Sunday 22 April 2018

New Year, new you... how to lose weight in record time

The food, the drink, the treats - the festive season is packed full of them. But now the new year has begun, you may be thinking that it's time to lose those newly gained pounds. Dr Michael Mosley and Dr Clare Bailey have the solution

Dr Michael Mosley and Dr Clare Bailey. Photo: David Bostock
Dr Michael Mosley and Dr Clare Bailey. Photo: David Bostock
Dr Michael Mosley and Dr Clare Bailey
Michael Mosley shows how to plank
Michael Mosley doing press-ups

It's that time of year when we step on the scales, look at the number, sigh, and realise that we are going to have to go on a diet. The Christmas holidays may have been great, but like almost all holidays we ate and drank too much and the fat piled on. The typical person puts on just under 1kg over the Christmas holidays and now the time has come to try to shed it. But what is the best way to go about that?

Well, with the help of Dr Clare Bailey, a GP, who also happens to be my wife, I am going to lay out what I think is the best way to lose weight and keep it off, long-term. There are some surprising, even controversial elements to the approach I advocate (most nutritionists would argue against rapid weight loss), as well as plenty of things about my regime that everyone can agree on, including the benefits of exercise and stress management.

As I am sure you are well aware, the shelves of bookshops and supermarkets are heaving with a fresh influx of diet books, adding to the 50,000-plus titles already out there. So why should you believe what I have to say?

I like to think that my main claim to fame is that my books are based on the latest and best science that is available, which is why they include plenty of scientific references as well as endorsements from leading medical specialists. I talk to a wide range of experts who are at the cutting edge of this research and I try to look at the whole body of current research, not just cherry-pick data. Above all, I try to keep up to date with what is happening.

Michael Mosley doing press-ups
Michael Mosley doing press-ups

In many ways, this is a legacy of my medical training. On my first day as a medical student at the Royal Free Hospital in London, the Dean of the medical school gave a speech to all the first years, of which I can still remember two things. The first was that medical science continues to evolve at an extraordinary speed and that much of what we would be taught over the following five years would be outdated a decade later. That, he said, was why it would be so important to keep up with the latest research and keep challenging our beliefs.

The other thing he said was that, based on previous experience, four of us in this room of 100 strangers, would marry someone else in the room. He was right in my case. I met my future wife, Dr Clare Bailey, in that room on that day.

So all of this is a rather lengthy preamble to the details of the diet. I'm going to start by laying out the science and the evidence, because I think it is important that you buy into the reasons for doing what I suggest. Then Dr Clare Bailey is going to suggest recipes and a meal plan to get you through the next couple of weeks.

The diet I am about to outline is based on The 8 Week Blood Sugar Diet, a book I wrote which was aimed primarily at prediabetics (people with elevated blood sugar levels, not yet in the diabetic range) or those with type 2 diabetes. It can, however, be done by anyone who has some fat they want to lose, fast, though there are those who really shouldn't do it (see more below).

You can either go for the most rapid form of the diet, cutting your calories to 800 calories a day every day for up to eight weeks, or you can go for the more gradual 5:2 approach, which involves cutting your calories to 800 calories a day for two days a week and eating a healthy, low carb, Mediterranean-style diet for the remaining five days.

If you go for the more rapid version, then you can expect a weight loss of over 3kg in the first week, 10kg in four weeks, and 14kg at eight weeks. Most of it will be fat, though some will be water loss and some muscle loss (which why it is so important to do a muscle building exercise regime at the same time. See below)

Dr Michael Mosley and Dr Clare Bailey
Dr Michael Mosley and Dr Clare Bailey

On the 5:2 version of the diet, weight loss will be slower. Expect to lose 3kg in the first four weeks, 5kg at eight weeks. Again, as long as you do some exercise, particularly resistance exercise, the vast majority of the weight loss will be fat.

As well as helping you lose fat and improve your blood sugar control (which is particularly important as we get older) the recipes I've included below are full of ingredients which have been shown to improve the quality of your microbiome, the 1-2kg of microbes that live in your gut. As those who have read my most recent book, The Clever Guts Diet, will know, having a healthy microbiome is important not just for helping maintain your weight, but also for its effects on mood, sleep and your immune system.

The recipes in our books, and the food we now eat, are based on Mediterranean-style, low-carb eating. This approach is low in starchy carbs, but packed full of disease-fighting vitamins and flavonoids.

It is rich in olive oil, fish, nuts, fruit and vegetables, but also contains lots of lovely things that down the years we have been told not to eat, such as full fat yoghurt and eggs. In huge, randomised studies, researchers have found that not only do people get multiple health benefits from a Mediterranean-style of eating but they are good at sticking to it (unlike those who go on a low-fat diet) because they find it easy and enjoyable.

The foods we try to avoid or at least minimise, include sugary drinks, cakes, sweets or pastries and too much processed meat like bacon or salami.

The 800-calorie rapid weight loss diet

Most of us have heard, countless times, that if you lose weight fast, you will put it all back on even faster. It is a key part of dieting folklore. A few years ago, I would have agreed, and if you had asked me what I thought of rapid weight loss, I would have said it was a terrible idea. Everyone knows, I'd have said, about the dangers of yo-yo dieting. Everyone knows that the only successful way to lose weight in the long run is to do it gradually, sensibly, cutting your calories slowly, aiming to lose around 500g-1kg a week. But that was before I took a serious look at the science. And it turns out that much of what I used to accept as "proven" is actually based on myth.

There is certainly a rich history of faddy crash diets out there, from the lemonade fast to the cabbage soup diet. The latest versions include juicing and "cleansing". Some of these diets do deliver impressive weight loss. At least initially. The problem is that most of them are so boring that they become impossibly difficult to sustain. What's more, some don't have enough protein in them, so lead to muscle loss (you need to maintain your muscle mass to keep your metabolic rate up).

Not surprisingly, aggressively marketed zany diets have cast a long shadow over the reputation of rapid weight loss. But as America's leading obesity experts pointed out in a review article in the New England Journal of Medicine, 'Myths, Presumptions, and Facts about Obesity', numerous trials have shown that "more rapid and greater initial weight loss is associated with lower body weight at the end of long-term follow-up".

In other words, if you want to diet successfully it can be better to lose weight quickly than slowly. An Australian study which was published in 2014 backs up these claims. In this trial, they took 200 obese volunteers and put half of them on a rapid weight loss diet. The goal was for the participants to lose 12.5pc of their body weight within 12 weeks.

The other half were put on a standard low-fat diet, cutting their normal weekly intake by about 500 calories a day. They were given 36 weeks to achieve similar levels of weight loss as the fast dieters.

There was a very high drop-out rate among the steady low-fat dieters: less than half made it to the end of the 36 weeks. It's not surprising as going low-fat is hard and people get frustrated by the slow rate of progress.

By comparison, more than 80pc of people assigned to the rapid weight loss programme achieved their goal.

Katrina Purcell, a dietician who led the study, said, "Across the world, guidelines recommend gradual weight loss for the treatment of obesity, reflecting the widely held belief that fast weight loss is more quickly regained. However, our results show that achieving a weight loss target of 12.5pc is more likely, and drop-out is lower, if losing weight is done quickly."

Both groups were then followed for another three years. Although most put some weight back on, the amounts were similar in the two groups.

Commenting on the results of this study, Dr Corby Martin and Professor Kishore Gadde from Pennington Biomedical Research Centre, Baton Rouge, Louisiana, wrote, "This study... indicates that for weight loss, a slow and steady approach does not win the race, and the myth that rapid weight loss is associated with rapid weight regain is no more true than Aesop's fable".

Professor Mike Lean of Glasgow University, is also adamant that for many people rapid weight loss is the way to go.

"Doing it slowly is a torture," he says. "Contrary to the belief of dieticians - people who lose weight more quickly, more emphatically, are more likely to keep it off in the long-term. Dieticians are still teaching that you should lose weight slowly to keep it off. This is based largely on the very old 1960s' low-calorie diets where people went on crash diets with no maintenance programme. If you have no maintenance programme, of course you put the weight back on."

So what is it like to do an 800-calorie diet?

The first two weeks are likely to be the toughest, as your body adapts to fewer calories, but this should in turn lead to some dramatic changes. To give you a flavour of what you are likely to experience, I asked a friend of mine, Dick, who was about to start my diet, to keep a detailed diary.

Dick is a foodie. Nothing wrong with that but he was eating big portions and drinking too much. "I am not a binge drinker," he told me, "but six o'clock used to be time for the first gin and tonic. And I don't mean a small one. Then most of a bottle of wine. Followed by a few whiskies." Even his non-alcoholic drinks were calorific.

He would start each day with four sugars in his mug of tea.

The reason he decided to do my diet was because he had just been diagnosed with type 2 diabetes. Weighing 98kg and with a 106cm waist, he was beginning to look not only paunchy, but also grey and ill.

We agreed that he would aim to lose 14kg and get his blood sugar levels (which were well over the diabetic threshold) back down to normal, without medication, within eight weeks.

He then had a good-natured bet with his doctor, who said he wouldn't succeed. I'm happy to report that he managed not only to surprise his doctor, but also to debunk every myth about rapid weight loss.

He didn't feel deprived.

On Day Three of the diet, he wrote in his diary, "Still feeling fine. Weird. Not light-headed 'weird'. Weird as in 'Everyone told me this wouldn't be possible and I'd be desperate enough to eat the dog, but that is so not the case'."

When he stood on the scales he found he had lost over 3kg. In three days. As he wrote: "I know this will slow down but it's very motivating."

By Day Nine, his blood sugar levels had fallen to normal. His delight is clear - "Yes!! First result under the diabetes threshold!! For today I am not diabetic." Two days later the reading was down again. He wrote, "Hello pancreas!"

He was hugely encouraged to see that it was all happening so rapidly. "You are dropping so fast. And it happens almost immediately." He kept on track by telling people what he was doing, avoiding refined carbohydrates, planning ahead, making sensible food choices.

He started to walk more. Not just by going for actual walks but also by playing several rounds of golf a week. This added up to around 4,000 extra steps a day.

Dick realised that the times when he thought he was hungry, it was often merely a craving and if he did something else - walk the dog, for instance - the feeling would pass. Not being able to drink alcohol was, admittedly, trickier. After the first week he began to sneak in the odd whisky. He still lost weight.

It wasn't all plain sailing. There were days when he lapsed, but rather than beat himself up, he just got back on track.

It took Dick two months to lose 14kg and get down to his target weight of 84kg. That was three years ago. He maintains his weight loss by continuing to be active and eating a low carb diet. His blood sugars are still in the normal range.

CAUTION

As a GP, I am fully aware that there are some people who should not attempt a rapid weight loss diet.

You must discuss the merits of doing so with your doctor if any of the following apply:

* You have a history of eating disorders

* You are on insulin or a diabetic medication other than metformin - you may need to plan how you reduce your medication to avoid too fast a drop in blood sugar

* You are on blood pressure tablets - you may have to reduce or come off them

* You are pregnant or breastfeeding

* You have a significant psychiatric disorder

* You are taking warfarin

* You have epilepsy

* You have a significant medical condition

Don't go on the diet if:

* You are under 18

* Your BMI is below 21

* You are recovering from surgery or you are generally frail

- Dr Clare Bailey

Going 5:2

Many people find rapid weight loss surprisingly easy and just keep going. But if you find 800 calories a day, every day, either too tough or too inconvenient to stick to, then I would recommend the 5:2 approach, which I pioneered, as a gentler alternative.

The 5:2 approach is very simple. For five days of the week, you don't calorie-count but simply go on a low-carb Mediterranean diet. Then, for two days a week, you cut down your calories to 800 a day, using the menus from The 8 Week Blood Sugar Diet Recipe book (below are some examples from that book; you can find out more at thebloodsugardiet.com).

You can do your calorie restriction on any two days of the week that suit you, but it is best to be consistent so you get into a pattern. Try consecutive days, such as Monday and Tuesday. Or you may prefer to split your days, Monday and Thursday. Whatever works for you. Studies suggest the 5:2 approach is easier to stick to than a conventional diet; you lose fat faster and you see bigger improvements in your insulin sensitivity.

I've written extensively about the health and weight loss benefits of the 5:2 "intermittent fasting" diet elsewhere (see thefastdiet.co.uk). In the original version of the Fast Diet, I recommended men stick to 600 calories a day, and women to 500, twice a week.

I've changed my recommendations because new studies show that going up to 800 calories seems to be just as effective, particularly if you go low-carb on the other five days

Mindfulness - reducing stress

We all know what it is like to feel stressed. To get out of bed and worry about the day ahead, allowing self-critical and unhelpful thoughts to rattle around inside our heads. Too much stress can lead to comfort eating, depression and insomnia. Saying, "Pull yourself together" rarely works. But you can counter these negative thoughts by making yourself more "mindful". Instead of obsessing, take time out to look at yourself and your thoughts in a less judgemental, more reasonable way.

Mindfulness is a modern take on the ancient practice of meditation. The good news is you don't need to be religious or go on a retreat to a Tibetan monastery to do it. You can buy books about mindfulness, but it's not really something you need to read about; it's something you need to do. I recommend joining a group or downloading an app that will guide you through the process.

The app sessions are short - at first it's just 10 minutes, then 15 minutes, and finally 20 minutes, so it's not a particularly time-consuming thing to do. You may be cynical, but it really is worth trying. I find it reduces cravings and helps me sleep better.

When I'm doing a mindfulness session, I sit in a comfortable chair, turn on my app, rest my hands on my thighs and close my eyes. Then, guided by the app, I spend the next few minutes trying to focus on my breath. I pay attention to the sensation of the breath going through my nostrils, filling my chest, expanding and contracting my diaphragm. I try to stay focused on this task and when I notice that my thoughts have drifted, which they do, I bring them back to my breath.

I try to treat thoughts like balloons that drift into my consciousness; once I have noticed they are there, I simply allow them to drift way. I say "simply", but when you first start, you will find it's almost impossible to stop thinking about deadlines, food, the overdraft, the kids, your ex-partner, etc... You might start thinking, "This isn't working, what is Michael Mosley on about?" Put those suspicious thoughts aside; it will get easier.

Like any skill, practice makes perfect. Mindfulness can be very effective in a surprisingly short time. In a recent study, researchers took 15 volunteers who had never tried anything like mindfulness and put them through a brain scanner. They also got them to fill in an anxiety questionnaire.

The volunteers then did four sessions of mindfulness training, spread over four days, and the tests were repeated. Anxiety ratings fell by 39pc. The results also showed that activity also increased in the areas of the brain that control worrying, particularly the ventromedial prefrontal cortex and the anterior cingulate gyrus. This supports the claim that mindfulness strengthens our ability to ignore negative thoughts and feelings.

Cassie's story

Cassie is a young nurse, in her 20s, who contacted me via our website, thebloodsugardiet.com. She was very overweight and on medication to control her blood sugar levels. She was a secret eater, constantly hungry and so desperate to change that she was considering weight loss surgery. She had tried every diet going and nothing had worked.

Could I help? The answer was "yes", if she was prepared to commit. Cassie told me she had no idea whether she would be able to stick to what sounded like a tough regime but she felt she had hit rock-bottom. "I have nothing to lose," she told me.

What surprised her was that it didn't take long to get into a new habit. The first few days were tough but she swiftly got into a routine that worked for her. Lots of protein and vegetables, no refined carbohydrates. In the evening, she would eat a smaller portion of what her husband was eating - a stir-fry or a salad.

After just a week, the hunger ended. For the first time in her life she was no longer obsessed by food.

She stayed on the diet for eight weeks and lost just over 20kg. She sent me an email to say: "I feel amazing. I don't think about food any more. I'm full of energy. Happy. I really do think I have been given another chance at life. I feel in control for the first time."

Losing that weight meant she could come off all her medication. And there was another pleasant surprise. A couple of months after finishing the diet she sent me another email to say that after years of trying, she was pregnant.

"Thank you. Not only have you freed me from food and put me back in charge of my own life, but you have also helped me to make a little miracle possible - which I never thought would happen."

- Dr Clare Bailey

TIPS FOR KEEPING ON TRACK

By Dr Clare Bailey

As I tell my patients, losing weight is tough, keeping it off is tougher. But it can be done. The following are tips that my patients say they have found useful:

* Sit down at the kitchen table for most meals. If you eat on the run or in front of the TV, you will eat badly and go on eating well beyond the point when you would normally feel full.

* Try to eat slowly. It takes time for the food you eat to reach the parts of your small intestine where cells release a hormone, PYY, that tells your brain, "I'm full". That's why if you eat slowly, you will eat less. Try to put down your knife and fork down for a while and try to wait 30 seconds or so before picking them up again. Leave food on your plate when you are no longer hungry. This probably goes against everything you were taught when growing up. The alternative is to take smaller portions in the first place, leaving yourself the option to go back for more. What McDonalds and other fast food outlets discovered long ago is that people tend not to go back for more (thus, "SuperSize Me")

* Try to avoid "diet" products as they are highly processed and often contain sugar and/or sweeteners (which may not switch off hunger signals).

* Drink soup a lot. It is satiating, cheap and practical. We make big quantities, often out of left-over veg, and keep the unused stuff in the freezer.

* Don't drink lots of alcohol. Alcohol contains plenty of calories and makes you disinhibited, so you are more likely to snack.

* Keep tempting foods out of the house or out of sight. In a fascinating study, Cornell University researchers visited houses in New York, taking photos of people's kitchens. They found they could predict a family's weight by the foods left out on the surface. If breakfast cereals, for example, were visible, the inhabitants were, on average, 10kg heavier than people in households where the cereals were put away. Breakfast cereals have a reputation for being healthy. They aren't.

* Don't keep your cupboards empty. If there's no food in the house you will probably order a takeaway. Make sure there's plenty of food around like nuts, yoghurt and eggs. Keep the fridge stocked with vegetable crudites, such as sticks of carrots, green peppers or tomatoes, perhaps with some salsa or hummus, for moments when you just have to snack.

* Weigh yourself several times a week. There is a widely held belief that you shouldn't weigh yourself more than once a week. Yet a recent study suggests more is better. In this particular trial they followed 40 people attending a health promotion programme. Some weighed themselves daily, others weekly, monthly or hardly at all. The more often people weighed themselves, the more weight they lost.

* Wear a belt. One of the surest ways of telling that you are putting on unhealthy fat is noticing when your belt starts to feel tight again.

* When you go out for a meal, ask the waiters to take the bread basket away. Try to stick to one course, with lots of vegetables instead of rice or potatoes. If you have a dessert, then share it with someone else. Research shows that a small amount of something sticky and tasty is just as satisfying as eating a large portion.

* When you can, take the stairs and occasionally try to run up them. It is sad how many people stand on escalators when they could be burning a few extra calories walking up them.

* We have a dog, Tari, and she barks loudly if we don't take her for a walk at least once a day. Walk the dog, though this is not the most practical tip if you prefer cats.

* I acknowledge "three good things". This is based on an idea devised by American psychologist Professor Martin Seligman. All you do, at the end of the day, is think of and/ or write down three things that went well that day and why they went well. It doesn't have to be anything major; perhaps someone complimented you, or you watched a beautiful sunset. The point is that it focuses your attention on the positive. It is a good way to lift your mood and bolster resilience.

Michael's HIT regime

As well as strength exercises, I do something called HIT (High Intensity Training) on an exercise bike. My regime consists of three bursts of 20 seconds, done three times a week on an exercise bike. You should only attempt this once you have built up some fitness.

1 Get on an exercise bike and do a short warm-up of gentle cycling, against limited resistance. You should just about notice the effort in your thighs.

2 After a couple of minutes, begin pedalling fast, then swiftly crank up the resistance. The amount of resistance you select will depend on your strength and fitness. It should be high enough for you to feel it after 15 seconds of sprinting. If, after 15 seconds, you can still keep going at the same pace without too much effort, the resistance you've chosen isn't high enough. It mustn't, however, be so high that you grind to a complete halt. It's a matter of experimenting. What you'll find is that as you get fitter, the amount of resistance you can cope with increases. It's not speed but effort you are after.

3 After your first burst of fast sprinting, drop the resistance and do a couple of minutes of gentle pedalling to get your breath back. Then do it twice more.

4 Finish with a couple of minutes of gentle cycling to allow your heart rate and blood pressure to return to normal before stepping off the bike. In total, this takes me less than 10 minutes.

Building Muscle

As well as cutting your calories, it is important that you build more activity into your day if you want to keep the weight off. We all know about the benefits of aerobic exercise, like running, walking or swimming. But a recent survey found that less than 4pc of adults do any form of resistance, strength-building exercise. That is a shame because not only do your muscles tend to shrink as you get older (you typically lose 5pc of your muscle mass every decade from age 30 onwards) but muscle is metabolically active and keeps burning calories, even when you are sleeping.

I hate the gym so I've devised a simple regime, designed to be done any time, any place. With my regime, you exercise as many major muscle groups as possible, varying which ones each time, so the ones not being worked get a bit of a rest. I start with push-ups (working the upper body), and follow these with something that works the core (abdominal crunches) or the legs (squats). What I do is based on a paper in the American College of Sports Medicine's Health & Fitness Journal and I do it at least three times a week, first thing in the morning. It only takes a few minutes.

Push-ups: lie face down with the palms of your hands under your shoulders and the balls of your feet touching the ground. Keep your body straight. Lower your body till your elbows form a 90-degree angle and then push up. If you find this too hard, do it with your knees on the ground.

Squats: Stand with your feet apart. Bend from the hips, keeping the weight in your heels. Make sure your back is straight. Keep bending until your legs are at a 90-degree angle - imagine you are preparing to sit in a chair. Push back up without bending your back. Squats work the biggest muscles in your body. You can make this harder with weights.

Crunches: Lie on your back with your knees bent, feet flat on the floor and your hands by the sides of your head. Curl up your upper body without lifting your lower back off the floor. Make sure your chin is tucked in towards your chest. When your shoulders and upper back are lifted off the floor, curl back down.

Bicep curls: This exercise requires small hand-held weights. You stand with your feet apart and your hands by your sides, with one hand clutching the small weight. Then, with your arm kept by your side, raise your hand by bending your elbow. Transfer the weight to your other hand and repeat.

MICHAEL_MOSLEY_097.jpg
Michael Mosley shows how to plank

Plank: Lie face-down on the floor and then raise yourself on to your forearms and toes so that your body forms a straight line from head to toe. Make sure your mid-section doesn't rise or drop. Squeeze your buttocks and hold the position for as long as possible. Remember, it should never cause pain in the lower back.

I suggest you start by doing one set of 10 repeats of each of these in Week One of the diet (with 20-second holds on the planks). In other words: 10 press-ups, 10 crunches, 10 squats. You will do this three times in the first week.

* Aim for two sets of 10 repeats by Week Two, and three sets by Week Four.

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