Lose weight and regain health

Here are some stark graphs to begin with. The first one published in the Annals of Internal Medicine in 2003 is from the Framingham Heart Study between 1948 and 1990. It showed the results of 3457 participants whose ages were between 30 and 49 at the start of the study. The graph shows that people who had the longest lifespans were normal weight, non-smokers. As weight increased in each category, life expectancy decreased.

Being overweight shortens your life

Mortality increases both by being underweight and overweight

Here is another very revealing graph published in The Lancet 1990. It shows the death from all causes in 900,000 participants from Western Europe and North America recruited around 1979 and followed up for an average of 13 years. Death was lowest in those with a BMI (Body Mass Index) between 20 and 25 in both sexes and at all ages. Please note that this is in a mainly caucasian population and is unlikely to hold true for Asians who tend to have metabolic problems such as diabetes at lower BMIs.

The sweet spot seems to be a BMI around 23.

Lose weight and keep it off

After stopping smoking and lowering your alcohol intake, normalising your weight is the best thing that you can do to improve your health. It will also help to prevent disease and increase lifespan.

But as we all know that is easier said than done. There are numerous diets around which will all help you to lose weight. Some of them help you lose weight faster than others. People usually start with the idea that they will go on a diet and then start eating healthily and having a healthy lifestyle when they have achieved their target weight. Of course, what actually happens is that they usually put back on most if not all the weight they have lost afterwards. In fact, they will probably end up at a higher weight than before the diet.

The key is to lose weight and keep it off permanently. I help people to do this every week in my clinic. It does not involve calorie-counting contrary to the standard medical advice which, by the way, does not work but you already know that. Over 30 years of practising medicine, I have never seen calorie-counting work for may patients and it has never worked for me. The only way to stay a normal weight is to eat what human beings should be eating.

Diet vs Exercise

People normally mention diet and exercise in one breath when talking about weight loss. Unfortunately, so do the government guidelines and most clinicians. Diet and exercise are not the same when it comes to losing weight.

There is also a perception that exercise is the key to weight loss and it is not difficult to see why. Advertising, the gym industry, Jane Fonda, and all the other celebrities out there who are making money from their exercise DVDs have been giving out that message for decades. Every year, people start by taking out their gym membership full of good intentions. For most people, these do not last very long and their exercise habit wanes, whilst the monthly gym subscription continues. Most gyms will not give you the exact statistics but one gym owner told me that only 7% of their subscribers actually attend regularly. Now that is a great business to be in!

Exercise is important in keeping fit and improving heart health, but its contribution to weight loss is tiny compared to what you put in your mouth. How much of a contribution do diet vs exercise make to weight loss? The answer is around 6 vs 1. If you want to lose weight and keep it off, then you will need to eat differently, forever. It is easy when you know how and is all about finding delicious recipes that you enjoy eating. That may take some experimentation and some people will need to make bigger changes than others. Overall, it would be better to hold that gym membership and put that cash into good quality food.

How to lose weight FAST

Many people lose weight just fine doing it slow and steady by reducing the amount they eat and exercising. Weight Watchers and Slimming World are also great for this type of weight loss. However, both organisations have a poor record in helping people lose weight and keeping it off. It may be because they rely on calorie counting which does not work long-term. I will explain that later.

The 2 fastest ways that I know to lose weight fast are bariatric surgery and very-low calorie diets. These are extreme treatments and only sometimes recommended.

Bariatric Surgery

Bariatric surgery is essentially weight reduction surgery. The 2 most common procedures are gastric sleeve and gastric bypass surgery. Both of these result in a small stomach size so that the person just cannot eat much before they feel full. They also result in beneficial hormonal changes.

I was lucky enough to work in a specialist hospital where they did this type of weight reduction surgery. I followed up many patients and saw amazing and quick weight reduction. This was accompanied by normalisation of their blood pressure, sugar and cholesterol. One by one, I found that I had to reduce and stop their medication until they had stopped all or most of them. This was the first time in my life that I had seen this happening consistently.

That does not mean that I recommend bariatric surgery for weight loss because there is always a risk with surgery. But for some people, it may be the only answer.

The reason I mention it is because it demonstrates a principle. Losing weight lowers blood pressure, can reverse diabetes, lower cholesterol and the risk of certain cancers.

Very-low calorie diets

In 2011, Professor Roy Taylor and his team at the University of Newcastle showed that diabetic patients on a very-low calorie diet day were able to reverse their diabetes.

Since then there have been a number of diets that have been launched to enable people to benefit from this method.

Most of these diets have premixed sachets and shakes that you can buy. They are safe to use if you follow the instructions carefully. Of course, they are in no way normal and cannot be continued indefinitely. But they do result in rapid weight loss which can be more appealing to people than the slow-and-steady diets. Very-low caloried diets include the Cambridge Weight Plan, Lighterlife, Slimfast and Exante. Recently the NHS has also started very-low calorie diets in some parts of the UK to help people reverse their diabetes.

The Greatest Loser

My wife and I once watched a series of The Greatest Loser on TV. I must admit that it was quite entertaining. It is a reality TV show about a group of people who compete to lose weight with the winner being the one who loses the most percentage weight by the end of the show.

The most interesting thing was that the contestants had to undergo a series of challenges all of which involved some type of exercise. They were also doing about 4 hours of exercise daily co-ordinated by a personal trainer. There was virtually no mention of healthy eating. It gave the impression that the people who sweated the most were the most successful in losing weight.

A study conducted 6 years after the series showed that most contestants had regained their weight. Not only that, but their basal metabolic rate had slowed down since the series making it even more difficult to maintain a low body weight. Unfortunately, they really were the biggest losers! This is also one of the reasons you should never do a low calorie diet.

Thank you to Professor Taylor for demonstrating the principle, but massive calorie restriction is not possible to be maintained long-term. Do not bother trying it as it might set you up for future weight gain.

Lose weight by lifestyle change

The methods above are useful for losing weight fast but staying at a healthy weight is all about changing your habits. It stands to reason that you cannot be a different weight if your lifestyle stays the same.

Change is difficult especially if you have had the same habits for years. Doing something dramatically different usually does not work for most people. It is better to think about weight loss as a journey during which you start to eat more healthily, little by little. That is the only way that weight loss can become permanent and the only way I have ever seen people lose weight successfully long-term, except for bariatric surgery.

Here are a few eating habits that you can incorporate into your life that will help you lose weight and maintain your weight loss. It’s all about what you usually do, not the odd party, celebration or night out.

• Eat only between 7am-7pm or 8am-8pm. Do not eat anything after your evening meal. Your body cannot process it and it will be stored and make you put on weight. Did you ever wonder why night-shift workers are mostly overweight? Your metabolism is not geared for eating at night. Nothing will change that.

• Don’t drink your calories. Stick to water – about 6-8 glasses per day. No soft drinks or juice. You can drink tea and coffee but only before 2pm.
• Do not drink milk. It is designed to make baby cows weigh a ton very quickly. It will make you gain lots of weight also. Try a plant-based milk instead such as soya, almond, oat or rice milk.

• Reduce sugar and junk food; e.g. sweets, chocolate, biscuits, cake, crisps etc. No surprise there!

• Avoid refined carbohydrates – the white stuff; e.g. white rice, potatoes, white bread, white pasta. Eat wholemeal bread and brown, wholegrain rice and pasta. Try sweet potato instead of potatoes. The quantity should be no more than a quarter of your plate or what can fit in the palm of your hand.

• Have one or more vegetarian days during the week when you only eat vegetables and fruit; no meat, chicken or fish.

Of course, weight is not just about food. Exercise, sleep and stress management are important in maintaining a healthy weight.

Weight loss injections

Over the past year new injections have come onto the market that help you lose an average of 15% of your body weight over a period of 16 months. The first of these weight loss injections is called semaglutide or brands Ozempic and Wygovy. These have revolutionised weight loss and I personally do not believe that weight loss surgery is needed any more. These weight loss injections are a game changer. Click here to read more.

Why lose weight

Health Benefits

• reduce risk of diabetes
• lower blood pressure
• reduce risk of heart disease
• reduce risk of cancer
• improve mobility
• reduce back and joint pain including osteoarthritis
• reduce risk of stroke
• reduce risk/improve sleep apnoea

They say that prevention is better than cure but, in my experience, people rarely try and lose weight in order to prevent disease. Even though this is one of the best reasons to do it, most people want to lose weight because of lifestyle factors.

Lifestyle Benefits

• improved body image
• greater confidence
• better sleep
• more active social life
• improved sex life
• reduced stress
• improved energy
• improved mood

What to do when your metabolism makes it difficult

Those people with a BMI more than 30 can have hormones which make losing weight difficult. These hormones such as letptin are not being received by your brain to tell you that your are full. It means that you are always feeling hungry and seeking high calorie food. You are also likely to have insulin resistance which makes losing weight even more difficult.

Once you are on a healthy diet and getting the nutrition you need, your hormones will normalise over a period of time. Some people may be helped with medication such as liraglutide and semaglutide that delay gastric emptying and make you fill full for longer. Another medication, metformin can also be helpful. This is a well-established medicine for diabetes that has been shown to also be effective in overweight people. These medicines augment weight loss by working on the hormones that make losing weight so difficult. They also make it easier to stick to healthy eating until such time that your hormones adapt.

Summary

Normalising your weight really is one of the best things you can do to improve your health. It is going to depend mostly on changing your diet to a healthy way of eating. There is absolutely no way around that fact. The good news is that it is easy when you know how. There is no need to count calories or weigh food if you eat natural, minimally processed foods. Eating according to how your body functions is the key to success, weight loss and great health.