Weight Loss can be challenging. However, if you have the correct information and support, you can achieve a good outcome and benefit your health.

Why Do We Need to Lose Weight?

If you are overweight (Body Mass Index, BMI* > 25) or obese (BMI > 30), you are more likely to develop heart disease and stroke, even if they have no other risk factors. Obesity is unhealthy because excess weight puts more strain on your heart. It can raise blood pressure and cholesterol and can lead to diabetes. Losing weight is one of the best ways for you to reduce your risk of heart problems and many other diseases including some cancer.

Please note the advice provided here is general in nature, please see your doctor for a weight loss program tailored for you.

How Do I Lose Weight?

Once you are ready to lose weight, lets explore the options available together, to help you lose weight. There are
many strategies to reduce energy intake.

The main approaches we propose are:

1.DIETARY

  • Very low energy diets
  • Reduced energy diets
  • Low carbohydrate diets
  • Intermittent diets

2. EXERCISE
3. MEDICATION
4. SURGERY

They may also be used in combination. However, before you choose of the above options, you need to complete the following:

Energy expenditure Overview

To lose weight, it is necessary to reduce energy intake below energy expenditure. Energy expenditure is predominantly your basal metabolic rate plus heat generated after eating a meal, plus the energy expenditure from physical activity.

You can calculate your energy expenditure using The Harris-Benedict Equations.
You will have to input your age, your height, your weight, and do an estimate of your level of activity.

⇒ Click here to calculate your daily energy expenditure. Alternatively, you can use an App like My Fitness Pal. Key in your details and it will calculate your daily allowed Calories to achieve your desired weight loss.

A case study

A 40-year-old woman, who weighs 140 kilograms, is 1.65 metres tall, has a sedentary job, and walks her dog around the block daily. If we put in the Harris-Benedict equation for women – 140 kg of weight, 165 cm of height, age 40, and 1.3 as the level of activity, we come up with the answer that she burns, daily, 11,475 kj, orapproximately 2,800 cal.

How much do we need to reduce intake to?
To lose weight rapidly, energy intake needs to be reduced to around 3,280 kj (or 800 cal) daily.

1.DIETARY

Very low energy diets (VLED)

We recommend very low energy diets (VLED) first, as research indicates the greatest weight loss are reported with very low energy diets, at six months. The higher success rate is most likely due to the fact that the patients trialing VLED achieved ketosis. Ketosis occurs when your body starts using fat as its main fuel source due to limited access to glucose, or blood sugar. Ketosis often suppress your appetite, which also helps with your weight loss.

It’s of interest to note that the rate of your weight loss had no impact on your rate of weight regain.

To achieve rapid weight loss, it is necessary to have a large gap between energy intake and energy expenditure, which is an intake of around 3,280 kj (or 800 cal).

However, this cannot be achieved by restricting the usual diet since to obtain the necessary vitamins and micronutrients it is necessary to have an intake of between 4,920 and 6,150 kj (1,200-1,500 cal). The only way to maintain nutrition and reduce energy intake to 3,280 kj is to use a very low energy diet (VLED).

Are very low energy diets safe?

Unlike their counterparts in the 1950s, modern very low energy diets are very safe and well-formulated. Individuals with severe obesity may need to be on this regime for many months, so this is an important issue. Some years ago, it is reported that a patient lost 72 kg over a year, and this patient was on one of the very low energy diet diets for nearly 12 months, and at the end of this, many parameters were measured. All of which were in the normal range.

Find out more here

Some examples of commercially available VLED Products include:

Optifast (Not Protein Plus Shakes – including Shakes, Bars, Soups & Desserts);
Optislim (Regular VLCD range only – including Shakes, Bars and Soups)
Formulite (NOT Lupin soups – including Shakes and Bars)
BN Slim (Shakes)

VLED contraindications and precaution – Who should not use very low energy diets without medical supervision?

Very low energy diets should be used with caution in the following:

  • Diabetes If you have diabetes, especially if you are treated with insulin or taking sulphonylureas.
  • Pregnancy or breastfeeding – Very low energy diets must not be used if the patient is attempting to become, or is, pregnant or breastfeeding.
  • Warfarin use and certain diseases

Also, individuals taking warfarin or who have heart, liver or kidney diseases, porphyria, gallbladder problem, gout or on Lithium therapy should be supervised by your doctors.

Some doctors suggest that a partial VLED diet, with a VLED replacing two meals only, is preferable to replacing three meals a day, as this gives you the pleasure of looking forward to a meal each evening. This may make it easier for you to stick to the VLED program

If you are not certain whether a VLED is suitable or not, see us for a referral to a dietitian.

These VLEDs serve two purposes:
• Firstly, they replace two meals (usually breakfast and lunch)
• And secondly, they provide the micronutrients needed, such as vitamins (such as vitamins A, B, C etc.) and minerals (iron, calcium, selenium, zinc etc.). This is very important, as you will not be consuming enough food to obtain all of these for the time you are losing weight.

TIP: Prepare some protein e.g. roast chicken the night before you start. If you are a vegetarian, prepare small amount of non-starchy vegetables e.g. Asparagus, beans etc.

Below is an illustration of how you can use VLEDs to lose weight.

Day 1
Very low energy diets come as powders that are mixed with water to make a shake, or as preformed bars for convenience.

So how does this diet work?
You purchase these products (as per link https://www.baker.edu.au/-/media/documents/fact-sheets/baker-institute factsheet-vled-one-meal.pdf) and then pick a day when you are going to start the diet.

Breakfast
On the first day of this diet, you take the first VLED shake, soup or bar and has your usual morning drink. Make sure you do not use or add sugar to your tea or coffee and do not consume any sugary drink. You eat nothing else.
At morning tea – You have another drink, but you cannot eat anything.
However, on the first day, if you are very hungry, you can nibble some protein such as roast chicken that you have prepare the night before starting. If you are a vegetarian, the extra food can be in the form of non-starchy vegetables e.g. Asparagus, beans etc.

Lunch
At lunchtime, you have a VLED second shake, soup or bar and another sugarless drink.
Afternoon tea – You may have another drink for afternoon tea if you wish to, but you must not eat anything (with the exception of nibbling some protein or non-starchy vegetables if you are still hungry).
Dinner – You can have a substantial dinner – but this dinner must all fit one normal sized plate and you cannot go for seconds. However, there must NOT be any carbohydrates in the dinner.
The dinner is made up of some protein (which can be any type of meat, red or white, fish or seafood, egg, or tofu), plus they have three different vegetables, and they can also have a salad.
It is also necessary that you have a small quantity of fat (such as oil in the salad dressing, for example) each day. This is to empty your gall bladder in an effort to avoid gallstone formation.

Allowed proteins
Below shows a list of proteins that are free of carbohydrate. The amount of protein is the size of the palm for someone who has a BMI between 30 and 40, and the size of the whole hand for a BMI greater than 40.
Meat – red or white; Fish and seafood; Eggs; Tofu

Allowed vegetables
Below lists some of the allowed vegetables. They are mainly carb-free.
Alfalfa sprouts, Asparagus, Beans (green), Beetroot (fresh), Bok choy, Broccoli, Brussels sprouts, Cabbage, Capsicum, Carrot, Cauliflower, Celery, Cucumber, Eggplant, Fennel, Garlic, Lettuce, Mushrooms, Onion, Radish, Silver beet, Snow peas, Spinach, Squash, Tomato, Watercress, Zucchini

Day 2
On Day 2 of the diet, the same regime as Day 1 is followed.

Day 3
On Day 3 of the diet, it’s the same as the other two days, but you will notice you have less tendency to want to go to
the fridge to top up with roast chicken or non-starchy vegetables, because you are less hungry than you were on the first two days. This is because on the third day you are developing ketosis. As previously mentioned, ketosis occurs when your body starts using fat as its main fuel source due to limited access to glucose, or blood sugar. Ketosis often suppress your appetite, which further help with your weight loss.

Day 4 onwards
From Day 4 onwards, we suggest you continue with a regime of replacing two meals a day with a very low energy diet and having a carbohydrate-free dinner until you have lost all the weight you wish to lose.
Adjustments:
An adjustment for very large patient needs to be made for the very low energy diet programme.
Generally, for patients with BMI < 45 kg/m2, we recommend the use of two very low energy diet products per day, and this, together with the dinner, supplies around 800 calories.
However, if the patient is very large, which we define as a BMI above 45 kg/m2, it is necessary to give extra micronutrients in the form of an extra VLED per day. This will give the patient a 1000 calorie intake. Now this extra VLED can be taken either as supper, after dinner or at other times during the day. For example, a bar can be divided into two, and half can be given for morning break, and the other half for afternoon break.
What about social occasions and eating out, whilst you are on a VLED diet?
Managing social occasions and eating out can be a challenge. Strategies include:
• Skip the scheduled VLED for that meal and choose a meal that includes lean protein and low-carbohydrate salad or vegetables.
For example:

  • grilled steak or fish fillet with vegetable-based salad OR
  • stir-fry chicken / tofu with Asian greens OR
  • poached eggs with grilled tomato and spinach.

Request sauces or dressings on the side.
Avoid extra bread if provided at the table.
Avoid deep fried or crumbed foods.
Order 2 entrée size dishes instead of entrée and main and add a side of salad or green vegetable.
Choose water, sparkling water, tomato juice, sugar-free soft drink as preferred drink choices.
Order a pot of tea or black coffee to finish the meal instead of dessert.

Alternative strategies
Not everyone will tolerate a very low energy diet, and you may be intolerant of some component of the diet (such as, for example, having lactose intolerance). In such cases, we need alternative strategies to reduce energy intake in a healthy way.

Reduced energy diets
Reduced energy diets usually prescribe an intake that is around 2,500 kj (or 600 cal) less than the patient’s estimated usual energy intake. If adhered to, this results in a weight loss of around 0.5 kg per week.
Does the macronutrient composition matter (variation of protein and carbohydrate)?
The conclusion of a study by Sacks et al. was that reduced calorie diets result in clinically meaningful weight loss, regardless of which macronutrient is emphasised. In this study, the diets were 20% or 40% fat; 15% or 25% protein; and ranged in percentage of carbohydrate from 35% to 65%.

Low carbohydrate diets
The next approach to review is low carbohydrate diets. This is a low carbohydrate diet without a very low energy diet, so the energy intake must be sufficient to ensure adequate intake of micronutrients. The advantage of the low carbohydrate diet is that it induces mild ketosis, which also suppresses hunger. Research has shown that a low carbohydrate diet that was not energy restricted – in other words, the patients were not asked to reduce total intake, they were just told to avoid carbohydrates – appeared to be at least as effective as a low fat, energy restricted diet.

Research also shows than when comparing low carbohydrate versus conventional weight loss diets in severely obese adults, at six months, the low carbohydrate diet resulted in greater weight loss and lower triglycerides. However, by one year, although there was no difference in weight loss now between the two types of diet, the low carbohydrate diet resulted in greater improvements in lipids (cholesterol) level and better sugar level control.

Intermittent diets
Intermittent diets such as the 5:2 diet have become popular recently. In these diets, the patients reduce their intake significantly on two non-sequential days and have their normal intake on the other five days. Harvie et al. have shown that these diets have no advantages over the continuous restriction diets – however, they may suit the lifestyles of some patients.

In Intermittent diets, you follow an eating schedule every day, only consuming food during a set number of hours during a specific window of time, then fast for the remaining hours. Some people find intermittent fasting appealing because you don’t have to remember to follow specific diet rules, scrutinizing which foods are ‘approved’ and which are not.

You may gradually lose weight when they practice intermittent fasting, because the you tend to consume fewer calories over the course of the day if you can’t graze all day or snack late at night. Additionally, you may lose weight because when you eat significantly less often, your body produces less insulin, the hormone that converts food into energy. When you eat frequently, insulin helps your body store unused energy as fat. But when you go without food for 12 hours or more, instead of storing unused energy, your body burns through its existing energy stores, then begins burning stored fat for energy, which aids weight loss.

Find out more about Intermittent diets

Alcohol
If you drink alcohol, it will reduce the weight loss results as it is high in energy. If you choose to drink alcohol, limit your intake and consider the following options:

  • Alternate alcoholic drinks with water or a sugar-free soft drink or sparkling plain mineral water.
  • Order wine by the glass rather than by the bottle and sip slowly.
  • Mix a spirit with sugar-free cola or soda water.
  • Choose a light beer rather than full-strength beer and order the smallest beer size available. Try alcoholic free beer options e.g. Pure Blonde Ultra Low Carb Lager, Holsten Alcohol Free.
  • Avoid regular soft drink, juice or pre-mixed options.
  • Avoid sweet cider and dessert wines.

2. EXERCISE

What about exercise?

Is exercise important for achieving weight loss? In terms of weight loss, exercise is not as important as the reduction in calorie intake. The fundamental reason for this is that moderate exercise uses only a small proportion of the total energy we burn in one day.

For example, if a person jogs for half an hour a day or walks around for a total of one hour a day, the energy expenditure breakdown is as follows:

  • Basal Metabolic Rate, which is approximately 368 kj per hour, over 24-hour period works out at 8,832 kj a day
  • If you jog for half an hour, you burn a lot more energy per minute obviously when you’re exercising – up to 3,075 kj
    – but multiplied by half an hour gives you just 1,538 kj a day
  • Walking for one hour, which burns around 1000 kj per hour, is still a small proportion of the Basal Metabolic
    Rate over a 24-hour period.

The problem in our modern life is that people have no time to jog more than half an hour a day, most of the time.

The important reason for encouraging exercise as part of a weight loss regime is to reduce the amount of muscle lostas a result of weight loss.

As always, the amount and type of exercise that you do must take into account your age, your general cardiovascular and respiratory health and the presence of any joint problems.

Explore some exercise options

3. MEDICATION

What about medications?

If using a ketogenic diet, it may not be necessary to prescribe medication until the patient is re-introduced to a balanced diet. However, these medications can be introduced at any time during the weight loss phase, especially if you are struggling to avoid carbohydrates.

If you are using a non-ketogenic diet, you should probably use medications from the start, because, as you lose weight, there are hormone changes that increase hunger.

Following the weight loss phase, we recommend that you see a dietitian for balanced diet and lifestyle advice. Careful supervision is required at this time as this is when hunger returns. If you are struggling to maintain weight loss, medication will be needed to suppress hunger. Since physiological changes leading to increased hunger and reduced energy expenditure are long lasting, some patients may need life-long medications to maintain weight loss.

Please discuss with your doctors to explore the use of medications if you fail to lose weight with dietary changes.

4. SURGERY

Finally, we have surgical approaches. When diet and medication fail, or for those patients that request surgical therapy, referral to a bariatric surgeon is necessary.
At the moment, surgical approaches to weight loss give the best long-term outcomes. Three different operations are undertaken at present, although the operation that is preferred changes with time.

At present, the three most commonly used procedures are adjustable gastric banding, sleeve gastrectomy, and Roux-En-Y bypass.

  • Gastric banding: Adjustable gastric banding is the least invasive but requires the most follow-up and revision. For this reason, its use
    is declining.
  • Sleeve gastrectomy: Gastric sleeve is rapidly becoming the most popular operation.
  • Roux-en-Y bypass: has the longest history, and is the standard operation in many centres, especially in the United
    States. There is some evidence that Roux-en-Y bypass is particularly useful in improving type 2 diabetes.
    Please discuss with your doctors to explore the surgical options if you fail to lose weight with dietary changed and
    medication.

LONG – TERM HABITS

After achieving weight loss and introducing balanced meals, it is important to maintain healthy food habits. This may include smaller serve sizes and a lower intake of higher fat and carbohydrate foods. Making time for daily physical activity will help you to maintain weight loss and muscle mass. This should include a mixture of both cardiovascular and resistance-based exercises.

For expert advice, make an appointment with your GP and an Accredited Exercise Physiologist.