How to choose a diet? Why doesn't the weight come off? PP, weight loss, nutritionist

WORLD CLASS
Oksana Lishchenko
opens her column at the “Championship” .
Look for more useful materials using the tag #NutritionistWill Tell
.

Today, together with Oksana, we will try to answer the most common question of people who have recently decided to make changes in their body: how to understand that your diet is not working?

Oksana Lishchenko:

To conclude that a diet is not working, you need to understand what result you want. As a rule, the main goal of any diet is to solve the problem of “losing weight” or “reducing weight.” Why doesn't this work? Let's figure it out.

Photo: istockphoto.com

The most common questions and misconceptions when losing weight:

Question 1: “I eat only healthy foods, no junk foods, why am I not losing weight?”

Answer:

There are three reasons why you are not losing weight with proper nutrition.

Reason 1:
among the right foods, there are “dangerous” foods that contain a catch, since they contain a lot of calories, although they have beneficial properties. If you exclude them from your diet or significantly reduce their quantity, you will begin to lose weight. What products are these: nuts, cheese, avocados, sweet fruits (figs, dates, persimmons, grapes, bananas), various sauces. It is also very important to name alcohol - those losing weight should absolutely exclude it during weight correction. Alcohol of any strength and in any quantity is prohibited!
Reason 2:
you eat the right foods all week, and on the weekend you have a “cheat day”, or in some other way you give yourself a “reward” in the form of sweets, fast food, sushi, pizza, dumplings, hamburgers, and so on. Remove such meals from your diet, and you will notice the effect much faster just from daily adherence to a properly balanced diet.
Reason 3:
medical problems, when weight cannot be reduced in any way, and additional consultation with specialists is needed: endocrine pathology (thyroid diseases, obesity of the 1st-3rd degree, hypothalamic syndrome, etc.), gastrointestinal problems (pancreatitis, peptic ulcer, colitis, etc.), male or female health problems (hormonal imbalances, when consultation with a gynecologist or andrologist is needed).

Photo: istockphoto.com

Obesity and overweight

We consider obesity as a chronic disease, manifested by excessive development of adipose tissue and progressing in its natural course, which has a certain range of complications and has a high probability of relapse with a course approach to therapy.

Data published in the open press show that in Russia 54% of men over 20 years of age are overweight, and 15% are obese. Among women, obesity is observed in 28.5%, overweight - in 59% of women (data from the RIA Novosti news agency dated May 30, 2014).

In accordance with the standards of modern classification, body weight is considered normal if the body mass index (BMI) is in the range from 18.5 to 24.9 kg/m2, overweight - BMI 25.0–29.9 kg/m2, obesity diagnosed if BMI exceeds 30.0 kg/m2.

How much fat is in the body?

An indicator of the content of adipose tissue in the body of a healthy person

Male type of obesity

Of fundamental importance for diagnosis and subsequent therapy is the type of obesity - gynoid (synonyms - female, lower, pear shape) and android (synonyms - male, abdominal, upper,).

Types of obesity

It is the abdominal type of obesity that seems to be the most dangerous, leading to the development of insulin resistance and type 2 diabetes mellitus, arterial hypertension, coronary heart disease, dysfunction of the gastrointestinal tract and tumor diseases, arthrosis, early reproductive disorders, etc. There are stages in the development of obesity stable and progressive stage.

The insidiousness of this disease lies in the fact that for a long time the patient does not have any pain, and the regulatory systems cope more or less successfully with a gradual increase in body weight for some time. Both the patient and the doctor begin to deal with the problem, as a rule, when complications of obesity appear and progress - arterial hypertension, diabetes mellitus, coronary heart disease, osteoporosis, reproductive disorders or erectile dysfunction, fatty hepatosis, etc. And even in these cases, the main attention is paid to issues of treating consequences, not causes, although every good-level professional will definitely give the patient an instruction to reduce body weight. However, it rarely comes down to specific recommendations on how to do this; it’s good if a specialist has time to offer some advice. As a result, the patient is left alone with the problem of obesity, and the first thing he turns to is diet therapy.

Diet as a “mantra”

Many patients think: “Now I’ll go on a diet and solve all my problems.” And the point is not even that making a decision does not mean implementing it, but that diet therapy in its sole form does not always allow us to meet the expectations of our patients.

Diet is undoubtedly the basis for the treatment of any metabolic disorders, including obesity, but the first thing to do is to determine the genesis (from the Greek genesis - the origin, origin and subsequent development process leading to a certain condition) of obesity, choose the right tactics and determine the role and place of diet therapy in the system of complex measures.

Complexity of the diagnostic process

According to the etiology and characteristics of pathogenesis, obesity is divided into two large groups:

Primary (nutritional, alimentary-constitutional) obesity:
Exogenous form of obesity (dietary factor).
Hypothalamic and/or mixed forms.
Secondary (symptomatic) obesity:
Obesity caused by a hereditary genetic defect (Prader-Willi syndrome, Bardet-Biedl syndrome, Aldström syndrome).
Cerebral obesity (adiposogenital dystrophy, Babinski-Pechkranz-Fröhlich syndrome, brain tumors, dissemination of systemic lesions, infectious and mental diseases).
Iatrogenic obesity (caused by taking a number of medications).

Even a quick glance at the presented classification allows one to appreciate the complexity of the upcoming diagnostic process and the mandatory participation of specialists from various fields in it. Solving the problems of obesity is not a mystical rite in which you just need to believe in the result and wait for a miracle.

Against common sense

It’s surprising to see girls and boys walking along the streets in crowded places with badges saying “if you want to lose weight, ask me how?” or online advertisements about the miraculous effect of weight loss drugs. But even more surprising is the fact that they find clients.

Perhaps the effectiveness of this approach on the part of non-professional physicians lies not only in mastering the methods of neurolinguistic programming, but also in the inner nature of man - the desire for a miracle, contrary to common sense.

Can a nutritional supplement or even an established treatment such as diet therapy provide sufficient therapeutic benefit without addressing the underlying cause of the disease in secondary forms of obesity? The answer is ambiguous. Most often, no, and if they do produce a certain effect (diet), it will be unstable and short-term. But time for such treatment (often money) will be wasted.

It is known that the earlier the diagnosis is made, the better the treatment result, and distraction by half measures can delay the diagnostic process and worsen the prognosis for the patient. Although you can look at this from the other side: the lack of effect from diet therapy is a diagnostic criterion that allows one to suspect secondary obesity.

Even in the case of primary exogenous constitutional obesity, diet therapy may not always be quite effective, especially when it comes to stages II and III of obesity.

About metabolic syndrome

I would like to pay special attention to such a concept as metabolic syndrome, the leading and obligatory manifestation of which is abdominal obesity. In addition to obesity, metabolic syndrome includes:

insulin resistance and hyperinsulinemia;
dyslipidemia;
arterial hypertension;
impaired glucose tolerance/type 2 diabetes mellitus;
early atherosclerosis / ischemic heart disease;
violation of hemostasis;
hyperuricemia and gout;
microalbuminuria;
hyperandrogenism.

Considered:

liver steatosis;
obstructive sleep apnea syndrome.

The first pathogenetic connection between these manifestations was seen by the American scientist G. Reaven in 1988. There is still no single point of view on the trigger mechanism of the processes leading to the development of metabolic syndrome. The most established hypothesis considers hypersympathicotonia as the root cause, leading to the development of arterial hypertension, which contributes to the development of chronic peripheral circulatory failure and a decrease in the sensitivity of peripheral tissues to insulin. A decrease in the sensitivity of insulin receptors increases blood sugar and its utilization by fat cells, while the breakdown of fats decreases. This leads to the development of abdominal obesity, and constant hyperstimulation depletes the reserve capacity of pancreatic b-cells. Other known hypotheses include those that consider endothelial dysfunction or primary insulin resistance as a trigger. But, most likely, several factors acting simultaneously are important for the development of metabolic syndrome.

Obesity in this context can be seen as both a consequence and a cause. It is known that for every “extra” 4.5 kg of body weight, the level of systolic pressure increases by 4.4 mmHg. Art. in men and by 4.2 mm Hg. Art. among women. A dangerous threshold for the accumulation of adipose tissue is considered to be an area of visceral fat of more than 130 cm3 (at the waist circumference it is 94–101 cm) in men, and an area of visceral fat more than 110 cm3 (at the waist circumference it is 80–87 cm) in women. The primacy of obesity is also indicated by such facts as a decrease in the severity or elimination of other manifestations of metabolic syndrome after normalization of body weight. Therefore, in the treatment of any patient with manifestations of obesity, the main and primary task after eliminating the etiological factor is to reduce excess body weight.

Question 2: “I eat so little, why am I not losing weight?”

Answer:

The misconception is that you need to eat very little to lose weight! It is important to get enough calories from food (only 20% less than you spend) and a normal balanced composition of proteins, fats and carbohydrates! If you create a very large calorie deficit (50% or more), then you will definitely lose weight incorrectly: you will lose muscle and water, not fat, since it is a strategic reserve of energy in the body precisely for such “hungry” periods of life. As soon as you maintain a proper balance of calories, proteins, fats and carbohydrates, your body will begin to work “like a clock” and get rid of excess fat, not muscle.

High cortisol levels

Fat tissue in the abdominal area is more susceptible to excess stress hormones. If you are constantly under stress, the first thing it will affect is your figure. Stressful situations also include excessive consumption of carbohydrates, excessive physical activity, lack of sleep, and disrupted daily routine. To cope with the load, the body begins to intensively produce cortisol, mobilizing energy that will stimulate the work of the muscles and brain. In a normal situation, the hormone will regulate carbohydrate metabolism and strengthen the immune system, and in stressful situations it will be deposited in the form of adipose tissue.

What to do:

In this case, consultation with a preventive medicine specialist will help. It will help normalize hormonal levels and reduce stress levels with the help of a daily routine and diet.

Question 3: “I lost weight on... a diet, but then I gained even more, is the diet not working?”

Answer:

first of all, nutritionists are against diets! Diets remain only for the treatment of patients in hospitals. Secondly, the vast majority of people are helped to create a slim and healthy body simply by a balanced, rational, varied diet! If you lose weight and then gain weight again, then you are definitely doing something wrong! In dietetics, this is called “yo-yo syndrome,” when after too much calorie restriction (eating 500-700 kcal per day), a person switches to a regular diet and gains even more weight than he originally had. Contact a nutritionist, do a body composition analysis (bioimpedance) and choose the right diet based on calories and the composition of proteins, fats and carbohydrates.

Obesity treatment

Obesity, like any other disease, requires a professional diagnostic approach and proper treatment. And since obesity, including primary obesity, is an endocrine disease, treatment should be lifelong, and monitoring of results should be permanent. Therefore, for these patients it is better to talk not about diet therapy, but about changing eating behavior and eating patterns.

When starting to treat primary forms of obesity, we must first of all enlist the support of the patient. We will never see results if the patient is ready for obesity treatment only in words, without internal motivation. Sometimes this requires the involvement of a professional psychologist or psychotherapist.

A nutritionist is involved in the treatment of patients with obesity at all stages (inpatient, outpatient, sanatorium-resort), and the main task he solves is to reduce the intake of calories so that their consumption prevails over intake. Despite the fact that this is a more gentle method than the use of appetite suppressants, patients may still develop depressive states, and then psychological correction methods will be simply necessary.

The principles of a rehabilitation program for an obese patient are currently formulated:

appeal to the patient’s personality, active involvement of him in the treatment and rehabilitation process, cooperation with the doctor in achieving rehabilitation goals;
unity of effects of both biological (drug treatment, regulatory therapy, physiotherapy, etc.) and psychosocial (various types of psychotherapy, occupational therapy, etc.) measures.

As for the treatment of patients with secondary forms of obesity, in these cases the approach was and remains the same - eliminating the main cause (removal of the adenoma, if we are talking about hormonally active tumor formations; prescribing hormone replacement therapy for hypothyroidism, menopausal syndrome and diabetes), and then it is possible to use the same approaches as in the treatment of primary obesity.

Basic principles of obesity treatment:

Restore the circadian rhythm of hormone secretion:
Change eating behavior by providing 4–5 meals a day with the correct distribution of the quantity and structure of food intake.
Diet therapy.
Diet as a course therapy does not provide the required effect. Diet should be considered only as a mandatory component of systemic lifelong therapy.
Structure-balanced nutrition (proteins, fats, carbohydrates).
Get rid of bad habits that lead to metabolic disorders and chronic tissue hypoxia (smoking, drinking alcohol).
Activate the muscular system as the main consumer of energy, both constantly supplied (in the form of carbohydrates) and deposited in the form of fat.
Pathogenetic therapy of the underlying disease (in the case of central and endocrine disorders).
Drug therapy for complications (it is possible to reduce the need or completely eliminate some medications due to a decrease in the manifestations of complications with normalization of body weight).
Additional methods of both systemic and local influence (lymphatic drainage stimulants, massage, wraps, hardware lymphatic drainage and other methods of non-drug therapy).

In young patients with a high level of obesity, bariatric surgery (reduction of the size of the stomach or creation of anastomoses to bypass the stomach) is acceptable. A new direction is also the development of drugs that stimulate energy expenditure based on the proteins isolated in the process of studying brown and beige adipose tissue.

Question 4: “At what rate does fat burning occur?”

Answer:

It is considered normal for the body to lose weight by 1 kg of fat per week (or 4 kg of fat per month)! Please note that the calculation is in kilograms of fat, and not just in reducing kilograms of weight. These are absolutely real numbers that can easily be achieved with proper nutrition and regular exercise. At this rate of fat loss, you definitely won’t starve or break down, there won’t be any hormonal imbalances or complications, your skin won’t sag and unsightly folds won’t form.

Photo: istockphoto.com

Why don't you lose weight after 40 years?

Age-related changes after 40 years can cause a slowdown in the weight loss process. During this period, metabolism decreases, the rate of fat metabolism slows down due to hormonal imbalance, the development of chronic diseases, and women can gain excess weight. Even if you follow a diet and exercise, you will not be able to lose weight as much as was possible in your youth - one size in a week.

The solution to the problem is to reduce the total daily caloric intake to 1500-1800 kcal and adhere to simple but effective physical activity. Fast walking, fitness, yoga will do. A diet after 40 years is ineffective - try switching to fractional healthy meals, arranging fasting days every week. Before losing weight, it is advisable to be examined by a doctor to determine your hormonal levels.

Lose weight to be healthy, or lose weight to become beautiful?

We are all used to thinking that our problems are some very unique and individual issues that are exclusively in our heads. At the same time, we completely ignore the social context (the social environment that is around us).

Humans are social creatures, so we are characterized by social conformity. The same situation in different contexts will be assessed and experienced differently by us. We dress and look a certain way, not because we want to or have such taste, but because we do it for others, to be accepted by the surrounding society.

You can argue with me as much as you like about what you look like for yourself, but all these arguments are broken by several dozen experiments in social psychology. What does this mean in the context of excess weight problems and the desire to lose weight? If we discard health arguments (metabolic syndrome, risk of developing diabetes, problems of potency and infertility, risk of developing diseases of the cardiovascular system, problems with the musculoskeletal system), then appearance . Even with health issues, not everything is so simple, and there are many facts of falsification of certain research conclusions.

Beauty standards (especially for women) are constantly changing , to be convinced of this, just look at the covers of magazines for 20-30 years, or watch films of several decades. There are no standards of beauty, the media creates images for us, and we strive to imitate them. It seems to us that the more we look like the people on the covers, the better our lives will turn out, the more admiration I will receive. This is true to some extent, but not everything is so simple. You may be disappointed when, after all your efforts, no one throws your arms around you, you don’t earn more, and little has changed in your life, except for part of your wardrobe.

Conclusion: If you state that you want to lose extra pounds, it may not be your desire, but a desire to improve social success. Personally, you are not ready for this!