The science is clear. Most weight loss programs and diets fail. Clinical research has been inequivocal about these disappointing facts regarding current popular diets.
In the long run, dieters almost always regain lost kilograms – with up to 60% eventually weighing even more than they ever did before dieting. Focusing on weight loss alone as an avenue to wellbeing, is akin to a doctor focusing on treating the signs and symptoms of a disease – without treating the actual disease.
Excess weight and being underweight are both likely to be a symptom of a bigger problem.
These problems may be an expression of a lifestyle problem, a symptom of poverty, a consequence of stress, of altered sleep patterns, psychological, physiological and hormonal illnesses, among other conditions.
An Orthopaedic Surgeon's outlook on appropriate weight
In Dr Maina’s orthopaedic practice, she encourages healthful interventions to manage weight for several evidence-based reasons:
- Weight management aids in pain management. Biomechanical data show that, for people with excess weight who suffer knee pain, for each 1kg of total weight lost, approximately 4kg of joint reaction forces are reduced across the knee. This decrease relieves pain symptoms, which, in turn, leads to decreased painkiller use and limits the risk of dependence on analgesia.
- Individuals with well-managed weight are met with both reduced anaesthetic and surgical risk and have generally improved recovery outcomes.
- Coupled with good baseline fitness, a healthy weight results in a better response to physical rehabilitation measures. This ease of mobility, in turn, decreases the risk of falling and of complications like deep vein thrombosis and pulmonary emboli.
Often overlooked, being underweight or undernourished predisposes one to increased fracture risk. The “Female Athlete Triad” is one example where undereating has a direct correlation with the development of osteoporosis. This increases the risk of fractures in young, active women. Similar risks apply to men who undereat and overtrain. These underweight individuals also have an increased risk of complications after fractures, presenting with problems such as delayed healing, refractures, wound complications, and so on.
Excess weight, on the other hand, increases the risk of a prolonged surgical time, bleeding and wound healing problems among other perioperative issues.
Size diversity is real
Body shape alone does not equate fitness.
Not everyone who is thin may be considered ‘fit’ by any measure. In the same way, being overweight doesn’t necessarily equate unfitness. In fact, a positive predictor of survival to ICU admission includes being overweight (not obese, mind you!).
While a dietitian will assess and aid you in achieving your ideal weight goals, your dietitian’s main focus is in improving the quality of your life, well being and longevity.
To do this, several parameters, called anthropometric measurements, are assessed at each consultation. They include hip/waist/stomach circumferences, bioelectrical impedance testing, Body Mass Index (BMI) calculations among others.
A word of caution regarding BMI scores
While the medical community has long used the BMI score to categorise people of various weights (into underweight, overweight, obese groups, etc.), BMI scores can be inaccurate gauges of health. Your BMI is calculated using your weight in kilograms, divided by height (in meters squared).
Current literature does not support the exclusive use of BMI scores in the assessment of health and fitness – especially in the Black female population. This is because BMI scores were originally never studied in a diverse population. For this reason, relevant variables in a wider population, such as ethnicity, gender, age and so on, were not considered at the time the BMI scoring system was conceived.
So, while nutrition is an incredibly complex process, in an oversimplified nutshell, the most important anthropometric measurement is total body fat and visceral fat.
A good dietitian can help you obtain your values to guide you to a realistic and appropriate weight and ‘healthy fat’ range.
Yes, you do need carbs and fats in your diet!
Again, while the dietitian’s main goal is not necessarily to aid weight loss (although often their recommendations may improve one’s habits, and, as a result, weight), their goal is to promote wellbeing through healthful, mindful eating.
The good dietitian will also promote a balanced approach to your lifestyle and meal planning.
Their dietary advice details the quantity and frequency of consumption of various dietary components, including fats and carbohydrates (yes, you do need both in your diet or else your body starts to break down good muscle protein to compensate), as well as fruits and other nutrients.
The dietitian will offer custom, practical advice to suit your day-to-day situations. Because of this approach, the plan becomes sustainable, leading to healthy habits in the long run.
Crash and fad diets fail mostly because they are rigid, unhealthy, costly, and impractical in social settings.
Healthy habits include making informed shopping and meal choices that are balanced and healthful, dished up at appropriate portion sizes, at regular times of the day.
After your initial dietitian’s assessment, you will need to continue with regular (usually monthly) follow-up assessments to encourage a consistent effort.
These follow-up sessions ensure an ongoing review of existing (and possibly lifelong) dietary challenges and your response to any changes. The dietitian may recommend dietary supplements (if needed) and review any other issues that may be hampering one’s progress and health. These follow-up sessions are relatively inexpensive, but are essential to the sustained measurement of progress and success of your meal plan.
Can I look thin and still have excessive fat?
Yes! You most definitely can be both slim and unhealthy.
When most people visualise someone with excess weight, they typically tend to picture someone with a round belly, but the reality is that slim people sometimes also carry unhealthy proportions of visceral fat.
The term “TOFI” (thin outside, fat inside) has been coined to describe these individuals. TOFI individuals would also benefit from dietary advice and assessments from a dietitian.
It cannot be overstated: health is more than a number on a scale.
Thin does not equal healthy.
All individuals with increased visceral fat (irrespective of size and weight) are at higher risk of diabetes, heart disease, stroke, and Alzheimer’s disease, among other conditions.
How should I tackle my weight if it troubles me?
As above, inappropriate weight is a symptom of a bigger problem – be it an undiagnosed medical condition, lifestyle imbalance, or stress-related gain.
Because of this complexity, a multidisciplinary approach to weight management is important.
An ideal weight management team should involve, but may not be limited to:
- A dietitian – to analyse problematic meal habits, to curate a custom nutrition plan and to serially document your anthropometrics.
- A physical trainer – be it a physiotherapist, personal trainer or biokineticist to ensure a safe and steady return to exercise without injury.
- A physician, weight gain can be caused or exacerbated by certain hormonal conditions. With weight changes, the burden of associated medical conditions may lighten, meaning the need to reduce or even stop the use of certain chronic medications.
- A general surgeon: surgeons skilled in the management of various endocrine diseases, and even gastric bypass surgeries, may also be important providers of surgical treatment options available for weight management. They may also provide valuable input in assessing and diagnosing gut malabsorption as a cause for poor weight gain and other digestive issues.
- A psychologist – to address expectations and stressors aggravating the process of weight management (stress eating, impulse control, etc.).
What's the take-home message in all of this?
Addressing the issue of weight requires a dynamic and wholistic approach.
Be kind to yourself. Focus on what you can control.
Weight management is a process of learning new habits and un-learning the old. Be prepared to try and even fail, but never stop trying.
Don’t jump on crash/fad diet bandwagons. You will be disappointed – regardless of the short-term appearance of things.
Take regular breaks, sleep well, find healthy, balanced ways to cope with stress.
Get into fun and engaging exercise programs if possible. This will keep you going back to training time and time again, with a smile on your face. Fitness should never feel like punishment.
Excess weight, didn’t appear overnight. Don’t expect the kilos to melt away overnight!
Do not be discouraged by the rate at which you arrive at your goals. Weight management is a lifelong, journey, not a destination.
A balanced, mindful, approach predicts the success of your plans.
Dr Anne Maina
Specialist Orthopaedic surgeon
MBBCh (Wits), FC Orth (SA), MMed Ortho (Wits) CIME
References:
- Hartley Rachel. What is health at every size? Rachel Hartley Nutrition. Published: 11 May 2016. Accessible at: https://www.rachaelhartleynutrition.com/blog/2016/05/what-is-health-at-every-size
- Jaliman Debra. What is visceral fat? Nourish by WebMD. Diet & Weight Management. Published: 26th August 2021. Accessible at: https://www.webmd.com/diet/what-is-visceral-fat#1
