Overweight

Overweight is a large (sorry!) subject about which gazillions of words are written and squillions of diet books have been sold. The following are my thoughts on the topic and what has worked well for my patients over the years.

If you are overweight, you have two issues to deal with. Firstly, being overweight puts you at risk of heart disease (stroke, heart attack), diabetes and some cancers, all the common killers of today. The second issue is that you are under constant societal pressure to look differently (ie thin), to what you are (that is, fat). Generally, it’s the second issue people are motivated by, rather than the patently more important first issue, which explains why fad diets are so popular. Losing weight to conform to society’s narrow view of attractiveness takes up enormous amounts emotional energy, time and money – and only confirms that we humans are queer creatures (except thee and me). What sane animal would obsess about this issue?

(Dear reader, note that this has been written by an ex anorexic/bulimic and exercise addict who has spent many years obsessing on exactly this issue.) Jody, would the reader find this too personal and not relevant?

Two simple ways to determine if you are overweight is by taking your body mass index (BMI) and measuring your waist.

BMI

The body mass index is a measure of a human’s body shape based on weight and height.

• Underweight: <18.4
• Healthy weight: 18.5–24.9
• Overweight: 25–29.9
• Obese: 30+

To get to these figures, you will need to put your maths head on, but it’s not too difficult to calculate. Your BMI is measured by dividing your weight in kilograms by your height in m2. So, for example, if you are a 74 kg woman measuring 1.67 m, your BMI would be 74 kg/(1.67 x 1.67) = 74kg/2.79 = 26.5, which is slightly over ideal, but not too bad. (If maths is not your bag, there are plenty of online calculators that make it easy.)

There are limitations to this one-size-fits-all BMI calculation. Athletes, for example, may be very heavy for their height, but much of their weight is in muscle mass which is a good health look, whereas some elderly or sedentary folk may weigh less, but have a bigger fat to muscle ratio. BMI is also unsuitable for children under 18 and pregnant women. And some people really do have big bones.

Waist measurements

The other determinant to being overweight is to measure your waist. A tape measure sounds very old-fashioned, but this simple technique compares favourably with the more modern, fancy-pants, high-tech medical equipment when it comes to assessing your risk of heart disease and diabetes.

Women

• Increased risk: > 80 cm
• Substantially increased risk: > 88 cm

Men

• Increased risk: > 94 cm
• Substantially increased risk: > 102 cm

What causes it?

• Very often, overweight is caused by the simple mathematical equation of too many kilojoules in, and not enough kilojoules out, so the excess kilojoules are stored as fat.
• A sedentary lifestyle. Humans were apparently designed to walk over 40 km a day. We do much less with our bodies and eat more ice-cream than our ancestors ever did.
• Genes do play a role. If you come from a family who are overweight, it is likely you will have more difficulty losing weight than some skinny minny.
• After menopause, a woman’s metabolic rate drops, causing weight gain.
• Polycystic ovarian syndrome (PCOS) interferes with insulin resistance and often has weight gain as part of its symptom profile.
• Certain conditions including hypothyroidism (low thyroid function) can increase weight.
• Various medications, including cortisone and some antipsychotic medicines, can increase weight.
• Lack of sleep is known to pile on the kilograms.
• Stress, particularly ongoing stress, can increase weight. This is due to the diabolical stress hormone, cortisol, which is chemically identical to cortisone.
• One diet too many. If you have been a yo-yo dieter, trying many diets over your life, particularly low-kilojoule diets, you will probably be heavier than people who have never dieted.
• Emotional eating. Overeating is an addiction to food that should be given the same consideration as any other addiction including alcohol and heroin. The problem with food addiction is that you can’t go cold turkey. When you were a baby and terribly vulnerable, an important source of comfort and nourishment was mother’s milk (or formula). When you were afraid or tired or angry and cried, you were given the breast or bottle. As an adult, when you are upset or stressed, it is common to crave food to feel comforted, just as you did as a baby. Trouble is, eating more than your body needs is a fleeting comfort and probably a source of your distress.
• The more you watch TV the more likely you are to be overweight.

What to do

Losing weight isn’t easy, but it doesn’t have to be difficult. Once you get your head around a few simple rules, you are set for life. Quick fix diets don’t work. Studies have found that over 95 per cent of dieters who lose weight on stringent diets will regain the lost kilograms plus extra within a year. I have developed an eating plan with a few simple rules that allows you to eat healthily while losing or maintaining your ideal body weight. Most people feel more energy, notice better concentration and improved general health. You can live a normal life, go out to restaurants and not rely on ‘special’ foods. This diet is not only good if you want to lose weight, but it can also help prevent diabetes, some cancers and heart disease. A good choice for a healthy, lifelong way of eating.

The BWH diet works well for children and teenagers, however, they need to eat more starches as energy requirements are proportionately higher. The best starches would be whole grains, potatoes with skins, rather than processed products.

The low-starch eating plan (or, the beaming-with-health eating plan)

• Avoid sugar. Absolutely no refined sugar added to or within your diet. Any packaged or processed food that has over 5 g of sugar per 100 g of food has sugar added. (Be aware of all the different names for sugar on labels. Google this if necessary or out of interest.)
• Eat protein with each meal. For main meals, this means about the size of your palm and as thick as a pack of cards. For snacks or smaller meals, halve this amount. Protein foods include lean meat, chicken, fish, eggs, nuts, seeds and legumes.
• Reduce starchy carbohydrates. If you want to kickstart your diet, avoid them completely for one month. For a slower weight loss and maintenance, include 2–3 starches in your diet a day. Choose from the list below. Starchy foods generally have a high-glycaemic index (GI). High-GI foods cause a rapid increase in blood-sugar levels, which in turn causes an increase in the amount of insulin. High amounts of insulin in the bloodstream increase fat storage.
• Don’t go hungry. Eagerly anticipating a meal is a good thing, but when you are very hungry it indicates your blood-sugar levels have dropped too low – and you are likely to eat something that you will later regret.
• There are two types of people. Those who do best by grazing and those who thrive on 3 square meals a day. You know who you are. Grazers are known to quiver and feel faint and queasy if they don’t eat lunch on the dot of 12, while the 3-square-meal types can more easily miss a meal. Grazers need to ensure they eat a small meal every 2–3 hours. The 3-square-meal individuals must make sure that they don’t miss meals, especially breakfast, as this will lower your metabolism.
• Don’t go low fat, but don’t go crazy. If you like yoghurt, choose full cream (unsweetened of course), good quality probiotic yoghurt and have a small serve. Same goes for cheese and milk. 
- Don’t eat food containing artificial sweeteners. Not only will they keep your sweet tooth ignited, they do not supply you with any nutritional goodness – the overwhelming characteristic of any good food. Studies have shown that people who drink diet sodas are heavier than people who drink the normal fizzy drinks – with their 9 teaspoons of sugar!) Avoid both kinds, please.
• Eat no more than 3 pieces of fruit daily and, although not ‘starchy’, also avoid the fruits with higher sugar levels such as melons, grapes and dried fruits.
• Most people feel fantastic eating this way. However, by removing breads, pasta and cereals, inadvertently you are also removing a certain amount of fibre, which may result in constipation. So it’s important to ensure that you drink plenty of water (1.5–2 litres a day) and eat a wide variety of vegetables, nuts, seeds and legumes to increase fibre. If this is still not enough, supplement with 2 tablespoons of psyllium husks daily.
• The low-starch eating plan is designed as a lifelong diet. You do not need to buy special food or supplement and you can still go out to restaurants with your family and friends. For instance, if you love spaghetti marinara, you can still enjoy eating it, but it means you forego toast for breakfast and a sandwich for lunch.

Starchy foods

One serving of the following is equivalent to one serving of starch.

Grains

Bread – one slice Rice – ¾ cup (cooked) Pasta – ¾ cup (cooked) Oats – ¾ cup (cooked) Quinoa – ¾ cup (cooked) Crackers (eg Vita-Weat, rice cakes) – two pieces

Fruit

Banana – one average

Vegetables

Potatoes – 3 chats; 1 medium Pumpkin – 1 small piece Peas – ½ a cup Corn – ½ a cup Parsnip – 1 average

Other

• All fruit except bananas, melons, grapes and dried fruit. (You can eat these, but they will take up one of your starch options.)
• All vegetables except peas, potatoes, corn, parsnip, pumpkin. (Again, be aware that these will take up 1 of your starch options.)
• All protein foods: meat, chicken, fish, eggs, nuts, seeds, cheese, legumes, and tofu.
• Protein powders: pea protein, soy protein, rice protein and whey protein.
• Fats and oils: walnut oil, sesame oil, cold-pressed olive oil, macadamia oil, flaxseed oil and coconut oil.
• All spices and herbs; soy sauce.
• Alcohol. If you like to drink alcohol, you can enjoy 1 or 2 glasses of dry white or red wine, spirits or champagne daily. Avoid beer, liqueurs and sweet wines.
• Juice. Avoid fruit juices; they are high in sugar. Better to eat the whole fruit rather than its juice. But if you want to, dilute a little with water. Vegetable juice once a day is OK.

Meal suggestions

Breakfast

• Scrambled, poached or boiled eggs on a bed of spinach and/or mushrooms and/or tomato.
• A smoothie made from soy milk, cow’s milk, juice from an orange or other fruit and/or yoghurt. Add an egg for protein or LSA, a mixture of ground linseeds, sunflower seeds and almonds. You can buy this blend ready-made from health food shops or supermarkets.
• Try a combination of chopped almonds, walnuts and/or cashews together with sunflower seeds, sesame seeds, linseeds and/or pumpkin seeds. Have as much as you like mixed with a spoonful of milk or yoghurt.
• A cup of ricotta mixed with fruit such as apricots, kiwifruit or berries.
• If you wish to have starch at this meal, try toast, porridge, baked beans or a banana.

Lunch/dinner

• Meat or chicken casserole and vegetables.
• Fish, meat, or chicken and salad.
• Meat, chicken or tofu and vegetable soup.
• Stir-fry vegetables with meat, chicken, fish or tofu.
• Fish (canned or fresh) and salad (eg canned tuna with grated beetroot and carrot).
• If you wish to have starch at this meal try bread, rice or pasta.

Snacks

• Meat, chicken or tofu and vegetable soup.
• Almonds, walnuts, etc.
• A boiled egg.
• Small can of tuna with lettuce or salad.
• Small can of baked beans.
• Fruit and cheese.
• If you wish to have starch at this meal try crackers, baked beans, bread or a banana.

Remedies

• Health-foods shops, pharmacies and online superstores are heaving with weight-loss potions. The bottom line is that they don’t work. Better not to waste your money. Sorry. My rationale for not recommending supplements for weight loss is that it takes the onus off the individual to do the hard yards and take responsibility for their own health. Maintaining weight is a lifestyle choice, not something to fix with a pill. What a nag I am. Having said that, there are a few situations where supplementation will assist in weight loss, in addition to exercise and the low-starch plan.
• If you have low thyroid function, supplementation will assist your weight loss. Take rehmannia, iodine or kelp.
• Likewise, if you have polycystic ovary syndrome (PCOS), try the herbs and supplements on page 00 to help you lose weight. The low-starch diet mentioned in this chapter is also perfect for this condition as it helps those with insulin resistance, which is part of PCOS.
• If your excess weight is due to stress and the effect that cortisol has had on your body, take a B complex each morning and the adaptogen herbs (see page 00) including Siberian ginseng, schisandra, licorice, withania and rhodiolia.
• The Bach remedies may help if emotions are getting in the way of weight loss. Crab Apple is the one for feeling ashamed of the way you look, Chestnut Bud hits the spot if you tend to repeat the same pattern of sabotaging your diet.

Following is a list of foods and supplements that have been shown in some studies to assist in weight loss.

• Tyrosine – can possibly suppress appetite, stimulate brown fat cell metabolism, precursor to thyroid hormones.
• Carnitine – an amino acid that facilitates the breakdown of fats.
• Damiana – a good herb for energy, sometimes promoted as a weight-loss agent.
• Fish oil – some evidence that EPA reduces insulin resistance, thus improving weight loss (see Diabetes on page 00).
• Ginger – a few studies have shown that ginger helps in weight loss, for reasons unknown.
• Green tea – studies have shown green tea reduces food consumption by possibly decreasing the appetite hormone, leptin. Green tea may also increase your metabolic rate. These studies have been done on animals, however, not humans.
• Guarana – decreases appetite and increases metabolic rate, working very similarly to caffeine.
• Gymnema – this herb is interesting as it decreases your desire for sweet food, decreases appetite and improves insulin resistance.
• Licorice – one study showed licorice reduced thigh fat! One thing licorice is very helpful for is to decrease the effect of cortisol, the stress hormone.
• Oranges – a chemical found in oranges, synepthrine, can increase fat breakdown.
• Psyllium – this soluble fibre taken before meals will increase your sense of fullness, reducing the temptation to overeat.

Other

• Exercise is the other essential ingredient to losing weight. There are 3 reasons why exercise helps to lose weight, and these reasons will inform which exercise you choose. The first reason is that when you exercise aerobically, where your heart and lungs are working hard and you are increasing your heart rate, this will burn kilojoules and more importantly, boost your metabolic rate for up to 48 hours after the activity. The second reason is that when you exercise to increase muscle mass, such as cycling or weights, you burn kilojoules again, but more importantly, you increase the number of your muscle cells. Muscle cells, even at rest, burn considerably more kilojoules than fat cells. And thirdly, exercise helps reduce stress levels. Stress is associated with weight gain via an increase in cortisol. If you are an emotional eater, exercising will reduce the triggers for overeating.
• Which exercise to choose? Luckily many exercises and sports incorporate both aerobic and muscle building – jogging, hill walking, cycling, gym classes, flowing yoga, skiing.
• Meditation is one of the most effective activities to reduce stress hormones. Learning this skill will markedly improve your health – and help you lose those excess kilos.
• If you find that you are sabotaging your diet, or know that you eat for emotional reasons, then why not seek counselling? The therapist you choose does not need to specialise in eating problems – your emotional eating is only a symptom and you need to address the originating cause or find ways to handle your day-to-day stress. Once you understand what drives you, your desire to overeat or eat foods that undermine you, will be much diminished.

Rationale behind the low-starch diet

Evolution

Our body (and digestive tract) has remained essentially unchanged for hundreds of thousands of years – yet the food we eat has changed substantially. Grains (including rice, rye, wheat, barley and corn) have only been cultivated for the last ten thousand years – the beginning of agriculture and civilisation – long after our digestive systems were up and running. In the modern diet, there is an overemphasis on grains such as wheat, which appears in bread, pasta, biscuits and most breakfast cereals. This is not to suggest that we go back to prehistoric times and eat cockroaches and dinosaur dung, but a return to the kind of foods our bodies were evolved to thrive on: leaves, seeds, nuts, fruits, meat, eggs, vegetables, fish and the occasional flower.

Recent history

Over 40 years ago, the western world was swept up by Pritikin fever. US based Nathan Pritikin wowed the experts with evidence that fat was a major cause of heart disease, then the number-1 killer of Americans. Pritikin recommended a diet severely restricted in all kinds of fat. Chips and chops were out, boiled potatoes and pasta were in. Lots of people lost weight and lots of people avoided heart disease. However, the news wasn’t all good. By focusing on processed carbohydrate foods (at the expense of ‘good’ fat and protein), this ultimately causes a shift in the way the body deals with glucose, encouraging weight gain and even a tendency towards diabetes and obesity – diseases that are now epidemic.