Life Health & Wellbeing

Thursday 17 January 2019

Here's the plan: I'll tell you how to lose weight and keep it off forever

The self-doubt and yo-yo weight gain of traditional diets was all too familiar to Zoe Harcombe. So she did something about it...

Zoe Harcombe
Zoe Harcombe
Zoe Harcombe
'There is a pain motivator that you can harness'
Make your goals Specific, Measurable, Achievable, Realistic, and Timebound
The Diet Fix

'I still have the cheque I wrote to my first diet doctor - Baltimore, 1977. I was 23 years old, 67kg, a size 8, and I thought I was fat. The doctor put me on a 1,200-calorie regimen, and in less than two weeks I had lost 10lbs (there's nothing like the first time...). Two months later, I'd regained 12. Thus began the cycle of discontent, the struggle with my body. With myself."

With that first step, Oprah Winfrey joined the dieting brigade - Beverly Hills, Atkins, Scarsdale, Cabbage Soup - we know them all; we've done them all. Like so many other dieters, she lost weight, felt terrific, vowed never to regain but always did and so the vicious cycle took hold.

Oprah lost and regained and lost and regained with each and every diet. At her heaviest, she was 107kg and full of self-loathing. Each time she hit the target, she did a special show, parading in her 'slim' jeans or whatever outfit made her look and feel sensational.

I know how Oprah, and many others, feel. I've not lost as many pounds, but I have been on a calorie-deficit diet - many times. The first time, I lost weight, regained it and a bit more. Then I went on another calorie-controlled diet, lost weight (not as easily the second time round) regained it and a bit more. And then another, and another.

When I started this vicious cycle aged 15, I was 5ft 2in and about 54kg. That's a body mass index (BMI) bang in the middle of the normal range, but a couple of comments at school and I thought I was fat. I went to a newsagent and picked up a booklet about calorie counting.

The book said: "To lose 1lb of fat you need to create a deficit of 3,500 calories." That was supposedly it - the secret to weight loss. Apparently all I needed to do was eat less and/or do more, and for every 3,500 fewer calories eaten and/or 3,500 more calories exercised off, I would magically lose 1lb of body fat. The timescale was supposed to be completely flexible too - cut back by 500 calories a day to lose 1lb in seven days. Or cut back by 1,000 calories a day to lose 2lb per week. I've seen suggestions that cutting back by a 50-calorie biscuit a day will result in a 5lb weight loss at the end of the year.

My mother was a sports teacher, so I was already following in her footsteps and 'doing more' than any of my peers: swimming, hockey, rounders, tennis, badminton, athletics - you name it - I was doing more of it. The food bit seemed like a piece of cake (excuse the pun). I went on to do maths and economics at Cambridge University, so memorising the calorie content of many foods and totting them up every time I ate was a doddle.

I started my 1,000-calorie-a-day diet in the autumn and began to lose weight. By spring, when winter tracksuits came off, my sports team-mates noticed my weight loss. In the six months of dieting, according to the 3,500-calorie formula in my diet book, I should have lost 23kg in fat alone, and more on top in terms of water and muscle (sadly) - approximately 27kg, in fact. I had lost a fraction of that. I'd gone under 45kg, but had lost a third of what the formula said I should have done.

I cut back even more. I reached the point over the summer where I was trying to live on black coffee and green apples - that's approximately 400 calories a day. At my lowest weight, I dipped under 41kg and I started getting threatened with school/doctor interventions. So I decided that I would stick at that weight for a while, take the pressure off, and then return as soon as possible to what by now had become an obsession. Only that didn't work out too well.

The booklet said that weight could be maintained at approximately 1,500 calories a day. I hadn't spotted that bit when I started my first diet. I hadn't seen 'the small print' when I was excited about 'the new me'. I hadn't signed up to eating three quarters of what I needed to eat (and a fraction of what I had eaten as a sporty teenager) for the rest of my life. It turned out that this too was a lie. If only one could eat three quarters of calories needed and not regain weight.

I started on my 1,500-calorie-a-day 'maintenance' diet and I started to regain faster than Usain Bolt can sprint. I panicked and tried to slash back to the apples and black coffee. Only I didn't seem to have the willpower for that any more. I had reacquainted myself with the taste of cereal, toast and calorie-counted 'fake food' and I wanted more of it. The more I tried to cut back, the more food seemed to compel me to eat it. I was at the start of the worst period of my life.

My late teens were marred by being in complete turmoil about food. I went from 41kg to closer to 64kg, but even the despised extra weight wasn't as bad as the sense of being powerless. I was a drug addict, desperate to get my fix, but knowing that I would feel so much better if I could get my starving/bingeing under control.

Food is, in many ways, the worst addiction to have. We can give up cigarettes, we can avoid alcohol, and we can come off social media. We can't stop consuming things. (The temporary success of liquid diets, by the way, is largely due to the fact that they stop us eating for a period of time.)

We have been fed many cruel lies when it comes to weight loss. We want to be slim more than pretty much anything else in the world. It's not our fault that we're not. We are not failures - the slimming advice that we have been given has set us up to fail.

Did you know that there is no evidence for that 3,500-calorie promise in diet books? Did you know that there is no evidence that calorie-deficit diets have ever achieved long-term, sustained weight loss? Do you know what happens when you try to eat less and/or do more? Would you like to know why calorie-deficit diets don't work? Would you like to know what does work?

We have consistent and repeated evidence for this and yet we meet the definition of madness every Monday morning by starting another calorie-controlled diet and thinking that this time will be different.

I have worked one-to-one with people to try to help them to lose weight. The first question I ask is -when did your weight problem start? Nine times out of 10, the reply is: "I wasn't that overweight, but I went on a calorie-controlled diet, lost weight, regained it and a bit more. So then I went on another calorie-controlled diet, lost weight, regained it and a bit more." The dieter ended up with a bigger weight problem having tried to diet.

My story has a happy ending. Indeed, I've been enjoying the happy ending for over 20 years. I've found a way to maintain my ideal weight (50kg) without hunger, starvation or deprivation. I enjoy food in a way that I could never have imagined. I used the trauma of the 'worst period of my life' to start a long-term study of obesity, weight loss and emotional relationships with food.

It has been a fascinating journey and I have been helping others to get slim and stay slim since 2004. I want to help you to get off the rollercoaster of losing, regaining and probably a bit more. I want the next pounds/kilos that you lose to be the last that you need to lose - the ones that come off and stay off.

This is an edited extract from The Diet Fix: How To Lose Weight And Keep It Off... One Last Time by Dr Zoë Harcombe (Short Books) Disclaimer: This extract is intended to inform, entertain and provoke your thinking. This is not intended as medical advice. It may, however, make you question current medical and nutritional advice. That's your choice. It's your life and health in your hands. Neither the author nor the publisher can be held responsible or liable for any loss or claim arising from the use, or misuse, of the content of this book

FYI...  what the Franz review found

There are many studies which show calorie restriction doesn’t work long-term. One of my favourites is the Franz review — you’ll find it online. Published in 2007, it reviewed the results of 80 weight-loss studies carried out between January 1997 and September 2004. A total of 26,455 participants were involved.

At the one-year follow-up, across all the studies, 29pc of people had dropped out and were no longer available for assessment. The first interesting finding was that people struggled to stick to a diet even when they knew they were involved in an important academic study. And many of these diets were not tough either — some just involved doing exercise or even taking a weight-loss drug.

The Franz review contained some very interesting findings:

The smallest weight loss was in the studies where the intervention was exercise alone. The adage ‘you can’t outrun a bad diet’ was nicely proved. The largest weight loss was achieved in the very low-calorie (liquid) diets.

The largest weight loss group was also the largest weight regain group. The very low-calorie (liquid) diet studies grouped together dipped to the lowest point and then the regain was almost as rapid.

Something happened at approximately six months. In every group, weight loss was lowest at the half-year mark and then regain started.

Despite some of the interventions achieving far greater than a 1,000-calorie-a-day deficit, the average weight loss was 5-9kg in six months. The “plateau at approximately six months” was better described as the bottom of the weight loss curve before regain started.

After four years, where data were available, dieters were lucky to be 3-6kg down from their starting weight. Does that sound like a good deal? If you can stick to a diet for four years, you might be a few kilos down at the end of your ordeal.

Your 10-step plan for success

Know what doesn't work

Counting calories doesn't work. Trying to eat less doesn't work. Trying to do more doesn't work.

It's a myth that "To lose 1lb of fat you need to create a deficit of 3,500 calories". The powers-that-be know not from whence that myth came and they cannot prove it.

The most important studies from the past 100 years (including the Minnesota Starvation Experiment and the Stunkard and McLaren-Hume study) have shown that low-calorie diets don't work. In fact, we've learned that hunger is comparable with war in terms of the devastating effect it has on people.

They also show that weight loss on dramatically restricted calorie regimes is a fraction of the amount predicted. The less you eat, the less you must continue to eat to have any chance of losing more weight and weight loss will stop, at some point, whether you like it or not.

The body will do whatever it takes to reverse the effects of starvation/dieting. Eating less and/or doing more doesn't work: We can't sustain a calorie deficit because trying to eat less makes us want to eat more and do less and trying to do more makes us want to eat more and do less. We are hard-wired to eat more and do less. We can't change that hard-wiring. We need to start working with our bodies - no more fighting the entire history of evolution.

Even if, in the short-term, we could sustain a calorie deficit, the body eventually adjusts. There are nine systems in the human body - all of which can and do adjust. If we put less fuel in, the body does less - it doesn't just give up body fat. That's one of the last things that it wants to do, as body fat has been our survival blanket through times long before supermarkets existed.

The mere act of trying to eat less drives bad food choices. We graze, to make us feel less deprived. We try to get the biggest bang for our calorie buck, to make us feel less deprived. This leads us to high-carbohydrate, low-fat foods, drip-fed throughout the day.

This turns out to be the worst possible thing to do to lose weight.

And Know what  does work

Weight loss is the act of breaking down body fat. The hormone in the body that does this for us is called glucagon. Glucagon (see opposite) needs us to meet four conditions to be able to break down body fat: We must not have glucose available as fuel. We must not have insulin present. We need to do things that enable glucagon to be called upon; and not do things that inhibit the operation of glucagon.

Accept that only you can achieve this

Once you have the requisite knowledge, the acceptance that you are the only person who can achieve your goal is the most vital next step.

Take all the tips and inspiration that you need, but then accept that you - and only you - are the person who can achieve what you want.

FYI...  Insulin and clucagon: meet the fat makers - and the fat breakers

The simplest and easiest fuel for the human body to use is glucose. If you consume any food that contains glucose (that's any carbohydrate in essence), the body needs to deal with it quite rapidly, because a high blood glucose (or blood sugar) level can be damaging.

The body releases the hormone insulin to bring down blood glucose levels. There are a number of ways in which insulin controls blood sugar. It allows glucose to be transported into muscles, where it is stored as glycogen. It also switches on the glucose storage system in the liver, turning glucose into glycogen. In addition to this, it can activate biochemical pathways in the liver that turn glucose into fat.

As a general rule, only when the body has run out of glucose will it look for an alternative fuel - fat, for example. The body is quite happy fuelling on fat. However, it finds carbs (or glucose) easier, and our current carb-heavy diet has led to most people having a suboptimal ability to fuel on fat.

The body has two options for fuelling on fat: dietary fat and stored (body) fat. If you have recently had a butter coffee, for example, your body can use the fat from the butter for fuel. If you are out of stored glucose and out of dietary fat, your body can start to break down body fat. That's weight loss. The body can also break down body fat if your blood glucose level gets low.

The mechanism by which body fat is broken down involves a hormone called glucagon. Think of insulin and glucagon as equal and opposite hormones. Insulin takes glucose out of the blood stream and stores fuel; glucagon puts glucose back into the blood stream and accesses fuel. They are not in play at the same time. If insulin is doing something, glucagon is dormant. If glucagon is doing something, insulin is dormant. If glucose is available, there is no need to break down body fat. If insulin is present, it is not possible to break down body fat.

What makes glucose available? Carbohydrates. What makes insulin present? Carbohydrates again, but also protein. The only macronutrient that doesn't appear to have an impact on glucose or insulin is fat. I hope you're wondering now why we are told to eat so much carbohydrate.

 

Understand your 'why' (and what you're prepared to do to achieve it)

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'There is a pain motivator that you can harness'
 

There are only two motivators of change: pain and pleasure. Pain is the greater motivator of the two. So is there a pain motivator that you can harness?

The pain motivator may involve others - for example, concern that you may not be around for grandchildren. Many people with weight problems are the carers and feelers in this world and a goal that involves others may inspire you.

If not a pain motivator, is there a pleasure motivator that you can strongly visualise and connect with? You'd probably choose being slim for life over winning the lottery, so be bold in what you're prepared to do to achieve your goals.

 

Set smart goals

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Make your goals Specific, Measurable, Achievable, Realistic, and Timebound
 

Make your goals SMART - and by that I mean Specific, Measurable, Achievable, Realistic, and Timebound. They also need to be written down and clearly captured. Stick a copy on the fridge. Keep a copy in your purse or wallet. Maybe even make it your screensaver, so that you see it every time you look at your phone or computer screen. If you know where you're going, you're far more likely to get there.

Specific means that your goal needs to be as clearly described as possible. An example? Something like: ''I want to be able to wear my favourite jeans again'' or ''I want my blood glucose levels in the normal range''.

Measurable means that you will be able to monitor progress. If your goal is to lose however many kilos, you will be able to measure this along the way.

Achievable means something that you can achieve. The great thing about personal health goals is that they are almost always achievable. Provided that your goal is realistic, you will be able to achieve it.

Realistic means what it says. The diet goal doesn't have to be ''organic everything and below 25g of carbohydrate a day''. Start with ''eat real food'' and master this first. Then you can reduce carb intake to see what is optimal for your weight, activity and health.

Timebound means putting a timescale on it. This is particularly important with weight and health goals because those are the ones we always want to start tomorrow.

If you want to knock them dead at the college reunion, get your specific goal and then work out what measurements you need to achieve along the way to make it happen.

 

Understand your beliefs - especially your limiting beliefs

Keep a notebook and jot down any insights into what has stopped you achieving your goal in the past. It is likely to have been just the wrong dietary advice. The chances are that along the way you have lost faith in yourself. You can change this. Indeed, only you can change this. There are some tools that can help...

Understand your personal relationship with food

Which ingrained messages from childhood are hampering your progress? Do you still think that sweets are treats? Have you always thought this? Which emotions do you associate with food? How can you generate or deal with those emotions in non-food ways?

Be prepared for a period of rawness in emotions when you don't turn to food as a crutch. Be proud of every step you take when you handle emotions as they should be dealt with - with interpersonal skills and not food.

We can't change things unless we know they need to change.

This brings us nicely to...

 

Use tools to change your behaviour

Observe your mind scripts - those mini-dramas that you put on in your head. Observe the messages that you give yourself by the minute, the hour and the day. You communicate more with yourself than with any other person. Which good and encouraging messages are you sending (that you can do more of )? Which unhelpful and critical messages are you sending (that you need to drop like a hot coal)?

Become conscious of your behaviour. You can't change a bad habit unless you know you have a bad habit. You can't improve something unless you know that something needs to be improved. An unhelpful mind script, a bad habit, a destructive action... Becoming the watcher will help you to spot it. Then you work on doing the right thing until it becomes second nature.

Reflection. You may like to reflect each Sunday night or Monday morning about how things have gone for you over the past week. Always start with positives - at least three; only when you have these written down are you allowed to think of what could have gone better. Notice that we don't call these negatives - they are always opportunities to learn. As you do this more and more often, you will learn more and more about yourself. All of this understanding will help you to achieve your goal.

 

Eat naturally, move naturally

Adopt these five principles and make them the way that you do things from now on:

1 Eat real food. The essentials in a real-food diet are: meat, eggs and dairy foods — ideally from pasture-living animals; fish, vegetables and fruits — ideally those in season; beans and pulses, and non-wheat wholegrains, such as brown rice and oats.

2 Choose whatever real food you eat for the nutrients it provides. When we factor in the essential nutrients — the complete protein, essential fats, vitamins and minerals that we must consume to survive and thrive — we will naturally prioritise foods of animal origin (meat, fish, eggs and dairy) and green leafy vegetables, as these are the most nutrient-dense foods. This will naturally manage carbohydrate intake because meat and fish contain no carbohydrate (with the exception of glycogen in liver); eggs contain barely a trace and dairy products no more than 10pc. Non-starchy vegetables are also naturally low in carbohydrate.

If you do want to choose carbohydrate meals from time to time, avoid combining them with the staples of fat meals — meat, fish, eggs and dairy products. Irresistibly delicious meals, such as beef and Yorkshire pudding, cheese and bread ‘Ploughman’s’ and fish and chips, are all wonderfully fattening.

3 Eat a maximum of three times a day — no more.

4 Manage alcohol intake to enable fat burning. The alcohol choice is yours — how much and how often. But you will inhibit the operation of the fat-breaking hormone glucagon for a period of time after drinking alcohol. Alcohol is one of life’s pleasures and part of many social activities. You can decide when to enjoy a glass of wine or champagne (ideally not beer or spirits and sugary mixers) armed with knowledge.

 You can also be prepared for the blood glucose dip that will follow alcohol consumption. The human body has just 4g of glucose in the entire blood stream at any one time. That’s one teaspoon of sugar. So rebalance with just the right amount of food to get your blood glucose back into the normal range — one square of very dark chocolate or one bite of a piece of fruit. You won’t need a kebab and pitta bread!

5 Do what we’re designed to do: walk, talk, dance, sing, cook, clean and tend the land. The good news is you don’t need to go to the gym to lose weight. You don’t need to go jogging or sign up for the amateur Tour de France. Indeed, exercise can be unhelpful at times when you’re trying to slim — it’s how we work up an appetite.

Hopefully it will also be good news to know that you should find something that you enjoy and do it as often as you can. Walking is the single best activity that you should do — as much as suits your lifestyle every day. Learn to dance? Become a street litter-picking champion? Join a choir? This is your chance to do something active, natural and fun.

Just do it! One last time!

From now on, your focus will be on eating better, not eating less. Your eating philosophy will be about nourishment, not deprivation. We now know that to lose weight, we must change our lifestyle, not go on a diet - certainly not a calorie-controlled diet. We must make healthy eating, not starvation, our way of life.

 

 

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