Weight loss – from diets to injectables | Neos Kosmos

Here is an update from the Doctor in the House, Associate Professor Magdalena Simonis AM, on what’s out there and how to have this chat with your health professional.

If you are thinking about becoming healthier or just losing that belt of fat around your belly and hips, by losing some weight, it’s important to know what’s safe, what a healthy and realistic weight for you is, and how to maintain this. You might have already heard about injections for weight loss or have seen ‘fat -burning’ pills advertised at the chemist, or listened to friends talk about their ‘special’ cabbage soup diet, the keto diet, intermittent fasting, ‘chrono-eating’ or the 5/2 diet. It can be very confusing.

People usually want the ‘fastest, easiest’ approach, but this is generally not the healthiest and certainly not a sustainable approach to take. This article will briefly cover how weight is categorised, medical causes of weight gain followed by a discussion on weight loss approaches covering injectables first, as they are the newest weight loss fad. Discussion around making lifestyle choices will be covered using a different lens to what you commonly hear about.

 

Medical causes of weight gain

Other than overeating, not exercising and spending most of your working day sitting, there are several medical causes for weight gain for which you should see your doctor such as:

• depression/ anxiety
• sleep apnoea
• binge eating disorder
• taking certain medications (high dose steroids over time, some antidepressant and antipsychotic drugs),
• hormonal disease such as an under active thyroid, or an adrenal gland tumour, or brain tumour (usually benign and rare),
• menopause and the years leading up to this during which ovaries function less reliably.
• polycystic ovarian syndrome which is the commonest hormone disorder in women during their reproductive years and is associated with insulin resistance and can lead to type 2 diabetes mellitus (T2DM), also referred to as ‘late onset’ diabetes.

 

Measuring weight

We classify weight by measuring body mass index (BMI) which is weight in kilograms (kg) divided by the square of height in meters (m2) – so a weight of 70kg and height of 1.7m gives a BMI of 24.2 which is in the healthy BMI range of 19-25. A BMI up to 30 is overweight and a BMI of over 30 is considered ‘obese’. Most of us are somewhere in the 25-30 range which means we carry a few kilos we wish we could lose. Other measures of weight include waist circumference and skin fold thickness, but keep in mind that the these are approximate tools and can disadvantage some races who have different body shapes.

I try to steer away from just focussing on body shape, body-size and weight because we all know and love people who carry excess weight and are healthy. Some might have been diagnosed with an eating disorder in the past, and for some, this might be triggering so it’s important to know the whole story behind the person asking to lose weight before any decision is made.

 

Injectables

People are more ready to ask for injectables these days as a first option for weight loss than ever before. You probably already know them by brand name, but I’ll be referring to them as the GLP-1 drugs, which work by helping control blood sugar levels and triggering a feeling of fullness.

It’s common to hear, ‘I’ve tried everything else and frankly, I’m fed up and want something that works.’ Thanks to the TikTok videos promoting injectables for weight-loss going viral, they’ve become the new ‘wonder weight-loss drug’. Although designed for type 2 diabetics

(T2DM), they’ve been promoted through social media effectively, and self-injecting is now considered by many non-diabetics as an acceptable, fast, weight-loss treatment.

 

Side effects of injectables

The GLP-1 drugs were designed for those who develop diabetes in later life, which is very common amongst the Greek population (around 7%, Liatis et al, 2019), affects around 4.6% of Australians (AIHW 2023), and for obese people. The companies that produce them post weight loss expectations of 6kg -12kg in 6-12 months.

Common side effects that have been reported and you should be aware of if considering them are vomiting, nausea, bloating, dehydration and constipation. There are people who are less responsive to injectables, with minimal weight loss despite persisting with them. With the large numbers of people being prescribed these off-label, we are seeing more of the rarer complications such as intestinal blockage and inflammation of the pancreas which are excruciatingly painful and life-threatening. Kidney failure is also a risk.

 

Supply and demand of injectables – a booming market

GLP-1 drugs have been a hot commodity for their ‘off-label’ use (this means prescribing them to people without diabetes), and people are willing to pay between $200-$400 per month to have them prescribed and sadly, most people gain the weight again when they stop. Despite this, demand is high and as a result, there has been a worldwide shortage since April of 2022, which has driven some pharmacies to produce their own versions or source them from other manufacturers. These versions of the products referred to here are referred to as ‘compounded medicines’. In other words, they are made by a pharmacist on their own premises or sourced from premises that are not regulated by the Therapeutic Goods Authority (TGA). When medicines go into production this way, concerns some members in the medical world have expressed are that the standards and quality can vary from site to site. You can understand how difficult it would be for the TGA to go into every pharmacy and every production site that makes compounded medication to assess the standards and quality for every compounded drug.

The TGA’s role is to protect the community by regulating medications that come to market in Australia and making sure they’re safe. The compounded products being made might not be quite as effective or as safe and the shortage of supply caused by ‘off label’ use has created an opportunistic market expected to generate sales of over $100 billion (US) by the end of the decade.

 

Your relationship with food

Think about your relationship with food – we all have one. Ask yourself why you want to lose weight, what’s been tried if anything, what’s worked or what hasn’t worked in the past, then write down your food diary and be honest – include portion size, sugar in tea, coffee, number of serves, how full the plate looks or how many times you go for seconds. I do this quickly in my rooms – what did you have today? Breakfast, snacks, lunch, what will you have tonight? Do you cook? Do you like to cook? If not, what are your options? Who shops for food? Do you purge or take laxatives and how often do you think about food and what you eat? How do you feel after you’ve eaten? Alcohol, fruit juice and soft drinks are high in calories so make sure you include these in your diary too.

It’s important to reflect on scenarios where overeating or poor choices occur and identify what the ‘go to’ options are when you feel hungry, become upset about something, go out to restaurants, or just can’t be bothered preparing food and order home delivery.

List some of your emotional triggers for ‘comfort eating’. Just as some people eat reactively, others smoke or drink alcohol reactively. Try to pre-empt situations that generate emotions, which can lead to unhealthy habits.

 

Think of food as nutrition for your cells

It’s useful to visualise what happens when you ingest food. Food is chewed, swallowed then liquified and the diluted molecules are absorbed into our cells after passing through our intestinal walls and carried through the blood stream to our tissue, muscles, brain. The molecules are the fuel used for all the processes that make us fight infection, grow new cells, feed our pregnancy, make sperm, produce our hormones and support our mental well-being.

Good fuel comes from eating unprocessed foods and eating a mainly Mediterranean diet which is rich in ‘whole foods’ such as vegetables, leafy greens, olive oil, seeds, nuts, grains, legumes. It forms the basis of well-being and disease prevention, and results in higher energy levels. Even brain fog and low mood can improve. Couple this with water, good clean air which oxygenates the cells and at least 30 minutes of brisk walking daily, you will feel the difference.

 

When trying to lose weight consider the following:

1. Self-awareness: ask yourself the questions listed earlier.
2. See your GP/ health care professional or personal trainer to set a realistic goal and check in monthly with your weight and for discussion.
3. If you have a chronic disease, you might choose to see your GP for a chronic disease team care referral, such as a dietician or exercise physiologist to guide your program.
4. Create your food diary with meals and snacks plan. Shop according to this only.
5. Plan meals with high protein and complex carbohydrates and high fibre – visualise your plate – 2/3 vegetables 1/3 protein
6. Aim to reduce your weight by 0.5 -1 kg per month. Be kind to yourself if this mark isn’t achieved and review your plan. It’s a long term project – slow and steady, with bumps and curves along the way.
7. Make a ‘movement / activity’ list – pick what you feel like from the list which can include dancing in the kitchen, star-jumps while watching the news, tai-chi, Pilates, a brisk walk. Do the things you like and know you will maintain. As time passes, you might introduce other activities. If you have a partner or exercise buddy, this can be fun to share.
8. Make use of wearables and measure your activity daily. There are free online exercise programs of most types which you can do in your own time and place of choice.
9. Drink 2 glasses of water before a meal – this gives a sense of fullness and can reduce overeating, especially if you are looking forward to eating the food in front of you.
10. Eat mindfully – eat at a slower pace and don’t gulp your food down.
11. Prepare for those situations that create temptations for you – decide what you will order, before you go somewhere out to eat.

 

For further information on how to eat well there are some links below and if any of this has made you feel uncomfortable or brought back negative feelings please see your GP or health care provider.

 

Here are some useful websites:

Healthy eating – Diabetes Australia

Mediterranean Diet – Mayo Clinic

 

Eating disorders helplines:

au.reachout.com/articles/support-services-for-eating-disorders

butterfly.org.au/get-support/helpline