A weight-loss programme includes changes in lifestyle, exercise, dieting and, in some cases, weight-loss medicines or bariatric surgery. Such a programme is usually run by psychologists, nutritionists or other professionals.

This review is on the role of diet in weight-loss programmes.

GOALS

It is important to start a weight-loss programme by setting realistic goals.

Your first goal should be to avoid gaining more weight. Many people have a “dream weight” that is difficult or impossible to achieve. However, losing any amount of weight is a move in the right direction.

As an example, people at high risk of developing diabetes who are able to lose 10 per cent of their body weight and maintain this new weight will reduce their risk of developing diabetes by about 30 per cent and significantly reduce their blood pressure. This is a success!

Losing 15 per cent of your body weight and staying at this weight is an extremely good result, even if you never reach your dream weight.

STRATEGIES

To start a weight-loss programme is to start a treatment that will improve your overall health status.

First, one needs to follow these steps:

Identify eating triggers

This involves figuring out what you eat, where and when. To figure out what triggers you to eat, keep a record for a few days of everything you eat, the places where you eat, how often you eat and the emotions you were feeling when you eat.

For some people, the trigger is related to a certain time of day or night. For others, it is related to a certain place, such as sitting at a desk working or driving past a favourite fast-food outlet.

Eat

You can change your eating habits by breaking the chain of events between the triggers for eating and eating itself. There are many ways to do this. For instance, you can:

• Limit where you eat to a few places (eg, the dining room)

• Bring only a plate of food to the table, not the whole meal or pot. Doing so makes it more difficult to go back for seconds

• Drink a glass of water five to ten minutes before you start your meal and take sips of water between bites

• Stop eating before you are full and walk away, telling yourself that if in five minutes you are still hungry, you may come back and eat more

• Do not watch TV or check your computer, but rather be mindful of the act of eating

• Do not drink alcohol or sugar-sweetened beverages with your meal and avoid sweets (candy, cakes, cookies) for dessert

Reward yourself

Rewarding yourself for good eating behaviours can help you to develop better habits.

This is not a reward for weight loss; instead, it is a reward for changing unhealthy behaviours into healthy ones. Obviously, do not use food as a reward; some people find clothing, an outing or personal care (eg, massage) to be effective rewards. Treat yourself immediately after making better eating choices to reinforce the value of the good behaviour.

Other strategies that contribute to successful weight loss

• Establish a “buddy” system: Having a friend or family member available to provide support and reinforce good behaviour is very helpful

• Learn to be strong when tempted by food. You will need to learn how to say “no” and continue to say no when urged to eat at social gatherings. Develop strategies for such events, such as eating before you go or taking low-calorie snacks with you.

• Reduce stress: Stress can trigger uncontrolled eating in some people. It is important to find a way to get through difficult times without eating or by eating low-calorie foods, such as raw vegetables. Exercise, yoga and meditation can help.

CHOOSING A DIET

A calorie is a unit of energy found in food. The goal of any diet is to burn up more calories than you eat.

How quickly you lose weight on a given calorie intake depends upon several factors, such as your age, gender, and starting weight.

Older people have a slower metabolism than young people, so they lose weight more slowly.

Men lose more weight than women of similar height and weight when dieting because they have more muscle mass, which uses more energy. People who are extremely overweight lose weight more quickly than those who are only mildly overweight.

Most people need 1200 to 1500 calories per day to meet their needs and steadily lose weight. While there are hundreds of “diets” to choose from, they can be summarised in two main types:

• Low-fat diets: Those that contain less than 30 per cent of calories from fat. Fat is listed on the food facts label.

For a 1500-calorie diet, this would mean about 45 grams or fewer of fat per day.

• Low-carbohydrate diet: Low (for example, South Beach diet) and very low-carbohydrate diets (such as the Atkins diet) have become popular.

With a very low-carbohydrate diet you eat less than 60g of carbohydrates per day (a standard diet contains 200g to 300g of carbohydrates). With a low-carbohydrate diet, you eat between 60g and 130g of carbohydrates per day.

Carbohydrates are found in fruits, vegetables, grains (including breads, rice, pasta and cereal), alcohol, and dairy products. Meat and fish contain very few carbohydrates. Side effects of very low-carbohydrate diets can include headache, bad breath, muscle cramps, diarrhoea or constipation, and weakness.

What is a Mediterranean diet?

It refers to a way of eating that is common in olive-growing regions around the Mediterranean Sea and includes:

• A high level of monounsaturated fats (from canola or olive oil and nuts) and a low level of saturated fats (from butter)

• A high amount of vegetables, fruits, and grains (seven to ten servings of fruits and vegetables per day)

• A moderate amount of dairy products (skimmed milk, fat-free yoghurt, low-fat cheese)

• A low amount of red meat (substituted by fish or poultry).

Which diet is best?

Studies have compared the above diets (except Mediterranean) and found that no one diet is “best” for weight loss.

Any diet will help you to lose weight if you stick with it; therefore, it is important to choose a diet that includes foods you like.

While the Mediterranean diet was not compared head-to-head with others, studies over the past ten years have shown many health benefits of this diet, beyond weight, including cardiovascular ones.

Fad diets

Fad diets often promise quick weight loss and may claim that you do not need to exercise or give up your favourite foods.

Some fad diets cost a lot of money because you have to pay for seminars, pills or packaged food. Fad diets generally lack any scientific evidence that they are safe and effective, and they are not recommended.

Joe Yammine is a cardiologist at Bermuda Hospitals Board. He trained at the State University of New York, Brown University and Brigham and Women’s Hospital. He holds five American Board certifications. He was in academic practice between 2007 and 2014, when he joined BHB. During his career in the US, he was awarded multiple teaching and patients’ care recognition awards. The information herein is not intended as medical advice nor as a substitute for professional medical opinion. Always seek the advice of your physician. You should never delay seeking medical advice, disregard medical advice or discontinue treatment because of any information in this article