Losing weight and maintaining it.

The science behind weight loss
The science behind weight loss in some respect is quite simple. Your weight is a balance between how much energy you take in (calories in food and drink) and how much energy your body expends (burns):
• If the amount of calories that you eat equals the amount of energy that your body uses up, then your weight remains stable.
• If you take in more calories than you burn up, you will put on weight. The extra or excess energy is converted into fat and stored in your body.
• If you consume fewer calories than you burn up, you will lose weight. Your body will then begin to tap into its fat stores to get the extra energy to supply its needs.
In essence, to lose weight, you need a calorie deficit. You can achieve this calorie deficit by:
• Eating less: taking in fewer calories from food.
• Engage in more physical activities: burning up more calories.
There are 3,500 calories in one pound (0.45 kg) of fat. Therefore, cutting down your calories by about 500 calories each day can result in losing one pound of body weight each week.
It is not advice to lose weight too fast. You should aim to lose the weight gradually. If you lose more than a kilogram per week, you may lose muscle tissue rather than fat. This isn’t sustainable weight loss. So, it is recommended that you lose an average of 0.5 to 1 kg per week or about one to two pounds per week.
Losing weight required lifestyle change for life
Some people lose weight by strict dieting for a short period. However, as soon as their diet is over, they often go back to their old eating habits, and their weight goes straight back on. Losing weight and then keeping it off, needs a change in our lifestyle for life. This includes such things as:
• The type of food and drink that you normally consumed.
• The type of meals that you eat.
• Our eating pattern.
• The amount of physical activities that you do.
Tip: Work with family and friends to help and encourage you to stick to a healthy lifestyle. You can consider a lifestyle change for your whole family.

Before you get started
Motivation is crucial
To lose weight and to keep it off require you being motivated to really wanting to lose weight and to improve all aspects of your lifestyle. No weight-loss plan will work unless you have a serious desire to lose weight. You may not feel that being overweight or obese is a problem to you. So, you may have little motivation or desire to lose weight. That is fine, so long as you understand the health risks.
Tip: Write down the reasons why you would like to lose weight. Put it in a place that you can see at all times so you can keep referring to this list so as to keep motivating yourself.
Set goals with a realistic timescale
Based on the recommended rate of weight loss I explained above; set a clear weight loss goal with a realistic timescale for you. Some people aim to get down to a perfect body weight. However, this may be a lot of weight to lose for you and you may get fed up about poor progress, and give up. So, you may find it helpful to break up your weight loss goal. For example, you may wish to set yourself a goal to lose 4 kg over the following 4 to 6 weeks. Once you have achieved that goal, you can set yourself another.
For most people, you can start to get health benefits by losing even just 5-10% of your starting weight. For example, if your starting weight was 100 kg, losing 5-10 kg in weight will produce some health benefits for you, even if you are still not at your ideal weight.
Tip: Aim to lose weight steadily, around 0.5-1 kg per week. For most people, health benefits can come from losing the first 5-10% of their body weight. This is on average about 5-10 kg.
Set up an action plan
In addition to setting yourself realistic weight loss targets, it is also helpful to set yourself an action plan. Be realistic and consider what you feel will have the most impact on your weight. For example, if you currently have a piece of cake every day, your action plan could be to reduce this to trice per week only. Your action plan might start with three main goals, and once you have achieved these goals, you can reset your action plan and think about other changes you might be able to make. The idea is to make small, gradual changes that you can stick to for life.
Keep tab on your current food intake
It is helpful to know how much you normally eat. Try keeping a diary, writing down everything that you eat and drink over a week or so. Include even the smallest of snacks. Are there times of the day that you tend to snack more? Are you eating three meals a day? Are there some snacks that you don’t need? You may find it helpful to discuss your diary with your practice nurse, your doctor or a dietician. The simple fact is that, to lose weight, you must eat less than your current food intake.
Tip: Do not forget that some drinks contain large amount of calories, including alcohol and some fizzy drinks.
Eating to lose weight
Aim to eat a healthy balanced diet
Briefly, a healthy diet means:
• Making up the bulk of most meals with starch-based foods (such as cereals, bread, potatoes, rice, and pasta). Wholegrain starch-based foods should be eaten when possible.
• Eating plenty of fiber in your diet. Foods rich in fiber include wholegrain bread, brown rice and pasta, oats, peas, lentils, grain, beans, fruit, vegetables and seeds.
• Having at least five portions of a variety of fruit and vegetables per day. These should be in place of foods higher in fat and calories. For example, fruit makes a good, healthy snack if you feel hungry.
• Limiting fatty food such as fatty meats, cheeses, full-cream milk, fried foods, butter, etc. Use low-fat options where possible. Examples are:
o Skimmed or semi-skimmed instead of full-cream milk.
o Using low-fat, mono-unsaturated or polyunsaturated spreads instead of butter.
o If you eat meat, eating lean meat, or poultry such as chicken.
o Try to grill, bake or steam rather than fry food. If you do fry food, choose a vegetable oil such as sunflower, rapeseed or olive.
• Avoiding sugary drinks and foods such as chocolate, sweets, biscuits, cakes, etc.
• Limiting other foods likely to be high in fat or sugar such as some take-away or fast foods.
• Eating three meals a day and not skipping meals. Always have breakfast. Eat each meal slowly. Skipping meals will just make you feel more hungry, make you think more about food, and make you more likely to overeat in the evening or snack between meals.
• Trying not to add salt to food, and avoiding foods that are salty.
• Including 2-3 portions of fish per week. At least two of these should be ‘oily’ (such as herring, mackerel, sardines, kippers, pilchards, salmon, or fresh tuna).
Tip: Low-fat foods are generally best. But remember, some low-fat foods and drinks such as alcohol, sugary drinks, and sweets, are still high in calories.
Extra tips for losing weight
1. Eat regular meals. This can help you to burn calories at a faster rate and avoid becoming too hungry. It can help in regulating the hormones that are involved in controlling appetite. It can also help you adapt well to a routine, reduce the likelihood of unplanned temptations, and encourage you to develop good self-control.
2. Eat breakfast. Eating breakfast helps to control your blood sugar levels, can kick-start your metabolism and prevent you from snacking or eating impulsively later on. It has also been linked with increasing activity levels throughout the day, by replenishing your energy levels.
3. Make sure each meal is balanced. Think about what you’re putting on your plate at each meal time. Half your plate should be made up of fruit and/or vegetables. A quarter of the plate should contain your meat, fish, beans or other protein sources. The other quarter should contain your starchy carbohydrates such as rice, pasta, potatoes or bread. A balanced meal will provide you with all the nutrients you need while keeping your blood sugar levels steady and satisfying your hunger.
4. Don’t let yourself get too hungry. If you go for long periods without eating, this can result in you eating more when you eventually do eat and can cause you to crave unhealthy snacks. Eating every 3-4 hours will help to prevent this.
Plan what you eat
It is important to plan ahead. Perhaps you could plan each day’s meals and recipes the day before, or plan a week’s meals at a time. In this way you will know exactly how much food you will be eating. This is better than looking in the cupboard and fridge before mealtimes or snacks to see what is there.
It is best to separate eating from other activities. This helps you to keep to your planned eating for the day. So, try not to eat whilst on the move, whilst watching TV, during meetings, etc.
Tip: plan what you are going to eat tomorrow today.
Modify your eating habits
Do you have any eating habits that can improve?
• Are you eating larger and larger portions when you have a meal? Deliberately try to take smaller portions when you have a meal. Do not feel that you have to empty your plate. Perhaps change the plates in your cupboard which may be large to more medium-sized plates. In this way you will naturally serve up smaller portions.
• What do you have for snacks? Try changing chocolates, cakes or crisps for fruit.
• Do you have second helpings at mealtimes when you are really already full?
• Skipping meals is usually a bad idea. It sounds a good idea, but many people just become hungry, have snacks later in the day, and eat too much at the next meal. Eating at regular mealtimes may be a first important change. It is best to have three healthy meals a day.
• Do you always have a pudding? Will light yoghurt do instead of a sweet pastry?
• Do you eat quickly? Are you ready for a second helping before most people have half finished their first plateful? Overweight people, on average, eat faster than slimmer people. It is best to train yourself to chew each mouthful for longer, and to eat slowly.
• Do you give yourself time to feel full? It takes 15-20 minutes for the brain to register that you feel full. The hormones that regulate your appetite need time to kick in. So, eating slowly and allowing yourself time to feel full can help you to lose weight.
• Do you watch TV while you are eating? Sometimes having distractions and not concentrating on mealtimes can cause you to overeat. Sit down at the table during meals, focus on what you are eating, taste the food and become more aware of your food and eating habits.
Tips: eating three healthy meals each day, including breakfast, is better than skipping meals. Eat slowly, chew longer. Put your knife and fork or spoon down between each mouthful.
Change the food you buy
One step towards improving eating habits is to change the contents of your shopping basket. For example, if you never buy biscuits, they will not be in the cupboard to tempt you. Most food labels say what is in the food, so this can help you to buy healthier food. It may be helpful to plan a shopping list, and stick to it. However, whilst you are learning which the healthier foods are, it may also be helpful to spend some time comparing food labels before deciding on what to buy.
Tips: do not shop for food when you are hungry; after a meal is best. Remove temptations by changing the contents of your cupboards.
Try new recipes
Most people have a standard set of recipes and meals that they repeat. These may be old favourites, but you may need to adapt these and also find new, healthier recipes.
Tip: when you are on a weight-reducing diet, try to learn a new healthy recipe each week. When you have reached your goal weight, you should then have plenty of new healthy meal ideas to maintain the new weight.
Consider using more soup
There is some evidence that eating soup may fill you up for longer. Also, if you have soup as a starter to your meal, you are less likely to overeat for the rest of your meal. If you take, for example, chicken and vegetables and have this with a drink of water, you will feel full for a certain period of time afterwards. However, if you take the same food but blend it with the water to make a soup, eating the soup can keep your hunger satisfied for a longer period. This is thought to be due to the fact that your stomach empties more slowly if you eat soup than if you eat chicken and vegetables and drink water separately. As a result, your stomach wall is stretched for a longer period and messages are sent to your brain switching off the feeling of hunger for a greater period of time.
Tip: Avoid creamy or high-calorie soups and make sure that it is a low-fat soup that you are consuming.
Are you feeling physically hungry?
Your appetite is a very powerful thing. This is why many people find it so difficult to lose weight. It is true that some people feel hungry more often than others. However, feeling hungry does not always mean that your body physically needs food. Sometimes you can feel emotional hunger. That is feeling hungry because you are tired, bored, fed up or upset. Think about this and try to resist eating as soon as you feel hungry. Are you feeling physically hungry or are you just looking for food to fulfil an emotional hunger? If you do have a strong appetite, try to fill up at mealtimes with vegetables and fruit. These have a lot of fiber and bulk, but are low in calories.
Tips: drink lots or water and eat lots of fruit and vegetables to help counter physical hunger. Think about whether your hunger is for emotional reasons.
About special diets
Many special ‘wonder’ diets are advertised, but they are often not helpful. This is because your old eating habits will usually return after a short special diet, and weight often goes back on.
Tip: it is not usually a special diet that you need, but a lifelong change to a healthier diet as part of a healthier lifestyle.
Watch what you drink
Many people use drinks full of calories to quench their thirst. Sugary drinks, such as cola, tea and coffee with milk and sugar, milk, and alcoholic drinks, all contain calories. Alcoholic drinks also contain a lot of calories. One of the easiest ways to cut back on calories is simply to drink water as your main drink which is the best.
Top tips: keep some water in a plastic bottle in the fridge. Chilled water is surprisingly very refreshing. .
A research trial involving water
A study published in 2010 concluded that drinking water just before meals may also help people to lose weight. In the study, 48 overweight adults aged 55 to 75 were put into two groups. The first group was asked to eat a low-calorie diet but not to drink any extra water before meals. The second group was asked to eat the same diet but also to drink two glasses of water (500 ml) just before each meal. After 12 weeks the group drinking water had lost, on average, about 2 kg more than the non-water drinking group. The theory was that the group drinking water felt fuller during the meal and so ate less food at each meal.
This is just one small study and so it is difficult to base firm advice on it. However, it sounds logical and may be worth a try. Note: drinking excessive amounts of water is not helpful and, in rare cases, can be dangerous. There have been a few case reports of people dying from drinking excessive amounts of water. However, the extra 500 ml of water per meal in this study is good.
Increase your physical activity levels
It is recommended that all adults should aim for at least 30 minutes of moderate-intensity physical activity at least five days per week. However, if you are overweight or obese and are aiming to lose weight, if possible you should try to do around 60-90 minutes at least five days per week.
Moderate physical activity includes: brisk walking, jogging, dancing, swimming, badminton, tennis, etc. In addition, try to do more in your daily routines. For example, use stairs instead of lifts, walk or cycle to work or school, etc. Avoid sitting for too long in front of the television or a computer screen. Take regular breaks whilst working. The good news is that you don’t have to do this physical activity all in one chunk. You can break it up into blocks of 10-15 minutes.
Top tip: build your exercise levels up gradually. If you are not used to physical activity, try starting with a 30-minute brisk walk every day and then building up from there.
Monitor your behaviour and progress
Just as keeping a food diary can be helpful at the beginning if you are trying to lose weight, it can also be useful as a way to monitor your eating during your weight loss. Studies have shown that keeping a food diary can help people lose weight just through the process of writing things down. You can use the same diary to keep a track of your physical activity levels as well.
It is also important to weigh yourself regularly to monitor your progress. Once weekly is recommended. The first kilogram is the easiest to lose. This is because you lose water from your body at first as well as fat. Be aware that the first kilogram or so may seem to fall off, but then the weight loss slows down. This is normal. Also, don’t be disheartened by minor weight increases or levelling off in weight for a few days. Look for the overall trend in your weight loss over several months.
Top tip: regular weighing and encouragement by a practice nurse; your doctor or dietician may be helpful.
Get help and support
Some people may feel motivated enough and have all the information they need in order to lose weight without any help from others. However, you don’t have to try to lose weight alone. There is a wealth of help available. Ask your doctor or practice nurse for advice. A referral to a dietician may be helpful. One-on-one counselling or group counselling may be available in your area on the NHS. There may also be some local groups to help you increase your physical activity levels.
A number of commercial weight loss groups meet regularly in the UK. In fact, there is some research evidence to suggest that people who join a weight loss group are more likely to be successful in losing weight than those who don’t. There are also internet-based programmes and self-help books that can help you with your weight loss.
Treatment with medicines to help with weight loss
Medication to help with weight loss may be an option for some people who want to lose weight. However, there are no wonder medicines available, and lifestyle changes to improve your diet and increase your physical activity levels are still paramount.
The medicine called orlistat is available on prescription from your doctor. Low-dose orlistat is also available to buy over-the-counter in pharmacies. Doctors and pharmacists are given specific guidelines on when orlistat should be used. It cannot be used in everyone who wants to lose weight and is only recommended in people over a certain body mass index (BMI). For a doctor to prescribe orlistat, they also need to be sure that you have tried changing your diet and increasing your physical activity levels first.
Orlistat works by blocking chemicals (enzymes) in your gut (intestine) which digest fat. Nearly a third of the fat that you eat is blocked by orlistat. The undigested fat is not absorbed into your body, and is passed out with your stools (faeces). It is important to follow a low-calorie, low-fat diet and maintain regular physical activity if you are taking orlistat. You will also need regular follow-up with your doctor or pharmacist.

Surgery to help with weight loss
This may be an option if you are very obese. However, surgery is usually only offered if other ways to lose weight have not worked (including diet, increasing your physical activity levels and orlistat). Weight loss surgery usually gives very good results and most people do lose a lot of weight. But this is specialist surgery and it is a major operation. In some people, surgery may not be advised because health issues may mean that having an anaesthetic could be dangerous.
Surgery to aid weight loss is called bariatric surgery. There are different types of bariatric surgery available. In one type, the surgery reduces the size of your stomach so that you are not able to eat as much. You feel full more quickly. Another type of bariatric surgery makes the food that you eat bypass some of your intestine. This means that you are not able to absorb as many calories from food as you would normally. There are also newer techniques that have been developed to help weight loss, including intragastric balloons (small balloons that sit inside your stomach).
After surgery, you will need to make long-term changes to your eating habits. You will be given help and guidance with this. You will also need long-term medical follow-up.
Tempting situations and special occasions
It is natural that you will be tempted by different situations to put you off track with your eating and weight loss. It is important to recognise that holidays, festivals and eating out may affect your everyday food choices and what you had planned to eat.
Can you identify any tempting situations? Some people find that watching food programmes on TV makes them feel hungry. How about smells from the kitchen from someone cooking who is not aware that you are trying to lose weight? Do you get pressure from family or friends to eat or drink more? Can you avoid tempting situations? If not, think about ways of coping with them. If you are going to be faced with a tempting situation, create a plan of action. For example, if you are going out for dinner your plan of action might be to have a starter or a pudding rather than both.
Top tip: clean your teeth or take a short brisk walk when you are tempted to eat between meals.
Stress, depression and your weight
Many people eat as a comfort, or as a way of coping with stress. How do you cope with stress? Is stress, unhappiness or depression a reason for you to overeat or to binge eating? If so, can you plan alternative strategies such as relaxation tapes, going for a walk or talking to a friend?
Top tip: see a doctor if you feel that depression is a problem. Depression can often be treated.
Keeping the weight off
Many people lose weight but at the end of their ‘diet’, the weight goes back on. The main reason this happens is because their weight-reducing diet was only a temporary change to their unhealthy diet and lifestyle. To keep your weight off, it is important that you make permanent changes. This usually means:
• Keeping to a healthy diet.
• Exercising regularly.
• A change for the whole household. It is difficult for one member of a household to shop and eat differently to the rest. It is best that the whole household should eat a healthy diet.
It does not mean less enjoyment of food. However, it may take a while to learn to enjoy different foods, meals, and recipes. Some people need more support to keep to their new weight than when they were actually dieting and losing weight. A local support group may be able to help.
Top tip: after losing some weight, weigh yourself once a week to keep a check on your weight. This way you will see if your weight starts to increase again and you can do something about it early on.
Dealing with lapses
When we slip off track, it’s easy to feel like forgetting the whole thing altogether. Lapses are a very normal part of losing weight and the way you deal with it can either make or break your weight loss success. It’s better to learn from it and move on, rather than giving up completely. If you have a lapse, consider the following points:
1. What was the reason for going off track?
2. What other ways could I have dealt with it?
3. What can I do in the future to deal with the situation better?
Think back to the reasons why you wanted to lose weight in the first place. It can be helpful to consider the positive and successful aspects of your weight loss journey so far. Concentrating on the positive aspects and what you have achieved can help to re-motivate you and remind you not to give up on your weight lost programmed.

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