Transcript `Trying to lose weight? Everything you need and don`t need to know`

'Trying to lose weight?
Everything you need and
don’t need to know’
Anna Read
Obesity Specialist Dietitian
QMC - NUH
Copyright Anna Read 2013
1940s – Manual work and full time
motherhood.
Walking, high streets, sweeping, cleaning and
chopping, washing by hand, carrying water,
visiting people, making beds, manual jobs.
Copyright Anna Read 2013
Modern Life – The obesogenic
environment
Driving, supermarkets/home delivery, vacuuming,
pre-prepared foods, washing machines,
dishwashers, texting/messaging people, duvets,
desk jobs.
Copyright Anna Read 2013
Then and Now
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1940’s
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Average man was
10 stones 2.
Average woman
was 8 stones 7.
1% of men and 2%
women were obese.
2010’s
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Average man is 13
stones 2.
Average woman is
11 stones 1.
26% of adults are
obese.
Since 1950, the amount of nutritional information available to the public has
doubled every 7 years.
Obesity has risen by 214%.
Obesity research has blossomed.
Copyright Anna Read 2013
The mars bar challenge!!!
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How many calories are in a mars bar?
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How quickly can you eat a mars bar?
Copyright Anna Read 2013
Energy balance
One mars bar (260 calories) can be
eaten in less than a minute.
 260 calories takes a long time to burn
off:
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147 Minutes sitting.
 73 Minutes walking
 27 Minutes jogging.
 ?? Minutes of rowing.
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Copyright Anna Read 2013
National Weight Control Registry
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American cohort of people who have
successfully managed to lose a
substantial amount of
weight……………..AND kept it off.
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This group of people are real life
examples of what works.
Copyright Anna Read 2013
Do diets work?
Copyright Anna Read 2013
The Basics
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Weight loss requires a negative energy
balance.
Daily calorie intake needs to be less than total
daily calorie expenditure.
Recommendation to reduce calories to 600
less than daily requirement.
An increase in calories burned off (exercise)
increases weight loss, prevents plateau and is
especially important in preventing regain.
Increasing exercise alone is often insufficient
to achieve weight loss as amount of exercise
needed is beyond practical/physical
capabilities.
Copyright Anna Read 2013
Why is losing weight so hard?
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To lose weight you have to eat less than your body
needs, every day, every week, every month………….
This might involve: being hungry, resisting favourite
foods and snacks, putting more effort into food,
changing habits and changing behaviour.
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To keep the same weight you can eat as much as your
body needs and if you can be quite active you can
‘burn off’ treats or extras.
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A person trying to lose weight has to work harder at it
than a slim person who eats healthily and is quite
active.
Copyright Anna Read 2013
The (boring) Basics
Three meals per day.
 Watch portion size.
 Reducing sugar.
 Reducing fat.
 Controlled low calorie snacks.
 Five a day.
 Low calorie drinks.
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Copyright Anna Read 2013
Regular meals
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Breakfast IS the most important meal of the
day!
 Regular planned meals helps people to stick to
their planned food and reduces the likelihood
of snacking.
 Snack foods are the most likely to be high in
fat and or sugar.
 Long gaps between meals can lead to
snacking, overeating at the next meal and
changes in metabolism hormone levels.
Copyright Anna Read 2013
Portion sizes
Aim for ‘your palm size’ protein.
 Aim for ‘your hand size and thickness’
starchy food.
 Plenty of vegetables and salad.
 Watch portion size of breakfast cereal.
 Aim two slices bread (medium sliced).
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Copyright Anna Read 2013
Reducing sugar
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‘Empty calories’
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1 teaspoon sugar is ‘just’ 20 calories.
4 drinks per day is 29,120 calories per year.
(8 drinks = 58,240 calories, 8 drinks with 2
teaspoons sugar is 116,480 calories……)
Sweeteners
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No human data that unsafe.
Much sweeter than sugar so only need tip of a teaspoon.
Try different sweeteners.
Copyright Anna Read 2013
Reducing fat
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Healthy fats have just as many calories as
unhealthy fats.
 Try to use minimal amounts of fat during
cooking.
 Remove visible fat/skin from meat/poultry.
 Use low fat milk and dairy products.
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Give 1% milk a go!
Low fat cheeses have improved so much in the last
couple of years.
Avoid pastry, processed meat products and
fried foods.
Copyright Anna Read 2013
Careful snacking
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Stop
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Think
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Are you hungry?
Can you wait?
Will a drink do?
Low calorie
Filling.
Nutritious.
Go
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Fruit.
Vegetable.
Low fat savoury snack e.g. 2 crisp breads.
Small sweet treat (e.g. 100 calorie small chocolate bar).
Copyright Anna Read 2013
Five a day
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One portion is generally one small handful:
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One apple/pear/banana.
Two satsumas
Twelve grapes/berries.
Two tablespoons vegetables.
Small bowl of salad vegetables.
Fruit juice 150ml maximum one a day.
Dried fruit one tablespoon maximum one a day.
Can have more than five portions per day but try to
limit fruit to four portions if having trouble losing weight
or if you have diabetes.
Copyright Anna Read 2013
Calories from drinks
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Avoid adding sugar to any drinks.
Choose low fat milks.
Do you regularly have lattes? Grande regular 230 calories, semi
skimmed milk 190 calories, skimmed milk 130 calories.
Choose diet / light / zero versions of soft drinks.
Limit fruit juice.
Choose no added sugar squashes.
Think about calories from alcohol:
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One pint of beer
One large glass of wine
One single spirit and diet coke
One measure of baileys
170 – 200 calories.
220 calories.
75 calories.
130 calories.
Copyright Anna Read 2013
Simple techniques
Reduce all meals by a third.
 Cut out all snacks except for fruit and
vegetables.
 Don’t eat after main meal.
 Only choose foods with less than 5% fat.
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Copyright Anna Read 2013
Planning for success
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Get support and arrange weighing.
Identify your realistic goals.
Plan your week’s meals.
Write a shopping list and stick to it.
Consider home delivery.
Use fresh meals first: stir fries, salads, fish/meat/chicken and
vegetables and towards the end of the week choose jacket
potatoes, omelettes, pasta dishes.
Bulk cook healthy meals such as lasagne, cottage pie, stews and
casseroles.
Take own lunch to work – sandwiches, salads, leftovers or tins of
soup and bread or crackers are a quick and easy choice.
Include fruit and vegetables in meals and snacks.
If eating out, try to look at menu’s in advance.
Copyright Anna Read 2013
Healthy Surprises
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Fruit juice has more calories than beer ‘beer
bellies’……..
Smoothies – very healthy but not very helpful
for losing weight.
Olive oil has the same calories as lard.
Flapjacks and cereal bars can be very high
calorie snacks.
Dried fruit and dried nuts are also very healthy
but very high in calories.
Low calorie and ‘diet’ foods still ‘add up’.
‘Energy Drinks’ not healthy, never will be…..
Copyright Anna Read 2013
Exercise
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‘For health’ recommendations of thirty minutes
moderate intensity activity five times a week.
Equivalent health benefits achieved by 15
minutes vigorous activity five times a week.
All adults should minimise time spent sitting for
long periods.
‘For weight loss’ recommendations are higher
than this.
Active Commuting a government priority –
what could you do?
Copyright Anna Read 2013
Exercise
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For weight loss:
Focus on decreasing sedentary behaviour.
 Aim for 45 – 60 minutes exercise daily
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For preventing weight regain:
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60 – 90 minutes total exercise daily
achieved by those who manage to prevent
weight gain after losing weight.
Copyright Anna Read 2013
Active Commuting
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Walk to work / part way to work.
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Cycle to work / one way to work.
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Walk to next bus/tram stops.
Get off a few stops early.
Leave cycle overnight in secure compound.
Be dropped off or collected with foldable bike.
Lunchtime walks
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From QMC – part of the University Lake, as far as University Central
Building, corner shop at Leengate, round the QMC perimeter road,
loop of A floor East Block to West block and up to a higher floor and
back again.
From City – To Hucknall Road roundabout co-op, walk around the
campus.
Copyright Anna Read 2013
Weight Loss Medication
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One safe and effective medication that can be
prescribed by the NHS:
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Orlistat (Xenical) for BMI above 30 (or 28 with
health problems).
Stops body absorbing some fat so requires low fat
diet to prevent unpleasant bowel side effects.
Only GP can prescribe, must be taken three times a
day with regular meals and must lose 5% of your
weight in 12 weeks to be eligible for continued
prescription.
A weaker strength can be bought in chemists – Alli.
Copyright Anna Read 2013
Weight Loss Surgery
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Dramatically increasing business in NHS and
private settings.
 VERY strict NHS availability - for BMI over 50
(or 45 with serious health problems).
 Available privately for BMI above 35 (or slightly
lower with weight related problems). ~£7000
for a gastric band, ~£11,000 for a gastric
bypass.
 The only weight loss treatment that is not
associated with weight regain.
Copyright Anna Read 2013
What’s available in Nottingham?
Commercial Slimming Organisations – Slimming World, Weightwatchers,
Rosemary Conley – joining fee and weekly fee.
 Motivate – Notts County Football Club 12 week programme. (BMI 30+
(28+Asian ethnicity)-Nottingham City Boundary -home or GP address).
 Healthy Change – self or health professional referral for Slimming World,
YMCA exercise, cook and eat sessions. (BMI 30+-Nottingham City
Boundary – home or GP address).
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Ridewise training.
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Local council exercise referral schemes.
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Practice Nurse – first line advice.
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Dietitian referral community or hospital for BMI above 35 (or 30 with
health problems).
Copyright Anna Read 2013
What’s available at NUH?
NUH Active.
 Staff Weight Management group
(BMI>30) to run from September –
contact Steph Knowles if keen to find out
more.
 Weightwatchers QMC Tuesday
lunchtimes – self pay.
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Copyright Anna Read 2013
What doesn’t work
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Drastic, limited diets.
Expensive programmes.
Fat melting potions, tablets or lotions.
Internet/illegal drugs.
Unsustainable exercise.
Anything described as ‘miracle’, ‘magical’ or
that ‘requires no dieting’.
Tummy tuck/liposuction.
Believing everything you read in the papers….
Copyright Anna Read 2013
What probably doesn’t work
Hypnotism.
 Gastric Balloon.
 Jaw wiring.
 Fear factor.
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Copyright Anna Read 2013
Everything, nothing and anything
case study.
Weight (kg)
105
100
95
90
85
80
75
70
65
60
1970
1975
1980
1985
1990
1995
2000
Year
Copyright Anna Read 2013
2005
2010
2015
2020
National Weight Control Registry
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Average weight losses of 70 pounds (30 kg) and kept it off for 5.5
years.
Over three quarters had a ‘triggering event’ to start their weight
loss.
Lost their weight by wide variety of methods.
45% did it on their own, 55% were part of a programme.
Almost all eat breakfast everyday.
Watch less TV than average.
Weigh themselves at least once a week.
Exercise for average 60 minutes a day.
Huge reported increased in levels of energy, physical mobility,
general mood, self-confidence, and health.
Copyright Anna Read 2013
Summary
You need: a plan, help and support,
a realistic
goal and determination.
Copyright
Anna Read 2013
Any Questions?
Copyright Anna Read 2013