Calories matter but they are not the full story
Yesterday I read an extract from Jenni Murray’s new book, Fat Cow, Fat Chance. Dame Jenni is a highly successful journalist and broadcaster, known for presenting BBC Radio 4 Woman’s Hour. After a particularly difficult day, depressed, working away from home and menopausal, she called The Samaritans. Here was a highly successful woman, at the peak of her career, loving her job, her family yet totally and utterly desolate about her weight which was sitting on top of a number of other things going on in her life. My heart broke for her. Jenni had tried everything including psychotherapy, anti depressants, HRT and hypnosis as well as every diet under the sun.
It’s a very familiar story for people in all walks of life but it is a particularly hard pill to swallow for a person who considers themselves highly successful and in control of everything they do but can’t for some reason control their weight. The pressure is now on - being overweight is known as a key factor in being seriously affected by COVID-19 if you are unlucky enough to contract it. Two thirds of critically ill patients in the UK during the height of the pandemic were overweight. Obesity promotes inflammation, which leads to other conditions such as diabetes, cancer and heart disease. We can now add serious complications from C-19 to the list. People, even GP’s are scared to acknowledge that others are overweight as we are now accused of ‘fat shaming’. You can’t even congratulate your friend for losing weight in case you are accused of thinking she was fat before. However we do need to talk about being overweight. Britain is in the middle of an obesity epidemic, not just a coronavirus pandemic - and the two are related. Excess weight can shorten your life and create serious health issues.
Weight loss is contentious and everyone and their dog has an opinion on the topic or happens to be expert. There is a reason why the global weight loss and weight management diet market size was valued at $192.2 billion in 2019, and is projected reach $295.3 billion by 2027. It has become a cultural obsession. The whole industry is profiting from people’s misery and awash with fad diets that do not work long term. Further, the science around nutrition and weight loss is inconsistent, confusing, frequently biased and often funded by industry or activist groups. Anyone can find a study that supports any premise.
There are ‘experts’ on the internet who mockingly tell people that it’s just a calories in and calories out issue (CICO), or that it’s about “calorie deficit stoopid”, or worse, “eat less, exercise more”. These are the ones who deliberately court controversy on Instagram as a marketing ploy - in order to get likes and blue ticks as a way to promote their business. Then there is the celeb brigade, lying about how they lost their weight or promoting dangerous products like Skinny Jab which put their health at risk, not to mention the gross side effects. Neither approach does anything to address eating behaviours or emotions – they both equally make people feel weak and stupid. It’s cruel and generally poor advice, especially when you feel hopeless, defeated, guilty, heartbroken, ashamed or not worthy.
There are a number of reasons why the world’s population is fatter than it was even just in the 70’s and a quick search on PubMed will give you plenty of research that proves the point. Obesity and weight loss has many layers. Hruby and Hu (2015) define obesity as a complex, multi-factorial disease involving behavioural, socio-economic, genetic and environmental issues impacting one third of the world’s population - which is largely preventable. It sums up the problem pretty well.
George Monbiot in the Guardian wrote a thoughtful article a couple of years ago talking about how we need to stop shaming the overweight. He provided data to show that the tipping point for our society gaining weight started around 1976 - after that people started getting fatter. Apparently we ate more in 1976 than we do today. Government figures suggest we consume an average of 2130 calories today, but in 1976, we consumed 2280 calories – 2590 if you include alcohol and sweets. He cited a number of possible hypothesis, all with merit, but as ever, no silver bullet – because there isn’t one. The photograph he published alongside the article showing people on a beach in 1976 said it all. I found a better one on the internet which you can see in the headline of this article – not one fat body.
I have been in Jenni’s shoes but not to the same extent. I have struggled all of my adult life to remain a “healthy” BMI – also a controversial topic. It has generally been at the upper end, which is some kind of miracle given the number of stressful and sedentary jobs, a gym phobia and often a ridiculous amount of long haul air travel, long days and a lack of sleep. About six months after moving to California, I noticed my weight creeping up, so I employed a personal trainer for three sessions a week as I thought I needed a kick up the backside. She looked at my food diary, pronounced “I was not eating enough” (that old chestnut), and gave me a diet sheet which incorporated a daily oatmeal pancake for breakfast. About a month in, we did a review. My weight had ballooned (fat, not muscle), and she accused me of drinking too many cocktails at the weekends. It was probably the most hurtful thing someone could say to a person sensitive about their weight and doing all the ‘right things’.
Back in the office, there was a group of dudes who were really into the ‘biohacking’ scene which had been going in Silicon Valley for a couple of years. It seemed a really cool thing to try so I abandoned the diet plan from the trainer and joined them. I carried on gaining weight even though some of the things they were doing were excellent and grounded in evidence – but it didn’t work for me. By this time I had started my training as a Nutritional Therapist and I worried about how on earth could I possibly help people if I couldn’t help myself.
Fast forward five years and I’m no longer overweight. It was not calories in, calories out (although calories do matter), nor was it ‘eat less, exercise more’. I developed a plan that was unique to me and my circumstances based on research and by following a very high nutrient density plan tailored to my needs. I subjected myself to a lot of functional testing, including gut testing, hormone testing, organic acids testing, genetic profiling, nutrient profile testing and others, to find out what was going on – some of it was necessary and extremely useful, some a complete waste of time and money. I did however find the root causes and it gave me a few levers which really helped. The single biggest difference was really working hard to improve my sleep hygiene. I also had (and still do have) a fabulous ‘squad’ - a group of incredible women with a shared interest in health and well being.
Going through the experience personally has taught me a number of things:
Behavioural change. 80% of us change our eating behaviours in response to stress. Let’s face it, during this pandemic, people have been bored, stressed or lonely. Little wonder many in the UK have gained corona curves. Stress affects our sleep and lack of sleep impacts our hunger hormones and makes us want to eat even more. This leads to feelings of shame and creates more stress. Weight loss needs to be approached with compassion, understanding, patience and without judgement. It is a highly complex issue and it requires time to figure out the key drivers of behaviours in order to figure out what works and does not. It helps if someone has your back to help figure it out, to support you and to and help you stay motivated.
For Life. There is no one size fits all for weight loss, nor is there a lasting quick fix. It’s about finding the root cause of your weight gain, addressing behaviours, and putting a plan in place to address the health imbalances. If it were easy, there would be no-one overweight. You might be attracted to the latest thing your friends in the gym or work colleagues do but it may not necessarily be right for you. Find a way of eating that works permanently with your lifestyle - don’t fall for the latest fad. Food is to be enjoyed and shared. It is one of life’s greatest pleasures.
Work with your body. Our bodies are biochemically different and we may have different genetics, digestive systems, heath histories, hormones, medication requirements, nutrient profiles and other life stuff going on. We may also be exposed to different things going on in the environment which is making weight loss elude you. In clinic with weight loss clients, if they are not in a consistent calorie deficit, for a period of 6-12 weeks, I nearly always start with gut health, as it is unlikely that people can lose weight unless gut health is addressed first. I also look closely at hormones as the balancing of these often matter more than calories.
Buddy Up. There is a reason why Weight Watchers and other weight loss accountability forums are so popular. The shared sense of accountability, support and learning from others is a highly powerful combination and a key success factor - even though I don’t agree with counting. Some of my closest friends are from people I met when I was losing weight. The topic can form very powerful bonds based on a shared purpose, common understanding and empathy.
Tracking can be helpful for some but not everyone. Tracking calories on app’s like My Fitness Pal and Cronometer may help you feel accountable and can be great for figuring out what works for you, and to understand your starting point, ie how much you really eating and your macronutrient levels. If you have a specific sporting or fitness goal and you are training for something specific, counting macros and calories can be helpful.
On the other hand the variations in what you might need vs. what is tracked are often so big to be helpful. It also creates the wrong mindset for weight loss. There is a device called an indirect calorimeter which measures energy expenditure, establishes more precise nutrient requirements, measures physical fitness and evaluates macronutrient utilisation during exercise and rest. As it is a highly accurate determination of energy expenditure, it is often used to optimise nutritional support and to quantify the precise energy and macronutrient requirements of athletes and those with metabolic disorders. It proves that tracking calories and macros can be wildly out and helps in some way to explain why people get frustrated. Tracking however can lead to obsession with numbers and food and can become problematic for some, ie leading to binging or restricting. It is also not sustainable to be constantly counting in real life.
Consider the nutrient quality/density of food. As I have said before, calories matter, but it’s not the full story. Nutrient density is more important - and of course, staying away from highly processed foods. I encourage people to eat foods which have a very high nutrient density, as they are more satiating than convenience foods. I’ll do a post on nutrient density at another time as it is the single biggest lever in losing weight.
Weigh daily for best results. To weigh or not to weigh as a means to track progress is controversial. Weight loss is not linear; if you track the weight loss curve of someone who has had success, it always shows a jagged up and down line. You will hear advice like ditch the scale completely and measure only, weighing weekly or weighing daily. The majority of research favours weighing daily in studies of successful people losing weight, but there is often a negative fallout from that in respect of self esteem, (especially when the scale goes up), as well as potentially encouraging obsessive behaviours. The scale can become a sort of a dictator and tells you whether you are allowed to have a good day or not. I am a fan of weighing, but preferably on a machine where you can see body composition. My personal preference though is the tape measure around the waist.
Exercise. Whilst this is only 20% of the equation, I have worked with clients who have successfully lost weight who have done zero exercise and have also made big improvements in their cardio metabolic markers. People who exercise as part of a ‘diet’ sometimes end up eating more to ‘reward’ themselves. Exercise is fabulous for keeping you motivated, improves insulin sensitivity and decreases cortisol, the stress hormone. Many people who struggle to lose weight suffer with insulin resistance.
Movement is information for the body and as you exercise, it will help to use the nutrients you are consuming to determine your fat to muscle composition if you want to make changes to your body. Consistency is key in exercise, even if it is just daily walking, you don’t have to do a boot camp style workout every day. The benefits of exercise are worthy of an article of their own.
Integrating behaviour, nutrition and exercise is an optimum strategy, ideally with someone to provide support and accountability. I gained a dress size in lockdown, but I know why and I know what to do about it. If you are stuck with your weight loss goals and are frustrated, please get in touch.