Are you wanting to lose some weight? There are hundreds of weight loss programs available that range from the useless to the ridiculous. But as anyone who’s tried a ‘fad’ diet will tell you, the promises of weight loss are very seductive. That’s the reason so many ‘quacks’ market them-so as to take your money?
This brief overview will look at the ‘hard’ scientific evidence behind the strategies which are proven to increase your chances of losing the weight you want. It is not going to recommend ANY diet approach but will give you the hard researched evidence to evaluate any particular diet you are considering.
Look at this like this
Would you go to see a surgeon and discuss a procedure you needed doing without them discussing the evidence, risks and outcomes? I know I wouldn’t.
The problem
Within the U.K. today the National Service Information Centre tells us that Obesity (BMI over 30) is rapidly becoming a major public health concern (NHSIC 2010) with 24.5% of U.K. Adults measured as being obese.
We are leading Europe in this particular race but at the moment lagging behind the Americans. Time and again research has shown that mass education of population groups at risk of obesity are of very little use in changing people’s life-styles long term (Bennett 2007). Society has and continues to struggle with how to change attitudes that will bring positive changes. And the evidence suggests we are not moving forward on this very fast. If you consider the Food manufacturer ‘lobby’, who have for years resisted putting dietary advice about the ingredients in their products, in the end it will come down to us to manage our weight!
So how do I know what to-do?
Firstly take a look at the box below (taken from NHSIC 2010) and see where you fit?
So now you know the risk, what benefit will you achieve from reducing your weight? Well from a physical perspective the positive gains you will reap are great. Take a look below-
Benefits of 10kg weight loss in the obese individual
Risk factors Benefits from weight loss
Mortality
• 20% reduction in total mortality.
• 30% reduction in deaths related to diabetes.
• 40% reduction in obesity-related cancer deaths.
Blood pressure (BP) in hypertensive individuals
• 10mmgHg reduction in systolic BP.
• 20mmHg reduction in diastolic BP.
Diabetes (benefits in 50% reduction in fasting blood glucose for those newly diagnosed)
Lipids
• 10% reduction in total cholesterol.
• 15% reduction in low density lipoproteins.
• 30% reduction in triglycerides.
• 8% increase in high density lipoproteins.
Shepherd A (2010)
So you know your risk and what the benefits of weight loss will bring! Next we’ll look at good old dietary advice. As alluded to earlier there are loads of ‘guru’s, quacks and charlatan’s who will sell you their advice. The National Institute of Clinical Excellence in publishing its guide line No 43 (2006) on obesity said that by reducing your calories by 600 a day will lose you 1-2 lbs a week. But remember you will lose less as your weight decreases if you stay on 600 cal/day
reduction-why? Because as you lose weight your body will naturally need less over all calories so to continue weight loss you will either have to increase the relative calories/day or use up the calories you are consuming by additional exercise.
• Fad diets such as-The Atkins, South Beach, Cabbage Soup, Zone, Sugar Busters etc have been shown to reduce weight initially but study after study has demonstrated that initial weight loss is more than often replaced by relapse and weight gain to pre-diet levels or even higher, Johnson A (2006). There are no published long-term studies that have shown that these diets lose and then keep the weight off. The restriction of certain food groups i.e. carbohydrates or proteins in some of them may cause problems (American Heart Association 2010).
So to spot a fad diet remember these points, they
• Promise a quick, easy fix with rapid weight loss
• Suggest that certain foods 'burn fat'
• Promote the eating of just one of two foods
• Have lots of rules about how to eat
• Sound too good to be true
So when thinking about the dietary aspect of weight loss, choice one that best suits your needs taking into consideration your lifestyle i.e. do you sit down all day in an office or dig ditches? Clearly one type of diet here may not suit both. Are you single or having to cook for others? Do you have specific medical needs? Are there cultural/time/financial constraints? Whatever the constraint there are some practical things to consider.
Practical dietary advice to promote weight loss
• Start the day with breakfast, for example eating a wholegrain cereal.
• Eating an egg for breakfast has been shown to promote weight loss without raising fat and cholesterol levels in the blood. This needs to be considered in terms of how the egg is cooked, for example the benefits of boiled and poached eggs versus fried eggs.
• Consume five portions of five fruit and vegetables per day.
• Half fill the plate with salad or vegetables and divide the other half between meat or fish and a starchy carbohydrate such as potatoes, rice or pasta.
• Boil, bake, grill or steam foods instead of frying.
• Choose low fat dairy products, changing from full-fat milk to semi-skimmed milk or from semi-skimmed milk to skimmed milk if preferred.
• Choose tomato sauces for pasta and rice instead of those with cream or cheese.
• Aim to eat at least three balanced meals a day and have snacks at planned times to suit lifestyle.
• Do not skip meals as this can lead to fluctuation in hunger levels and may predispose the individual to binge eating.
• Limit the consumption of diet carbonated drinks, as these can promote long-term damage to tooth enamel.
• Swap a standard size bar of chocolate for a ‘fun size’ smaller version.
• Eat low fat or baked versions of crisps and savoury snacks.
• Pay attention to labels on foods and choose those that are low in fat and sugar.
• Eat whole food products i.e. whole grain rice and pasta.
(Vander W al et a l 2008, Williams et al 2008)
Physical activity
The evidence is clear from many research studies that if you diet and exercise you will lose and maintain weight loss. You will reduce mortality form weight related diseases. You will improve your self-esteem, confidence and increase your circle of friends i.e. by attending classes etc. This improvement has been seen to-be especially evident in women wanting to lose weight after pregnancy (Amorim AR 2007). Doing High Intensive Exercise has been shown to be the best type. Don’t think this has to be in a gym either as doing the house work at a faster rate or walking briskly to school or the office can bring initial benefits to those not use to regular activity. Initially you may feel more supported by doing activities with the family. Use a pedometer to just increase your number of steps a day. Also making a cognitive reframe and thinking of it as a reduction in inactivity, rather than increasing activity may help. Whatever you do take small incremental steps and
Weight loss drugs
There are a range of weight loss drugs available now either by prescription by a Dr or pharmacist (or depending on your country over the counter). Whilst these may aid weight loss before turning to these consider these points,
• Is your BMI 27-35?
• Have you tried dietary restriction and failed at least 3 times for a sustained period?
• Physical exercise levels are not adequate?
In an article titled ‘Tackling the obesity crisis in the UK’. Shan Y (2008) noted that drugs used for weight loss work in one of three ways.
• Ones that reduce energy intake by acting as energy suppressants.
• Ones that increase the metabolic rate.
• And ones that alter fat metabolism and storage.
The two drugs currently licensed in the USA for the long-term treatment of obesity, Orlistat and Sibutramine, provide only modest weight-loss benefits and are associated with high attrition rates owing to side effects (Salem 2010). I would urge that before going down the drug route you discuss with your Dr. If you want a much more inner depth review of drug choices read Salem’s in-depth article. My final note here would be that this strategy is only an adjunct to wider life-style changes.
Surgery
This is the last and most risky of all the approaches discussed so far. Good Dr’s would only recommend this if you fulfil strict criteria. These of course will vary from country to country, The National Institute of Clinical Excellence has published guidance on this and can be found (see ref)but in essence this option should only be considered for you if
• You havea BMI of >40 or >35 with associated co-morbidities, such as diabetes or hypertension.
• All appropriate non-surgical measures have been tried and you failed to achieve or maintain adequate clinical weight loss for at least six months.
• You are receiving or will receive intensive specialist management.
• You are fit for anaesthesia and surgery.
• You will commit to the need for long-term follow up.
• You meet the local criteria and policies.
• You have been referred to a dietician for assessment.
Conclusion
This brief overview has summarised the latest evidence that is relevant to you if you are considering weight loss. There are thousands of dietary advice sources available for you to look at and no end of fad diets to ‘woo the cash out of your pocket’. But as discussed there is no evidence they work long term. Choosing a diet that suits your personal requirements is essential if it is to become a life style change for the long term. This must be paired with increased physical activity. Drug interventions and surgery can be considered if set criteria are met but again need to be associated with calorific restraint and exercise.
References
NHSIC-National Health Service Information Service (2010) Statistics on Obesity, Physical Activity and Diet-(2010) http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/obesity/statistics-on-obesity-physical-activity-and-diet-england-2010
Bennett D. (2007) Nurses at the cutting edge of Obesity. Practice Nurse 18,9. 454-458.
Shepherd A (2010) Current management strategies in the treatment of obesity. Nursing Standard. 25, 14, 49-56.
National Institute for Health andClinical Excellence (2006) Obesity: the Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children. Clinical guideline 43. NICE, London.
Johnson A (2006) The Truth About Fad Diets. http://tinyurl.com/3xvqdpr
American Heart Association (2010) What about Fad Diets? www.americanheart.org.
Vander Wal JS, Gupta A, Khosla P, Dhurandhar NV (2008) Egg breakfast enhances weight loss. International Journal of obesity. 32, 10, 1545-1551.
Amorim AR, Linne YM, Lourenco PM (2007) Diet or exercise, or both, for weight reduction in women after childbirth. Cochrane Database of Systematic Reviews. Issue 3.
Shan Y (2008) Tackling the obesity crisis in the UK. Primary Health Care. 18,8, 25-30.
Salem, Victoria; Bloom, Stephen R (2010) Approaches to the pharmacological treatment of obesity Expert Review of Clinical Pharmacology, Volume 3, Number 1, January 2010 , pp. 73-88(16)
National Institute for Health and Clinical Excellence (2006) Obesity: the Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children. Clinical guideline 43. NICE, London.
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