Have you been struggling with your weight for years and are at your wit’s end? Feel like you’ve tried everything – weight watchers, Keto, fasting and nothing seems to work? If this is the case read on, because this is an important article that could make the world of difference to you.
I’ve been seeing people with weight struggles for many years now and I’ve learned a lot. In this article, for the first time I’m going to publicly share our proprietary formula for weight loss. I am going to lay it all out on the table for you to read through and see if there’s any stone left unturned as to why you’re struggling get to your weight loss goal. Why am I doing this? Well, for a few reasons. I genuinely want people to achieve a healthier weight and live their best life. Also, there is a lot to cover in a one-on-one consultation and I want to give you a detailed overview of what is happening in the background in my mind, and the process our weight loss clinicians use because there isn’t usually enough time to discuss all of this during a consultation.
So, let’s start with the point where you’ve made the decision that you genuinely want to get to a healthier weight. You’re at a point where you’re ‘coachable’, open and accepting of our expertise even if goes against what you thought you knew about nutrition and weight. If you don’t have a lot going on medically, this initial session could be with our dietitian. If you are looking to lose significant weight (>20kg) and/or you take prescription medication, it would best to have your initial assessment with one of our doctors (myself or Dr Stephanie Sheu).
The first appointment is about us gathering your medical and weight history, organising baseline measurements and tests and getting you started on a treatment plan while we wait for the results of those tests to get back.
The first objective of the weight loss journey is really to shift your metabolism to being better at burning fat. Usually we’ll recommend to do this via some form on carbohydrate restriction and being fairly liberal with the natural fats starting out. The approach might seem a bit strict initially with eliminating carbs, and this is for the purpose of getting the fat metabolism going. At the same time we’re getting you to try and be intuitive about your eating: eat when you’re hungry and stop when you’re comfortably full, without trying to restrict portions. We’re not pushing too much intermittent fasting at this point either. This is far more humane than trying to ‘white-knuckle’ through a low calorie diet from the outset which is what most doctors and dietitians recommend for weight loss. The downside of actively restricting calories in the first instance is you get hungry, and over time develop a drop in your basal metabolic rate (BMR) making it progressively harder for your body to let go of fat and predisposing you to regain any weight lost.
Our approach is trying to work WITH your body, not against it. The ultimate objective is trying to coax your body into burning its own fat stores with less willpower and hunger required. Part of this early phase of the process might involve backing off with exercise and paying attention to stress management and sleep. Heavy exercisers find it hard to get their head around it when I tell them to temporarily back off with the HIIT and heavy cardio, put their personal training on hold and simply go for morning walks for a few weeks. However, it can be beneficial as low-moderate aerobic activity such as a fasted walk accelerates the fat oxidation state and is a more relaxing and restorative type of exercise for the body. High intensity exercise can counter-intuitively be detrimental as it is a glycolytic activity, that is, it burns muscle glycogen primarily. It does also burn some fat, yes but it is a high stress state and to achieve our first objective of fat burning we actually want to back off the high intensity exercise and return cortisol to a normal level. Don’t worry, it will return down the track because there are definite positive metabolic effects to be had with Interval Training.
Once we’ve shifted your metabolism to more of a fat burning state, you should notice you’re less hungry between meals and naturally gravitate to eating less frequently. This is where we will gently encourage accelerating the body’s own fat oxidation. This might involve pulling back slightly on dietary added fats and gently stretching the fasting windows, by a few hours at a time and not necessarily regimented to 7 days per week. We’re still encouraging nutrient dense whole unprocessed foods and at this point it might be beneficial to think about layering in some prescription medication to help things along. I used to be dead against medications to help with weight loss but my thinking has shifted on this.
The old generation of medications back in my dietitian days were frankly rubbish. Orlistat known as Xenical is a horrid drug which inhibits intestinal fat absorption which we now know is a bad idea, limiting satiating and nutrient dense fats and causing a bad case of greasy farts and ‘disaster-pants’ in the process. Then there was high dose phentermine (Duromine), aka ‘medical speed’ that suppressed appetite by revving you up, but with the downsides of sending the blood pressure soaring and keeping people awake for most of the night. As a side note, these days I’m not averse to prescribing medications such as liraglutide (Saxenda) and phentermine as an adjunct, but in a much, much lower dose than typically recommended by the drug companies.
As we move along, we’re gauging progress as we go. No doubt you are too, usually by way of weighing most days but we encourage people to not get completely caught up with the number of the scales because it’s only one part of a much bigger picture. Of course we’re assessing degree and rate of weight loss as we go, but we’re also monitoring body composition by 3-6 monthly DEXA scans and in-room body composition scales. We’re tracking subjective feelings too – how are your energy levels? How are the bowels?
Most importantly, we monitor blood markers because safety is paramount. We want to confirm an improvement in your blood metabolic markers and that your risk of diseases such as diabetes and heart disease is actually decreasing. And troubleshooting along the way. Are you not achieving an expected level of weight loss? While we discourage food tracking early on, at this point we might encourage some periods of tracking on an app such as Easy Diet Diary or Cronometer to help us trouble-shoot a nutrition issue by getting our Dietitian to have a look over it.
Or maybe you know that it is actually stress eating that’s getting you unstuck. We might recommend you see a psychologist with an interest in this area to address the root cause of those issues because ultimately, anything else you try will merely be a band aid solution. Maybe your life is so hectic you don’t have time to plan and cook meals, in which case we’d direct you to some of the pre-prepared meal options to have on hand for when you get stuck like Keto Loco or Be Fit Foods.
There might still be insulin resistance that we still need to overcome as it hasn’t fully resolved with the strategies used so far. If this is the case, we’ll revisit exercise and recommend to ensure you have a couple of resistance training sessions in your weekly schedule and might refer you to an exercise physiologist to make sure this is done safely. We might even prescribe Metformin in this instance to get you over that ‘hump’ of insulin resistance.
Sometimes, however there is an ‘X’ factor that it’s hard to put a finger on. Maybe there is some underlying gut dysbiosis, hormonal or environmental problem that’s keeping your weight stuck. If I suspect this is the case, I might suggest you see our Functional Medicine doctor, Dr Ravi Gornall to dive deeper into this, and treat it which will hopefully get things moving again.
As you can see, there’s no one size fits all when it comes to losing weight. Everyone’s journey is unique to them. The big thing I would recommend is that you stay engaged. Because the real results come with consistency and tweaking the approach as we go. Book to see us if you’re struggling or just want to check in. We’re always here to help.