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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 big fat debate about carbohydrates

The big fat debate about carbohydrates

The big fat debate about carbohydrates

I recently wrote a piece about food myths, which was unfortunately given the headline “carbs don’t make you fat”, and whilst slightly misguided, not completely wrong.  Interestingly, of all the myths mentioned, the focus of readers was “not all carbohydrates make you fat”.  Amongst other things, the main lesson learnt was not to read people’s comments in the Daily Mail!

After reading more around the topic, it’s become clear that the debate over fat versus carbohydrates is still controversial and not something I intended to be part of.  Seeing how the content of my article was spun by readers (many of whom simply commented on the headline without reading the article) only proved my thinking behind the myth as many related the information to their own personal experiences, which can’t be applied to the general population.  People have different lifestyles and energy needs so it’s difficult to generalise about fats and carbohydrates.

I still stand by my view that not all carbohydrates make you fat but accept that the topic requires more explanation to comment on both sides of the debate and cannot be summed up in two paragraphs of a health article!

 

My clients and training

I also received many negative comments about my training and clients I choose to work with and feel I need to fight my corner!  I’m happy to be completely transparent about my work.

Firstly, I’m not a vegan (not sure where that one came from!).  Even if I were, then this would still not impact on my views about carbohydrates.  I’m a registered nutritionist with the UK Association for Nutrition and have a BSc in nutrition (not nutritional Therapy) and a MSc in public health nutrition.  I currently work with food companies, mostly restaurants to improve the quality of their food and help them to meet legislation that provides transparency to customers about the food on their menus. I also work with care homes to improve the food offered to residents with dementia as well as schools and nurseries to ensure the nutritional needs of our vulnerable population groups are met.

I currently work with one of the UK’s largest supplement companies as their head of nutrition in a role that requires me to objectively ensure the right information is given to customers within the strict legislation around health claims.  I don’t promote unnecessary use of supplements and stick with a message and belief of food first.  Most importantly, I’m independent and simply use the scientific facts as a basis for my writing and not those of commercial companies.

I have written a recipe book with my good friend Lily called ‘The Detox Kitchen Bible’ and we exclude wheat, dairy and refined sugar from our food (which was initially based on the needs of the clients we deliver food to who include vegans and those with diagnosed food intolerances).  I hold my hands up that the word ‘detox’ has bad connotations,  but our ethos is to cook from fresh and focus on including lots of nourishing foods that ensure nutrient balance (including carbohydrates) rather than those excluded.

 

Nutrition is a science

At its core, nutrition is simple; eat healthy foods in the right portion size for your energy needs, don’t fear food or categorise as good and bad and understand there is room for all foods as part of a balanced diet. Putting this into practice is more difficult and is influenced by other factors such as behaviour change, food access, income, cooking skills and the information made available. We all know when we’re eating the wrong foods and don’t need to be patronised by health professionals like me, however, those interested in health often like to learn more about the subject.

Nutrition is also a science and research will continue to emerge that questions traditional thinking. Understanding how to read scientific papers requires training and reporting about health in the media often focuses on the initial findings of studies and those that can’t be translated to everyday life such as animal studies or those carried out on small study groups. Reporting these findings undoubtedly causes some confusion and frustration as often the messages contradict themselves between articles.

I try to avoid focusing on a single aspect of any diet and prefer to keep the bigger picture in mind as there are many challenges facing public health nutrition, but here are my views about carbohydrates and in particular their impact on weight.

 

Carbohydrates

Carbohydrates are one of the three macronutrients that provide energy, along with proteins and fats and an excess of any one will cause weight gain.  Most foods contain a combination of these nutrients so blaming a single food or nutrient for weight gain makes little sense. There are also other factors that influence weight as mentioned above but these are not relevant to the question at hand.

Yes, carbohydrates raise insulin levels that can trigger the uptake of fat, but not before the body has taken what it needs for energy.  The role of insulin is to regulate the usage and storage of both glucose and fat.  This hormone controls blood glucose levels by messaging muscle, liver and fat cells to take up glucose from the blood, which is used for energy.  When the body has enough to meet its energy needs, glucose is taken up by the liver and muscles to be stored as glycogen.  Once the liver has stored all the glycogen it can, fat cells take up glucose and store it as triglycerides.  Insulin also inhibits the breakdown of fat, glycogen stores and proteins as well as the pathway that produces ketones (more on that later).

It’s also worth noting that energy metabolism is not an all or nothing process and the body will use fat and glycogen stores simultaneously in response to its needs.

However, just because you eat carbohydrates doesn’t necessarily mean a sudden rise in fat storage! People have different energy requirements relating to their lifestyle (particularly exercise) and not everyone needs to lose weight.

 

You can’t lump all carbs together

Brown rice and quinoa are not the same as calorie-laden pizza and chips that also contain high amounts of fat and other nutrients such as sodium, which can negatively impact on your health.  Wholegrain carbohydrates contain fibre, which is lacking in the UK diet, as well as other essential nutrients such as magnesium and B vitamins.  Foods made with flour, mostly white (fortified in the UK with calcium, iron, thiamin and nicotinic acid),  also provide valuable nutrients, which are especially beneficial for those on a low food budget.

A far as low fat diets versus low carbohydrate is concerned then the science behind them does differ and as explained above, an excess of glucose will be stored as fat and effect how the body utilises these nutrients for energy.

 

The traditional low fat diet

The traditional dietary advice for losing weight is to follow a low fat diet and is favoured by the Department of Health. The principles are that you cut down on your overall intake of fat, which helps to reduce your overall calorie intake and so lead to a steady reduction in body weight over time, an approach that many consider easier to maintain in the long-term as opposed to short-term fashionable diets.

The low fat diet also requires sticking to a reduced number of calories and endorses following other key healthy eating messages such as reducing your intake of saturated fat and sugar, eating oily fish and plenty of high-fibre foods such as wholegrains, pulses, fruits and vegetables, which will benefit long-term health.  There is no recommendation in this diet to reduce your carbohydrate intake but guidance suggests that half your daily calories should come from foods rich in this nutrient and that you should opt for those that are unprocessed. High fibre carbohydrates have also been shown to help with weight loss as they have a filling effect, especially when eaten with protein and healthy fats that slow down the release of sugar.

Health bodies including the Department of Health worry that low carbohydrate diets encourage the intake of saturated fat that may impact on your risk of heart disease, however research shows that a moderately low carbohydrate diet may benefit the heart as long as proteins and fats come from healthy sources (1).

Some researchers believe that saturated fat may not be such a major factor in the development of heart disease compared to other dietary habits such as an excessively high intake of carbohydrate foods including sugar.  Whilst this is a whole other issue it adds another dimension to the low fat versus low carbohydrate debate.

 

The low carbohydrate diet

Diets such as Atkins remove virtually all carbohydrates from the diet during their initial phases (prescribes just 40g of carbohydrate daily, which is the equivalent to about two slices of bread).  In the absence of glucose from carbohydrates, the body is forced to use some protein and also fat stores for energy.  Fats are converted to ketones that the body uses to supply energy to cells of organs such as the brain that usually favour glucose.  In essence, your body is burning fat, which is the basis for the weight loss and loss of fat tissue, the latter of which is generally better for your health.

Low carbohydrate diets are effective, which is backed up by plenty of studies that report quicker weight losses and reductions in body fat compared to a traditional low fat diet (2, 3, 4).  Researchers have even suggested that this may be a better approach for treating obesity.  However, low fat diets can also help you to lose weight and studies have shown that both low fat and low carbohydrate diets can lead to significant weight losses (5).  It’s also not fully clear how significant the weight losses are in the long term between the two approaches,  although it’s been suggested that both are similar over time. Diets high in protein are also very satiating, which can lower overall calorie intake.

Its also worth noting that glycogen can make muscle tissues hold on to extra water,  which may reflect the numbers on your scales.  This is one reason why drastically cutting back on carbohydrates can initially result in a quick loss of weight as you use up glycogen stores and with that, lose water.

A recent study looked promising to finally end the debate about low carbohydrate diets versus low fat diets but as is the case with nutrition, it only provided another take on the debate and little to sway the argument either way (summed up nicely by NHS choices).

 

Diets are temporary

Diets are considered by most to be temporary, meaning they have an end goal.  However you decide to lose weight, bear in mind, its important to think about how you’re going to keep the weight off that you have worked so hard to lose.  My advice is to focus on adopting small realistic changes that can be followed through to the way you eat after you have lost the weight, whether that’s to eat less processed carbs, serve smaller portion sizes or choose low fat varieties of dairy foods.

 

You can’t generalise about food intake

Interestingly, my concerns from the article were only proven by readers comments, many of which favoured the low carbohydrate approach.  Everyone has his or her own personal experiences, some react badly to gluten and wheat so cutting out certain carbohydrate foods is necessary and others have had more success losing weight following a low carbohydrate diet rather than a low fat approach. However, when advising public health, the message has to meet the needs of everyone in a way that is easily understood and able to be applied.

Whilst the low carbohydrate approach is convincing, these diets are not that straight forward, especially those that include different phases of carbohydrate intake and require the body to enter ketosis in order to achieve the fat burning state. It’s hard to see how this could be relayed to the general public and the last thing you want is for ketosis to be considered a healthy body state, especially for those with underlying health conditions.  Saying that there may be some benefit to cutting down on your carbohydrate intake.

Yes, a diet high in sugar, pizza, pasta with creamy sauces or toast laden with butter and jam will encourage weight gain, especially when partnered with a sedentary lifestyle and excess calories but including carbohydrate foods, especially unprocessed, in the right portion size, will not.

When you talk about carbohydrate foods, many people automatically refer to cases of high calorie diets laden with large amounts of sugar and foods mentioned above, which are linked with obesity and other diet related diseases such as heart disease.  For those with a healthy weight and active lifestyle, there is no reason to completely remove them from the diet.

There are many books citing the perils of carbohydrates (namely processed) and especially sugar. Whilst these are very valid arguments backed up by credible research, our body’s are more than capable of dealing with this food group in the diet, dare I say, even a little sugar.  Ill health occurs in those who are over consuming large quantities of all foods including an excess of sugary processed carbohydrates; a diet that is typical in those with other unhealthy dietary habits and lifestyles.

 

My concerns about vilifying carbohydrates

My main concerns include:

  1. People self-diagnosing food intolerances and allergies resulting in unnecessarily removing food groups, potentially putting them at risk of nutrient imbalances.
  2. These food views getting filtered down to feeding young children and other vulnerable groups.
  3. Labelling foods as bad, which encourages an unhealthy relationship with food.
  4. The idea that all carbohydrates are the same.  Eating a portion of foods rich in complex carbohydrates such as wholegrains, starchy vegetables and pulses is not necessarily the same as eating the same serving size of sugar.

 

The most effective diet is one you can stick with

In my opinion, if you’re trying to lose weight, which seems to be the main association with carbohydrates in the diet, then the decision of what diet to choose is really up to you and there is no right or wrong approach as sticking to either low fat or low carbohydrate will result in weight loss.

Unfortunately, the media exposure of research and debating on the topic has detracted away from the fact that the most effective diet is going to be the one that you stick with.  Dr Susan Jebb at the MRC Cambridge summed the situation up perfectly with the comment, “there is too much significance placed on the nutritional composition of diets when the biggest challenge is finding strategies that help people to adhere to them”.

My point still stands, carbohydrates are a beneficial nutrient and choosing the right foods (preferably opting for unprocessed grains), in the right portion size as part of a balanced diet tailored to meet your energy needs poses no serious threat to health.

 

References

  1. Halton TL, Willett WC, Liu S, et al (2006). Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 355:1991-2002.
  2. Hu T1, Mills KT, Yao L, Demanelis K, Eloustaz M, Yancy WS Jr, Kelly TN, He J, Bazzano LA (2012). Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. Am J Epidemiol. Oct 1;176 Suppl 7:S44-54.
  3. Foster GD, Wyatt HR, Hill JO, et al (2003). A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;348:2082-90.
  4. Samaha FF, Iqbal N, Seshadri P, et al (2003). A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 348:2074-81.
  5. Una Bradley, Michelle Spence, C. Hamish Courtney, Michelle C, McKinley, Cieran N. Ennis, David R. McCance, Jane McEneny, Patrick M. Bell, Ian S. Young and Steven J. Hunter (2009). Low-Fat Versus Low-Carbohydrate Weight Reduction Diets Effects on Weight Loss, Insulin Resistance, and Cardiovascular Risk: A Randomized Control Trial. Diabetes. Dec; 58(12): 2741–2748