Losing weight is hard. And keeping the weight off is even harder.
This is because when we lose weight, our hormones which control hunger increase our appetite to encourage us to gain it again. And recent research shows increase in appetite is long-term.
In other words, our biology works against us to stop us maintaining our weight loss.
“That hunger is a terrible thing. Our primary instinct is to eat,’’ Professor Joseph Proietto, Head of the Weight Control Clinic at Austin Health, says.
That doesn’t mean long-term weight loss is impossible, however.
Proietto, an endocrinologist who specialises in diabetes and obesity, advocates for rapid weight loss through an intensive very low calorie eating regime.
He has seen the best long-term weight loss maintenance results when patients subsequently do all of the following: practise mindful eating, exercise and eat healthily, take medication to suppress appetite and weigh themselves weekly. If more than two kilograms is regained, that’s a trigger to restart the intensive weight loss eating regimen.
Dr Catherine Keating, Head of Preventative Health at Medibank, said several weight loss myths have been busted in recent years. Firstly, it is a myth that losing weight slowly is always better; there is now strong evidence that rapid weight loss is more effective for many people. Secondly, it is a myth that people’s lifestyle is the only determinant of their excess weight; genetics also plays a big role.
“Our customers report that weight loss is one of their biggest challenges – they are encouraged by health professionals to lose weight – but they don’t know where to start and struggle to find time to invest in their own heath in their increasingly busy lives,’’ says Keating, formerly an academic specialising in obesity.
“We need to support Australians by providing them the right information and tools. Supporting people to maintain a healthy weight is probably the most important contribution we can make to the health of Australia”.
When people do lose weight, they experience a raft of health benefits. One of the most dramatic outcomes is improvement of Type 2 diabetes by decreasing insulin resistance.
A loss of 15-20 per cent of body weight can mean Type 2 diabetes patients can reduce or even cease taking medication.
Another well-known benefit to losing weight is that Metabolic Syndrome can be reversed. Metabolic Syndrome is a cluster of cardiovascular risk factors including high blood pressure, obesity, high blood triglycerides, low levels of HDL cholesterol and insulin resistance.
There is also a decreased risk of some cancers, including breast cancer, after weight loss.
But there are other less well-known health benefits to losing weight – and some may surprise you.
It can help your knee pain
There are 2.1 million Australians suffering from osteoarthritis, and the knee is commonly affected. And while not life threatening, the impact on quality of life is significant.
People with knee osteoarthritis can have difficulty with stairs and everyday activities, their sleep can be interrupted and they are at risk of depression and anxiety from living with chronic pain.
It’s not just a disease of the elderly either, with half of sufferers at working age, says Professor Kim Bennell from the Department of Physiotherapy at the University of Melbourne.
People with sporting injuries of the joints are also at risk of developing the disease.
“So it affects young people as well,’’ Bennell says.
Surgical intervention via a knee replacement is not always successful, particularly in overweight patients.
For all these reasons – losing weight is looking like a promising strategy for easing the debilitating effects of knee osteoarthritis.
Losing 10 per cent of body weight is the general recommendation, says Bennell.
“Research shows that’s where there are more benefits,’’ she says.
“And the more weight you lose, the better the benefit.”
In an effort to find out more about how weight loss might help knee osteoarthritis symptoms, Bennell is leading a study for Melbourne University in partnership with the Medibank Better Health Foundation.
She says the ‘Better Knee Better Me’ study will assess the effects of an exercise program alone, versus an exercise program plus a very low-calorie ketogenic diet, on knee osteoarthritis symptoms.
At the end they will assess the participants’ knee pain and function, as well as quality of life, weight, mood and whether in the long term the participants needed knee replacement surgery. The study started in 2018 and will continue until 2020.
It can help you get a better night’s sleep
Obesity is the biggest risk factor for Obstructive Sleep Apnoea where the airway gets obstructed during sleep, due to relaxation of the tongue and airway-muscles.
It is estimated that 58 per cent of moderate-to-severe obstructive sleep apnoea is due to obesity.
Having obstructive sleep apnoea often means getting a bad night’s sleep from snoring and repeatedly waking throughout the night choking or gasping for air.
It also carries a higher risk of death and heart disease.
There’s increasing evidence of a two-way relationship between obesity and sleep apnoea. A vicious cycle which can develop where lack of sleep can exacerbate feelings of tiredness and depression and decrease motivation, making it harder to lose weight.
Treatment is available, the most successful being Continuous Positive Airway Pressure where a small machine pumps air at a continuous pressure through a mask, however the cardiovascular benefits are uncertain.
However weight loss can reduce the severity of sleep apnoea, and may mean other treatments are not required.
Your asthma can improve
The link between asthma and obesity is not immediately obvious, but inflammation may be the culprit, says Proietto.
“Asthma has an inflammatory component and obesity is an inflammatory state,’’ he says.
“If you reduce the inflammation, the asthma improves.”
A systematic review of randomised controlled trials published in January 2019 found participants who were overweight or obese and subsequently lost weight reported improvements in asthma-related quality of life and, to some degree, asthma control.
A recent American study on mice also found that obesity resulting from a high-calorie diet led to asthma symptoms in the animals by causing lung inflammation, and a drug that blocks inflammation eased those symptoms.
Australian Bureau of Statistics data shows that women aged over 55 are most at risk of dying from asthma and need to take extra care in managing their condition.
Your fertility can increase
Polycystic Ovary (Ovarian) Syndrome (PCOS) is a hormonal disorder affecting 12-18 per cent of women of reproductive age, which can affect fertility, though 70 per cent remain undiagnosed.
Modest weight loss will not cure PCOS, but it will help. Research studies have shown it only takes weight loss of 5-10 per cent of initial body weight to reduce insulin resistance by about 50 per cent, restore ovulation, regulate menstrual cycles, reduce pregnancy complications and improve fertility.
Recently, Monash University Professor Helena Teede led a team of researchers and released new guidelines for the diagnosis and treatment of PCOS.
Your mental health can improve
Research has shown that there's no clear, one-way connection between obesity and depression.
Australian adults who are above a healthy weight report higher rates of many chronic conditions, such as mental health issues, than adults in a healthy weight range.
Eating a healthier diet has shown improvements in mood among people with moderate to severe depression, according to a 2017 Australian study.
Possible reasons given include a reduction in inflammatory and oxidative stress pathways, as well a better gut microbiota. There may also be a “therapeutic benefit” from the simple act of cooking and eating healthier food.
To help support Australians living with ongoing knee pain, Medibank has partnered with The University of Melbourne to trial a treatment program with members. The Better Knee, Better Me™ study will compare the effects of different approaches to supporting Australians with chronic knee pain. Click here to learn more about the Better Knee, Better Me™ study.
Bonus to losing weight
Shantelle lost 33 kilos and in the process gained her life back. Hear her story in the Better Bodies episode of Dr Michael Mosley's Reset, which you can stream now on SBS On Demand. This program was created in partnership with Medibank, editorially produced independently by SBS.