Weight
Healthy weight
What is a healthy weight range?
Healthy Weight Range = Body Mass Index (BMI) of roughly 20 to 25.
It is calculated using your weight in kilograms divided by your height in metres squared.
Doesn’t account for muscle mass, fitness, family history or insulin resistance. All of which are important.
Death
67% of adults + 25% of kids are above a healthy weight range.
It reduces life expectancy due to all causes of death shown in this study
BMI 25 to 30 = 3 years of life lost
BMI 30 to 40 = 6 years of life lost
BMI > 40 = 9 years of life lost
Being above a healthy weight range is also resopnsible for 8% of the total burden of all diseases.
Disease
Being above a healthy weight range is linked to over 200 medical conditions:
Type 2 diabetes
Coronary heart disease
Stroke
Gallbladder disease
Osteoarthritis
Sleep apnoea
Low quality of life
Anxiety and Depression
Cancer
Being above a healthy weight range increases the risk of cancer including-
Endometrial Cancer 2x to 7x
Oesophageal 1.5x to 4.8x
Stomach, Liver and Kidney 2x
Multiple myeloma 1.1x to 1.2x
Meningioma 1.2x to 1.5x
Pancreatic 1.5x
Colorectal 1.3 x
Gallbladder 1.2x to 1.6x
Breast Cancer 1.2x to 1.4x
Ovarian 1.1x
Thyroid 1.2x
Causes
Our brains have evolved to reinforce behaviour that leads to finding nutrient and energy dense food, so that we don’t starve.
In addition with have a body fat set point, so once we put on a little weight, our metabolism slows and hunger increases to try not to lose this weight. Again so we don’t starve.
Unfortunately due to capitalism and the food industry, we are now surrounded by cheap, readily available, energy dense foods that are also designed to be hyper-pallatable and maximally delicious and addictive.
Overview
Find an eating style that works for you, with foods you enjoy, and can afford.
Make your goals specific e.g. abstain from alcohol for the month of July
Pick the simplest change first.
Limit sugar
High amounts of sugar and refined carbohydrates is likely responsible for the majority of weight gain. Limit foods with added sugar or a high glycaemic index (soft drinks, fruit, white bread, white rice, potatoes).
Move your body
Any movement helps. General aim is about 150 min of moderate exercise per week e.g. 5 days, 30min, brisk walk.
General Principles
Eat food, not too much, mostly plants.
Eat food: Eat things that look like food. Limit packaged, processed ‘foods’. Only shop around the outside of the supermarket where fresh ingredients are. Don’t eat anything your great grandmother wouldn’t be able to identify as food.
Not Too Much: Try to always leave the table a little hungry. Not too much also means a diverse variety of foods.
Mostly Plants: The majority of quality nutrients we eat come from plants. The cultures are the world that live longest all eat plant focused diets. Whole plant foods are less energy dense but still fill us up.
Mediterranean Diet
Diets similar to the Mediterranean Diet has the best evidence for promoting health and longevity.
High in Fruit and Vegetables, Fatty fish, Olive Oil, Dairy and Cheeses, Nuts, Grains and Pulses.
Limited red meat, minimal processed foods, full of fibre, good oils, omega-3 fatty acids.
Eating Timing
Choose when you like to eat.
If you like regular meals then you could choose a balanced eating style that involves three meals a day with healthy snacks.
If you don’t usually eat breakfast then choosing Intermittent Fasting for 16 hours with an 8 hour eating window from midday to 8pm might suit you.
Meal replacement products.
Products such as Optifast that provide a meal replacement shake, soup, or dessert can be helpful. Can be used for short-term intensive weight loss as part of a Very Low Energy Diet for up to 12 weeks.
Food Diary / Apps
e.g. My Fitness Pal. Really useful to understand how energy dense some common foods are.
Recruit Helpers
Dietitian, Exercise Physiologist, Psychologist, or GP can all help.
Drink
Try not to drink calories. Drink mostly water or clear fluids like coffee and tea. Limit milk, juice, soft drinks and alcohol.
Food Restriction
I like Dr Peter Attia’s approach - Try to always being doing one of - Time Restriction, Dietary Restriction or Caloric Restriction.
1) Time Restriction e.g. Intermittent fasting
2) Dietary Restriction e.g. Limit refined sugars
3) Caloric restriction Having periods of time with reduced kilojoules or fasting
Medications
We know that as little as 5 to 10% weight loss makes a huge difference to overall health but that most people will struggle to do this with diet and exercise alone.
Medication can assist with weight loss and is indicated with a BMI > 30 or a BMI > 27 with a comorbidity and they can be used long term if effective.
These can be useful to help kick start weight loss, particularly if have a pre-existing medication like diabetes, sleep apnoea, knee osteoarthritis, or depression that makes it hard to keep a healthy eating plan or to exercise.
Phentermine
(Duromine)
Cost: $100 to 150 per month.
Works on hunger by releasing Noradrenaline.
Class: Stimulant / Sympathomimetic
Dose: 1 tablet daily in the morning of either 15mg, 30mg or 40mg.
Effect: 4% to 6% weight loss at 6 months.
Side effects: Poor sleep, agitation, palpitations, nausea, diarrhoea, dry mouth.
Precaution: Anxiety disorders, cardiac disorders, seizures, stroke.
Can be combined with Topirimate for up to 14% weight loss at 1 year.
Saxenda
(Liraglutide)
Cost: $375 per month. Cheaper if lower dose.
Works on hunger.
Class: Diabetes medication / GLP-1 analogue.
Dose: Subcutaneous injection into abdomen. Start at 0.6mg. Increase dose by 0.6mg with minimal interval of at least 1 week up to 1.2mg, 1.8mg, 2.4mg, to 3mg maximum dose.
Effect: Weight loss is 8% at 56 weeks. Those who lost >5% at 16 weeks, lost 11% at 56 weeks.
Side effects: 25% has significant nausea, peaks around week 6. Titrate up slower over 3 months to reduce. Slight increase risk gall stones. Stop after 12 weeks if not achieved 5% loss on 3 mg per day dose.
Contrave
(Naltrexone / Buproprion)
Cost: $250 per month.
Works on both dopamine reward system and hunger.
Dose: 2 tablets twice daily, titrate over 4 weeks.
Effect: Weight loss 5 to 7% at 1 year, can be up to 12% with behaviour modification therapy. Stop if weight loss not >5% at 16 weeks. Good time to quit smoking or alcohol.
Side effects: Nausea, vomiting, constipation, headache, poor sleep.
Contraindications: Contraindicated in high blood pressure, drug use, pregnancy, opiates use, seizures.
Drug interactions: Increase levels of Antipsychotics, B blockers, Antidepressants, limit to max 2 tablets if on clopidogrel.
Newer Medications
Ozempic (Semaglutide). GLP-1 analogue. Weekly subcut injection into abdomen. 1mg gets 10% weight loss, 2.4mg dose achieves 13% weight loss. Not available presently.
Tirzepatide. Not available yet. Weekly subcut injection into abdomen. Weight loss around 20 to 22% weight loss. Newer triple injections in development with 3 x GLP-1 analogues get around 30% weight loss.
Surgery
Bariatric surgery is a really effective long-term option.
Programs
VLED program
Support from a tele-dietician and weight loss coach over 18 weeks.
And it’s FREE with almost ALL private health insurance
Needs referral from GP