There’s no doubt about it – losing weight is tough
I thought it would be useful to highlight this blog post again which we originally published last year.
There’s been a lot in the media over recent weeks about the association between obesity and severity of Covid-19 related illness.
Media doctors have criticized businesses for donating unhealthy food to hospital staff in the midst of the pandemic. The Prime Minister was reported to have said that he thinks his weight was a significant factor in the severity of his Covid infection.
Books are already being published that tell us how to lose weight to boost our immunity.
We all know that being a healthy weight is really important. There are so many health problems related to being overweight, from the widely recognised like type 2 diabetes, to ones that are commonly overlooked like gastric reflux and certain cancers. And of course now Covid-19.
It’s fine knowing we should be a healthy weight but it’s a whole different ball-game getting there. Weight issues are an extremely complex combination of the way our body works, our lifestyle and our mood. We are all individual and there is no one-size-fits-all solution to weight problems.
Losing weight & willpower
We know that people with obesity are not just lacking in the willpower to avoid unhealthy foods. Our body weight has a significant genetic component.
We also know that our body tries to stick to a “set point” weight. If we lose weight from that set point two things happen that make it more difficult to maintain weight loss. Firstly our hunger hormones rise, meaning we feel hungrier and want to eat more. Secondly our body reduces the amount of energy it uses to try and conserve as much energy as possible. This makes it hard both to lose, but also to maintain weight loss in the longer term.
Losing weight is tough – but even a little makes a difference
So now we’ve established it’s really important and also really hard – harder for some people than others. But it can be done. We all know people who have successfully lost weight and kept it off. We also know that you don’t have to lose a huge amount of weight to gain health benefits. You can begin to see signs of health improvements at about a 5% weight loss – or 5 kg in an 100 kg person (less than a stone in a 15.5 stone person). Of course the more you lose, the more health benefits there are.
Food and energy intake
Firstly, let’s consider food and energy intake – what are the reasons for over-eating? Some people feel hungry all the time and have a big appetite, some people eat because it makes them feel better, some people have eating disorders like binge eating. Some people don’t know how to cook, or don’t have cooking facilities. For some the cost of healthy food can seem unmanageable or they don’t really know which food choices are healthy.
In our modern environment food is constantly available. It’s often full of sugar and fat making it really tasty and hard to resist. This is one of the reasons that although our ancestors would have had the same issues with big appetites and comfort eating, there wasn’t a problem with obesity until recent decades.
Activity and energy expenditure
On top of that you can add the reduction in our average amount of daily physical activity relative to previous generations. Not only are our jobs often much more sedentary, but the labour saving devices throughout the home from remote controls to washing-machines also reduce how active we are at home.
So the odds are stacked against us – it really feels like that. What can we do?
Losing weight is tough – but it can be done
The mainstay of weight loss always has and still boils down to the dreaded healthy eating and exercise, but to have the best chance of actually getting somewhere we should figure out our individual issues with honesty and in detail.
We can consider our personal issues with food? Is it a big appetite? Is it a sweet tooth? Are we comfort eating because of a stressful situation in our life? Do we just lack knowledge about healthy cooking and budgeting?
We can think about our physical activity. Are we doing enough or are we kidding ourselves on that because we’re on our feet a bit at work, or slowly walking a toddler to and from nursery that we’re doing enough. Or is it just so long since we did anything we have no idea how to start? Or are we embarrassed to be seen exercising because of our weight?
And what about our health otherwise? Physical health can impede our ability to move, but it’s rare that it will stop us exercising completely. We may need a bit of help to work out what’s right for us. In terms of mental health we know that depression and obesity go hand and hand. People living with obesity often find in impacts negatively on their mood. People with low mood may comfort eat and put on weight. Anti-depressants, along with some other medications can also sometimes cause weight gain. Poor sleep can increase appetite.
If you’ve worked out where your issues lie the next step is to get help. If you have a big appetite, joining a weight-loss club or seeing a dietitian may be helpful in terms of looking at your food choices, helping you set goals and keeping you motivated. There are many eating plans to choose from, the main ones being calorie counting, intermittent fasting or low carbohydrate diets. At present there aren’t clear winners between the main contenders in terms of weight loss. They all work if they fit in with your life and you can stick to them.
Most areas have cooking and budgeting classes available either through the local council or charities. The local library often has information about resources or they can be found on-line.
If you think you have issues in relation to your mood, your eating and your weight it would be worth looking for help with this. Your family doctor is the person to talk to about low mood and depression. If you’re under a lot of stress, and it’s having an impact on your eating habits find out what local resources are available to help you cope with that. Again your family doctor or practice nurse may be able to direct you. Eating disorders like binge eating can improve with psychological therapies either self-directed via a book or face to face. The availability and set up will vary from area to area.
Most areas will have access to exercise referral schemes or physiotherapists depending on your physical needs. They can guide you with the best ways to start moving again. Otherwise doing something in a group can be motivating and increase your chances of keeping it up eg. local healthy walking or rambling groups.
Medication and Weight Loss
Medications to help with weight loss are limited. Orlistat is a tablet which prevents absorption of fat in the gut and can be helpful with weight loss if you are careful to eat a low fat diet. The side effects if fat is consumed can be pretty awful, such as diarrhoea and problems with bowel control. Injectable medications that help reduce appetite are already being used in people that also have Type 2 diabetes. They are not generally available on the NHS at present for people without Type 2 diabetes. For a certain group of individuals weight loss surgery can also be very effective.
Make a plan
Set goals – Nothing big, nothing you can’t achieve – just a step in the right direction, a small change.
Recognise and accept it’s a long-term commitment – Obesity is a chronic disease. Like other chronic diseases it can be controlled but is always lurking in the background if you don’t look look after it.
Remember your motivation – For most people this will be to be as healthy and able as possible and to feel well. Write it down and stick it somewhere obvious so you see it over and over again.
If you have a bad day don’t chuck it all in – pick yourself up, remember why your doing this and get going again.
Other useful blogs:
Examples of local council initiatives: