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A "healthy warning" about:

Obesity, with tips for weight reduction.

A recent study indicated that a staggering 65% of Australian men are now overweight, and 40% of woman are overweight.¹ Obesity is also an increasing problem in children. Therefore the study and application of weight reduction is becoming more and more pressing issue. 

This web page is not aimed at trying to make overweight/obese people feel guilty. There are many and complex factors involved with being overweight and sometimes food is not the real issue. Examples of this are hypothyroidism, sleep apnoea and obesity due to chronic adenovirus infection.

The risks of being overweight or having obesity are many and include:

1. Cardiovascular disease. ^{2, 3}
2. Hypertension (high blood pressure). ^{2, 3} 
3. Poor cholesterol and blood lipid levels. ^{2, 3}
4. Diabetes mellitus. ^{3, 5}
5. Endometrial cancer in women. ³
6. Colorectal cancer in men. ³
7. Chronic hypoxia (low oxygen levels) and hypercapnia (high carbon dioxide levels). ³
8. Sleep apnea. ³
9. Gout. ³
10. Degenerative joint disease. ³
11. Stroke. ³
12. Gallstones. ⁴

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Weight Reduction

Disclaimer.
Although there are many people who are obviously overweight (or obese), there are some who think they are overweight when they are not. Before proceeding, please make sure that you really have a problem in this area. Assessing your "body mass index" can be helpful. Or better still see a health professional who deals with this area. Body mass index (BMI) is calculated by dividing your weight in kilograms by your height in metres squared (kg/m2). If your BMI is less than 25 it is very unlikely that you have a problem. If it is less than 20 you may be underweight.

Another important point is body composition. Some people have an overall weight problem while being underweight with respect to lean body mass. Lean body mass is basically a measure of your non-fatty tissue. It gives an indication of whether or not you have a healthy muscle mass. It is not uncommon for people to be overweight because of too much fatty (adipose) tissue and yet have inadequate muscle mass due to poor protein status. So when losing weight it is important to pay attention to getting an adequate supply (quality and quantity) of protein to avoid losing muscle mass. With respect to weight the real aim of a healthy lifestyle is not just to be the "right" weight but to have the optimal body composition. That is why the quality of what you eat and exercise are very important. Don't just stop or minimise eating!

1. Beware of the mistake of "starvation diets" -- either by restricting too severely the number of calories, or by eating a diet which is deficient in protein, essential fatty acids, vitamins etc.

2. Beware of the mistake of of losing too much weight too rapidly. Why is this a problem? Because it can make your body say to itself, "I am being starved! I will have to take emergency measures and turn down the rate at which I am using fuel." This means that your body will turn down the basal metabolic rate (BMR)  so as to conserve energy. If this happens you may end up being one of the people who complains, "I eat so little and yet I am not losing anything!" What can you do if the BMR is tuned down? I think the best thing to do is to exercise more and at the same time eat a bit more. Hopefully this will tune the BMR back up

3. Make it a rule not eat or drink between meals except to consume water. Don't have more than three meals a day and try to eat meals at regular times.

4. Follow the adage, "Eat breakfast like a king, lunch like a prince and dinner like pauper". This is very important. Large late meals contribute significantly to obesity, as you're not working on the food. You can miss the evening meal if you wish, although this is not advisable if you suffer from fainting spells or hypo-glycaemia (low blood sugar). Try never to miss breakfast or lunch.

5. Drinks large quantities of the water between meals. I suggest adults aiming to drink about two and a half to four litres of good quality water per day.

6. Go for a walk everyday you can for 30-60 minutes. Moderate sunlight exposure while walking is very good.

7. Chew your food very thoroughly and slowly. Remember that enjoyment of food is not dependent on how fast you eat it but on the length of time it is in the mouth!

Try to use organic foods wherever you can.

9. Completely avoid "junk" food, and fatty things, refined carbohydrates, sugar and all sugary items. Try to avoid processed foods as much as possible.

10. Limit seasonings and spreads to the following:
a). Lemon juice.
b). Linseed (flaxseed) oil up to two dessertspoons per day.
c). Pure olive oil up to two dessertspoons per day.
d). Sesame butter (tahini) up to two teaspoons per day.
e). Avocados up to two dessertspoons per day.
f). Salt up to one quarter of a teaspoon per day. This may need to me more in very hot climates. Discuss it with your health professional.

11. For protein I would recommend 1-2 free range (and organic if possible) eggs and the careful use of vegetable protein combinations as listed below. You should not need to worry about cholesterol on this number of eggs because of the other parts of your diet and anyway eggs are not as bad as once thought for cholesterol -- as long as you don't have them with bacon! Eggs are a superior source of protein than red or white meats and free range organic ones will be much less likely to carry undesirable residues or diseases. If you don't want to use eggs then you should use a protein supplement drink to avoid losing muscle mass. I would suggest avoiding other animal proteins. But if you really can't do without them I would use small quantities of the following (in order of preference):

(a) Oily fish such as salmon, tuna or sardine.

(b) Cottage cheese.

(c) Yogurt (especially Lactobacillus acidophilus).

(d) Lean chicken.

(e) Lean lamb or beef.

Rice + legumes.
Rice + sesame.
Wheat + legumes.
Wheat + peanuts + milk.
Wheat + sesame + soya-beans.
Corn + legumes.
Peanuts + sunflower seeds.
Sesame seeds + beans.
Sesame seeds + peanuts + soya-beans.
Sesame seeds + wheat + soya-beans. 
(From Davies S, Stuart A., Nutritional Medicine, London, Pan Books Ltd, 1987 p. 416.)

1. Dunstan D, Zimmet P, Welborn T et al. Australian Diabetes, Obesity and Lifestyle Study. 2001. 

2. J Am Coll Nutr 1994 Jun; 13(3):256-61 Relationship of weight loss to cardiovascular risk factors in morbidly obese individuals. Anderson JW, Brinkman-Kaplan VL, Lee H, Wood CL. Metabolic-Endocrinology Section, VA Medical Center, Lexington, KY 40511.
"OBJECTIVES: This study critically examined the relationships between weight loss and changes in serum lipid and blood pressure levels.
DESIGN: Eighty morbidly obese women and men were treated with an intensive very-low-calorie diet (VLCD) and behavioral education program. Body weight and blood pressure were measured weekly. Serum lipids were measured biweekly.
RESULTS: Patients lost an average of 35.3 kg in 25.6 weeks. These values decreased significantly: fasting serum cholesterol, 15.1%; low density lipoprotein cholesterol, 17.0%; triglycerides, 14.2%; systolic blood pressure, 8.7%; and diastolic blood pressure, 10.2%. Changes in serum lipids and blood pressure were significantly (p < 0.001) correlated with baseline values and with changes in body mass index (BMI) after adjustment for baseline values. Patients maintained an average of 19.7 kg of their weight loss at the 2-year follow-up.
CONCLUSIONS: Weight reduction through a multidisciplinary VLCD program significantly reduces risk factors for cardiovascular disease; for morbidly obese individuals, improvements in risk factors were significantly and linearly related to changes in the BMI."

3. Am J Clin Nutr 1991 Jun;53(6 Suppl):1595S-1603S Health implications of obesity. Pi-Sunyer FX. Division of Endocrinology, Diabetes and Nutrition, St Luke's/Roosevelt Hospital Center, New York, NY 10025.
"The health risks of obesity increase with its severity and reach significance at a weight greater than 20% above optimal, by using life insurance tables, or at a body mass index greater than 27. Risks include hypertension, insulin resistance and diabetes mellitus, cardiovascular disease, hypertriglyceridemia, low high-density-lipoprotein cholesterol, and, in some studies, high total-and low-density-lipoprotein cholesterol. There is an increased mortality from endometrial cancer in women and from colorectal cancer in men. Chronic hypoxia and hypercapnia, sleep apnea, gout, and degenerative joint disease can occur with more severe obesity. The distribution of body fat is directly related to these health risks. Abdominal obesity is more dangerous than gluteal-femoral obesity because the amount of intraabdominal fat seems to determine much of the increased peril; therefore, risks of cardiovascular disease, stroke, hypertension, and diabetes increase with abdominal obesity, even independently of total fat mass."

4. Ann Intern Med 1993 Nov 15;119(10):1029-35 Contributions of obesity and weight loss to gallstone disease. Everhart JE. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
"OBJECTIVE: To examine the relation of obesity and weight loss to the formation of gallstones according to pertinent clinical and research issues.
DATA SOURCES AND EXTRACTION: Original reports obtained through a MEDLINE search from 1966 to 1992 on gallstones plus obesity or reducing diets, supplemented by a manual search of bibliographies, a Current Contents title search from 1991 to 1992 on gallstones and gallbladder, and expert opinion. Only studies of humans were cited.
DATA SYNTHESIS: For women, but less so for men, obesity is a strong risk factor for gallstones, and this risk is increased during weight loss. Between 10% and 25% of obese men and women may develop gallstones within a few months of beginning a very low calorie diet, and perhaps one third of these will develop symptoms of gallstones. Persons with the highest body mass index before weight loss and those who lose weight most rapidly appear to be at the greatest risk for gallstones. Treatment with ursodeoxycholic acid (ursodiol) during weight loss dieting is the only proven prevention for the formation of gallstones. Issues to be resolved include how different diets affect the risk for developing gallstones, the identification of other risk factors for gallstone formation during weight loss, the effect of weight loss among people with preexisting gallstones, and the optimum means of preventing gallstones during weight loss.
CONCLUSIONS: During weight loss, particularly among the obese, an increased risk exists for symptomatic gallstone formation. This acute risk offers the opportunity to investigate the cause of gallstones and possibly to prevent them."

5. Ann Intern Med. 1995 Apr 1;122(7):548-9 Weight gain as a risk factor for clinical diabetes mellitus in women. Colditz GA, Willett WC, Rotnitzky A, Manson JE. Harvard School of Public Health, Boston, Massachusetts.
"OBJECTIVE: To examine the relation between adult weight change and the risk for clinical diabetes mellitus among middle-aged women.
DESIGN: Prospective cohort study with follow-up from 1976 to 1990.
SETTING: 11 U.S. states.
PARTICIPANTS: 114,281 female registered nurses aged 30 to 55 years who did not have diagnosed diabetes mellitus, coronary heart disease, stroke, or cancer in 1976.
OUTCOME MEASURES: Non-insulin-dependent diabetes mellitus.
RESULTS: 2204 cases of diabetes were diagnosed during 1.49 million person-years of follow-up. After adjustment for age, body mass index was the dominant predictor of risk for diabetes mellitus. Risk increased with greater body mass index, and even women with average weight (body mass index, 24.0 kg/m2) had an elevated risk. Compared with women with stable weight (those who gained or lost less than 5 kg between age 18 years and 1976) and after adjustment for age and body mass index at age 18 years, the relative risk for diabetes mellitus among women who had a weight gain of 5.0 to 7.9 kg was 1.9 (95% CI, 1.5 to 2.3). The corresponding relative risk for women who gained 8.0 to 10.9 kg was 2.7 (CI, 2.1 to 3.3). In contrast, women who lost more than 5.0 kg reduced their risk for diabetes mellitus by 50% or more. These results were independent of family history of diabetes. 
CONCLUSION: The excess risk for diabetes with even modest and typical adult weight gain is substantial. These findings support the importance of maintaining a constant body weight throughout adult life and suggest that the 1990 U.S. Department of Agriculture guidelines that allow a substantial weight gain after 35 years of age are misleading."

Dr David Bird Mb.Chb.  D.C.N.  F.A.C.N.E.M. compiled the web site. Copyright © 2000, David Bird. Web site address: http://www.lis.net.au/~dbird/  

Questions or comments may be sent to dbird@lis.net.au. A reply will be sent as soon as practical, but may take a few days.

Disclaimer: These notes are not intended to provide personal medical advice. Such advice should be obtained personally from a qualified health professional.