SECTION 1: THE PROBLEM
What is obesity and how has it become such an issue?
Being overweight and obese is defined as having accumulated abnormal or excessive fat which presents a health risk.
Crudely obesity is measured by one’s body mass index (BMI). This is calculated by taking someone’s weight and dividing it by the square of that person’s height. People with BMIs of 30 or more are generally considered obese. People with BMIs of 25 or above are considered overweight.
Being overweight and obese poses significant risks of a number of chronic diseases, including cardiovascular diseases, diabetes, and cancer.
It was once considered a problem restricted to high-income countries, but the problem is now rising in both low- and middle-income countries, particularly in the urban areas in these countries.
Indeed, worldwide obesity has almost tripled in the past 45 years. According to the World Health Organisation, in 2016, over 1.9 billion adults, aged over 18 years, were considered overweight, with 650 million of these being obese.
That’s 39% of all adults being overweight and 13% being obese.
The majority of the world’s population lives in countries where people are more likely to die from being too heavy rather than being underweight.
The WHO estimates that in 2016, 41 million children younger than five years were considered overweight or obese.
More than 340 million children and adolescents aged between five and 19 years were overweight or obese in the same year.
Growth in people’s consumption of fast food, eating more trans-fatty acids (TFAs), and an increased intake of fructose, along with a growth in portion sizes and people being involved in less physical activity are all implicated as potential contributing factors in the global obesity crisis.
Globally, this has involved:
- Higher intakes of energy-dense foods which are high in fat
- Decreases in physical activity due to the sedentary nature of many types of work, less movement because of changing modes of transportation, and increased urbanisation.
Adjustments to patterns of diet and physical activity are frequently caused by changes in environment and society that can be attributed to the development and lack of policies supporting key sectors like agriculture, health, transport, planning, food processing, education, distribution, and marketing.
Common health consequences of being overweight and obese include:
Raised BMI heightening the risk of non-communicable diseases like cardiovascular disease, diabetes, musculoskeletal disorders, in particular osteoarthritis and some cancers.
In addition, childhood obesity is associated with higher chances of premature death and disability in adulthood. Obese children may also experience difficulties with their breathing along with the increased risk of hypertension, fractures, and early indications of cardiovascular disease increased insulin resistance and psychological effects.
Obesity in childhood adds up to some significant health problems that frequently can last a lifetime. When obesity occurs in adults the problem is linked to increased risk of suffering from heart disease, type II diabetes, high blood pressure, particular cancers, and other conditions that are considered chronic.
Previously rare in people aged between 12 and 19 years, type II diabetes is being increasingly discovered in children and adolescents, particularly in minority communities.
SECTION 2: THE DECEPTIONS
The Calories Myth
Weight control is torture that millions of dieters have to go through. For a very long time, people who are overweight have been living with real pain and guilt as they try to apply the advice that is at best confused and in many cases just plain wrong.
The guidance that doctors and a string of nutritionists have provided in the past has been unanimous: to lose weight eat less and move more and keep tabs on your progress by counting your calories.
A typical example is someone who at their heaviest has a body-mass index—the ratio of height to weight of 35.6, well above the mark of 30 that doctors use to define someone as clinically obese.
The majority of government guidelines indicate that, as a man, this person needs to consume 2,500 calories a day to maintain their weight (the female target is 2,000). On this basis the advice would have been, by eating fewer than 2,000 calories a day, a weekly “deficit” of 3,500 would mean the person would be on target to lose 0.5kg a week.
The argument has always been consuming fewer calories than you burn each day would soon show results. The problem is that keeping to low-fat, low-calorie food doesn’t work. Dieters all over the world are familiar with the frustrations this myth has caused.
The majority of studies demonstrate that over 80% of people put on any weight they lose in the long term. As a result, most people assume this failure is down to being too lazy or greedy!
In general, it is true that by eating vastly fewer calories than are burned people become slimmer, and by consuming far more, people put on weight.
Calories as scientific measurement are not disputed. But working out the exact calorific content of food is! The reason is that is much harder than is implied in the precise numbers shown on food packaging. Two types of food that have identical calorific values can be digested in different ways and everybody processes calories differently.
There are plenty of variables, for example, the time of day that we eat can change the outcome. The fact is that tallying calories does little to help control weight or even to maintain a healthy diet.
The idea that counting calories in and out will help us control our weight is dangerously flawed.
Calories are ubiquitous in our daily lives. They take top billing on most packaged food and drink information labels. Increasing numbers of restaurants list calorie numbers found in each dish on menus.
Counting calories expended is just as standard. Wrist pounted fitness devices, our gym equipment, even phones inform us of the rate at which we supposedly burn calories.
It wasn’t always this way. For many centuries, scientists made the assumption that what was important was the mass of food we consumed. In the late 1700s, the Italian physician Santorio Sanctorius came up with his “weighing chair”, which dangled from a giant scale.
He would sit in it at regular intervals to measure his weight, all the things he ate and drank, and all the output he produced. He did this for 30 years but came up with no real conclusions about the impact his consumption had on his own body.
Later the focus shifted to the energy various foods contained. By the 18th century, the French aristocrat Antoine Lavoisier had come to the conclusion that burning a candle needed gas, which he named oxygen, to feed the flame, releasing heat.
Applying the same principle to food, Lavoisier concluded that it feeds the body like a fire burning slowly. This led to him building a calorimeter big enough to contain a guinea pig to measure heat generated by the animal so he could estimate the amount of energy produced.
Lavoisier’s research was literally cut short when the French revolutionaries removed the scientist’s head with the guillotine. It was not the end of developments. Later scientists built “bomb calorimeters” that burned food and measured the potential energy released.
The word calorie derives from the Latin for heat “calor” and was originally used to describe the efficiency of steam engines: one calorie is the energy needed to warm 1kg of water by 1⁰C.
By the 1860s German scientists began using the calorie to calculate the energy contained in food. But it was an American, Wilbur Atwater, who made popular the concept that the calorie could be employed to measure not just the energy in food but also the energy our bodies expend on an activity like muscular work, powering organs or repairing body tissue.
After visiting Germany in 1887, he penned articles that became hugely popular for their suggestions that “food is to the body what fuel is to the fire”. Atwater also introduced the notion of fat, carbohydrates, and protein, which he called “macronutrients”.
The drive for most of us today is to keep in touch with our calorie consumption so we can lose or maintain weight. It was the opposite concern that drove Atwater, the son of a Methodist minister, who was living at a time when malnutrition was affecting poor people. He wanted to uncover the most cost-effective foods that would satisfy the appetites of the poor.
The digestion rate differs among individuals but on average food takes between eight and 80 hours to travel through our systems. Atwater assessed how much energy a variety of macronutrients gave to the body by feeding samples of what was considered an “average” American diet. Atwater believed a large proportion of the constituents were made up of barley meal, molasses cookies, and chicken gizzards.
For as many as 12 days at a time, one volunteer would eat, sleep and exercise inside a 6ftx4ftx7ft container. With walls filled with water, Atwater was able to calculate the amount of energy each student’s body was generating.
The experiment also involved collecting the students’ faeces, which was burned to discover just how much energy was left behind in the body during the process of digestion.
Back in the 1890s this was pioneering stuff and Atwater concluded that a gram of either protein or carbohydrate created an average of four calories of energy, and each gram of fat provided an average 8.9 calories, which was rounded up for the purposes of convenience.
Since then we have learned much more about how our bodies work and have found that Atwater was correct that a proportion of every meal’s potential energy is excreted, but he had not realized that some energy was expended on the digestion process itself or that different foods generate different amounts of energy.
However, over a century later, the figures Atwater worked out that each macronutrient is still regarded as the standard for measuring calories in food!
Atwater believed there was no difference wherever calories came from. Whether a person was eating chocolate or spinach, if their bodies absorbed more energy than was used, then the excess would be stored as body fat, and people would put on weight.
The public imagination was captivated by the idea and in 1918 the very first book was published in the US promulgating the idea that healthy diet involved nothing more complicated than adding and subtracting the number of calories consumed and expended.
Lulu Hunt Peters in “Diet and Health” encouraged people to eat what they liked, including candies, pies, cakes, fatty meat, butter and cream as long as the calories were counted. The book was a best seller!
The cult of the calorie was entrenched in the public and government policy imagination by the 1930s.
However, by the late 1960s, obesity was a pressing health concern as people began eating more highly processed foods and an increased amount of sugar, while also leading a more sedentary lifestyle. With a growing number of people needing to lose weight, the focus of attention shifted to changing diets.
A war on fat was triggered, and Atwater’s calorie calculations became an unwitting ally. With counting calories seen as the ultimate authority on the health qualities of food, it was assumed obvious that the most calorie-laden food constituent —fat— had to be bad.
Dishes that were low in calories, but laden with sugar and other carbohydrates, were considered healthier. Fat became increasingly blamed for a lot of the health ills, aided and abetted by the powerful sugar lobby.
One researcher at the University of California has recently discovered documents from the later 1960s revealing how sugar companies secretly funded research at Harvard University with the aim of blaming fat for the obesity epidemic.
After a US Senate committee reported in 1977 that it recommended a low-fat, low-cholesterol diet, other governments quickly followed suit. The food industry removed fats from food items and replaced them with sugar, along with starch and salt to maintain flavour.
But the expected improvements in public health didn’t manifest themselves. Instead, the trend led to the most dramatic increase in obesity in our history. Indeed, obesity almost tripled worldwide between 1975 and 2016, according to the WHO.
This has contributed to the fast rise in cardiovascular diseases like heart disease and stroke, that is now recognized as the leading causes of death throughout the world. Rates of type-II diabetes have more than doubled in the past 40 years.
It isn’t just wealthy countries that have been witnessing these trends. In Mexico, urban middle-class families have put on weight aided by an increasing trade with the US that led to cheap sweets and fizzy drinks flooding the shops.
On top of this, it is now reckoned that the labels on food may be understating the calorie contents by as much as 20%.
But governments worldwide are not helping. They have enshrined calorie-counting into policy. Indeed, the WHO put the “fundamental cause” of obesity down to “an energy imbalance between calories consumed and calories expended”.
Last year the US government demanded that food chains and vending machines provide calorie details on menus. Australia and the UK are going in a similar direction. Government bodies encourage dieters to record meals in calorie journals to lose weight. The results of experiments of a 19th-century scientist have hardly been changed—and are rarely ever questioned.
Yet millions of people give up their attempts at diets when the calorie-counting efforts are unsuccessful.
Food producers give specific readings: a slice of a Domino’s double pepperoni pizza is purported to be 248 calories. Yet the calories listed on food packaging and menus are often routinely wrong.
One nutritionist at Tufts University in Boston discovered that labels on US packaged food miss the correct calorie counts by 18% on average. US government rules allow food labels to understate calories by as much as 20%.
But some processed frozen foods get away with misstating calorific content by up to 70%!
It isn’t the only problem by any stretch of the imagination. The calorie counts printed on labels are invariably based on the amount of heat created when food is burned in an oven.
However, the human body is more complex than any oven. Food burned in a laboratory surrenders its calorie content in seconds. In real life, the journey food takes from our dinner plates to our toilet bowls averages about a day but has been found to range from eight to 80 hours depending on the individual.
Also, the calorie of one carbohydrate and that of a protein contain the same amount of stored energy, and as a result perform in the same way in an oven. But when those calories are put into a real body they behave very differently. US researchers last year discovered that we’ve been exaggerating by about 20% the calories absorbed from almonds. And we have been doing so for more than a century!
Dozens of factors influence the process our bodies use to store fat—the “weight” most of us seek to lose. As well as calories, our genes, the bacteria that live in our guts, the way we prepare food and how we sleep all have an effect on how we process food.
The fact is that the act of counting calories is a very crude and an often misleading way of dieting. All carbohydrates break down into sugars, which are the body’s main fuel source. But the speed at which your body gets its fuel from food can be as important as the amount of fuel.
Simple carbohydrates are quickly absorbed into the bloodstream to provide fast shots of energy: we absorb sugar from fizzy drinks at 30 calories per minute, compared with just two calories every 60 seconds from complex carbohydrates like potatoes or rice.
This matters because sudden hits of sugar prompt the rapid release of insulin, which carries this sugar from the bloodstream into our body’s cells. The problems occur when too much sugar is in the blood. While out liver is able to store some of this excess, the remains are stashed as fat.
This is why consuming sugar is the quickest way of creating body fat. And, if that’s not bad enough when the insulin has finished its job, our blood-sugar levels slump leaving us hungrier.
The reason why obesity is getting worse is as a consequence of civilisation. While our ancestors would enjoy a sugar hit maybe four times a year, with each new season producing fresh fruit, many of us are now able to enjoy this sugar kick every day. Those of us in the developed world now consume 20 times as much sugar as our forebears did even in Atwater’s age.
When we consume complex carbohydrates like cereals although these still break down into sugar they do so much more slowly, so our blood-sugar levels remain steadier. Fruit juices may contain fewer calories than a wholegrain bun but the bread delivers less sugar hit and leaves us feeling satiated for longer.
Other macronutrients with different functions include protein, which as the primary constituent of fish, meat, and dairy products has a major role to play in our bones, skin, and hair among other body tissues. When carbohydrate is absent in the necessary quantities protein also serves as fuel for our bodies. And because it breaks down slower than carbohydrates, is not so readily converted into body fat.
Fat should leave us feeling full for longer because our bodies split it into fatty acids slower than they process either carbohydrate or protein. Fat is needed to create hormones and helps protects our nerves.
Fat has also always been crucial for us to store energy, enabling us to survive even in periods of famine. Today our bodies are programmed to store extra fuel just in case there is a lack of food.
The fixation with counting calories makes the assumptions that calories are all equal and that all our bodies react to calories in the same way. Men are told they need 2,500 calories a day to maintain their weight. But there is an increasing amount of research that indicates when different people eat the same meal, the impact on each of those individual’s blood sugar and formation of fat varies according to their lifestyles, genes and unique gut bacteria.
One study published earlier this year shows that a certain group of genes is to be found more frequently in people who are overweight than those who are skinny. This suggests that some of us have to work harder than our peers to stay thin.
How we process food can be altered by differences in our gut microbiomes. In one 2015 study of 800, it was discovered that the rise in each person’s blood-sugar levels could vary by a factor of four even when everyone at identical food.
In addition, some of our intestines are 50% longer than other peoples and the people with shorter intestines absorb fewer calories. The knock on effect of this is that these people excrete more of the energy derived from food, which means they put on less weight.
Our own body’s response may also change depending on when we are eating. When we lose weight, our body tries to regain it, which slows down our metabolisms and even reduces the energy we spend on twitching and fidgeting our muscles.
Even our eating and sleeping schedules are important. When we go without a full night’s sleep it may be spurring our bodies to create a larger amount of fatty tissue. We may increase the amount of weight we put on by eating small amounts over a 12 to 15 hour period than we would if we ate the same amount of food in three separate meals in a shorter period of time.
One other weakness in the system of calorie-counting is that the energy we absorb from food is directly linked to the way the food is prepared. Grinding and chopping ingredients do part of digestion’s work, which means more calories are available to our bodies by cell walls being ripped apart before we eat.
This effect is magnified when the heat is applied. Just the act of cooking something increases the amount of food that can be digested in a stomach and small intestine, from 50% to an astonishing 95%. Digestible calories in beef rise by 15% with cooking. In sweet potato, the increase is around 40%. Boiling, roasting or microwaving all have different effects.
This impact is so significant it is why many scientists believe the discovery of fire and application to food played a crucial role in human evolution and is what made the human race the dominant species on earth. Put simply, the revelation of using heat to cook enabled the neurological expansion that created Homo sapiens.
The difficulty in accurately counting calories doesn’t end there. Calorie loads of foods heavy in carbohydrate, including pasta, bread, rice, and potatoes are slashed just by the acts of cooking, cooling and reheating them. As the starch molecules chill they form new structures which are more resilient to digestion. We absorb fewer calories when we consume toast that has gone cold than when it is hot off the grill.
Sri Lankan scientists have found that by adding coconut oil to rice during cooking and then cooling the food they could more than halve the calories potentially absorbed. The starch became less digestible so the body takes on fewer calories.
The Exercise Myth
The message that emanates from many public authorities and operations that produce food, especially those companies in the fast-food industry that sponsor sports events is that we can swerve getting fat if we take plenty of exercise.
There are unassailable health benefits from taking exercise for sure, but the truth is that unless you’re a professional athlete, the role it plays in weight control is much less than people are led to believe.
Of our daily energy expenditure on average, as much as 75% comes not through exercise but from ordinary daily activities, like digesting food, maintaining regular body temperature and powering our organs. We even force our bodies to burn calories when we drink ice-cold water.
By all means, exercise regularly, but rather than limit your calories, eat natural foods and steer clear of low-calorie products that are heavily processed and focus instead on the quality of the food you eat rather than the quantity.
To stop feeling ravenous all the time listen to your body and eat whenever you are hungry but only then and eat real food, not food ‘products’. Bacon, cheese, whole-fat milk, steaks, egg yolks, olive oil and nuts are not what causes people to put on weight.
There is a growing band of academics and scientists who advocate that persisting with the obsession with calorie-counting is actually compounding the obesity epidemic, not remedy it.
Counting calories disrupts our ability to eat the right amount of food. It has persisted because of its simplicity.
The scientific and health establishment is well aware that the current system is flawed. WHO officials acknowledge there are problems with the current system but argue that it has become so entrenched in industry standards consumer behaviour, and public policy that it is too expensive to make big changes.
Physical activity plays a very small role when it comes to tackling obesity. It is recognized that rather than playing it up public health messages should instead be squarely focusing on unhealthy eating.
In one editorial in the British Journal of Sports Medicine, a group of international experts called for people to “bust the myth” about exercise, saying that while activity is key to staving off diseases like diabetes, dementia and heart disease its impact on obesity was minimal.
The argument is that reducing the consumption of sugar and carbohydrates is key to tackling obesity. Experts blame the food industry for encouraging the belief that exercise is a way of counteracting the huge impact of unhealthy eating.
Obese people, they say, do not need to do any exercise to lose weight, but they need to eat less sugar and carbohydrates. The evidence is that as much as 40% of people within a normal weight range still harbour the harmful metabolic abnormalities that are typically associated with obesity.
The experts now say that public health messaging has “unhelpfully” been focusing on healthy weight maintenance through calorie counting when in fact it’s the source of calories that matters most. For example, research indicates diabetes increases by as much as 11-fold for every 150 added sugar calories consumed compared to equivalent fat calories.
Indeed, the Lancet global burden of disease programme has produced evidence that demonstrates unhealthy eating is linked to more ill health than lack of physical activity, drinking alcohol and smoking combined.
Leading Cardiologist Dr Aseem Malhotra says that an obese person does not need to do any exercise in order to lose weight. His biggest concern is that the messaging emanating from the authorities suggests people can eat what they like as long as they exercise. He argues that this is “unscientific and wrong” because “you cannot outrun a bad diet.”
SECTION 3: THE WAY AHEAD
Understanding obesity and hormones
The hormones like insulin, oestrogens, androgens, leptin and growth hormones have a big influence on our metabolism, appetite and body fat distribution.
It is common to hear people say they are fat or overweight because of a hormone imbalance and that it is predetermined and even inborn and they feel like victims of nature. But often the problem lies in those on people’s behaviour, like lack of activity and confidence, which can lead to hormonal imbalance and consequently to obesity.
Hormones are chemical messengers regulating our body’s processes. They play a role in causing obesity. Particular hormones – leptin, insulin, our sex and growth hormones- influence our metabolism, our appetite and how fat is distributed in our body.
Metabolism is the rate our body burns kilojoules to provide is with energy, and the levels of these hormones in people who are obese can encourage abnormal metabolism and accumulation of body fat.
A gland system, called the endocrine system, is what secretes hormones into the bloodstream. It works in conjunction with our nervous and immune systems to assist our body in coping with various stressful events. If we have these hormones in excess or deficit it can both lead to obesity and to obesity leading to hormonal changes.
Fat cells produce leptin, which is secreted in our bloodstream. This hormone reduces our appetite by working on specific centres of our brain to reduce the urge to eat. It has also been linked to the way the body manages the storage of body fat.
Leptin levels have a tendency to be higher in obese people because it is produced by fat. However, despite higher levels of the appetite-reducing hormone, obese people aren’t as sensitive leptin’s effects and so don’t benefit from feeling full when eating.
Insulin is produced by our pancreas, and importantly regulates carbohydrates and how our body metabolises fat. It works by stimulating our muscles, liver and fat, for instance, to take up glucose/sugar, which ensures energy is available to us to function and maintain normal levels of circulating glucose.
In an obese person, insulin signals are disrupted and sometimes lost and the body’s tissues can no longer control glucose levels, which can lead to type II diabetes and metabolic syndrome developing.
The distribution of our body fat distribution plays a key role in how obesity-related conditions develop, including strokes, heart disease, and various forms of arthritis. Fat around the abdomen is riskier than fat stored on our bottoms, hips and thighs.
It seems that what helps to decide body fat distribution is oestrogens and androgens. Oestrogens are sex hormones that are made by the pre-menopausal women’s ovaries and account for prompting ovulation during the menstrual cycle.
Postmenopausal women and men hardly produce any oestrogen. Instead, the majority of oestrogen is produced in body fat.
As sex hormone levels of both men and women change with age there are associated body fat distribution changes. Ageing men and postmenopausal women increasingly tend to store fat around their abdomen and become apple-shaped. Postmenopausal women who take oestrogen supplements don’t tend to accumulate fat around the abdomen. Studies of animals indicate lack of oestrogen can lead to excessive weight gain.
Our brain’s pituitary gland produces growth hormone, which has an influence on a person’s height and assists in building bones and muscles. Growth hormone also has an effect on metabolism. Indeed, studies indicate that growth hormone levels in obese people are lower than those people who benefit from having normal weights.
There are associations between obesity and low-grade chronic inflammation within fat tissue. When there is excessive fat storage it can lead to stress reactions within the fat cells, which then can lead to pro-inflammatory factors from the fat cells being released.
There is an increased risk of many diseases, including stroke, cardiovascular disease, and many types of cancer linked to obesity. For example, older women who are considered obese have an increased risk of breast cancer risk.
Obese people, unfortunately, have hormone levels which encourage body fat to accumulate. It would appear that such behaviours as overeating and failing to take regular exercise can over time make a person physiologically more likely to put on weight.
Numerous studies have demonstrated that the leptin level in a person’s blood falls following a low-kilojoule diet. These lower levels of leptin can increase appetite and slow down a person’s metabolism, which may explain why people who go on crash diets tend to put the lost weight back on.
Evidence suggests that with behaviour changes like healthy eating and regular exercise, the body can be re-trained to shed body fat and keep it off. Studies also indicate that weight loss can lead to enhanced insulin resistance, beneficial modulation of obesity hormones and decreased inflammation. Losing weight is also linked with decreasing risks of developing problems like stroke, heart disease, type II diabetes and specific cancers.
Sugar versus fat
Traditionally obesity has been thought of as the result of a caloric imbalance: our intake of calories exceeds the expenditure of calories.
However, the truth is more nuanced and suggests that the state of obesity results from a hormonal imbalance and nutrient and energy deficit that leads to a natural disinclination to get involved in physical activity.
Added sugars not only displace nutritionally superior food, but they can also deplete the nutrients from other food consumed. Moreover, by over-consuming sugar can trigger leptin and insulin resistance and result in what is known as ‘internal starvation’ which leads to increased hunger signals encouraging more eating. Sugar promotes obesity by promoting nutrient and energy deficit.
Sugar has hit the headlines and is now considered “the new tobacco”. High sugar consumption has been linked to the rise of both obesity and diabetes.
The warning is that in addition to sugar being a primary cause of obesity, there is evidence that added sugar enhances the risk of people developing type II diabetes, fatty livers and metabolic syndrome.
Indeed, experts have now come to the conclusion that fruit juice has so much sugar it should no longer be counted as one of the five-a-day fruit and vegetable portions.
Campaigners against sugar in food believe there is a link between calories and obesity caused at least in part by high consumption of sugar. They argue that not enough is done to tackle the obesity and diabetes epidemic.
Most people are eating too much sugar, much of which is hidden in the food we consume. The British Dietetic Association (BDA) says that adding sugar is unnecessary for a healthy diet. They point out that research indicates many foods with added sugars also have a lot of calories, and few other nutrients, like vitamins, proteins, and minerals.
Carbohydrate and low carb diets
It appears to be clear that the consumption of large amounts of carbohydrate invariably leads to weight gain.
New research by a US team has shown that consuming low carbs enhances the success rate of obesity treatments assisting people to maintain their weight loss. For example, studies published in The British Medical Journal (BMJ) have revealed how eating a low carb, high-fat diet benefitted the metabolisms of obese participants and enabled them to expend more calories, while experiencing less hunger than their counterparts who consumed a high carbohydrate, low-fat diet.
The research involved 164 overweight people with Body Mass Indexes (BMI) of 25 or more. Every participant lost 12% of his or her body weight on the initial 10-week weight loss diet, where 45% of the total energy was generated by carbohydrate, 30% by fat, and 25% by protein.
After this initial period, each participant was then assigned either a high, medium or low carb diet for another 20 weeks. In the high carb diet, the carbohydrates accounted for 60%, in the moderate carb diet 40% and in the low carb diet 20%.
Those assigned the low carb diet burned an average of 200 kcal per day more than other participants on high carb diets. They also demonstrated a 12% reduction in levels of the hunger hormone ghrelin, compared with 5% in the participants on high carbohydrate diets.
These benefits were even more striking among the participants who demonstrated higher insulin secretion – which may lead to heightened insulin resistance in people who are overweight – with the low carbers from the higher insulin secretion group burning over 300 kcal per day on average when compared to the high carbohydrate group.
The researchers believe their results demonstrate that increased insulin levels after a high carbohydrate meal can increase hunger and lead to less energy being burned.
The findings cast even more doubt on the calories in, calories out (CICO) obesity model. They are more consistent with the new carbohydrate-insulin obesity model.
The British Dietetic Association has released a statement that clarifies how a low carb diet should become one of the possible dietary approaches for managing type II diabetes in adults.
What Needs to Change About Our Diet
The world is awash with diets. There are millions of them but there still seems to be a distinct lack of improvement in the fight against weight gain.
The reason is many faceted but starts from a lack of understanding of the problem of obesity. We eat too much sugar and an excess of carbohydrates. It is almost an addiction, comparable to alcohol, nicotine and many drugs.
Karen Thomson, the founder of Cape Town’s Help (Harmony Eating and Lifestyle Program), believes sugar is no less an addiction like alcohol, heroin or anorexia. Her operation is the world’s first and so far only rehab centre offering bespoke programs tailored to tackle sugar and carbohydrate addiction. To do this Help employs traditional rehabilitation techniques.
In the same way, a smoker finds it difficult to stop his or her habit of smoking and discovers that many anti-smoke programs are useless, so someone who finds it impossible to break the sugar and carbohydrate habit cannot stop consuming their favourite foods and finds diets do not help much.
As Thomson says it’s strange to think of someone hankering for a cupcake in the same way as others do for a crack pipe, but there is increasing evidence indicating that sugar may be triggering similar responses in the brain as more traditional forms of addiction.
Positron emission tomography (PET) scans are imaging tests which enable doctors to check for diseases in our bodies. According to Help, PET scans have been showing that the very same neural pathways that are to be found in the brain come alight when obese children are exposed to sugar as they do when an alcoholic has a drink.
Currently, sugar is not classed as addictive. Instead, as is the case with gambling, the hit of pleasure that accompanies the consumption of sugar is seen as merely leading to addictive behaviour.
There is a ‘No Sugar’ movement, with Dr Robert Lustig at its head, whose claim that sugar is the world’s leading health risk, responsible for heart disease, diabetes and obesity, has been gaining traction.
The ‘No Sugar’ campaigners highlight Sweden, where low-carb/high-fat diets are long-established, and rates of obesity have been stabilised. There is an increasing number of health specialists who recommend we cut down on sugar. For example, Mandy Saligari, who founded London’s Charter Harley Street rehab centre, believes that sugar plays a key role in all manner of eating disorders, and sometimes even in cases of alcoholism.
Cape Town’s Thomson believes sugar addiction has to be treated in the same way as other addictions. Thomson is a recovering cocaine addict and alcoholic herself and adheres to the 12 steps approach used in Alcoholics Anonymous and other support groups. Her clinic employs a 24-hour team involving nurses, a medical doctor, clinical psychologists, trauma specialists, psychiatrists, addiction counsellors and a detox unit.
Her program consists of one-on-one therapy, learning programs tackling subjects like nutrition, trauma and group therapies, the 12-step program and diet.
Meals are all low-carb and high-fat, and a typical menu for a day could include avocado and eggs, tuna salad and chicken curry, with nuts and biltong for snacks. Because sugar is widely available, there is always a concern about patients relapsing so Help provides a complete after-care program with online support, and Skype counselling calls and WhatsApp support groups.
SECTION 4: THE SOLUTION
An enormous amount of attention is concentrated on diet and physical activity. As a result, it seems that a great part of the population is still in the dark about the exact causes of obesity.
Too many people still hold the strong opinion that the way to weight loss means adopting some special diet and combining this with time spent on exercising. The idea is that the stricter the diet and the harder the physical activity, the better result will be achieved as far as weight loss is concerned.
Actually, neither solution is a solution at all. A main cause of disability is hormonal dysfunction.
If your BMI is within the range of obesity, it is typical for a health care provider to review your health history, carry out a physical exam and then recommend some tests, which will generally include:
- Reviewing your weight history, any efforts you’ve made to lose weight, your exercise habits, your patterns of eating, any other conditions you’ve ever had, what medications are you taking, whether you are stressed and other health issues. Your doctor will probably ask about your family’s health history to identify if you are predisposed to certain conditions.
- Physical examination to measure your height; check vital signs, like your heart rate, your blood pressure and your temperature; listen to your heart and lungs, and examine your abdomen.
- Calculate your BMI by checking your body mass index (BMI) in a bid to determine your obesity level.
- Measure your waist circumference. Fat that is stored around the waist, also visceral or abdominal fat, may increase the risk of diseases, including diabetes and heart disease.
- Check for signs of other health problems.
- Blood tests.
Armed with all this information helps determine how much weight you need to lose and what health risks you already face, which will help guide any treatment decisions.
The goal of any obesity treatment is to aim for and retain a healthy weight. You may need to work with a team that could include a dietitian, a behaviour counsellor and an obesity specialist.
Initially, treatment is aimed at modest weight loss of between 3% and 5% of your total weight, but the more weight you are able to lose, the greater the benefits are likely to be.
To lose weight will require changes to eating habits and increased physical activity.
As well as dietary changes and activity other management techniques include:
- Behavioural changes which can assist in making lifestyle changes so weight is lost and kept off. Steps to take include:
- Examination of current habits to find out what factors might have contributed to obesity.
- Behaviour therapy, which can include:
- Counselling with trained mental health professionals who can help tackle emotional issues related to eating.
- Support groups where others are able to share the challenges they have had with obesity.
- Taking weight-loss medications, though there is a high likelihood of regaining weight when the medication stops being taken.
- Bariatric surgery includes:
- Gastric bypass where a surgeon makes a small pouch at the stomach’s top and cuts the small intestine a short distance below the main stomach and connects it to the new pouch so food and drink flow directly from the pouch into this part of the intestine and bypasses most of the stomach.
- Gastric banding where the stomach is split into two pouches with an inflatable band. The band is pulled tight, like a belt and a tiny channel is created between the two pouches.
Setting a Strategy
As with any strategy to tackle obesity you need to have a plan that is easy to follow and to understand.
Plan your day and week ahead.
Take a look at what kind of products you have in your refrigerator and kitchen lockers.
In most cases we eat what we have at home at the times we want to eat. There is not much time to go buying some products when you are hungry. Your stomach and your brain are telling you that need it immediately.
Usually, we don´t tend to think consciously. Instead, we act automatically because we need to fulfil our hunger. It´s only natural. So what we need to develop is a habit of planning what we are going to be eating over the next couple of days.
Make this pan as easy as possible. Complexity is our enemy. So take a seat and consider which products you are going to need and reject any that are extra to requirements.
Take a piece of paper and write it all down. Have you noticed that in many cases you buy the same products when you go shopping? You probably are used to picking these automatically, especially if you have done so for a long time.
You probably know the store you are buying in, so you can save time and finish shopping very quickly. But by planning and writing down the things you need you can avoid the trap of buying the same things automatically.
When you want to add something new to your daily rations or to prepare a different salad it is highly recommended that you choose meals that can be made with only a few ingredients – maybe two or three – to avoid having to buy too much and putting pressure on your wallet.
You don’t need recipes where the ingredients are difficult to find. To be sure you are buying just the right things make your shopping as easy as possible.
Sometimes you may notice that many unnecessary products will gradually disappear from your house without them being thrown away because you are consuming these and instead of buying new ones.
In the beginning, it is bound to be a little unusual to be making the things that you have not cooked before, but this is normal when you are breaking habits that previously caused you to consume products that were unhealthy.
Don’t worry. Soon the new habits will lead you enjoying your new healthy life and the freedom from being addicted to fast food and food that is too rich in carbohydrates.
- Just take a five minutes break and consider what would like to eat today and tomorrow
- Take a piece of paper and write down your list of all the necessary products you are going to need.
- Shop little and often.
- Don´t throw away the food you may consider to be unhealthy. It will disappear automatically when you buy new alternatives.
- Make a plan for at least three weeks until your conscious new action becomes a habit.
- Keep your strategy as simple as possible.
Strategies only work when they are simple. This is valid in many life spheres, whether in sport, in business, or in education.
Your strategy needs to be individually yours. Each person responds differently.
Be confident and consistent so that in time you will see the results. It´s not just about following your plan once a week or a month, it’s all about regularity. Going to the gym and training for eight hours on one occasion does nothing lasting to your body, but going regularly and putting in 20 minutes in time will soon see your body change. Another way of looking at it is if you go to a dentist twice a year you won’t make your teeth healthy. But if you clean your teeth twice a day you will your mouth healthy for a long time.
Aim to eliminate the cause but not the result. Many people don´t understand the underlying cause of a problem. If you think that carrying excess weight is the problem you are misunderstanding the issue.
It would be like an alcoholic or drug addict thinking that it’s the alcohol or the drugs that are the root cause of their addiction.
The problem lies instead in internal factors, such as low self-esteem, lack of confidence, being socially challenged, and in some cases, the problem may grow out of a lack of education or bad-breeding.
In the case of obesity, the problem is most likely as a result of hormonal dysfunction.
One study has indicated that exercise may both increase the sensitivity of insulin and simultaneously decrease its production. On another hand, a diet doesn’t affect either the sensitivity or the secretion of insulin.
This is very important because insulin resistance leads to diabetes and weight gain. This is why some form of physical activity should be integrated into any plan to lose weight.
However, it’s important not to obsess about physical activity. It should not be the leading strategy when trying to lose weight, because it takes a lot of time and efforts to burn calories. Moreover, physical activity requires a lot of energy, which can encourage the body to find ways to gain calories to produce that energy.
Exercise must be balanced with other methods, like decreasing your sugar intake.
Several studies indicate that short-term and intermittent fasting of up to 24 weeks in duration, can lead to weight loss in some overweight individuals. There are various routines including:
- The 5:2 Diet, which means fasting on two out of every seven days and on these fasting days consuming between 500 and 600 calories.
- The 16/8 method, which requires fasting for 16 hours and eating only during an eight-hour window. For the majority of people, this eight-hour window would be between noon and 8 pm. Research into this method discovered that eating during the restricted period caused participants to consume fewer calories and lose more weight.
As the majority of us lead busy lives, we often eat quickly and on the run, while driving, at our desks, and during bouts of watching TV. As a result, many of us are hardly aware of the food we eat.
To eat more mindfully try:
- Sitting at a table to eat.
- Avoiding any distractions like the TV, working or driving while eating.
- Eating more slowly so you take time to chew and savour the flavour of your food.
- Considering your food choices so you select food that is full of nutrients and is likely to satisfy you for more than just minutes.
Eating protein for breakfast
Protein regulates our appetite hormones and helps us feel full, mostly because of a decrease in the hunger hormone ghrelin and an increase in the satiety hormones cholecystokinin, peptide YY, and GLP-1.
Studies of young adults who have eaten a high-protein breakfast have found the hormonal effects can last for several hours. Good high-protein breakfast ingredients include oats, eggs, nut and seed kinds of butter, quinoa, porridge, sardines, and chia seeds.
Reducing sugar and refined carbohydrates
Swapping high-sugar snacks for fruits and nuts is beneficial because it counters trends in the Western diet towards increasingly high uses of added sugars, with definite links to obesity.
White rice, bread, and pasta contain refined carbohydrates that no longer contain any fibre or other nutrients.
Quick to digest, these foods convert rapidly to glucose and excess glucose provokes the insulin hormone that encourages fat storage and weight gain.
What to eat
Where possible, we should be swapping processed and sugary foods for healthier options like:
- whole-grain bread, rice, and pasta replacing white versions
- nuts, fruit, and seeds rather than high-sugar snacks
- fruit-infused water instead of regular or diet sodas
- smoothies with water or milk rather than fruit juice
There are simple steps we can take to help keep our weight in check and reduce the risk of chronic diseases.
Healthy eating is crucial to good health and maintaining a healthy weight. It’s not just what and how much we eat but also how we eat that’s important.
The whole foods we should be using include:
- Whole wheat, oats, brown rice, quinoa
- Vegetables of all colours but not potatoes
- Whole fruits but not fruit juices, which are packed with natural sugar
- Seeds, nuts, beans, and other sources of protein like fish and poultry
- Olive and other vegetable oils
- Water and beverages that are naturally free of calories.
The food and drinks that need to be limited include:
- Soda, fruit juices, sports drinks
- White bread, white rice, white pasta and sweets
- Red meat like beef, lamb and pork and processed meats like ham, salami, bacon and sausages
- Highly processed fast food.
How Much to Eat
Body size, age, gender, and the level of physical activity carried out by an individual are what dictate how much we should be eating if we want to lose weight or maintain a healthy weight.
The recommended approach is to adopt those habits that are likely to help you avoid overeating and to skip the high-calorie, low-nutrient foods most strongly linked to people gaining weight, like sodas, refined grains, and potatoes.
To avoid over-eating it is advised to:
- Eat breakfast, because skipping this invariably backfires with hunger crashing in mid-morning leading to overeating.
- Eat slowly and choose small portions, both of which can help avoid excess consumption by allowing the brain time to inform the stomach that it’s had enough.
- Limit distractions like the television, the computer, or your smartphone to better focus on your food.
- Eat at home rather than out where the portions can be larger and are bound to be less nutritious than foods you cook for yourself.
- Eat mindfully so you take time to think about why you’re eating.
- Focus all of the senses on your food, so you truly enjoy what you eat.
SECTION 5: TO CONCLUDE
Obesity and its related non-communicable diseases are for the most part preventable. Choosing healthier food and regular physical activity are most easily followed in supportive environments and communities which prevent us from becoming overweight and obese.
At an individual level, we can:
- Limit energy intake from total sugars and carbohydrates
- Increase our consumption of fruit and vegetables, as well as legumes, nuts and whole grains
- Take part in regular physical activity
It’s important to avoid unrealistic diet changes, like crash diets, which are unlikely to help keep excess weight off in the long term.
The plan should be to participate in a weight-loss program for at least six months followed by a year of maintenance to boost the odds of weight-loss success.
There is no one best program. The key is choosing one that includes healthy food you feel will work for you. Dietary changes to treat obesity include:
- Feeling full eating less.
- Making healthier choices by eating more plant-based foods, like fruit, vegetables and whole-grain carbohydrates, as well as lean sources of protein including beans, lentils and soy along with lean meat and fish.
- Limit salt and added sugar.
- Restricting high-carbohydrate food.
- Cut out sugary drinks.
- Eat healthy snacks.
- Be wary of crash diets and quick fixes.
The food industry, of course, has a lot it can do to play a significant role in promoting a healthy diet by:
- Reducing the sugar and salt content of processed foods
- Ensuring that nutritious choices are available and affordable
- Restricting the marketing of food that is high in sugars, salt and carbohydrates, especially when they are aimed at children and teenagers
- Making sure there are healthy food choices available.