Obesity

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What’s the best way to lose weight?

What’s the best way to lose weight?

What’s the best way to diet and lose weight?

During my many years working as a nutritionist I’ve always shied away from the topic of weight loss mostly because I think it’s a hugely complex topic, which requires input from many disciplines and a unique skill set held by dietitians and nutritionists who specialise in this area.

I can tell someone what and how much to eat and devise menu plans and shopping lists to fit in with their lifestyle and food budget, which in some cases has been successful. However, on the whole my experience of helping people to lose weight has been frustrating and enlightened me to the realisation that, ‘you can lead a horse to water, but you can’t make it drink’.  I know that if a client has me at their disposal to follow them around each day and cook every meal then i’ll get great results, but the reality is that when they leave, the onus is on them to make healthy food choices.

Motivation 

Losing weight takes a huge amount of motivation and commitment and the factors influencing food choice are hugely complex.  It drives me absolutely bloody bonkers when I hear people say that losing weight is simple and just a case of eating less and moving more.  This ignorance comes from a complete lack of understanding amongst those that have never had an issue with their weight.  The problem is that being overweight is very visible and conjures up an unfair image of indulgence or greed as well as being associated with many other social stigmas and unfortunately society often has very little appreciation for the wider issues involved.

Mindset

Mindset is a major component of losing weight and the psychological issues involved are becoming more apparent as being a key factor in compliance and long-term weight maintenance.  One very relevant factor in the aetiology of weight loss is the link between food and mood, which often manifests as an emotional crutch, hampering efforts to lose weight.  Some people put all their faith and commitment into diet plans to the point at which falling off the wagon represents a huge failure impacting on their ability to stick to the programme and sometimes results in binge eating and reverting back to old ways of eating.  Tackling the psychological effects of food is something that needs to be addressed if this is getting in your way of losing weight.

Decision to lose weight 

When it comes to losing weight, there are those that just want to shift a few pounds and others with a much greater amount of weight to lose to improve their health.  In my experience it can be more challenging to shift the last few pounds and those with less weight to lose tend to get drawn to the abundance of diet fads. Unfortunately, for many people, the decision to lose weight is often made as a result of a health diagnosis that puts things into perspective but the positive here is that it’s never too late to reap the benefits. Many of the risks associated with being overweight can have a major impact on someone’s lifespan but just as damaging is the effect on long-term wellness and the number of years living with poor health.  Being overweight or obese can mean living with joint pain, difficulty sleeping, tiredness, breathlessness and psychosocial issues such as depression, low self-esteem and feeling isolated, all of which make it more difficult to drum up the motivation to lose weight.  On top of this, many of the conditions that often accompany being overweight or obese involve medication, which can have unwanted side-effects and become a day-to-day burden.

No hard and fast rule 

There’s no hard and fast rule to losing weight and one size certainly doesn’t fit all.  The key to long-term success has little to do with the speed at which you lose weight, but the habit changes made along the way, which often dictate the chances of keeping the weight off.

Weight loss is a minefield and there are some brilliant nutritionists and dietitians out there that can offer support and guidance.  The support provided by weight loss groups such as Weight Watchers has also been shown to be a key factor in success, but if this isn’t your thing then approaching weight loss with a friend or work colleagues can have a similar impact.  You can of course embark on a weight loss regime on your own but it’s important to do this in the right way and not get sucked into the hype around new diet fads.

Media confusion 

Ignore what you read in the media as this can often cause confusion.  Advice such as that telling you to cut out carbs, shun counting calories, eat loads of protein or avoid eating at certain times is fine in the context of certain methods of weight loss but these messages are good examples of our current obsession of defining diet and health by individual foods and nutrients.  The negative impact of such messaging is that it has the potential to cause false ideas around healthy eating and labelling foods as somehow being ‘good’ or ‘bad’ can detract away from the basic principles of eating well. Focusing on certain nutrients and positioning them as a key driver for weight gain also causes confusion, blurring the basics of healthy eating and making it seem more complicated.

Carbohydrates 

Carbohydrates are one of the best examples of how we have become overly focused on individual nutrients and foods groups.  The messaging around carbohydrates and health has become very negative and for some are viewed as being at the root of weight gain and disease.  A diet high in carbohydrates can cause weight gain, diabetes and inflammation but it needs to be put into context to be fully understood.  Whilst people attribute a diet high in carbohydrates to poor health, few actually define what this looks like, which has led to people taking the issue out of context.

If your daily diet includes over-sized portions of sugary cereals and muffins for breakfast, huge white baguette filled with something high in sat fat for lunch and an extra-large pizza for dinner, all of which are accompanied by sugary snacks, soft drinks and hot beverages doused with sugar, then this is clearly not a healthy way to eat and goes against the basic principles of healthy eating.  If you eat like this, then there’s also a very good chance that you’re unhealthy in many other ways such as lacking in exercise. However, this cannot be compared to a diet that includes a sensible portion of porridge oats for breakfast, quinoa and chicken salad for lunch and then a tofu stir-fry with brown rice for dinner, whilst also avoiding snacks and sugary drinks.  These two diet examples both include carbohydrates and one is clearly healthier that the other but without putting this nutrient in the right context, people develop false ideas and the confusion around what foods they should be eating continues to grow.

Small changes 

Taking a small changes approach is a good way to start.  Rather than becoming overwhelmed and trying to make dramatic changes to the way you eat, start by looking at your current diet and thinking about how you can adapt this to make it healthier.  The basics of healthy eating still apply to weight loss in that you need to cut down on the number of calories you eat and insure that these calories come from nutritious foods that will help to keep you feeling full and reduce your risk of disease (lean proteins, healthy fats, vegetables and fibre-rich wholegrains).

These are just a few ideas of some of the changes you might think about making:

  • Switch to low fat milk and dairy products
  • Choose lower fat meats
  • Avoid snacking or choose healthy snacks
  • Use a smaller plate to control your portion size
  • Make take-away food a treat and reserve to one night of the week (try making healthy choices)
  • Reduce your alcohol intake and avoid binge drinking
  • Gradually reduce your sugar intake in hot beverages and switch to low sugar food products and diet soda
  • Limit fruit juice and smoothies to one-a-day
  • Increase your intake of vegetables
  • Switch to ‘brown carbs’ such as wholemeal pasta and bread, and wholegrain rice
  • Work out your meal combinations in handfuls i.e. one handful of protein, one handful of ‘brown’ carb and unlimited veggies
  • Check food labels; the reality is that many people don’t cook from scratch so choose foods that are labelled as green or amber on the front-of-pack

The accumulation of many small changes can have a big impact on your food intake and weight loss. Every small change also represents a change in eating behaviour that can have a greater impact in the long-term.

Diets

Diets are another approach and can provide a kick-start that some people need to achieve their weight loss goals.  Diets are appealing because they offer a starting point and end goal as well as providing a set of rules to follow. The fact that you are told what, how much and when to eat also adds to their charm. Embarking on a diet can provide motivation, which is amplified by the availability of apps that can help to monitor and track your progress.

Putting very extreme diets aside, there is no single diet that can be said to be superior over another no matter what their marketing says.  The most successful diet is only going to be the one that you stick with and this is influenced by the way you live your life.  There are a multitude of diets out there, which will all tell you they are the best but just because your best friend or a certain celebrity lost lots of weight doesn’t mean you will.  Do your research and figure out what diet will work best for you.  If you know you can’t live without carbs then don’t try following a ketogenic diet (low carb).  If you struggle with energy levels across the day because of a very busy work schedule, then fasting two days of the week may not be realistic.  If your job involves long working hours and late nights entertaining clients then fasting for 16 hours could mean eating your first meal at 3pm, which is clearly not going to work.  If the diet becomes a chore then your chances of sticking to it are less likely.

Weight maintenance 

Whatever the outcome of your diet, you need to consider how you are going to take things forward once you have managed to lose weight.  It’s not uncommon for the end of a diet to signify an opportunity to revert back to old eating habits but what’s the point in dieting if this is the case. This all goes back to the benefits of developing new eating habits that will help you to maintain a healthy weight. A diet worth its weight in gold is the one that teaches you ways to eat that encourage healthy eating habits.

Many diets talk about other health benefits such as increased energy levels, reduction in certain diseases or glowing skin, but you should keep your eye on the prize and these are all potential benefits of losing weight and not specific to that diet per se.

I have no answer to the question of what the best way is to lose weight as it is dependent on the individual.  Losing weight is not simple and there are many factors that can impact on someone’s ability to do so and keep the weight off.  What I can tell you is that finding a method that fits in with your lifestyle and encourages you to develop new habits around food choice is more likely to result in long-term success and that tackling the wider issues such as the psychologically around food may be hugely beneficial in some cases.

The benefits of gut health go beyond digestion

The benefits of gut health go beyond digestion

The important role of the gut

Diet, exercise and sleep are key to good health and the prevention of disease.  The health of your gut is inextricably linked to the quality of your diet, which impacts on digestion. Besides this, research is beginning to identify how your gut may also be linked to immunity, sleep, mental health (stress, depression) and obesity, all of which can affect your health in a multitude of ways (1).

The initiative, ‘Love Your Gut Week’, starts on the 17thSeptember (2018) and highlights the importance of our digestive system to good health.

What is the microbiome?

The term ‘microbiome’ refers to the collection of around 100 trillion microbes that live in and on our body, most of which are found in the gut.  An army of microbes (including bacteria) colonise the body even before we’re born to form a protective barrier that defends against foreign invaders harmful to our health.

Your microbiome is unique like a fingerprint

Your microbiome is unique like a fingerprint reacting to the world both around and within you.  The microbes you cultivate make up the unique diversity of your microbiome. The bacteria in your gut help maintain the efficiency of your digestive system.  These bacteria also help to synthesise vitamin D, K, B12, folic acid and thiamine as well as assisting in the digestion of polyphenol compounds shown to protect the body against disease.  Gut bacteria also produce short chain fatty acids that supply energy to the cells of your colon and have been shown to play a key role in the maintenance of health and prevention of disease (2).

What can impact on the ‘health’ of your microbiome?

 Diet and lifestyle choices can impact on the diversity of bacteria found in your gut.  The ‘typical’ Western diet is characterised by an overconsumption of foods high in ‘added sugars’ and ‘bad’ fats. The impact of overeating and a lack of exercise has led to an overweight nation although the complexities of weight management are not as simple as calories in and calories out.

Being overweight is a risk factor for many diseases and the physiological effects it triggers such as inflammation are now widely recognised as being a contributory factor.  It’s often suggested that a diet overloaded with sugar and ‘bad’ fats encourages the growth of bad bacteria, but these effects don’t seem to be that clear cut. Another more straightforward explanation is that people who eat an unhealthy diet are less likely to eat the foods that support an environment that allows good bacteria to thrive such as vegetables, wholegrains and other high-fibre foods.

Five strategies to support the health of your microbiome

Whilst the overall quality of your diet can impact on the health of your gut, certain foods have been shown to be particularly beneficial in supporting the diversity of bacteria that live there.  Lifestyle factors and the use of medication have also been shown to impact on your microbiome.

1. Don’t underestimate the effects of stress

Stress is fast becoming a common side-effect of our modern lifestyle.  We all experience stress, sometimes on a daily basis, but the effects are usually short lived.  Problems can arise when stress becomes chronic, not only impacting on mental health but triggering inflammation within the body (3).  Stress can also increase the demand for certain nutrients such as the B vitamins and magnesium as well as influencing food choices that can result in a failure of the diet to provide everything the body needs.

Feeling ‘butterflies’ in your stomach or nausea are common symptoms of stress and illustrate how the brain is closely linked to the gut.  Sadness, happiness and anger are a few examples of the emotions that can affect the gastrointestinal (GI) tract, which is sensitive to such emotions.  In some cases, psychology combines with physical factors to cause pain and bowel symptoms that characterise conditions such as irritable bowel syndrome (4).  Psychosocial factors such as stress can influence the actual physiology of the gut, affecting movement and contractions of the GI tract, increasing inflammation and even making you more perceptible to infection (5).

The link between the gut and brain is referred to as the gut-brain axis and the association with gut bacteria is a new area of research.  Studies are beginning to unveil the potential impact this relationship between the gut and brain has on the microbiome.  Mental health is just one area of research and stress has been shown to alter the diversity of gut bacteria (6). These changes also appear to be amplified when stress is more severe or prolonged. In this regard, the concept of psychobiotics is being developed and refined to find ways of targeting the microbiota to help with mental health outcomes

Don’t dismiss the impact stress has on the body.  Addressing your mental health is just as important as the food you eat, exercise you take and sleep you get, all of which are intertwined.  Try exploring techniques such as meditation that has been proven to help with stress. There are many apps available that can help to teach you this practice.

2. Eat prebiotic foods in your diet

Certain fibres in foods are indigestible and commonly referred to as prebiotics.  Gut bacteria feed of these fibres, helping them to flourish and process by which they break them down (fermentation), produces short chain fatty acids.

The different types are prebiotic foods include:

  • Onions, garlic, leeks, asparagus and bananas contain inulin and fructooligosaccharides that act as prebiotics.
  • Oats and barley contain beta-glucans that act as prebiotics.
  • Starchy foods such as pasta, rice and potatoes form resistant starches (resistant to digestive enzymes) once they’ve been cooked and then cooled. Resistant starches act as prebiotics.

3. Watch your medication

Many people rely on the long-term use of medication to help manage the symptoms of their health condition. Aspirin and ibuprofen are types of Nonsteroidal Anti-inflammatory Drugs (NSAIDS) commonly used to treat inflammatory conditions such as rheumatoid arthritis, but these drugs have been shown to reduce levels of good bacteria in the gut (7).

Other medications such as antibiotics are prescribed as a short course to support the body’s ability to fight infection.  These drugs are not a friend of gut bacteria as they can wipe out swathes of both good and bad.  In certain cases, such as severe bacterial infections, they’re required to help the body recover but are of no use in fighting viral infections such as colds or flu.

Using probiotics alongside certain medications such as NSAIDS or after a course of antibiotics can help to re-balance your microbiome.

Another interesting issue surrounding antibiotics is their extensive use in the farming of food animals.  The issue is a topic of debate but eating less meat and choosing better quality meat may not only be better for your health but reduce the transmission of antibiotics through the food chain.

4. Include probiotic foods in your diet

Strains of bacteria that have been shown to have a positive health benefit are referred to as probiotics.  Bacteria from the Lactobacillus and Bifidobacterium family are some of the most widely researched strains.  One of the most common probiotic foods is live yoghurt, which contains strains such as Lactobacillus Acidophilus and Lactobacillus Casei.  These strains are also found in yoghurt ‘shot’ drinks that have become very popular. When you’re choosing live yoghurt or yoghurt products try opting for those that are low in sugar.

Fermented foods such as kimchi, kefir and miso also contain strains of bacteria that can support good gut health. These foods are now widely available in most supermarkets.

5. Take a probiotic supplement

Probiotic supplements offer a way of delivering large doses of specific bacteria to the gut.  Stick to preparations that contain well researched strains such as Lactobacillus and Bifidobacterium in a dose of at least 10 billion bacteria per serving.  To help with their transit to the gut, avoid taking with hot food and drinks or alcohol that can destroy them.

As the research linking gut bacteria to health and disease outcomes evolves, so does the potential role of probiotics supplements.  Their use and efficacy have recently come under scrutiny, but there’s still plenty of good quality research that points towards their beneficial role in health.

Prevention and treatment of diarrhoea

Bacterial strains such as Lactobacillus Rhamnosus and Lactobacillus Casei have been widely researched for their ability to prevent and reduce the severity of diarrhoea.  Research published in the Journal of the American Medical Association showed that taking probiotics helped reduce the risk of diarrhoea associated with antibiotic use by 42% (8).  Further research published in the Lancet showed that probiotics helped to reduce the risk of travellers’ diarrhoea by 8% and from all other causes in adults by 26% (9).

Immunity

The cells found in the gut are thought to make up almost 70% of the entire immune system, so it makes sense that it’s inextricably linked to immunity.  Research has shown how probiotic supplements containing certain strains can promote the production of antibodies. The same strains have also been shown to stimulate the activity of immune cells such as natural killer cells and T-lymphocytes that help to regulate immune responses.

Research has shown how probiotic supplements may prove beneficial for upper respiratory tract infections such as colds, coughs and flu. Research published in the British Medical Journal found that children who regularly took probiotics (Lactobacillus GG) had 19% fewer infectious diseases over three months compared with those that didn’t (10).

Obesity

This is new area of research and the question of whether obesity is linked to gut bacteria is not yet answered.  Data suggests that the composition of bacteria in the gut differs between people who are obese and those that are lean (11).  It’s also been shown that the typical Western-style diet rich in fat and refined carbohydrates may even increase the strains of bacteria linked to obesity (12).  Research has provided several potential reasons why the diversity of bacteria in the gut may be linked to obesity.  Certain bacteria are involved in the digestion of carbohydrates and fats (13), whilst others have the potential to increase inflammation in the body (14). Other may impact on the production of hormones that influence appetite (15).

Whilst in its early stage, this research highlights the future potential for probiotic supplements as part of personalised nutrition guidance to help in the fight against obesity.

Essential steps to good gut health

The bacteria in your gut play a role in health that’s essential to life.  New research not only helps to confirm this but is exploring the many benefits that go beyond digestion. Diet and lifestyle can both influence the diversity of bacteria in your gut and this can have a negative impact on your health.  Following a healthy balanced diet will help to maintain the health of your gut and the bacteria that reside in it as will addressing lifestyle factors such as stress. Research into the use of probiotic supplements is ever evolving but they can provide a useful way to help maintain the balance of bacteria in your gut.

Healthy gut plan

  1. Maintain a balanced diet and try to avoid foods high in sugar and ‘bad’ fats.
  2. Eat wide variety of plant-foods such as vegetables, nuts, seeds and wholegrains that are high in fibre and support efficient digestion.
  3. Include prebiotic foods in your diet – onions, garlic, bananas, oats, barley.
  4. Include probiotic foods in your diet – live yoghurt, kimchi, kefir and miso.
  5. Use relaxation techniques to address the issue of stress.
  6. Factor the use of medication into your diet and the effect on gut bacteria.
  7. Take a probiotic supplement that includes strains such as Lactobacillus and Bifidobacterium in a dose of at least 10 billion bacteria.

 

References

  1. https://www.bmj.com/content/361/bmj.k2179
  2. https://www.ncbi.nlm.nih.gov/pubmed/24388214
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341031/
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202343/
  5. https://www.ncbi.nlm.nih.gov/pubmed/15740474
  6. https://www.sciencedirect.com/science/article/pii/S2352289515300370
  7. https://www.ncbi.nlm.nih.gov/pubmed/26482265
  8. https://www.ncbi.nlm.nih.gov/pubmed/22570464
  9. https://www.ncbi.nlm.nih.gov/pubmed/16728323
  10. https://www.ncbi.nlm.nih.gov/pubmed/11387176
  11. https://www.ncbi.nlm.nih.gov/pubmed/27648960
  12. https://www.ncbi.nlm.nih.gov/pubmed/28199845
  13. https://www.ncbi.nlm.nih.gov/pubmed/15505215
  14. https://www.ncbi.nlm.nih.gov/pubmed/23985870
  15. https://www.ncbi.nlm.nih.gov/pubmed/27616451/