Weight loss 

The most important issue is to exclude medical conditions

Cushing’s disease

This is a condition where the adrenal gland secretes excess steroid hormones. Steroid hormones are stress hormones and these hormones are essential to support you through stress. Without adequate amounts of stress hormones, you would not even be able to face a cold. A minor viral illness will end you up in intensive care ( Addison’s disease). However, we are living in a world with stress on most days.

 Hypothyroidism ( Hashimotos disease)

Thyroid hormone is your metabolic accelerator. If this slows down, then fuel is not burnt efficiently. This can lead to weight gain. Hypothyroidism can also be associated with a number of symptoms including fatigue, muscle aches and pains and this is an important condition to exclude.

Polycystic ovarian syndrome

This is a poorly understood condition seen in women. However there are strong genetic factors that link up with this condition. It stands to reason that there will also be men with similar condition, but this may present with low testosterone levels, reduced libido and weight gain.

 Medications

There are a number of medications that can contribute to weight gain. This includes steroids and other hormones, some diabetes medications, anti depressants etc. It is worth looking at your medications in detail to see if your weight is related to medications.

  Obstructive sleep apnoea

Sleep problems lead to weight gain. It is worth looking at sleep pattern to see if disrupted sleep is contributory. Obstructive sleep apnoea is a condtion, which causes a vicious cycle of weight gain.

What do I need to start to do?

We need to correct as many factors as possible to lose weight. Speeding up metabolism is a good goal, but difficult to achieve as your body will start storing when ever you go into calorie deficit. Your body will not play ball if you try to lose weight. The bottom line is that if anyone starves with no food, they will definitely lose weight. However this is not a realistic goal.

It is much harder to lose weight if you are overusing the insulin pathway ( metabolic syndrome – insulin resistance)

Metabolic syndrome is a cluster of different factors which put you at increased risk for vascular disease (heart attacks and strokes) as well as metabolic disease (diabetes and elevated cholesterol).Metabolic syndrome almost certainly has a genetic element to it. It is likely that you have genes that make you very thrifty with energy expenditure particularly with a class of foods called carbohydrates. Excess carbohydrates tend to be stored due to the action of insulin and in people with metabolic syndrome, they require higher amounts of insulin to store carbohydrates.Excess carbohydrates are stored as fats as most people can only store about 400 g of excess carbohydrates. If not burnt off, with exercise, they do get converted into fat which initially get stored in the peripheral fatty tissue subsequently filling up visceral fat cells (abdominal weight) and subsequently leaking into the blood as excess triglycerides.

Metabolic syndrome is reversible but requires sustained lifestyle interventions this includes

A) carbohydrates cutting down carbohydrate intake to match your exercise. This would be between 100 and 120 g/day in a sedentary person. Carbohydrates can be refined carbohydrates as in foods containing sugar (cakes biscuits chocolate) or complex carbohydrates (bread rice potatoes pasta, noodles, naan bread, cereal – all starchy foods) please contact the dietician or look at food labelling for more information. You can have more if you are active. You can use a step counter to judge this and  less than 5000 steps per day does not need any additional carbohydrates.

B) nutritional content of your food increasing protein intake and consumption of good fats (mono and polyunsaturated fats). Good fats are good for you as they contribute to overall health. Protein intake is essential particularly in middle age to maintain bone mass and muscle mass.

C) being calorie conscious your total calorie intake should be slightly lower than your basal metabolic expenditure (BMR). In most people this would equate to between thousand 1800 to 2000 kcal/day. Embarking on a crash course to lose weight quickly may be counter-productive. That includes all the snacks , fruit that you eat. There are apps to estimate calories based on plate sizes.

D) exercise/ activity  Mild calorie restriction needs to be combined with regular sustained exercise which would be 60 to 90 minutes of brisk exercise every day. This does not need to be in a gym and can consist of a brisk walk enough to raise your heart rate to 70% of target for a sustained period.

E) alcohol consumption-remember excess amount of alcohol consumption can contribute significantly to calorie consumption. Gram for gram, alcohol provides more energy compared to carbohydrates. 2 Pints of beer has got the same amount of calories as a cheeseburger.   https://www.drinkaware.co.uk/

F) smoking can contribute significantly to blockage of blood vessels and should be strongly considered particularly if your have a family history of heart disease or you have had heart problems in the past.

G) sleep-sleep is one of the naturally occurring remedies that is significantly lost in modern life. Every person requires between 7 to 8 hours of sleep and should be able to wake up refreshed without requiring an alarm to wake you up. If you do require an alarm, consider going to bed earlier avoiding electronics prior to bedtime, coffee or caffeine containing beverages 6 hours prior to bedtime. Good sleep comes with significant health benefits including weight loss, reduced risk of cancer and Alzheimer’s disease

H) vitamins and minerals it is worth considering a vitamin and mineral supplement including vitamin D particularly in the winter months. As Our diet has becoming increasingly fat free, Our fat-soluble vitamin intake has also come down over the past few decades

Game changers on the market

Weight loss agents are a game changer when it comes to resetting your appetite. There is no need to say that weight gain is morla failure. We are living is a world designed to help you with weight gain.

GLP1 analogues ( Ozempic) GLP1/GIP analogues ( Mounjaro)

Action

They act in different ways on your appetite regulation

1. They slow stomach emptying which means that you feel full for longer
2. They increase insulin secretion to steady out glucose levels and prevent spikes
3. They reduce glucagon and prevent your liver from manufacturing glucose
4. They tell you brain you have had enough to eat.

Side effects

1. Nausea occasional vomiting 10 – 15% ofpeople mainly in the first 2 weeks
2. Acute pancreatitis – rare but can be serious
3. Gall stones
4. Constipation/ diarrhoea
5. Allergic reactions

less than 5% of people need to stop taking medication due to side effects

How long for?

This medication is expensive and can set you back a couple of thousand pounds.

The course will be 6 to 10 months of treatment and then put into place behavioral changes to maintain your weight.

Motivation and persistence

It is one thing to decide you want to lose weight, but are you ready? Weight loss is a long journey and will take considerable persistence. Long term studies show that rapid weight loss is associated with weight gain in a year to perhaps more  than you lost. If you dont have a worthwhile goal or reward yourself, you stick with it for a month and then stop. Because life happens when you make plans. EATING IS YOUR QUICKEST REWARD.

inspiring stories

Understanding yourself

Understanding your body

The hormone called insulin

Insulin resistance

What is for Breakfast?

What are your lunch options? 

What are your trigger points?

Maintaining weight loss