10 min read
Weight loss. A nemesis of 48% of the UK population who reported being on a diet in 2016 according to a survey performed by Mintel. We are a nation of dieters, yet obesity has risen from 15% in 1993 to 26% in 2016. If we include overweight, 66% of men and 57% of women are either overweight or obese. In 2016/17 there were 10,705 hospital admissions that were directly attributable to obesity, an 8% increase from the previous year. It is estimated that overweight and obesity-related conditions cost the NHS £6.1 billion in 2014 to 2015, but the wider economical costs are thought to be closer to £27billion due to lost productivity and slowed economic growth because of lost work days, lower productivity at work, mortality and permanent disability. These costs are projected to reach £9.7 billion and £49.9 billion per year by 2050 respectively. The stats do not bode well for a major public health issue that extends across the globe.
When I get into heated discussions about obesity on social media, I often get mocked for saying obesity costs the NHS money. It does; the NHS is buckling under the extra weight being carried by the country. There’s too much denial when it comes to obesity, one major factor of many I personally believe is contributing to worsening statistics. What is frustrating for health workers, is that obesity is largely, a preventable condition. Unlike the success from stop smoking campaigns which saw nearly 2 million people quit smoking following legislation implementing a smoking ban in all enclosed public spaces in 2007, the fight against obesity is proving to be far more challenging.
What I’ve found from reading comments on social media, is that there are two camps when it comes to weight loss. You have the ‘calories in versus calories out’ club which I have previously been a member of when I was a young and naive personal trainer. ‘Move more, eat less,’ was my mantra, whenever the topic of losing weight came up. Then you have the ‘it’s not their fault’ club. I don’t tolerate excuses very well, and this second camp is all about excuses. It’s genetics, it’s society, it’s advertising, it’s mental health issues, it’s my gut bacteria, it’s men’s fault (yes, I saw this a few times), but rarely does a member of this group hold their hand up and accept any responsibility for themselves. This division has never been so clear as it was when Tess Holliday, a plus-size obese model, recently got selected to be on the front cover of Cosmopolitan. You were either for this historic move by the publication or you weren’t. People from the latter group like to cite the laws of thermodynamics, and the way they see weight loss is through these simple equations:
Calories In > Calories Out = Weight gain
Calories In < Calories Out = Weight Loss
Calories In = Calories Out = Weight maintenance
Simple right? People who are obese and overweight just need to eat less, move more, or both. If they aren’t losing weight, then it’s their own fault. It is true to a certain extent. If we examine the plethora of famine studies, people lose weight under long-term calorie restriction. You don’t need to be an expert to understand that long-term starvation isn’t healthy. But please don’t kid yourself, long-term hyperphagia (overeating) isn’t either. The delusion surrounding the issue of obesity along with militant advocates for the body positive movement is dangerously leading to people wrongly claiming that you can be obese and be healthy. Being obese is not healthy and I have written another article that explains why here.
It would be completely irresponsible of medical and health professionals to claim that an obese model is promoting a body positive message. As a nutritionist I can’t condone the use of an obese model on the cover of a magazine, no more than I would condone the use of a super skinny model. But I also empathise with ladies who have always struggled with their weight, that they finally feel like they have a role model. But why flip to the other end of the spectrum with another extreme? The cynic in me believes this was a clever PR move to boost magazine sales. Why can’t we see a wide variety of healthy shapes and sizes like a size 14? There’s a novel idea! Probably wouldn’t have sold as many magazines though. Tess Holliday boosted magazine sales, so I really hope this encourages other publications to employ models that are of a healthy body size.
Although seeming a logical approach, statistics and fear tactics do not work very well when encouraging people to make changes to their lifestyle. So how can you convince people they need to lower their body fat percentage if they don’t even acknowledge their body weight is a ticking time bomb? People clearly are struggling to lose weight and people are influenced by these images whether they see them in magazines, advertisements or the catwalk. Having an obese model on such a massive publication could act as validation for some people that being obese is ok, and even healthy. These are just one of many barriers that overweight and obese people face when trying to shift the pounds.
Sorry camp ‘calories in versus calories out’ but losing weight is not as straight forward as you like to believe.
An obesity causal map has been devised by researchers to show just how complex the issue of obesity is, and when you see this, you start to get an understanding of why, despite several initiatives, the overweight and obese global populations are not losing weight. It is a complex multifactorial issue. But I can still hear the obstinate grunts from camp ‘calories in versus calories out.’ This indelible belief that if people really want something, they will do something about it, often stems from their own personal experience. “I’ve not put on weight so why can’t other people control their weight? “or “I’ve managed to lose weight, if I can do it so can they.” Newsflash! We aren’t all the same, and not everybody has had your life experiences or gained your level of knowledge about food and exercise.
Let’s look at a case study; an example that I have come across several times in various forms. Let’s call her Susan. Susan used to be a size 10 in her early twenties and she is now a married 35-year-old. She’s also had 2 children and works part time in between running the kids around and cooking for the whole family. The weight has gradually crept on and she is now a size 18. She is educated with a degree in accounting but her only understanding of nutrition is from home economics class at GCSE level and from reading runners’ blogs when she ran marathons in her early twenties. She understands that what she eats isn’t the best, but she doesn’t particularly eat much during the day. She struggles to find time to exercise and she is always tired. She tends to eat most of her food in the evening, with snacks and sometimes a glass of wine or two just before bed as this is her only time to unwind. At the weekends they get a takeaway on a Saturday night as a treat and a roast on a Sunday and tend to eat out wherever they go out as a family. One day Susan decides enough is enough and downloads a calorie tracker app. She enters her measurements into the app and she is now set to lose 1kg a week. Each day she is eating way below her daily calorie goal, and she thinks this must be a good thing as she will lose weight quicker. When it comes to the weekend she still eats out and finds she goes over her calorie target by 1300kcals over the weekend, but she doesn’t worry as she has eaten so well during the week. When she weighs herself on Monday she has gained 2 pounds. She ate below her calorie target for the week - so what went wrong?
Susan restricted her calorie intake so much, that her fat cells became efficient fat storage units. Despite being in a calorie in a deficit, when calories were plentiful, her body was storing those calories in the form of fat for future periods of restriction. When people say they want to lose weight, what they really mean is that they want to lose fat. You can absolutely be in a deficit and gain fat because calorie restriction lowers your basal metabolic rate. This has been shown in The Minnesota Starvation Study, where volunteers underwent severe calorie restriction. When they could eat ad libitum in the rehabilitation period, the participants had a higher body fat percentage after 12 weeks, despite weighing less than when they started. After 8 months abdominal fat was 40% higher than before the investigation and what was interesting is that the participants reported feeling hungry for many months after the experiment, even though food was plentiful. Therefore, when the Susans of this world say they are struggling to lose weight, whilst it is possible they could be lying about what they are eating, it could also be possible that they are semi-starving themselves by thinking less is more, and then binge eating from either uncontrollable urges or emotional eating. Maybe this sounds familiar to some of you.
The Minnesota Starvation study demonstrated that whilst no long term physical damage occurred, the body fights to remain at what has been coined a ‘set point.’ The study’s participants responded to initial dietary changes but then the weight loss or weight gain stalled suggesting the body was resisting and adapting to these changes. Most people do not eat the same amount each day, tending to under eat and overeat from day to day. Usually an individual subconsciously regulates their energy balance over time through being more active during times of high energy availability and moving less and conserving energy during times of low energy availability. However, age, sex, body mass, illness, stress, hormonal changes, weight loss/gain, exercise, medication and calorie restriction and overeating can all influence your RMR. If any of these things keep the balance tip towards either weight loss or weight gain, then the body will adapt accordingly, and a new set point is created. This is the basis of why weight loss can be so hard for some people.
Weight gain is typically slow, just like it was in our case study with Susan. Yet so many people think the weight will come off in a few weeks. As a rule of thumb if it took 5 years for the weight to go up, then people should allow the same amount of time for healthy weight loss, although with commitment and a strong mindset, it is possible to achieve fat loss goals more quickly. People don’t want to hear that though. People want a quick fix, and these quick fixes in the form of pills, juice diets, points-based diets, diets with extreme calorie restriction, and diets based on pseudoscience, can exacerbate metabolic damage or worse make people seriously ill. Some people are often put off embarking on a serious fat loss journey because they think it will be too hard. When, it is usually only small daily changes that are needed to turn an unhealthy lifestyle into a healthy one.
Losing fat is not hard, the execution of it is.
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