How to lose weight and keep it off

How to lose weight and how to keep it off. Those are the questions. Apologies to William Shakespeare. It is a sad state of affairs that in many affluent countries an epidemic of obesity is sweeping up many and carrying them off to early graves. In my irreverent way I have thought that country X should change its name to Lardarseland. They can then change the words and tune of their national anthem to "Oh lard-arse land, oh lard-arse land, your food I praise forever" - sung to the tune of Tannenbaum. Maybe that will get people's attention. Many people are in denial about their degree of obesity.

What qualifies me to write on obesity?

Here it is: in 1976 I graduated from medical school. In 1985 I gained a qualification allowing me to practice as a medical specialist, albeit not one dealing with obesity. I dealt with one of the consequences of obesity - snoring. Let me hasten to add that not all snoring is caused by obesity.

I am interested in physical fitness and staying in good shape. For many years I visited a gym three times a week, every week. For about five years this was not possible. However, in November 2006 my wife and I joined a gym again and have been going at least three times a week ever since. I read up on diet, physical fitness, metabolism and how to ameliorate the effects of aging. With my background, and a skeptical nature, I was able to separate the wheat from the chaff to a greater degree than most people will be able to do.

OK, what is the magic bullet?

The right genes. If you want to stay thin no matter what you do or don't do you must have inherited the right genes. Even that has its limits. There is nobody who cannot get fat, no matter what. However, some people get fat easier than other people. For some, to keep trim is a hungry business.

However, breathing makes nobody fat, despite the claims of many obese patients. Unless, of course, they eat as they breathe.

So, how does it work?

Getting fat depends on two things:

Energy intake
Energy expenditure

It is as simple as that.

Your body stores excess energy intake for a time of hunger. The body cannot store much energy in a carbohydrate form. It can only store several hours worth of energy as glycogen. The rest, several weeks worth of energy in some cases, is stored as fat. Enters obesity.

Do I need to lose weight?

That depends on you. I am not trying to sell you anything. If you are not overweight, good. If you are and are in denial, that is a problem I cannot fix over the Internet. If you are overweight and want to lose weight, read on.

One guide to wheter you are overweight is the Body Mass Index. However, it takes into account only your mass and height, not whether you are big-boned or small-boned, mesomorphic (big muscles) or ectomorphic (small muscles). Muscles weigh heavier than fat, so most body builders will have high Body Mass Indeces, despite the fact that they carry less fat than the general population and as such are not overweight.

Your BMI is supposed to be between 18.5 and 25 for adults aged 20 and over. For kids the BMI is measured against a graph for the general poplation; if a kid has a BMI higher than the 95th percentile of kids of his age, he is considered overweight. Similarly, if it is lower than the fifth percentile, the kid is considered underweight.

Here is a simple JavaScript BMI calculator gleaned from the Internet. Feed in your height in centimeters and your weight in Kilograms.

Please note that this little BMI calculator is not the last word on whether you are carrying too much fat, or not. If you are way outside the ideal range you are most likely either too fat or too thin. But just outside...

One very sensitive low-tech way of finding out if you are overweight is to look at yourself naked in the mirror. Is that really you? Maybe better not look. But be realistic. If you are sixty don't expect to look like a 30 year old film star. However, who said a sixty year old man had to have a pot-belly and a forty year old woman a really big, big bottom and thighs bigger than a California Redwood tree?

OK, I'm overweight. How do I get thin?

The best is to assault your problem on two fronts:

Decrease your energy intake
Increase your energy expenditure

Decreased Energy Intake, aka dieting

I'm talking way beyond dieting. Remember, you want to lose weight and keep it off.

Here's a new concept for you, one you must carry around with you and use often; energy dense foods vs non energy dense foods.

The energy content of different foods

The energey content of foods comes from three macro-nutrient groups:

Fat - a whopping 9 Calories per gram
Carbohydrates - half the Calories of fat
Protein - same as carbohydrates

One constituent of food, which is more plentiful in some foods than the three above, I did not mention. Why? It contains no calories! The first good news on this page, you say. What is it? Water! Unprocessed, fresh plant foods are often high in water content, and what is more, almost always low in fat. These are foods with a low energy density. It is not neccessary to tell you, you know, they are your friends.

On the other end of the scale are the foods with a low water content and a high fat content, like oils, butter, cream. They are energy dense foods. Keep away from them.

There is one foodstuff which also contains no energy as far as your body is concerned. That is fibre. Fibre is not absorbed. What is more, it may absorb other foodstuffs like fat, and carry them unabsorbed through your alimentary tract. Like water, fibre is found almost exclusively in plant foods. Eat only totally unrefined grains and grain products. Stay away from white bread and cakes. This way you will increase your fibre intake. A high fibre intake is not only good to keep the fat off your body, but protects against certain digestive tract cancers.

As far as fat deposition and energy use is concerned, your body is very good at two things:

Absorbing fat from your alimentary tract and depositing it as body fat
Burning carbohydrates to provide energy

Fat is broken down to fatty acids, or short fatty acid chains, absorbed and re-assembled as long fatty acid chain fats for storage. I remember a figure of two Calories for every 100 Calories worth of fat eaten being used for this process. On the contrary, converting carbohydrates to fats for deposition is much more chemically complex. Only 78 Calories worth of fat is deposited for every 100 Calories worth of Carbohydrates eaten.

On the other hand, your body is good at burning carbohydrates for fuel and bad at buring fat for fuel. The Atkins diet is based on this fact.

If you add the above two facts together it should be clear that the worst you can do is to eat a meal both high in carbohydrates and fat, like French fries. The fat is absorbed and goes to where you don't want it while the carbohydrates are absorbed and burned for fuel to absorb more fat, and also to drive your body.

Here's what you should eat

Unprocessed, fresh plant food. Whole grains. Go to Fat Free to find thousands of very low-fat recipes. Eat a great variety of foods, remembering the fresh fruit and salads. No, you won't die from a fat-deficiency disease. Eat a fruit as a snack instead of a donut or a lolly. Stay away from anything deep-fried. I know this is asking a lot, but the results are great. No pain, no gain. In the end you will find that your taste changes and you don't like fatty food anymore. Try not to add sugar to anything. Don't even think of adding fat to anything.

When should I eat and how much should I eat?

Eat when you are hungry. Many of us can't even remember the last time we were hungry. We eat when it is time to eat, whether we are hungry or not. Now don't wait until you are ravenously hungry. If you do you will attack the meal and eat more than is necessary. Also don't wait until your are hypoglyceamic - that is, until your blood sugar drops to below normal levels. Some people can go into hypoglyceamia without becoming hungry. That is not normal. This ariticle is for overweight, but otherwise healthy people. Anorectics also seem to have mastered hunger to an abnormal degree. If you are anorectic, eat more, not less. Anorexia kills. You could have asked Karen Carpenter, were she still alive. What a waste of a life and extraodinary God-given talent. Don't do that.

How much to eat? Until you are not hungry anymore. Eat slowly and ask yourself after every mouthful, am I still hungry? Stop eating as soon as you are not hungry anymore. Don't pile up your plate. If you are like me you will clean your plate because you don't like to see anything go to waste. Put only a little on your plate. You can always have a second small helping of whatever. The first helping was small, too. Right? Now don't lie.

What about that treat?

Ask yourself, am I hungry? Do I need that slice of cake for sustenance? If the answer is no, don't have it. Yes, maybe it looks good, maybe it smells nice, maybe you always had a weakness for chocolate. All that is irrelevant. Start humming "oh lardarseland, oh lardarseland" softly to yourself and ask yourself if that is what you want to be. Then say "no thank you" for that piece of cake.

On the other hand, if you succumb to the temptation once or twice, that is not the end of the world or your resolve to lose weight. Just don't do it again. Grit your teeth, pull in your belt one notch and look determined. You are in control. Nobody is holding you down and forcing food down your throat.

Increasing your use of energy

This is the other side of the coin. If you burn enough energy you can pack in massive amounts of energy and not get fat. Years ago I saw an article about Canadian lumbermen, what they ate (they lived in lumber camps and were fed at a mess hall), what they did (chopped wood with axes, this was in the days before chain saws) and what happened to their blood cholesterol and weights. They ate massive amounts, lots of eggs, yolks and all, and did not get fat.

However, the above is an extreme example. Your body is very efficient at using energy. You are not going to chop down trees for eight to ten hours a day with an axe. But you can push up your energy use, burn some fat and get fit at the same time.

How do you push up your body's energy consumption

There are two ways:

Exercise
Use drugs that push up your metabolic rate

There is no doubt in my mind whatsoever that the second one is the most popular. The silver bullet, the medicinal compound (Lilly the Pink, remember?), the pill that "melts" the fat. For various reasons this is not the page for that. Just forget pills, drugs and potions. We are going to do it the hard, but right, way.

Excercise

Anything, just not exercise! If that is you, stop reading and call your friendly, local, pizza delivery man. Ask for a double cheese. That beats exercise every day. Unfortunately, however...

How much exercise?

If you are healthy, three times a week and 45 minutes every time, at least. And that is not slowly pedalling the exercise bike, reading Woman's Day as you pedal. Oh no, that is 45 minutes of hard exercise.

That said, any exercise is better than none at all. But don't expect miracles from a leisurely stroll, even for a few kilometers, every so often. Start with what tires you only slightly, but quickly work it up over two to four weeks to decent amount of exercise done at a decent tempo.

What type of exercise?

My favourite is going to a gym. True, exercise against resistance will most likely not get you as trim as a supermodel, but we are concerned with fat loss more than weigth loss. And exercise against resistance is the only type of exercise that fights age related loss of muscle mass and bone density. That's right, jogging, walking and swimming does not do that. And forget the Calcium enhanced dairy products fighting osteoporosis if your dietary intake of calcium is adequate. Like PT Barnum said, there is a sucker born every minute.

There is something called interval excercising. It works like this: pedal (or row, or jog or whatever) at a leisurely pace for 15 seconds, then go all out for 10 seconds, then leisurely for 15 seconds, then all out for 10 seconds, and so forth. This is sheer murder, but the results are great. In your activity burst your body secretes catecholamines which mobilise fats so they can be metabolised. This really makes you lose weigth. If you do this, you have to spend much less time exercising.

You may find exercise boring. Most modern gyms have many exercise machines - rowing machines, execise bikes, a variety of treadmills and ski machines, all of them computerized. And these are only the machines you used for warming up before moving on to the resistance machines and weights. I spend less than 10 minutes, mostly only five, on a variety of these machines before going for resistance exercises - not enough time to get bored. And because these machines are compuerized one can see how one is doing on a certain machine compared to the last time one used that machine. Work rate, calories burned, these are all there.

Of course, if you want to burn calories increase the tissues in your body that burn most calories - your muscles. That said, it is hard to increase the size of ones muscles. There is no way one is going to look like Arnie in his heyday after a few sessions at the gym.

I must stress this: a gym membership won't make you lose weight. You really have to go to the gym and excercise - hard.

One can go on and on about the benefits of resistance exercise, like how one study found that people in their seventies and eighties had a decreased incidence of falls after starting a resistance exercise program. Another found that people in this age group actually gained strength quicker and to a greater degree than younger people. That merely means that old George, who could bench-press 25Kg at the start of the program and who bench-pressed 35Kg after a month had upped his bench-press strength by 40%. Young Clyde, who could bench press 65Kg at the start of the month only managed 70Kg after a month - a paltry 11% improvement.

Many people seem to get addicted to jogging. If it that is your cup of tea, by all means, go for it. It will also make you lose weight quicker than exercise in a gym. You will also most likely settle on a lower body weight.

Cycling, swimming, cross-country running, tennis, squash - they are all good forms of exercise. Pick one you like, or several, and go for it. A variety of exercises may prove to be more interesting than one only.

Your metabolic rate slowly decreases to normal after exercise. Except if you go to sleep soon after exercise. Then is quickly settles down to normal. That means excercise done early in the day is more beneficial than that done in the evening. I know, often it is not possible to exercise early in the day.

A last word about exercise; if it does not make you breathe hard and get physically tired, it is not exercise.

People become slaves of their habits. Cultivate good habits and you have nothing to worry about. One good habit is to drink lots of water, especially while you are exercising. But don't overdo the water bit. Just make sure you do not dehydrate. Keep up a healty urine output.

So, this is how to lose weight and keep it down permanently. Give this regime three or four weeks and see what happens. That is not too much to ask. You will be surprised at the results.

If you find any mistakes in this page or has any concerns with the contents of this page, please e-mail me.

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