Copyright Anna Read 2013 'Trying to lose weight? Everything you need and dont need to know Anna Read Obesity Specialist Dietitian QMC - NUH

Copyright Anna Read s – Manual work and full time motherhood. Walking, high streets, sweeping, cleaning and chopping, washing by hand, carrying water, visiting people, making beds, manual jobs.

Copyright Anna Read 2013 Modern Life – The obesogenic environment Driving, supermarkets/home delivery, vacuuming, pre-prepared foods, washing machines, dishwashers, texting/messaging people, duvets, desk jobs.

Copyright Anna Read 2013 Then and Now 1940s Average man was 10 stones 2. Average woman was 8 stones 7. 1% of men and 2% women were obese. 2010s Average man is 13 stones 2. Average woman is 11 stones 1. 26% of adults are obese. Since 1950, the amount of nutritional information available to the public has doubled every 7 years. Obesity has risen by 214%. Obesity research has blossomed.

Copyright Anna Read 2013 The mars bar challenge!!! How many calories are in a mars bar? How quickly can you eat a mars bar?

Copyright Anna Read 2013 Energy balance One mars bar (260 calories) can be eaten in less than a minute. 260 calories takes a long time to burn off: 147 Minutes sitting. 73 Minutes walking 27 Minutes jogging. ?? Minutes of rowing.

Copyright Anna Read 2013 National Weight Control Registry American cohort of people who have successfully managed to lose a substantial amount of weight……………..AND kept it off. This group of people are real life examples of what works.

Copyright Anna Read 2013 Do diets work?

Copyright Anna Read 2013 The Basics Weight loss requires a negative energy balance. Daily calorie intake needs to be less than total daily calorie expenditure. Recommendation to reduce calories to 600 less than daily requirement. An increase in calories burned off (exercise) increases weight loss, prevents plateau and is especially important in preventing regain. Increasing exercise alone is often insufficient to achieve weight loss as amount of exercise needed is beyond practical/physical capabilities.

Copyright Anna Read 2013 Why is losing weight so hard? To lose weight you have to eat less than your body needs, every day, every week, every month…………. This might involve: being hungry, resisting favourite foods and snacks, putting more effort into food, changing habits and changing behaviour. To keep the same weight you can eat as much as your body needs and if you can be quite active you can burn off treats or extras. A person trying to lose weight has to work harder at it than a slim person who eats healthily and is quite active.

Copyright Anna Read 2013 The (boring) Basics Three meals per day. Watch portion size. Reducing sugar. Reducing fat. Controlled low calorie snacks. Five a day. Low calorie drinks.

Copyright Anna Read 2013 Regular meals Breakfast IS the most important meal of the day! Regular planned meals helps people to stick to their planned food and reduces the likelihood of snacking. Snack foods are the most likely to be high in fat and or sugar. Long gaps between meals can lead to snacking, overeating at the next meal and changes in metabolism hormone levels.

Copyright Anna Read 2013 Portion sizes Aim for your palm size protein. Aim for your hand size and thickness starchy food. Plenty of vegetables and salad. Watch portion size of breakfast cereal. Aim two slices bread (medium sliced).

Copyright Anna Read 2013 Reducing sugar Empty calories 1 teaspoon sugar is just 20 calories. 4 drinks per day is 29,120 calories per year. (8 drinks = 58,240 calories, 8 drinks with 2 teaspoons sugar is 116,480 calories……) Sweeteners No human data that unsafe. Much sweeter than sugar so only need tip of a teaspoon. Try different sweeteners.

Copyright Anna Read 2013 Reducing fat Healthy fats have just as many calories as unhealthy fats. Try to use minimal amounts of fat during cooking. Remove visible fat/skin from meat/poultry. Use low fat milk and dairy products. Give 1% milk a go! Low fat cheeses have improved so much in the last couple of years. Avoid pastry, processed meat products and fried foods.

Copyright Anna Read 2013 Careful snacking Stop Are you hungry? Can you wait? Will a drink do? Think Low calorie Filling. Nutritious. Go Fruit. Vegetable. Low fat savoury snack e.g. 2 crisp breads. Small sweet treat (e.g. 100 calorie small chocolate bar).

Copyright Anna Read 2013 Five a day One portion is generally one small handful: One apple/pear/banana. Two satsumas Twelve grapes/berries. Two tablespoons vegetables. Small bowl of salad vegetables. Fruit juice 150ml maximum one a day. Dried fruit one tablespoon maximum one a day. Can have more than five portions per day but try to limit fruit to four portions if having trouble losing weight or if you have diabetes.

Copyright Anna Read 2013 Calories from drinks Avoid adding sugar to any drinks. Choose low fat milks. Do you regularly have lattes? Grande regular 230 calories, semi skimmed milk 190 calories, skimmed milk 130 calories. Choose diet / light / zero versions of soft drinks. Limit fruit juice. Choose no added sugar squashes. Think about calories from alcohol: One pint of beer 170 – 200 calories. One large glass of wine220 calories. One single spirit and diet coke75 calories. One measure of baileys130 calories.

Copyright Anna Read 2013 Simple techniques Reduce all meals by a third. Cut out all snacks except for fruit and vegetables. Dont eat after main meal. Only choose foods with less than 5% fat.

Copyright Anna Read 2013 Planning for success Get support and arrange weighing. Identify your realistic goals. Plan your weeks meals. Write a shopping list and stick to it. Consider home delivery. Use fresh meals first: stir fries, salads, fish/meat/chicken and vegetables and towards the end of the week choose jacket potatoes, omelettes, pasta dishes. Bulk cook healthy meals such as lasagne, cottage pie, stews and casseroles. Take own lunch to work – sandwiches, salads, leftovers or tins of soup and bread or crackers are a quick and easy choice. Include fruit and vegetables in meals and snacks. If eating out, try to look at menus in advance.

Copyright Anna Read 2013 Healthy Surprises Fruit juice has more calories than beer beer bellies…….. Smoothies – very healthy but not very helpful for losing weight. Olive oil has the same calories as lard. Flapjacks and cereal bars can be very high calorie snacks. Dried fruit and dried nuts are also very healthy but very high in calories. Low calorie and diet foods still add up. Energy Drinks not healthy, never will be…..

Copyright Anna Read 2013 Exercise For health recommendations of thirty minutes moderate intensity activity five times a week. Equivalent health benefits achieved by 15 minutes vigorous activity five times a week. All adults should minimise time spent sitting for long periods. For weight loss recommendations are higher than this. Active Commuting a government priority – what could you do?

Copyright Anna Read 2013 Exercise For weight loss: Focus on decreasing sedentary behaviour. Aim for 45 – 60 minutes exercise daily For preventing weight regain: 60 – 90 minutes total exercise daily achieved by those who manage to prevent weight gain after losing weight.

Copyright Anna Read 2013 Active Commuting Walk to work / part way to work. Walk to next bus/tram stops. Get off a few stops early. Cycle to work / one way to work. Leave cycle overnight in secure compound. Be dropped off or collected with foldable bike. Lunchtime walks From QMC – part of the University Lake, as far as University Central Building, corner shop at Leengate, round the QMC perimeter road, loop of A floor East Block to West block and up to a higher floor and back again. From City – To Hucknall Road roundabout co-op, walk around the campus.

Copyright Anna Read 2013 Weight Loss Medication One safe and effective medication that can be prescribed by the NHS: Orlistat (Xenical) for BMI above 30 (or 28 with health problems). Stops body absorbing some fat so requires low fat diet to prevent unpleasant bowel side effects. Only GP can prescribe, must be taken three times a day with regular meals and must lose 5% of your weight in 12 weeks to be eligible for continued prescription. A weaker strength can be bought in chemists – Alli.

Copyright Anna Read 2013 Weight Loss Surgery Dramatically increasing business in NHS and private settings. VERY strict NHS availability - for BMI over 50 (or 45 with serious health problems). Available privately for BMI above 35 (or slightly lower with weight related problems). ~£7000 for a gastric band, ~£11,000 for a gastric bypass. The only weight loss treatment that is not associated with weight regain.

Copyright Anna Read 2013 Whats available in Nottingham? Commercial Slimming Organisations – Slimming World, Weightwatchers, Rosemary Conley – joining fee and weekly fee. Motivate – Notts County Football Club 12 week programme. (BMI 30+ (28+Asian ethnicity)-Nottingham City Boundary -home or GP address). Healthy Change – self or health professional referral for Slimming World, YMCA exercise, cook and eat sessions. (BMI 30+-Nottingham City Boundary – home or GP address). Ridewise training. Local council exercise referral schemes. Practice Nurse – first line advice. Dietitian referral community or hospital for BMI above 35 (or 30 with health problems).

Copyright Anna Read 2013 Whats available at NUH? NUH Active. Staff Weight Management group (BMI>30) to run from September – contact Steph Knowles if keen to find out more. Weightwatchers QMC Tuesday lunchtimes – self pay.

Copyright Anna Read 2013 What doesnt work Drastic, limited diets. Expensive programmes. Fat melting potions, tablets or lotions. Internet/illegal drugs. Unsustainable exercise. Anything described as miracle, magical or that requires no dieting. Tummy tuck/liposuction. Believing everything you read in the papers….

Copyright Anna Read 2013 What probably doesnt work Hypnotism. Gastric Balloon. Jaw wiring. Fear factor.

Copyright Anna Read 2013 Everything, nothing and anything case study.

Copyright Anna Read 2013 National Weight Control Registry Average weight losses of 70 pounds (30 kg) and kept it off for 5.5 years. Over three quarters had a triggering event to start their weight loss. Lost their weight by wide variety of methods. 45% did it on their own, 55% were part of a programme. Almost all eat breakfast everyday. Watch less TV than average. Weigh themselves at least once a week. Exercise for average 60 minutes a day. Huge reported increased in levels of energy, physical mobility, general mood, self-confidence, and health.

Copyright Anna Read 2013 Summary You need: a plan, help and support, a realistic goal and determination.

Copyright Anna Read 2013 Any Questions?