WEIGHT LOSS

ACHIEVING WEIGHT LOSS

Weight is gained when more calories are consumed than the body needs for daily activities and cell maintenance; excess energy is stored as fat. Weight is lost when the body uses its stores of fat, i.e. when:

• fewer calories are consumed, and/or

• activity is increased.

Eating 300-500 calories fewer/day should achieve a loss of 0.5-0.9kg/week and ~20kg in a year. A healthy body weight is more likely to be achieved and sustained through a gradual change in patterns of eating and activity than it is with crash diets and bursts of extreme exercise. Key points are:

• Make small, permanent dietary changes – consume fewer calories, e.g. limit high-fat food, sugar-rich food and alcohol;  reduce portion sizes of carbohydrate (potatoes, pasta and rice);  have a balanced diet with plenty of fruit and vegetables, unrefined foods with more fibre, lean meat and low-fat dairy products

• Monitor waist circumference

• Ensure regular physical activity; this is especially important in maintaining weight loss

• Enlist support of family and friends.

Very low calorie diets (VLCD)

Studies have shown that people with type 2 diabetes who are overweight or obese can improve their glycaemic control, reduce diabetes medication, and in some cases, put their type 2 diabetes into remission by following a very low calorie diet.

The diet comprises soups and shakes adding up to less than 900 calories a day for 12 weeks, followed by gradual reintroduction of ‘real’ food. During the programme, available on the NHS, patients are offered group, one-to-one or remote support and monitoring and are closely supported by their GP practice.

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See also BMI; nutrition; obesity; physical activity; waist circumference.

NON-INTENTIONAL WEIGHT LOSS

A non-specific symptom that can indicate a serious underlying pathology. Weight loss will occur with:

• Inadequate food intake (e.g., loss of appetite, difficulty eating, anorexia nervosa)
• Malabsorption (e.g., coeliac disease, cystic fibrosis, Crohn’s disease)
• Increased metabolism (e.g., thyrotoxicosis)
• Type 1 diabetes (although appetite often increases)
• Malignancy
• Chronic disease (e.g. COPD)
• AIDS
• Or a combination of factors.

Any suspicion of cancer as the underlying cause should prompt urgent referral for further assessment in secondary care.