The weight loss tips your doctor can’t tell you…

So it’s not that there are any great secrets, although it’s not as simple as calories in versus calories out for some people. Often the doctor just runs out of time to dig into the detail.

First let’s deal with calories out. We need to understand what our weight is. A little biology revision:

We are made up of water, protein, fat and carbohydrate. The two main sources of fuel for the body are fat and carbohydrate. A misconception is that we burn carbohydrate, and fat is just unnecessary additional stores. However our day to day standard low level energy burn is largely from fat, with a gentle constant feed of fatty acid to the mitochondria in your cells. Only when you step up the activity levels do you start churning through sugars - eventually producing lactic acid which causes your muscles to fatigue, the sensation people think they should be striving for in deliberate exercise. You get back from a run sweating, glowing, gasping, and aching, and you feel that as good pain. As the nineties No Fear t-shirt said, “pain is weakness leaving the body.” Or maybe it’s fat? But it’s neither.

When people say they want to lose weight it’s usually that they want to be more toned, and with less adipose tissue (fat). So if you want to burn off some of the fat you need to reach a level of exercise where the mitochondria aren’t so overworked that they’ve shifted to using carbs, but are working harder than normal so that you’re actually achieving something. Fortunately this state is defined, and is known as Zone 2 training.

Zone 1 is normal daily activity. Zone 2 is when you’re exerting yourself to a level where your heart rate is up; it’s your ‘all day pace’ where you could just about hold a conversation but probably not sing, and the person you’re talking to knows you’re exercising, but you could keep going really as long as needed. You might get to the end of your session feeling like you haven’t done much. If you have a heart rate monitor it’s probably 65-75% of your maximum heart rate (which is, crudely, 220 minus your age). The ideal quantity per week to really optimise your health is 45-60 minutes 3-4 times a week, interspersed with some resistance training (but let’s leave that for another day…).

Now let’s deal with calories in. Fat stores are largely from sugar overload. That doesn’t make a huge amount of sense at first glance because fat is fat, but sugar is carbohydrate. However we are genetically developed to store away fat in the good times so that we can survive the lean winter months. The basic way of storing this fat away for primitive man was to take advantage of ripe fruit and veg over the summer, in essence sugar. The sugar in fruit is called fructose. The sugar in your cupboard is sucrose. Sucrose is a fructose and a glucose stuck together. The amount of fructose in a piece of fruit is processed by the gut lining in a perfectly healthy way to generate energy. If we eat more fructose than the gut lining can process then it’s shipped off to other parts of the body and processed to be stored as fat. Imagine the Neanderthal who finds a tree full of ripe fruit and starts tucking in. We have another genetic adaptation whereby overloading our fructose systems not only doesn’t fill us up very well but also makes us more hungry. This allows us to park ourselves on a branch and really go to town on the fruit, readying ourselves for the long hard winter months. However in a world where we can go to the cupboard and keep doing this over winter it’s really bad news for incessant fat build up.

And if you’re thinking you haven’t recently devoured a tree-full of figs, then consider your other sources of sugar. Complex carbs (bread, pasta, rice, potatoes etc) are essentially made of sugar. If you’ve ever tried to go sugar free you’ll know how much of the food we buy is loaded with added sugar.

So in essence it is often quite simple, but not as simple as “eat less, do more exercise”, rather it’s “eat the right things, do the right sort of exercise”.

At Lisle Medical a health screen includes body composition analysis, to determine your lean body mass (and therefore bypass the imperfect body mass index), true hydration status, fat mass, and a range of blood tests can be chosen to determine what your metabolism is doing. Always happy to chat this, and many more things, through in great detail, Dr Piers Foster is your contact in West Sussex to delve further into this evolving science.