Weight Management
As a doctor, I am passionate about helping patients attain a state of good health and well-being. Although we do use body weight as a measure, it's not just about the scales! The true victories are the non-scale ones, such as increased energy, better sleep, improved mobility, reduced pain, lower cholesterol levels, and healthier blood sugar levels.
One crucial issue I aim to clarify is the root cause of obesity. It's not simply a matter of willpower or self-control; rather, obesity arises from a complex interplay of genetics and hormones in combination with the "obesogenic environment" of our modern Western lifestyles. This environment includes highly processed and calorie-dense foods, sugary drinks, excessive alcohol consumption, sedentary habits, chronic stress, and inadequate sleep.
According to the Australian Bureau of Statistics, 67% of adults, and 25% of children, were overweight or obese in 2018. Some people are more vulnerable to the obesogenic environment, some are less vulnerable, and this can change as we age - thus it is a combination of genetics, hormones, and the environment that cause obesity.
Initially, we'll need one to two double appointments to assess your health, find what we need to work on, and individualise your plan. As we progress I will provide you with the most up-to-date scientific knowledge on medical weight loss options, as well as evidence-based recommendations for nutrition and exercise to assist you in your personal health journey.
This page covers some of the things we may talk about.
Mindset
Mindset plays the largest role in weight loss and weight loss maintenance. Your mindset is basically how you see things and what you believe in. It affects how you act and your overall vibe. If you're always thinking you're a failure or that you'll just end up back where you started, that negative thinking can become your reality. Some situations where mindset is really important include:
Those situations where you step off your plan and have that treat you weren't going to have. Instead of saying "bugger it" and just completely throwing the plan out the window, we need to see it differently. We instead think, "that's one small deviation, no need to throw in the towel altogether, I'm going to stop right now, and go back on plan".
Those situations where you're trying to resist eating a sweet or savoury carb and it leads to willpower fatigue. There are two ways of reframing this. Firstly, there aren't any foods that are completely off-limits, but moderation is important. Instead of trying to resist altogether, you can plan to enjoy small quantities later in the week. Alternatively, instead of bringing the hard-to-resist food into your household, leave it at the supermarket, don't purchase it. Out of sight, out of mind.
Those situations where there's some food left over and you can't bear to throw it out, so you end up finishing it. Well, changing our mindset is key to this too.
In the long term, mindset is the determining factor that enables us to sustain progress beyond the initial 4-8 week period. In our appointments, we'll discuss different situations that are personal to your own struggles.
Dietary Options
There are many dietary options out there, Keto, Low Carb, Mediterranean, DASH, Plant-based etc. The best diet is the one which you can do! If a diet suits your tastes, and you find it easier to do, then you're more likely to make it a part of your lifestyle.
If you have any medical conditions, or are on medications, it's best to speak to a doctor or dietitian before starting certain diets.
Very Low Energy Diets (VLED)
The Very Low Energy Diet (VLED) program creates an energy deficit using low energy meal replacements. You can replace one, two, or three meals per day:
Replacing three meals a day and keeping your carbohydrate intake low i.e. following the "Intensive Level", will lead to ketosis. With ketosis:
Your body produces ketones which help reduce your appetite - after four days on the "Intensive Level" your hunger should reduce.
Your body unlocks and uses fat for energy.
If you have any medical conditions, or are on any medications, it's best to check with your doctor or dietitian before starting the program, as it can be harmful for you.
Activity and Exercise
Purposeful activity
The recommended level of activity is:
At least 30 minutes of moderate or vigorous intensity physical activity 5 days per week - for example a brisk walk, golf, gardening, swimming, mowing the lawn, jogging, cycling, or aerobics
Plus at least 2 days of muscle-strengthening/resistance activity per week - for example heavy gardening (digging), squats, lunges, weights, push-ups or resistance-bands
Every bit counts though! Start with even 1 minute of activity, and build it up slowly.
Incidental activity
Incidental activity is important in health too. These are things like walking from your desk to the printer, walking from your parking to work, or taking the stairs instead of the escalator. You can create opportunities for incidental activity by parking further, choosing a desk further from the printer, or getting off the bus a few stops earlier for example. If you have a sedentary job, using a standing desk, or regularly getting up can be helpful.
Another way to think about incidental activity is you're trying to do things in a super inefficient way.
Medications
There are some medications that can assist with weight loss through appetite control. They are used with lifestyle measures in people with BMI >30, or BMI>27 with obesity related medical conditions.
The Body Mass Index (BMI) is an approximate measure of an optimal weight for health. It doesn't differentiate between muscle mass versus fat mass, thus in those that are athletic in build, it can overestimate the fat mass.
Before using any medications, it's important to have a thorough assessment of your health to determine the benefits and risks of medication use.
Bariatric-Metabolic Surgery
Bariatric-metabolic surgery is usually considered in people with BMI >40, or BMI >35 with obesity related medical conditions. The three most common surgeries are sleeve gastrectomy, Roux-en-Y gastric bypass, and gastric band.
Referral to a bariatric-metabolic surgeon can be organised if appropriate. These procedures are done both privately and through the public health system. The public waitlist is long, but it can be very worth it in the long run.