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Fad diets hit the headlines on a regular basis, with the 5:2 intermittent fasting diet being hailed as the ‘magic bullet’ of the moment. However, there’s no quick fix to fighting the fat

Low-carb, high protein, no fat, fasting, eating only orange food on Wednesdays – fad diets can be everything from the ridiculous to the downright dangerous. And while they may help people shed the pounds quickly, most don’t work in the long-term. Many people ditch their diet because they feel hungry and/or deprived of the foods they enjoy, often putting back on any weight they have lost, and sometimes more. Some diets are also so restrictive that they are actually nutritionally dangerous.

In today’s society, it can be difficult to control how much we eat. Food is so readily available and we are bombarded 24 hours a day by adverts and promotions. It’s not surprising therefore that obesity is at an all-time high in the UK. “Many people don’t have time to think about their diet,” says Azmina Govindji, registered dietitian at www.azminanutrition.com and spokesperson for the British Dietetics Association.

“They just grab whatever food they can, rather than make healthy eating a priority. Unhealthy foods are more accessible and much cheaper than healthier ones – for example, burgers and chips at fast food outlets and crisps and chocolate at petrol stations as impulse buys.”

Public Health England statistics 2014 revealed that in 2012, around a quarter of adults in England (24 per cent of men and 25 per cent of women aged 16 or older) were classified as obese (body mass index (BMI) of 30 or more). A further 42 per cent of men and 32 per cent of women were overweight (BMI of 25-30). Being overweight or obese can lead to severe and chronic medical conditions, including high blood pressure, type 2 diabetes, heart disease, stroke and several cancers. According to NHS Choices, obesity reduces life expectancy by an average of three to 10 years, depending on how severe the problem is.

It’s estimated that being overweight or obese contributes to at least one in every 13 deaths in Europe. Being overweight also has more noticeable effects, such as breathlessness, increased sweating, snoring, difficulty doing physical activity, fatigue and joint and back pain, as well as low self-esteem.

“People still seem to believe that if you are very fat, that’s all you are going to be,” says Tam Fry, spokesperson for the National Obesity Forum (NOF) and chairman of the Child Growth Foundation. “They never listen to the fact that eventually obesity becomes life threatening. Or they may be aware of this, but don’t believe it will happen to them. They then get a dramatic wake up call when they develop type 2 diabetes and risk losing a leg or going blind.”

Just a fad?

Sensible eating is the only way to lose weight and keep it off, but it’s often seen as boring. With fad diets remaining so popular, a key question is whether any of them actually work in the long term. “Some people like a prescriptive approach to weight loss, so latch on to these fad diets,” says Azmina.

“The 5:2 or intermittent fasting diet is backed by some research and there is evidence that it leads to metabolic changes. When people strictly control their food intake on two days in the week, it often means they control their portion sizes on the other five days as well. The GI (glycaemic index) diet also has some interesting research, particularly in the field of diabetes. It involves looking at what people can eat rather than can’t eat and which are the most filling foods so they feel less hungry.”

In January 2014, a conference for healthcare professionals, staged by the British Nutrition Foundation (BNF), looked at some of the most popular weight loss diets. According to Dr Michelle Harvie, research dietitian at the Genesis Prevention Centre in South Manchester, following the 5:2 diet (two days of low carbohydrate or a low-calorie intake of around 500 to 600 calories with five days of healthy eating) can be effective for weight loss in some people.

“Energy restriction is difficult to maintain over the long term, and people tend to find it easier to follow a diet with intermittent energy restriction,” says Dr Harvie. “The two-day low carb diet leads to a lower intake on non-diet days and an overall lower calorie intake. As well as weight loss, the results showed dieters achieved an improvement in insulin resistance when compared with regular diets.”

High-protein, low carbohydrate diets (e.g. Atkins, Dukan) have also been hotly debated in recent years. There is evidence that these diets can be useful in some people by controlling appetite levels, but they also carry health risks (affecting the bowel and kidneys in particular), so shouldn’t be used as a diet for life. “Data shows that the amount of weight lost on high protein diets is around double that lost on a comparable low fat diet at the six-month mark,” says Dr Alexandra Johnstone of the Rowett Institute of Nutrition and Health. “However, there is little difference in weight loss at one year as dieters lose momentum. Long-term, high-protein, very-low carbohydrate diets have some risks too.”

 

There’s no need for fancy gimmicks. Just be more in tune with what you are eating. Making a food diary can help.

Effective support

The more weight an adult loses, the more health benefits they are likely to gain. The most realistic goal is to lose around five to 10 per cent of body weight. However, according to National Institute for Health and Care Excellence (NICE) guidance published in May 2014, even losing just three per cent is likely to lead to health benefits, especially if the weight loss is maintained for many years. So, for example, someone who weighs 15st 10lb would need to lose just over six pounds to cut their weight by three per cent.

It’s important that people discover what works for them, so that they can lose weight slowly and steady and – most importantly – keep it off for good. “Every person is different. Within each individual, there are a number of bacteria, genes, etc, working positively or negatively to govern what they can eat without gaining weight,” says Tam. “People who are predisposed to obesity have drawn the short straw, but need to take themselves in hand. The official guidelines are 2,000 calories a day for women, but dropping to 1,500 calories a day won’t usually cause any damage. It is a case of finding out what does and doesn’t work for each individual.”

Thanks to their high accessibility, pharmacies are ideally placed to offer weight loss advice. According to the NICE guidance, healthcare professionals, including pharmacists, should mention local weight management services (e.g. Weight Watchers and Slimming World classes) to eligible customers during routine consultations. Pharmacists can identify eligible customers by measuring the BMI of overweight customers. They should also measure the waist circumference of patients with a BMI lower than 35 before considering referral.

“If customers come in for medication for cardiovascular disease, for example, this provides a good opening to discuss weight management,” says Azmina. “However, obesity is a difficult psychological condition, especially if it’s affecting someone’s selfesteem, so it’s important to listen carefully to what people are saying, rather than just tell them what to do.”

Getting the right messages across within the pharmacy environment and promoting healthy eating rather than quick fixes is essential. Using point of sale material can help. “People need to be motivated,” says registered dietitian Gaynor Bussell. “Maybe some posters about what the pharmacy can offer and leaflets on healthy eating, or even some warnings about the health dangers of gaining weight or eating an unbalanced diet, may prompt enquiries. Make sure you practice what you preach in the pharmacy, so no gimmick food products. Healthy, sensible food only!”

A food diary can help people work out how they could have done without unhealthier items

Healthy eating

For successful weight loss, the aim is to take in fewer calories than are used up. Simple lifestyle changes are often the easiest to make and maintain. The 2014 NICE guidelines promote lifelong changes rather than yo-yo dieting, when the weight is piled back on after initial success. So what advice should pharmacy staff be passing on to customers?

The first step is not to promote a specific ‘diet’. Customers need a healthy eating programme, with the right food choices, as well as a more active lifestyle. Careful planning is essential, whether it’s plotting daily meals and/or an exercise regimen in a diary, buying ingredients for the week ahead, tracking weight loss progress or learning how to cope with high-risk activities like meals out or parties.

“There’s no need for fancy gimmicks,” says Azmina. “Just be more in tune with what you are eating. Making a food diary can help. Look at what is written for each day and work out how you could have done without the unhealthier items.

“Research shows that losing five per cent of your body weight and keeping this off has benefits on blood pressure, cholesterol, diabetes risk, etc. To make this more realistic, behaviour change advice should be split into two week chunks, with a specific goal for each two weeks. For the first two weeks, for example, people could aim to always have vegetables with every meal.”

Setting a target weight gives people a goal to work towards to keep them focused and motivated. A weight loss of between a half to two pounds a week is a safe and realistic target. While most people weigh themselves weekly, Gaynor says that daily weighing has some advantages. “It can alert people to the creeping weight gain, which is how most people end up obese,” she says. “It is easier to tackle a few pounds gain, say after Christmas or a holiday, than having to lose several stone.”

Customers should avoid diets that claim huge weight losses in a short space of time. Weight loss supplements should also be used with caution. “You may see claims that certain natural chemicals, such as caffeine and other stimulants, green tea extract and conjugated linoleic acid, can make you lose weight,” says Gaynor. “There’s some evidence that these substances can speed up metabolism, but the evidence is not yet conclusive, and the extra calories you burn off by consuming these substances is minimal. Stimulants such as caffeine are not well tolerated by everyone and can lead to high blood pressure.”

When losing weight, it’s natural to opt for low-fat products. But a study presented at the European Congress on Obesity (ECO) in May 2014 shows that while most low-fat supermarket products contain a third fewer calories than their regular fat versions, one in 10 actually contain more or the same calories, mainly due to added sugars. It is therefore necessary to check food labels carefully. Supermarkets and food manufacturers now highlight the energy, fat, saturated fat, sugars and salt content on the front of their packaging.

Some products also use red, amber and green colour coding; the more greens on the label, the healthier the product. But customers should remember that even healthier ready meals might be higher in fat, sugar and calories than the homemade equivalent. Watching how much we eat, as well as what we eat, is important too. Research by the British Heart Foundation in October 2013 revealed that many people don’t understand portion sizes and will simply eat more when there is more food on their plate.

“Most people know about healthy eating, but don’t find it easy,” says Azmina. “I use a range of tools, such as images of food on a plate, portion sizes in terms of a fist (carbs) or palm of the hand (protein), so that people can visualise how much they should be eating. Buy smaller plates for the whole family and use a teaspoon instead of a tablespoon. Eating breakfast helps people to snack less, and protein is important in each meal, as it helps you feel fuller for longer.”

It’s also important that customers look at other aspects of their lifestyle that could be hindering their progress. According to the NOF’s ‘State of the Nation’s Waistline’ report in January 2014, proper hydration is largely being overlooked in favour of healthy eating. Many people think that they are hungry and grab a snack when they are actually thirsty. The European Food Safety Agency (EFSA) recommends a total water intake of two litres a day for women and 2.5 litres a day for men.

However, the amount a person needs to drink will depend on many factors, such as their size, activity level and the weather. All drinks count, including hot drinks such as tea and coffee and soft drinks. However, customers should try to swap drinks that are high in calories (e.g. sugary fizzy drinks) for drinks that are lower in fat and sugar (e.g. water).

Obviously, exercise shouldn’t be ignored either. The Department of Health recommends that adults aged 19 to 64 should try to be active daily, aiming for at least 150 minutes of moderate intensity aerobic activity (e.g. fast walking or water aerobics) every week.

However, any amount of physical activity is important, such as walking to the shops, gardening and even housework. Increasingly, research is showing that reducing sedentary behaviour is the key to being active, i.e. limiting the hours spent sitting at a computer, watching TV or at the wheel of a car.