The weight issue- if diets don’t work, what does?

Diets don’t work. (www.drmarcellestastny.co.za/diets do not work) An obese woman has a one in 677 chance of achieving a normal weight in a year. An obese man has a one in 1 290 chance of being a normal weight in a year. A major risk factor for being 5kg heavier in a year from now is to be on a diet now.

All recommendations seem to be that whatever you do it must be “simple, flexible and sustainable.” Kilojoule restriction for weight loss does not work. Permanent modifications to diet and lifestyle do work.

If you have been gaining 2kg every year since the babies were born, then you can expect to keep doing so. Rather than trying to lose weight, try to maintain your weight for a year. If you want to maintain your weight, you must look at what you are doing and make small, sustainable changes. For many of my patients, too many fizzy cooldrinks is a big culprit. Do you have a 3pm slump, helped by a coffee and rusk? It may be interesting to keep a food diary for a week to spot these easy targets. It may even have something to do with your chronic medication. Discuss this with your doctor. Could your contraception or antidepressant add to weight gain?

We are living our lives by a lot of external food rules – “Gluten-free”, “clean living” – or whatever the current trend is. Perhaps it is time to ignore the external rules and try to pay attention to our internal cues. Do you binge eat when you are emotional? Rehab programmes teach their clients about HALT, which can be usefully applied here. Do you binge eat when you are H-Hungry, A-Angry, L-Lonely or T-Tired?

These and other principles are covered in “mindful eating practices” or similarly “intuitive eating”. There are several self-help books on these topics. Mindfulness is a therapeutic technique which encourages you to be completely present in the moment, and not distracted or overwhelmed by what is going on around you. It is a difficult concept for the Western mind grasp. Our entire lives are filled with distractions and “escapes”.

Learning to turn your awareness inwards for your nutritional cues is hard, and you might need the help of a good dietician to help crack the code. In Cape Town, I work with Debbie Collings or Julie Deane Williams. My patients may or may not lose weight with mindfulness principles, but their weight mostly stabilises, which in this field is a major win.

Stop thinking about how you are going to lose weight. Rather, think of how you are going to feed your hunger.

I tell my patients to try to stop thinking about how they are going to cut calories to lose weight. I would rather they think of how they are going to feed their hunger. We are biological beings. We are going to get hungry. If we think of feeding our hunger, the concept of nutritional density comes into play. Eat fresh, healthy food that will give you all the nutrients you need and send the message to your brain that you are full. Do not buy processed convenience foods. That is what you will eat when you are hungry, so best if it’s not available Let’s talk about weight- why are we so fat?

The importance of committing to a healthy lifestyle cannot be overstated. One of my patients accused me of using the term “healthy lifestyle” to sugar coat the word for “diet”. But I mean healthy lifestyle, not kilojoule restricted lifestyle. We need to get enough sleep. We need to exercise. Let’s talk about exercise Weight loss is not guaranteed to follow. Perhaps it need not be the aim anymore. Maybe we should make peace with food and strive to be healthy and eat healthy food.

Further references:

• ” Brooks, S. (2015) Mindful Eating. CreateSpace Independent Publishing Platform.
• “Minding the food space”- an eight-week course offered in Cape Town www.mindingthefoodspace.co.za