Weight loss: every kilojoule counts

I recently attended a symposium, organised by Oldways in association with Adsa (Association for Dietetics in South Africa) and SAAFoST (South African Association for Food Science & Technology), which featured a number of thought-provoking lectures on obesity and how it can be treated. One such lecture was by Dr John Foreyt, Professor at the Department of Medicine, Baylor College of Medicine in Houston, Texas, who spoke on "Energy Balance and Managing Sweetness".

Scary statistics

As an introduction, Prof Foreyt reminded his audience about the mind-boggling statistics associated with the current global obesity epidemic. In a nutshell, here are some of the most sobering facts:

• 33% of adults in the world are either overweight or obese
• 23.2% of adults or 937 million people (24% men and 22.4% women), are overweight
• 9.8% or 396 million (namely 7.7% men, and 11.9% women), are obese
• If these trends continue, then by 2030, 57.8% of the global population will be overweight (2.16 billion) or obese (1.12 billion)
• In South Africa, 56% of our adult female population is already overweight or obese, which is slightly lower than in the USA, where 62% of adult women have a BMI exceeding 25.
• South African men with an incidence of overweight or obesity of 29% fare better than their counterparts in America, where a staggering 71% are overweight/obese.

(Foreyt, 2012)

In the light of these seemingly insurmountable statistics, Prof Foreyt (2012) pointed out that “All Calories Count” and that we need to strive for a healthy lifestyle that is all about balance based on a healthy diet and healthy physical activity.

Vital research results

Prof Foreyt who has collated the results of countless nutritional research studies that compared the diets of obese individuals, categorically stated that “scientists have not determined that any specific food or beverage is the root cause of obesity”.

Although most members of the public would like a simple solution and a "single culprit" theory (blame the obesity epidemic on sugar or carbohydrates or fat or cold drinks or alcohol), the actual "culprit" is an excessive intake of energy (calories or kilojoules).

Prof Foreyt maintains that the most important equation that determines overweight and obesity is as follows:

“If calories in exceed calories burned off, the excess becomes body fat and weight goes up.”

What about sweetness?

Human beings are born with a sweet taste and even mother’s milk is slightly sweet. It is, therefore, important according to Prof Foreyt that parents learn to manage, not to banish, sweet foods. At first glance this smacks of heresy - manage sweet foods? Nonsense, they need to be banished if we want to win the battle against obesity!

In this case, Prof Foreyt reported that research studies have shown that when parents banish a favourite food or foods (sweets, chocolates, etc), this can reduce children’s ability to control the intake of these foods the moment they are not being supervised and cajoled.

After all, forbidden fruit has always been desirable, ever since Eve saw that apple!

Consequently Prof Foreyt emphasised that we need to “reconcile our innate taste preferences with the realities of our modern life and food supply”. This means that all foods and beverages can be part of a balanced diet as long as we can control how much and how frequently we ingest these foods and drinks.

Finding the right diet?

Prof Foreyt continued his presentation by pointing out that our modern world is not only overburdened with ever increasing obesity, but that we are also constantly being bombarded with "new" slimming diets and "magic’" weight loss products.

So which of these myriad diets that promise you miracles, actually does the trick? Which diet provides the best solution and the greatest, permanent weight loss? Low-fat, or high-protein, or zero-carbs or 60% carbs?          

A study reported in the New England Journal of Medicine in 2009, compared the effects of six diets with different macronutrients compositions (i.e. protein, fats and carbs) on body weight after two years.  More than 800 overweight adults with BMIs ranging from 25 to 40 were randomly selected to use one of the following weight-reduction diets:

*either a low-fat diet (20% of energy from fat), or a high-fat diet (40% energy from fat)

*or either an average protein diet (15% of energy from protein), or a high-protein diet (25% of energy from protein)

*or either a high-carbohydrate diet (65% of energy from carbs), or a low-carbohydrate diet (35% of energy from carbs).

The researchers found the following results:

• Satiety (feelings of fullness), hunger, satisfaction with the diet and attendance of diet sessions were similar for all six diets
• Attendance, contact, commitment, engagement, adherence and other behavioural factors rather than the macronutrient composition of the diet were the main factors that determined weightloss
• As long as the energy content of the diet was reduced, meaningful weightloss occurred, no matter what the macronutrient content of the diet looked like
• Dieters who attended group sessions for support and encouragement were more likely to have lost weight and sustained their weight loss at the 2 year follow-up no matter which macronutrient combination they used to lose weight

(Foreyt, 2012)

Modest, but realistic goals

Most individuals who need to lose weight are totally discouraged before they even start with a diet and/or exercise programme. “I must lose 30 kg!” or “My hubby is obese and the doctor says he must lose 45 kg!,”are statements I often hear from the public. Faced with this type of demand, many people will just give up without even trying.

According to Prof Foreyt (2012), it is much more productive and less daunting to ask patients to try and lose 5-10% of their weight, than to present them with an unclimbable mountain! If a 90 kg man is told that he only needs to lose 9 kg or a 70 kg woman is encouraged to lose between 3.5 and 7 kg, the ‘do-ability’ of weightloss comes a lot closer.

It is interesting to note that studies indicate that even small losses of between 5 and 10% of body weight can produce improvements of all of the following health problems associated with overweight and obesity. 

Losing 5-10% of your body weight can:

• Reduce glucose and insulin levels which together with a reduction in glycated haemoglobin (diabetes marker), will improve your insulin resistance and/or type 2 diabetes
• Increase "good" HDL-cholesterol levels and decrease ‘bad’ LDL-cholesterol and triglyceride levels to improve your blood fat picture and heart conditions
• Decrease blood pressure which will help against hypertension

(Foreyt, 2012)

So forget about the "mountain" and concentrate on scaling the first little hill. Try to lose those first 5 or 10kg with a sensible balanced diet and by increasing how much exercise you do, and see what a dramatic improvement this will have on your disease markers, your general health and your quality of life.

Prof Foreyt’s secrets of successful weight loss 

Prof Foreyt outlined what we need to do every day to lose weight successfully:

• Sleep 8 hours
• Eat breakfast
• Walk briskly for 60 minutes
• Write down what you eat
• Weigh your food portions
• Find a support group
• Never give up

These simple steps can help even the most recalcitrant dieters to lose weight.

(Foreyt, 2012)

- (Dr IV van Heerden, DietDoc, May 2012)      

(Photo of woman eating a hamburger from Shutterstock)                             

References:

(Foreyt J P (2012). Energy balance and managing sweetness. Paper presented at Managing Sweetness, An Oldways Event in association with ADSA and SAAFoST, 23 February 2012. Sandton Convention Centre, Johannesburg)

Read more:

Are you ready to lose weight?
Lifestyle overhaul needed to cure obesity
Protein vs. carbs: the great debate
Obesity takes hold in Africa, UK