies reporting a single item, e.g., ONLY water swallows, ONLY thin liquid barium swallows, or ONLY saliva swallows, were excluded.
Participant Demographics
Demographic information regarding the participants of the 36 studies selected for qualitative synthesis showed that only three of these studies described swallowing or oral processing in children; one of these was a study of swallowing in premature infants, while a second explored differences in chewing behaviors in infants aged 6 months to 2 years of age. The third study involving children explored oral processing behaviors in two groups of typically developing girls aged 5 and 8 years old, as well as a control group of healthy adult women. Of the 29 studies describing swallowing or oral processing in adults, 27 reported data for healthy adult participants, with two studies restricting their focus to denture wearers. A total of 10 studies reported data for adults with dysphagia. Four of these studies described swallowing in stroke patients in comparison to healthy controls, and a 5th paper described a group of patients with dysphagia secondary to Chagas’ disease, again with comparison to a group of healthy controls. Two papers reported data for individuals with dysphagia related to head and neck cancer, in one case following surgical resection of the soft palate and the second exploring post-radiation dysphagia in patients treated for nasopharyngeal carcinoma. The remaining papers described swallowing in patients with Parkinson’s disease, in unspecified neurogenic dysphagia, or in unspecified dysphagia.
Food and Liquid Stimuli
The various food and liquid stimuli used in the studies selected for inclusion in the qualitative synthesis included radio-opaque liquid stimuli, non-opaque liquid stimuli, and solid stimuli. Of the 36 studies selected for detailed review, seven reported comparative data for swallows of thin liquid (either barium, water, or juice) and an extremely thick liquid (i.e., pureed or spoon-thick consistency). A total of 13 articles described swallowing measures for a narrower contrast, i.e., thin liquid compared to either a mildly thick liquid (also known as nectar-thick) and/or a moderately thick liquid (also known as honey-thick), with six of these articles including both mildly thick and moderately thick liquids. In terms of solid stimuli, which were explored in a total of 18 studies, there were effectively no stimuli that were the same in any two or more studies. Solid foods ranged from items that were described by authors as being softer (i.e., banana with barium paste; cooked rice mixed with barium; corned beef; gummy bears; konjac jelly, or gelatin cubes) to items at the harder end of the continuum (e.g., fresh raw carrots; biscuits or cookies).
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Boxing as a Weight Loss Strategy
Beyond texture modification for dysphagia, innovative fitness approaches like boxing can significantly contribute to weight loss and overall health.
The Engine Room: A Boxing Gym Success Story
Aaron Sloan, the owner of The Engine Room boxing gym, transitioned from being a registered nurse to a fitness entrepreneur. His experience in healthcare made him aware of people's poor health choices, which motivated him to create a gym that offers a fun and effective way to get in shape.
Popularity Among Women
The gym, traditionally popular with men, has seen a surge in female participation. Women are increasingly turning to boxing to lose weight, get in shape, and enjoy the process.
Factors Contributing to Boxing's Popularity
Sloan attributes the growing popularity of boxing among women to the success of female boxers in the Olympics. He notes that the achievements of women in competitive boxing inspire more women to explore the fitness side of the sport.
Testimonials from Female Boxers
Terri Watson, a boxer at The Engine Room, shared her transformative experience. Overweight and out of shape, she sought a new and different workout. She lost 75 pounds through boxing at the gym. Caitlin Redmond, another boxer, joined the gym to learn something new and quickly became addicted to the sport.
Sunny Leigh's Experience
Sunny Leigh tried a class at The Engine Room and discovered that boxing is more challenging than it appears, particularly the speed bag. She experienced firsthand why the sport is so addictive.
Training Differences Between Men and Women
Sloan observes that women tend to focus on technique first, which makes the training process smoother.
Benefits of Boxing at The Engine Room
Boxing at The Engine Room offers a fun and effective way to get in shape while learning proper technique. The gym also provides specialized classes for people with Parkinson's disease.