Weight Management

How do we actually lose weight?

Excessive weight: a modern epidemic

Nearly 50% of adults in the developed world suffer from overweight or outright obesity and South Africa is on par with countries such as the USA and the UK, with up to 40% of women suffering from obesity. About 1 in 4 boys and slightly more girls are overweight. Childhood obesity is a growing problem.

Causes of excessive weight gain

The main causes of obesity are easy access to inexpensive calorie rich, but nutritionally poor foods in our modern society and our sedentary lifestyles – the lack of physical activity.

There are many other contributing factors:

• One’s genes may influence weight gain.
• As we age, we tend to lose muscle, especially if we are less active, which slows down the rate at which our bodies body burn calories.
• Pregnancy is cause of weight gain in women.
• Sleep deprivation is another cause of excessive weight gain: people who don’t get enough sleep have insulin and blood sugar levels that are similar to those in people who are likely to have diabetes. Also, people who don’t get enough sleep on a regular basis seem to have high levels of a hormone called ghrelin (which causes hunger) and low levels of a hormone called leptin (which normally helps to curb hunger).
• Medical reasons for obesity are rare: less than one out of every 100 cases. Conditions such as Cushing’s syndrome (over-production of steroid hormones in the body), an under-active thyroid gland and Polycystic ovarian syndrome (PCOS) are rare causes of weight gain.
• Mental health conditions, such as depression which is very commonly undiagnosed, is another underlying cause.
• Certain medicines, including some steroids, seizure controlling drugs, taking the contraceptive pill and antidepressants can contribute to weight gain.
• Smoke cessation may increase appetite.

Consequences to being overweight

There are many well documented health conditions that are due to being overweight:

• Depression and low self esteem are common in overweight people, especially with modern marketing techniques that portray impossibly perfect bodies.
• Heart disease, heart attack, congestive heart failure, high blood pressure and stroke are common cardiovascular conditions.
• The development of type 2 diabetes which is a leading cause of early death, heart disease, stroke, kidney disease, and blindness. More than 80 percent of people with type 2 diabetes are overweight.
• High cholesterol, which is associated with heart disease.
• Metabolic Syndrome: this is the name for a group of risk factors linked to overweight and obesity that raise your chance for heart disease and other health problems such as diabetes and stroke. A person can develop any one of these risk factors by itself, but they tend to occur together.
• Cancer: being overweight or obese raises the risk for colon, breast, endometrial, and gallbladder cancers.
• Osteoarthritis: this is a common joint problem of the knees, hips, and lower back resulting in incapacity and pain.
• Sleep Apnea: this condition causes a person to stop breathing for short periods during sleep. This condition is associated with sudden death. It is a very common cause of daytime somnolence: falling asleep during the day, forgetfulness, irritability and depression.
• Reproductive Problems: obesity can cause menstrual irregularity and infertility in women.
• Gallstones
• Surgical risks: the risk for complications under anaesthesia, infection and bleeding during operations.
• Overweight and obesity also increase the health risks for children and teens. Type 2 diabetes was once rare in children. Now it accounts for 8 to 45 percent of newly diagnosed diabetes cases. Also, overweight children are more likely to become overweight or obese as adults, with the same risks for disease.

Programme principles

A weight loss programme should be based on the following principles:

1. There is no magic “quick fix” to this complex health problem.
2. The programme should recognise that every person has a busy life, with huge demands placed on them by family, friends, clients and employers. Children with weight problems require a child friendly approach.
3. A comprehensive medical assessment is necessary to identify underlying physical and mental causes of excessive weight gain, as well as the causes that prevent applying recognises weight loss strategies.
4. Each person is unique, so a unique programme is required for each person. Starting with a medical assessment, dietician, exercise and psychology experts should be involved where appropriate to design an individualised weight management programme that will include:

• Satisfying meals that ensure the right amount and type of calories are eaten. There is a trend toward “lower carbohydrate, higher protein” eating plans for weight loss.
• A sustainable exercise programme, that is both fun and challenging.
• Identifying and treating any health conditions.
• Managing any causal or complicating health complications.
• Appropriate and safe weight management medication prescription.
• Identifying and managing hurdles to healthy behaviours.

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