Most of us, as we age, are challenged by increasing weight.

The 2 major factors in weight loss are

• Decreasing your calorie intake,
• Reducing your insulin.

Dr Ben Bickman and other researchers working in this area suggest that it is 50/50 the above 2 factors. The ability to reduce your sugar intake will in turn reduce your body's need to produce insulin, which will in turn help make your cells more sensitive to insulin and reduce your propensity to store fat. Insulin is very efficient at turning on the cellular biochemical processes that cause us to store fat.

The good news is that with this new understanding of the importance of avoiding sugar and high glycaemic index foods it is quite “do able” to lose weight.

Below are 12 rules I have lived by, backed by science, in my journey losing 13+ kg between the ages of 57 and 60.

1.  Eat as much of the healthy stuff as you like ( above the ground vegetables, cheese, meat, eggs, fish, seafood) Do not allow yourself to get hungry.

   If you are hungry you are more likely to be tempted to eat something sweet or a high glycaemic index food like one of cardiologist  Dr Ross Walker’s “4 white poisons” ( bread, rice, pasta,  and potato). Providing you do not have high blood pressure you do not have to restrict your salt intake to 5 grams a day. Research has proven salt is no longer the demon we thought it was. Salt will help make your food more appetizing. Over a month you will adapt to the absence of the sweet taste of food.

2. Protein and oil are the 2 macronutrients that are most satiating on the appetite centre. When you feel hungry, eat something high in protein but low in net carbs e.g. meat, fish, egg, raw almonds, or macadamia nuts ( Nuts can be kept in the pocket of the dieter.) Raw macadamia nuts are my favourite and are about 70% fats and oils) After eating your appetite-suppressing snack, wait for half an hour. Extra virgin olive oil is your “new best friend” for cooking, salads etc. In Australia, Cobram Estate extra virgin olive oil has won “best” in class  as determined by independent tester “Choice Magazine” in 2018.
3. If you want to “supercharge” your weight loss I can recommend “The 5:2 diet”. Every third day reduce your calorie intake to 500 calories, a quarter of what it normally is on the days when you are not fasting ( 2000 calories) Don't eat excessively on the normal days.

   The Dr Michael Mosley video on the 5:2 diet, a BBC production is worth watching. Millions of people have used the 5:2 diet to lose weight.

4. If you are going to delay eating  one meal, make it breakfast. Wait till you are feeling hungry. Have a “brunch” say at 11 am. No lunch. Early evening meal at say 7 pm. Do not eat your evening meal within 2 hrs. of going to bed.
5. Weigh yourself daily at the same time. Being able to see there is some loss keeps you motivated. If there is no weight loss after 2 weeks, alter your strategy. Usually, this means less net carbs ( sugar and starch) and/or fewer calories by having smaller portion sizes. Try fasting for a whole 24 hrs. Get the help of your advisor.
6. Reduce your intake of physical and hidden sugars to 24g maximum  (ie 6 teaspoons). For many this is maybe 1/5th of what it is now.  Don't drink things in a carton which you buy out of the supermarket. Coca-Cola, Pepsi, lemonade, flavoured fruit juices, flavoured milk. All have significant amounts of added sugar. Be careful of drinks that claim to be high in protein but also have sugar added. Hidden sugar is the enemy.
7. We have an epidemic of type II diabetes. Clinical diabetes is just the tip of the iceberg. We have a large number of people in the population who are on the way to becoming type II diabetics i.e. they are pre-diabetic but usually do not know it.

   Measure your fasting blood glucose in the morning with a glucometer. ($45 to $70 even without government subsidies) It should be less than 5.5. Ask your "low carb" doctor to also measure your HbA1c as part of your annual blood test panel. HbA1c gives an average of blood glucose over 3 months. Fasting insulin is also important but most doctors do not know of the research of Dr Joseph Kraft showing elevated insulin precedes abnormally elevated blood glucose by approximately 10 years. Ask for Fasting insulin to be measured. You must refrain from eating breakfast before going for your blood test if you want the results to reflect your metabolic health.

   https://en.wikipedia.org/wiki/Glycated_hemoglobin

   If you are pre-diabetic try changing your diet (low sugar, low glycaemic index, high healthy  fat) 

8. Exercise is important, not so much for the calories that it burns up, but more importantly for the effect that it has on making our cells more sensitive to insulin. HIT (high-intensity exercise ) has a lot of good science behind it from many different research groups around the world. You are getting a maximal training effect from the time you invest in training when you are doing high-intensity training. However gentle aerobic exercise like walking is where you should start. (Take the dog for a walk?)
   

   Dr Michael Mosley video

   High-intensity exercise comes much later when you have a sound aerobic foundation to your fitness. High-intensity exercise is hard, and for some, it will never be part of their routine. Strength training ( eg lifting weights) maintains and develops your muscle mass which helps control your blood glucose.  Dr Rangan Chatterjee's “5-minute kitchen work out” is something that is simple and requires no additional equipment.

9. Omega 3 fatty acid-rich diet.  Almost everybody in the western world has a diet that is too high in Omega 6 (because of our grain and oilseed based diet) and is inadequate in omega 3 fatty acids. 5 to 10 x 1 gram fish oil capsules daily and or salmon as an oily fish are the 2 most common ways of getting adequate long-chain omega 3 fatty acids EPA and DHA.

   Monosaturated oils like those contained in extra virgin olive oil and avocados will become an important part of your diet. Avoid trans fats used in foods which have a long shelf life eg pies, doughnuts etc. Polyunsaturated seed oils like canola, sunflower, soya bean and safflower are off the list. The latter are potentially subject to oxidation which places an increased oxidative stress on your cells.

10. “Grazing” between meals is not ideal because each time you graze you are stimulating a release of Insulin "the fat-storage hormone". The insulin release will be greatest when you graze on sugar and starchy foods like a biscuit ( sometimes 70 grams of sugar/100 grams of biscuit). The insulin release will be least when you graze on macadamia nuts, my favourite snack food, (71.6 grams of fat and 3.9 grams of sugar/100 grams of macadamia nuts) ie high fat low sugar. My biggest problem is resisting the "naughty high net carb" foods. I solve this by putting a macadamia nut in my mouth and chewing it 50 times before I swallow it. Repeat if necessary.  This usually takes away the craving for the " naughty" food. Better to have eaten 4 macadamia nuts than a  biscuit!
11. Intermittent fasting should be introduced so that it becomes a habit after a month. This is the practice of compressing your eating into an 8  hour period so you have  16 hours of overnight fast. ie 7 pm for your last meal in the evening and 11 am for your first meal of the next day. See the article on our website at www.nutritionsciencegroup.com called “A Diet Strategy That Counts Time, Not Calories”.
12. Maximize your intake of above the ground vegetables. Fibre is fantastic for health through the establishment and maintenance of a robust and diverse population of friendly bacteria in your gut. Work up to maximizing your vegetable intake over a 7 day period.  Eat different types of vegetable with different colours for their polyphenol content. Children love “ticking off” the 3 different colours red, green and purple each week. Practicalities are that you should eat the vegetables that you like. Eating them cooked in a frying pan in butter or extra virgin olive oil or coconut oil improves their palatability. Steaming or boiling causes leaching of the water-soluble vitamin content and should be avoided. Maximize the above the ground vegetables like broccoli, broccolini, cauliflower, spinach, and the many different types of mushroom. Minimize the root vegetables like onion, carrot, potato and sweet potato as they contain too much starch.

    Making vegetable and fruit smoothies has helped me to increase my fibre intake. Frozen blueberries, strawberries, blackberries, raspberries etc are a lot cheaper than their fresh counterpart. Avoid ripe bananas and sweet apples like fuji. The fructose in ripe fruit is particularly bad for our attempts to reverse the much too common "fatty " liver. Get your fibre from above the ground vegetables not fruit

Why have we got this obesity problem?

If you think about the men and women in a cave hundreds of thousands of years ago, they did not have the plentiful supply of food that most of us in the Western world have today. In addition, the food supply was intermittent, especially during winter if they lived in a country where it snowed. Because they were hunter-gatherers they were active daily. We as a species in the western world do not get enough exercise. Our bodies have evolved to need exercise. When we don't give our bodies enough exercise things go wrong.

Is the problem going to go away?

I'm quite pessimistic about this. If you look at the increasing trend towards obesity, there are few incentives for the person who is becoming obese, to reverse this. Almost never does the fat person link their consumption of bread, rice, pasta, potato and sugar with their obesity. Why is this link not taught in schools and by every health professional? Fat people do not like being fat. It is not their fault that they do not understand the link between eating sugar and starch, the release of insulin and their subsequent weight gain.

We need a sugar tax. It has worked in Mexico to reduce type 2 diabetes. Our taxpayer-funded health care system requires taxpayer dollars to deal with the ill-health that comes with obesity.  In our "politically correct" society it is considered unacceptable for employers to discriminate against someone who is obese even if this means that they are slow at doing tasks, they lack the physical fitness to do manual labour and they have more sick days. The biology is simple. Fat cells produce inflammatory substances called cytokines.  A fat person in their pro-inflammatory state is a higher risk for cancer, heart attack, stroke and they are more likely to be depressed and because of their mental state less productive in the workplace. ( absence vs presenteeism)

Can't the government do something about it?

People who are on the way to becoming obese are in the majority. Politicians respond to votes. Where is the incentive for the government to do something about it? Certainly governments recognise that they have much larger healthcare bills because of the diseases that result from an obese population, but they are powerless because of our democratic society to make any tough decisions. We cannot even pass legislation to add a tax to the sale of sugary drinks. This tax has had a beneficial effect on the sale of sugary soft drinks in Mexico.

What is our best chance of success?

Smoking was considered acceptable in the 1960s, despite the fact that scientists knew that it was causing cancer. We need to educate, starting in primary schools, and make people aware of the problems associated with obesity. We should make heroes out of people who are able to lose weight.  I am concerned to see that more and more TV advertisements are now using people who are overweight. Fast food outlets need to offer almond meal bread as an alternative to high glycaemic index  wheat-based bread

References
Unwin D, Haslam D, Livesey G. It is the glycaemic response to, not the carbohydrate content of food that matters in diabetes and obesity: The glycaemic index revisited. Journal of Insulin Resistance. 2016;1(1), a8. http://dx.doi.org/10.4102/jir. v1i1.8