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Is Obesity a Disease?

The question of whether obesity should be called a ‘disease’ has sparked controversy for many decades.  One concern about labelling obesity as a disease process is the finding that some people with obesity are actually healthy and do not have any risk factors for associated diseases such as prediabetes, hypertension (high blood pressure) and dyslipidaemia (abnormal cholesterol) although they may be victims of stigmatisation.  However, studies have shown that in the long-term more than half of these individuals will develop some of these obesity-related diseases and orthopaedic problems during their lifetime.  Therefore, it is of utmost importance that we treat obesity seriously and start working more on prevention strategies.

An abundance of food, low physical activity, and other environmental factors interact with our genetic susceptibility which results in obesity.  It is believed that foods which are particularly high in energy and low in nutrients such as sugar-sweetened, fatty and highly processed foods are the primary agent in inducing obesity.  The magnitude of obesity and its adverse health effects fit the epidemiological model of a disease process only, unlike an infectious microbe, such as that which causes the flu, food is believed to be the culprit.

Reversing obesity will prevent most of its detrimental effects but unlike a disease of which do you either do or do not have, it is a continuum, like baldness and progresses with time.  Therefore, you need to make significant dietary changes such as reducing total calories, sugar and non-nutritious, processed foods first, then try to increase physical activity.

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Carbs, Grains and Quinoa… huh?

Its likely that you will have heard a lot in the media about reducing carbs in your diet, especially grains.

Carbohdyrates (aka ‘carbs’) are found in many healthy and wholesome foods including vegetables, fruit, dairy foods (yoghurt, milk, some cheeses), breads, rice, pasta, legumes/pulses (chickpeas, 4 bean mix, lentils) and smaller amounts in nuts and seeds.  Carbs are often given a bad name when they are used to refer to high processed foods made from these products such as sugary breakfast cereals, cakes, buns and sweet beverages like juices and soft drink.  Therefore, when considering which carbs to include in your diet, it important to think of the 5 food groups and how much of each food you need to meet your total daily nutrient and energy requirements.

  • Dairy products include over 10 essential nutrients, particularly Calcium which is important for healthy bones, plus they are often a good source of protein and contain low GI (Glycaemic Index) carbohdyrates such as lactose.
  • Vegetables and salads are generally reasonably low in Carbs, except for the well-known starchy carbs (eg; potato, sweet potato) and they also contain Dietary Fibre, natural Anti-Oxidants and Phytochemicals, Vitamins, minerals and they are mostly Low GI too.
  • Fruit is best consumed in it whole-food form, rather than juiced given it contains more dietary fibre, and it is less energy dense as well as excludes added sugars, preservatives and concentrates. Plus its nutrient levels are highest when fresh rather than packaged.
  • Meat, Fish and Poultry do not contain any carbs but they are important for protein, B Vitamins, Zinc, B12, Iron and Omega 3’s just to name a few of their nutritional benefits. Try to choose un-processed, leaner cuts of meat.
  • Legumes and pulse include all forms of beans and peas of which there are literally 1000’s of varieties and pulses and the amount of carbs they contain vary although they are usually high in dietary fibre and low GI as well as many vitamins and minerals.
  • Nuts and Seeds are predominantly fats, 40-60% compared to around 15-20% for protein and 15-20% carbs with the remaining content being undigestable dietary fibre. Nuts are low GI, contain significant essential fatty acids, dietary fibre and vitamins and minerals.
  • Breads, cereals and grains encompass such a wide variety of foods so its important to choose the least refined versions of these that you can such as whole oats, quinoa, brown rice, amaranth, rye, barley and wheat. A clear and simple way to identify and choose better wholegrain foods is to look for statements on products such as ‘very high in wholegrains’ or ‘high in wholegrains’ rather than just ‘contains wholegrains’ as these statements refer to the percentage of wholegrains in a product.

So what is all the hype about Quinoa?  Well unlike other common grains, Quinoa, belongs to a psuedo-cereal family along with Amaranth and Buckwheat.  Quinoa originated in the Andes and was cultivated by the Inca people.  Quinoa is low GI (53), high in protein (15%) and provides all essential amino acids including lysine, has a high ratio of protein to carbs, is high in dietary fibre, a source of many vitamins and mineral plus is relatively low in fat and is Gluten free.

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Nutritional Balance: what do you need for weight loss?

Achieving healthy weight loss is more than ‘energy in vs energy out’

Having the right balance of nutrients plays a huge role in a person’s overall health, wellbeing and weight loss journey. Important nutrients such as protein, low GI carbohydrates and unsaturated fats are needed in the diet in certain quantities to promote weight loss, maintain muscle mass, and provide the body with adequate energy. Following fad diets that restrict whole food groups can play havoc on metabolism.

Weight loss studies show that diets with moderate-to-high protein, low-to-moderate fat and carbohydrates (from healthy, low GI sources only), had greater short term and long term weight loss success. Adherence, diet acceptability, satiety and satisfaction were greatest with this type of healthy eating regime – enabling participants to adopt the well balanced protein/fat/carbohydrate diets as more of a lifestyle change rather than short term ‘diet’.  This nutrient balance lead to improvements in cholesterol levels, blood pressure and blood sugars.

So to achieve nutritional balance on our weight loss journey:

  1. Aim for a higher protein intake by including a source of good-quality protein with most meals to assist with satiety, maintaining lean muscle mass and increasing dietary thermogenesis. Ideally, go for a protein source that is low in saturated fat. Good options include lean red meat, skinless chicken, fish, eggs, low fat milk and yoghurt.
  2. Choose low GI sources of carbohydrates in small quantities to assist with maintaining energy levels, increasing fibre intake and providing adequate fuel. Carbohydrates are found in fruit, dairy foods breads, rice, cereals, pasta, legumes, grains and starchy vegetables. Look for wholegrain or high fibre options and steer clear of highly processed, high sugar products.
  3. Include some healthy fats. Unsaturated fats will assist with increasing satiety, enabling the uptake of fat soluble vitamins and they’re good for your heart. Snack on nuts, add avocado to your salad or drizzle it with a good quality extra virgin olive oil. Be mindful of portion sizes as these foods are energy dense and can quickly add up to exceed your energy budget.
  4. Up the micronutrients! Include plenty of vegetables and 1-2 serves of fruit to make sure you’re getting all the vitamins and minerals you need. Diet variety is the key to making sure you get enough.

It’s not just what you eat that determines the long-term outcomes of weight loss, regular monitoring, support and encouragement play a crucial role especially to reduce prevent regaining weight. In the same study, regular contact with a dietitian supported the participants, and lead to greater weight loss success after 2 years. Enthusiasm can waver when dieting, and a professional can help you to overcome challenges and re-motivate you on your weight loss journey.

Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates. Frank M. Sacks, M.D., George A. Bray, M.D., Vincent J. Carey, Ph.D., Steven R. Smith, M.D., Donna H. Ryan, M.D., et al. The New England Journal of Medicine 2009, 360:859-873February 26, 2009DOI: 10.1056/NEJMoa0804748. http://www.nejm.org/doi/full/10.1056/nejmoa0804748#t=article
Randomised trial on protein vs. carbohydrate in ad libitum fat reduced diet for the treatment of obesity. A.R Skov, S. Toubro, B. Ronn, L. Holm, A. Astrup. International Journal of Obesity, 1999, 23, 5;528-536. http://www.nature.com/ijo/journal/v23/n5/abs/0800867a.html
Effect of normal-fat diets, either medium or high in protein, on body weight in overweight subjects: a randomised 1-year trial. A Due, S Toubro, A R Skov, A Astrup, International Journal of Obesity, 2004, 28, 1283–1290. http://www.nature.com/ijo/journal/v28/n10/full/0802767a.html
Comparison of Strategies for Sustaining Weight Loss, The Weight Loss Maintenance Randomized Controlled Trial. Laura P. Svetkey,; Victor J. Stevens, Phillip J. Brantley, et al. JAMA, 2008;299(10):1139-1148. https://jamanetwork.com/journals/jama/fullarticle/181605
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Improving Gut Health for Weight Management

Recent research has shown a very strong link between gut health and many other aspects of our health, including both physical and mental health.

Inside our gut lives 50 trillion creatures from more than 1,000 different species, some good bacteria and others bad bacteria. This collection of bacteria makes up over 50% of our total body’s cells and around 90% of our total DNA gene pool and it is known as our microbiome.  A healthy and diverse microbiome is essential to our overall health and well-being with many studies showing that a poorly balanced microbiome can contribute to insulin resistance, low-grade inflammation, fat deposition and therefore indirectly participate in the onset of obesity and metabolic diseases.  There is also a very strong gut-brain link and studies have shown that the microbiome can also affect mental health and has even been linked to depression.

So how do we build a healthy microbiome? Firstly, if you have used anti-biotics you might need to take some ‘Probiotics’ (powder/capsules/chewable/liquid varieties) to replace those healthy bacteria that may have been destroyed.  Probiotics are also readily available in fermented foods such as yoghurt, kefir, kombucha, sauerkraut and miso. These foods will help to boost the levels of good bacteria in the gut.

Secondly, in order for these good bacteria to breed in your body and expand their populations, they need to receive adequate ‘food’, which is called ‘Prebiotics’. Prebiotics support the growth of good bacteria and are found in many foods including onion, garlic, leeks, artichokes, stone fruit, watermelon, dried fruit, barley, rye, wheat based products and legumes.

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Rapid weight loss: An effective, long-term strategy

Rapid weight loss has long been viewed with apprehension. There is often a negative stigma associated with diets that lead to an abrupt loss of weight, as people believe that this results in negative outcomes once they return to alternate patterns of eating.

But, extensive research conducted by various health professionals has suggested otherwise.

Rapid weight loss is often achieved by following a very low-calorie diet (VLCD). This type of diet involves very low daily energy consumption in the form of about 800-1200 calories. They are generally only used for short bouts, as people often say they can be difficult to follow.

In truth, VLCDs are formulated, nutritionally complete meals and can be produced as either a shake or bar, or as dietitian-approved meals to ensure an adequate balance of nutrients is achieved.

While following a VLCD, you will enter a state of Ketosis. Ketosis is a normal metabolic process that occurs when your body doesn’t have enough carbohydrates to burn for energy, so it uses stored fat as an alternative. This is generally achieved when your daily carbohydrate intake is <50g, which is equivalent to three medium potatoes or three slices of bread.

Once a very low calorie/ketogenic diet is commenced, it will usually take the individual three to four days (depending on their physical activity levels) to deplete glycogen stores. Lethargy, fatigue, hunger and headaches are common during this time as the body ‘fat adapts’ to its new preferred and primary source of fuel. During the breakdown of fat, your body produces ketones (a byproduct of fat metabolism) which assists in suppressing your appetite and reducing your hunger hormones (Grehlin), which in turn results in rapid weight loss.

Initially, you can expect to lose 1-3kg of fluid and glycogen, as every gram of carbohydrate within the body holds an extra 3g of fluid. This is regained rapidly once you switch out of ketosis; however, those who do follow a rapid weight loss diet often see between 10-25% weight reduction in the first three to six months. After four years, 5% of weight loss is maintained.

In the short term, rapid weight loss diets have been shown effective by scientific evidence all over the world to fight obesity, hyperlipidaemia (i.e. high levels of fat in the blood), and some cardiovascular risk factors such as high blood pressure. Additional benefits include higher satiety and feelings of fullness due to the higher protein intakes, reductions in fat production and increases in fat breakdown, and increased metabolic costs as the body uses more energy to breakdown fat and protein as an energy source in comparison to carbohydrates.

Ketosis also reduces insulin levels (a fat-storage hormone). Insulin activates enzymes, which store energy derived from carbohydrates. As carbohydrate intakes subside, so does insulin and therefore decreases in fat formation and accumulation are significantly evident. A recent study looked at the effects of a weeklong ketogenic diet on Type 2 diabetes mellitus patients. The results showed significant decreases in blood sugar levels as well as markers of body composition (weight, waist circumference, body fat %).

Interestingly, ketogenic/rapid weight loss diets are also widely used in the treatment of epilepsy, as it has proven effective in controlling seizures and other neurological patterns. Studies show that approximately 35% of children treated with the ketogenic diet have greater than 90% seizure control with half of these becoming seizure-free.

If you’re hesitant about losing weight in a short period of time, consider all the emerging evidence that suggests those who follow a rapid weight loss diet achieve greater weight loss in the short- and long-term, and reduce their susceptibility of regaining the weight.

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6 Ways to Optimise your Health this Spring

Now that Winter is on the way out and Spring is here, it’s time to lighten up your diet and take a look at your portion sizes and what you need to do to optimise your health.

Most hearty Winter meals can be quite stodgy and carb heavy. This, combined with cooler weather and decreased motivation to get outside and exercise, can lead to a few extra kilos being gained over the cooler months. Getting back to your optimum weight doesn’t need to involve a diet per se, it really just needs you to have a look at what you are eating, re-evaluate your goals and make some simple substitutions.

  1. Eat seasonally

Make the most of the wonderful spring fruits and vegetables that will be coming into season. Eating food that is in season means that you will be getting more of the nutrients that these foods contain as they most likely haven’t been imported or travelled half way across the country to get to you.

  1. Balance

At the end of the day, the most important thing about getting your diet right is balance, which means everything in moderation, no good foods, no bad foods, all equal foods. Some foods are designed to be eaten more frequently than others less often. Making sure you get variety is the key to a well-balanced diet – concentrate on eating the rainbow and reducing portion sizes.

  1. Avoid packaged foods

Avoiding packaged foods, within reason, can dramatically improve your health. Not only are packaged foods generally highly processed, they also contain preservatives and often a lot of salt and sugar. When doing your shopping and meal planning, think about whole foods – fresh fruit and vegetables, meat, chicken fish, dairy, grains nuts and seeds. If you can include all these things in your diet then you are on the right track. At the supermarket, most of these products (except grains) are generally located around the border, not down the aisles.

  1. Plan your meals

If meal planning is something you do during Winter, then continue it into Spring, but think lighter meals. Replace the casseroles, soups and pasta bakes with vegetable packed stir fries, lean cuts of meat with steamed spring vegetables or grilled fish and salad.

 

  1. Exercise

Reassess your exercise goals. In amongst the rain and cold mornings, Winter can be a hard time of year to keep up that daily exercise. Use these slightly longer days and sun that kisses your skin to get outside, get some vitamin D and set some goals around exercise and stick to them. It doesn’t have to be anything mammoth, even just a 20 minute walk 4-5 days a week is better than nothing.

  1. Socialise

Use the warmer weather to get outside a bit more, catch up with friends and socialise. With the warmer air, the birds sing more and become more social, so should we as humans. You will feel better for it and be better equipped with the daily challenges that life throws at you.

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The short- and long-term advantages of rapid weight loss

There has long been a stigma attached to rapid weight loss diets. Often, people say they lead to short-term success but set the individual up for long-term failure. They say the individual will regain all the lost weight, plus more.

But, as more and more research is done, it is becoming increasingly clear that this is simply not the case.

A study published by The Lancet Diabetes and Endocrinology journal looked at 204 participants enrolled into either a 12-week rapid program or a 36-week gradual weight loss program. The results showed that the rapid weight loss group had better short-term outcomes (greater weight loss) while the long-term weight loss was the same as a gradual weight loss diet.

Rapid weight loss is achieved by a very low calorie diet, usually using shakes, formulas and/or dietitian-approved meals to ensure nutritional adequacy, providing high protein and a balance of vitamins and minerals to help you lose weight while staying well nourished. Consuming low calories (approximately 1,000-1,600 calories per day) promotes rapid fat loss, resulting in improvements to blood sugar levels, blood pressure and cholesterol.

Further, it is very motivating for individuals to see results of their hard work thereby encouraging them to maintain a healthy eating regime. Individuals who follow a rapid weight loss diet often see 10-25% weight reduction during the first 3-6 months and maintain 5% or greater weight loss after four years.

So, if you’re thinking about the optimal rate of weight loss for you, consider this: those who follow a rapid weight loss diet achieve greater weight loss in the short-term AND long-term maintenance, and they are no more susceptible to weight regain than other dieters.

References:
  1. The effect of rate of weight loss on long-term weight management: a randomised controlled trial. Purcell, Katrina et al.The Lancet Diabetes & Endocrinology , Volume 2 , Issue 12 , 954 – 962.http://www.thelancet.com/journals/landia/article/PIIS2213-8587(14)70200-1/abstract
  1. The Association Between Rate of Initial Weight Loss and Long-Term Success in Obesity Treatment: Does Slow and Steady Win the Race?Nackers LM, Ross KM, Perri MG. International journal of behavioral medicine. 2010;17(3):161-167. doi:10.1007/s12529-010-9092-y.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780395/
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Shape up this Spring

Spring has finally sprung so it’s finally time to pack away your winter clothing and, while your at it, look at losing the few extra kilos you put on during winter.

Of course, this is often easier than said. So, how exactly do you go about getting healthier, particularly in time for summer?

Well, first you must get well-nourished and second, you must get active.

Here are 10 simple steps to help you get there:

  1. Start drinking more water
    Did you know we all need around 35-45ml of fluid (preferably water) per kilogram of our body weight per day to stay well hydrated?  For an average 70kg person, this means they need to consume around 2.5-3L of fluid per day! This may sound like a lot but some of this can come from eating more fruit, salads and vegetables which contain up to 99% water plus also drinking more calorie-free, low caffeine and non-alcoholic beverages.
  2. Move more
    Did you realise that during winter some of us don’t even achieve 3,000 steps per day and the recommendation for good health is around 10,000 steps per day? The easiest way to monitor your activity levels is to get a pedometer, FitBit or use a smart phone app to count your steps which will keep you motivated to stay active and achieve your 10,000 steps per day goal.
  3. Decrease the belly bloat
    Start by increasing your dietary fibre intake to assist with more regular and healthy bowel movements which can also assist with decreasing weight by keeping your fuller for longer.
  4. Nourish your gut flora and fauna
    Include some probiotics into your diet daily by adding yoghurt to your breakfast or as a snack for good gut health.
  5. Superfoods for Superhealth
    Superfoods include many everyday foods such as spinach, kale, sweet potato, tomatoes and berries as well as less well-known foods such as chia seeds, quinoa and amaranth.  Add a superfood from fruit, vegetable or whole-grain sources to every meal for better health.
  6. Increase dietary variety
    The key to a good diet is variety. No foods are good or bad but there are certainly foods which are best consumed either in smaller or larger quantities and at different frequencies throughout the week. Start with increasing the colour in your diet to boost your anti-oxidant intake which may also assist to improve immunity.
  7. Metabolism boosting foods
    It is true that some foods can slightly increase metabolism, therefore add some chilli and other spices to your plate as well as caffeine in moderation for a metabolic boost.
  8. Avoid unnecessary calories
    Rather than deprive yourself of all ‘indulgence’ foods, why not try avoiding unnecessary calories from condiments, dressings and sauces by asking for these to be served on the side when you are eating out. Then you can still have your little ‘indulgences’ occasionally.
  9. Consume protein-rich foods at every meal
    Did you know that protein-rich foods can help to moderate your appetite to avoid overeating? Start by including one protein-rich foods such as lean meat, chicken or fish, eggs, low fat dairy or legumes/beans/pulses to every meal.
  10. Aim to get a minimum of 7-8 hours sleep
    Sleep can also help to regulate appetite because when we are tired we tend to make poor food choices plus we often feel the need to snack due to boredom or  to increase our energy levels.
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Healthy ways to add flavour

Growing up, I was often told that salt was the only or best way to add flavour to a meal. But, that’s not really true.

In fact, there are several ways you can add flavour to your food without compromising the nutritional benefits it can offer.

  • Fresh herbs – Herbs will go a long way in adding flavor to a meal without the need for additional sauces and salt. Consider combinations such as parsley, garlic and lemon or coriander with Mexican foods or mint, coriander, dill and parsley in a salad drizzled with lemon juice rather than a creamy dressing.
  • Curry powder – this can be used to enhance the flavour of a meat and vegetable dish and will give a certain saltiness, removing the need for added salt.
  • Lemon juice – the zing and tartness of lemon juice can lift the flavour of many dishes when added at the end. Lemon juice with a fresh fillet of fish rather than tartare sauce. Add lemon juice to a grilled piece of lamb or chicken to give it a Mediterranean inspired flavour. Also perfect as a salad dressing.
  • Garlic – a great addition to most savoury dishes. With minimal calories, garlic packs a good punch of flavour and completes most pastas, casseroles and stews, and when sautéed with onion it makes the house small amazing and give a great caramelization to these dishes. It even gives a great bite to a salad dressing.
  • Cinnamon – such a versatile spice and when added to a bowl of porridge is the difference between a bland bowl of oats and something a bit more exciting. Often cinnamon added to oats eliminates the need for the addition of honey or sugar, saving excess calories. The same goes for a smoothie or a slice or muffin mix.
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7 easy food swaps… and why

Sometimes, making small adjustments to what we eat can lead to significant, long term better health benefits. In fact, it could be as simple as doing these seven easy trades.

  1. Milk chocolate for dark chocolate

Most dark chocolate contains less than half the sugar and calories than milk chocolate. Dark chocolate is also stronger in taste as it is bitter and richer, therefore you won’t be able to eat as much (hopefully!).

  1. Pasta for ‘zoodles’

For something different, try making zucchini noodles instead of pasta next time you make a Bolognese. You will find that you will probably be just as full but you will have consumed a fraction of the carbs.

  1. Beef Mince for Turkey Mince

Turkey mince is lower in calories and fat and higher in protein than beef mince, therefore it will do less damage to the waist line and you will feel more satisfied after eating it. Just make sure you choose a lean variety.

  1. Latte for White Tea

Most people need at least one coffee per day, but make it stop there. Before grabbing that second latte or cappuccino for the day, think of the calories it contains and consider swapping it for a good old cup of English Breakfast tea with milk. You will still get the caffeine benefits from the tea but will save yourself at least 100 calories.

  1. Mayonnaise for Avocado

Avocado is a great source of monounsaturated fats, which are essential for heart health. They also contain a lot less sugar and salt than your typical mayonnaise and will fill you up more than what adding mayonnaise to a sandwich will.

  1. Granola for Oats

Porridge has stood the test of time and is still one of the best breakfast options. It is low GI, low GL, a great source of fibre, is low calorie and it is filling. A similar sized serve of oats compared with granola contains about 1/3 less calories, half the fat and half the sugar. If you don’t like oats plain, add some fresh berries and yoghurt and you are still better off than eating the granola.

  1. Cream Cheese for Cottage Cheese

Wherever cream cheese can be used, cottage cheese can be substituted in for significantly less calories and fat. Things like cottage cheese on grainy crackers, in cheesecake, as a dip, in a sandwich.

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