Last partial update: July 2017 - Please read disclaimer before proceeding
Attitudes to dietary change
Problems with common attitudes to weight loss
For a long period, society has had simplistic and often misguided attitudes towards obesity and weight loss. It has centered around blaming obesity on laziness or gluttony and assumed everyone could be slim with a disciplined approach to diet and exercise. It also assumed that being thin optimizes health and happiness. The problems with these attitudes are they do not give a real understanding of the complex nature of the factors causing obesity and affecting its treatment, and they do not distinguish between weight and health.
People wishing to lose weight should focus on attainable and sustainable solutions that will deliver a comfortable weight and improved health. Such solutions will need to encompass behavioural change in both diet and exercise.
Concentrating on weight loss rather than on achievable behavioural change is not helpful
Concentrating on changing eating and exercise behaviour is a more successful approach than concentrating on short-term weight loss and these behavioural changes should be people’s main long-term priorities.
The behavioural goals in weight-loss strategies should be focused on what people can realistically achieve and sustain. Almost all overweight people have tried to lose weight on numerous occasions and failed. The prime reasons for this are that they impose dietary restrictions that they will never be able to maintain in the long-term and / or that they have unrealistic weight loss goals. This starts the ‘weight loss cycle’, seen in figure 11, and leads to repeated failure, making future success very unlikely. Repeated weight loss followed by weight gain has also been associated with generally poorer health and can cause a reduction in lean body mass (i.e. less muscle), thus making future weight gain more likely.
It is probably best not to have any definite weight loss goal at all and just concentrate on strategies to improve health. Having said this, it has been shown that people who have lost weight are better at keeping it off if they regularly monitor their weight.
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Adopting healthy attitudes to modifying eating behaviours
Positive attitude towards diet and body
Foods should not be categorised as ‘bad or good’, as this can increase feelings of guilt and failure. It is better to categorise foods as being ‘everyday’ or ‘sometimes’ foods. People should also not focus exclusively on the negative side of their body image. They should ‘accept’ their body while they are trying to change it. A good method is to write down body attributes, for example having good eyesight or musical ability.
Weight loss through dietary change is slow
As mentioned above, healthy weight loss is almost always a slow process. Dramatic dietary changes that are aimed at achieving quick weight loss are usually impossible to maintain in the long run and failure, which usually occurs within 12 months, just reduces self confidence and the likelihood of future success.
Long term modification of food intake
This section will be divided into three parts.
Part 1 - Achieving beneficial change through identifying problem habits that are likely to be causing obesity
Part 2 - Looking at general food / energy intake
Part 3 - Implementing change
Part 1 - Achieving beneficial change through identifying problem habits that are likely to be causing obesity
Implementing changes in diet is not easy, especially if numerous changes are required. This section provides a practical approach to achieving these changes.
Getting help
It has been emphasized throughout this section that losing weight in the long term is difficult and it is only achieved by about 10 to 15 per cent of those seriously attempting weight loss. It has been shown, however, that a person’s best chance of successful weight loss is through gaining initial advice and ongoing support from a dietitian or other health worker experienced in this field (perhaps a GP). Help is especially important where:
- Larger amounts of weight need to be lost. This includes any person who is more than 10% over their ideal body weight. (i.e. has a BMI of over 27.5). Losing more than 10% of total body weight is not an easy task.
- Previous attempts at weight loss have been unsuccessful. (This includes most people. Remember that repeated failure is detrimental for self-esteem and reduces likelihood of success in the future.)
- People who have in the past had problems maintaining other long-term change / commitments.
While there is obviously expense involved in gaining a dietitian’s help, it is definitely money well spent as it will significantly improve the chance of success at a task that will require considerable effort over a long period of time. Also, it is far less expensive than most of the ‘diet programs’ that people try. And remember that it is the ongoing monitoring by a health professional that is the key to success!
Dietary problems often affect all family members and it is therefore very beneficial to involve other household members in dietary changes. They will also be at least partly responsible for the purchasing and preparation of food. Sharing meal planning will help keep everybody happy and all will benefit from better eating habits.
A. Poor eating behaviours / emotional eating
Poor eating behaviours are commonly the principle cause of obesity. They are often based the interplay of our emotions / social situations and eating. For example; eating with you are with others, eating to cheer yourself up, eating to calm anxiety and eating to celebrate.
Our eating patterns are part of who we are and they are not always obvious. Before commencing any dietary change program, present dietary habits need to be assessed so that problem areas can be identified. This task of identifying dietary problems is best accomplished with the help of a dietitian who can look at eating habits. A three-day food diary in which all the foods eaten are documented is helpful in this process. The days should include two week days and one weekend day. It is also useful to note the degree of hunger by recording hunger level, on a scale of one to eight as below, each time food is eaten. Once again, this process is often best done in consultation with a dietitian or medical practitioner.
Hunger scale
1. Ravenous
2. Hungry
3. Slightly hungry { Preferred
4. No hunger { levels of
5. Feeling satisfied { hunger
6. Slightly full
7. Very full
8. Beyond full
From this assessment, areas requiring change can be identified and a dietary strategy worked out. This food diary needs to be fairly detailed and it is important to be accurate and not underestimate the amount of food consumed
Sample of food diary |
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Day…………………………. |
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Meal |
Time |
Food eaten |
Amount (weight in g) |
Total fat (in g) |
Hunger scale |
Other comments |
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A good way to identify dietary problems is to look at each day of the week and, as much as possible, group them into days that are similar. For example, many people have working day routines that are fairly similar. The completed diary can then be used to look at eating habits throughout the day. This can be done by dividing the day into six eating time zones; breakfast, between breakfast and lunch, lunch, between lunch and dinner, dinner and after dinner.
In each eating period, people need to look at what they eat and seeing what changes need to be made. Eating habits at dinnertime and after dinner do vary during the working week. However, these evening activities are often patterned on a weekly cycle, such as regular sporting commitments, meetings or social drinking on a Friday.
Eating habits during time off (often the weekend) do tend to be more varied and again people should note any significant patterns that aren’t represented in their food diary, especially if they are detrimental to a healthy lifestyle. There is not much use moderating food and alcohol intake during the week if binging on food and drink occurs on the weekend.
Cognitive Behavioural Therapy
As many eating problems are behavioural / psychological it makes sense to use pychotherapy to help address them. Techniques such as cognitive behavioural therapy are often used by treating practitioners (GPs, dietitians or in some cases psychologists) to help overcome poor eating behaviours. These techniques can be used to break old bad habits through by helping patients:
- become aware of emotion cues and non-hungry triggers that initiate eating
- find alternative ways to address problems rather than with eating e.g. increasing exercise
- identify why we choose paticular unhealthy and find foods that are both enjoyable and heathy as replacements
Addressing poor eating behaviours
1. Non-hungry eating
Identifying why a person eats will help find solutions to their weight problems. Normally people feel hungry three to five times per day. This occurs because blood sugar (glucose) levels decrease when a person has not eaten for some time. Non-hungry eating occurs in most people and is an important factor in obesity. Many obese people have lost the ability to tell when they are hungry. A hunger scale mentioned above is useful for assessing hunger levels.
Once a person’s level of non-hungry eating is established, the reasons can be determined. They may include eating when people are supposed to eat, for example when the clock says it is lunchtime; the feeling that everything on the plate must be finished; tiredness or boredom; emotional problems; and the association of eating with another activity, such as watching TV or playing cards. Many young adults retain the eating behaviours they practiced as adolescents while they were still actively growing in height. Once they stop growing, this energy intake is excessive compared to their energy use and they thus become obese young adults.
Some people will find that they are not hungry at meal times. This can be due to snacking or because their previous meal was too large. (See below.) Occasionally people are not even hungry at breakfast. Breakfast, however, should never be missed as it gets the body going for the day. People who skip breakfast tend to snack more during the morning and are often obese.
2. Snacking
Snacking is often a major problem, especially if the snacks comprise foods that are high in fat or sugar, as most commercial snack foods are. A helpful way to reduce eating between meals is for people to clean their teeth after each meal. This signifies the end of the eating period and the fresh mouth feel is a reminder that the time for eating has now finished. It is also good for teeth and gums, as long as not done excessively. As well as reducing total food intake, a reduction in non-hungry snacking will allow people a more varied and interesting diet at meal times.
People who are hungry between meals should delay the feeling of hunger by ensuring that each meal contains foods that take a long time to digest. This means that the person’s blood sugar level following a meal stays elevated longer, which delays the onset of hunger. The glycaemic index (GI) categorises each food according to the speed that it raises blood sugars once it is eaten and the duration of that blood sugar rise. Foods with a high GI, for example white bread, potato chips and biscuits, cause an early and high rise in blood sugar after eating. The body then initiates an early release of insulin to reduce this elevated blood sugar level and as this occurs hunger starts to return. Foods with a lower GI, such as apples, pasta or a bowl of muesli, are digested over a longer period. Thus, the rise in blood sugar occurs more slowly, is not as high, and lasts longer. The subsequent fall in blood sugar also occurs later, delaying the onset of hunger.
3. Large portion sizes
If large meals are a problem, the quantity of food you eaten can be reduced by:
- Reducing portion size.
- Only make enough for one serving for each household member
- Don’t go back for seconds
- Use smaller plates
- Eating food slowly
- Drinking lots of water with the meal
- Not eating dessert
- Not eating everything on the plate
4. Binge eating
Binge eating is a significant contributor to weight gain; in women the incidence is as high as 40 per cent. It is part of the unhealthy diet cycle that occurs with weight-loss programs that impose unsustainable dietary restrictions. The resultant dietary failure is accompanied by subsequent feelings of guilt and loss of self-esteem and these feelings make future attempts at weight loss even less likely to succeed. Binge eating often occurs with stress, after exercise (as a reward), when eating with others, at festive occasions, and with alcohol consumption. The answer is to make more modest dietary modifications that are sustainable in the long-term and to be aware of the problem.
5. Using quick fix diets that excessively restrict energy intake
Most commonly recommended diets act by severely restricting energy (calorie / kilojoule) intake to the extent that the energy consumed is significantly less than the energy used by the body. This results in a relatively quick weight loss as large amounts of the body’s glycogen stores (the storage form of glucose in our bodies) are used to supplement the reduced energy provided in the diet. As these glycogen stores are used up, water that is needed for storing the glycogen is also lost. Further body water is lost when the kidneys excrete nitrogenous waste products derived from the breakdown of protein to make glucose for energy. While this initial loss of glycogen and water can result in a weight loss of several kilograms, it is replaced by the body as soon as energy intake increases again.
Diets that significantly restrict energy intake are unpleasant and difficult to maintain. Also, it is obviously not possible to continue with severe energy restricting diets as a person can’t continue to use more energy than he or she consumes. Thus, such diets are only maintained for short periods and are usually often followed a return to previous eating patterns or even binge eating. These diets are usually associated with large fluctuations in weight but little overall weight loss in the long term.
Another problem with such diets is that, as a protective mechanism, the body reduces its energy needs (i.e. its resting metabolic rate (RMR)) when dietary energy supply is significantly reduced, thus reducing the effect of the energy restricting diet. (This strategy is also used by the body in times of famine.) Such diets also result in a loss of muscle mass (lean body mass) and this reduces RMR further.
Diets that excessively restrict energy intake are also associated with numerous side effects, including impaired concentration, which affects work and study; poor nutritional balance; and decreased self-esteem associated with diet failure. This decrease in self-esteem can in turn affect many aspects of life and lead to, or worsen, depression. Finally, these diets also increase the likelihood of developing eating disorders, such as anorexia, as they discourage normal eating patterns and give the message that good foods, such as bread and pasta, are ‘bad’.
In contrast, healthy dietary advice recommends a combination of modest reduction in energy intake combined with increased exercise that can be sustained for the long term.
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B. Dietary planning initiatives
Once a person has identified dietary ‘problem areas’, the sensible plan is to keep the good parts of the diet and change the ones that are likely to be contributing most to weight gain. Usually there will be just a few anyway, such as snacking at morning and afternoon tea or excess alcohol consumption with snacking after work. Even if it is ‘all bad’, it is probably still best not to make radical changes as such a program will be difficult to maintain. Decide with a GP or dietitian what changes can be coped with and then stick to it. With some extra exercise, it will make all the difference. And, once these changes have been mastered, new ones can be attempted. Just remember that making longstanding changes to a diet means just that. Six months or a year will provide no benefit. It has to be forever.
Below are some important initiatives that can be incorporated into dietary planning.
1. Plan meals ahead
Family members should make an extensive list of suitable evening meals that everyone enjoys and then plan the week’s meals a week ahead from this list. People should allow adequate time for food shopping and planning meals a week ahead will help minimise the number of trips to the shops that need to be done. Planning should also include a few easy options for those ‘I couldn’t be bothered’ nights. This can be done by ensuring there are always the ingredients for a couple of easy nutritious meals in the fridge and making healthy meals ahead that can be stored frozen. Freezing sandwiches ahead for work is also a good idea. All this planning will reduce the need to revert to takeaway meals during the week. As well as being unhealthy (usually), takeaways are often more expensive.
2. Plan for family meals
Make sure that there are at least several days during the week when the whole family sits down to eat together. These times are especially important if families are to keep in touch with how members are getting on and they can be used to help in planning family activities. Ensure enough time is allowed to enjoy family meals. Having a couple of smaller courses rather than one big one will mean the dinner lasts longer. (A fruit salad or a soup is a suitable addition to the main meal.)
3. Make meals more equal
In Australia, the evening meal is usually the largest. This is unfortunate as it is usually followed by the period of least activity. If possible, try to change this practice on some days by reducing the size of the evening meal and making the three main meals of the day more equal. Family lunches on the weekends are a great start. Larger breakfasts and lunches will also help reduce snacking during the day.
Planning a daily diet
At this stage people should have assessed the information contained in their three-day food diary to detect dietary problems. It is now time to go over the days again and correct problem areas. This next section looks at each part of the day and suggests ways to help reduce common dietary problems areas.
Breakfast
Having fasted overnight, it is important to have a substantial breakfast to provide energy needed to start the day. Skipping breakfast is commonly associated with obesity, mostly because it leads to increased snacking and larger, fattier lunches. It also interferes with cognition or thinking, reducing morning work performance. Unfortunately about a third of adults miss at least one breakfast during the week. Make time for breakfast. Get up early enough to avoid running late. This just makes people irritable and is a bad start to the day. Breakfast is a great time to find out what family members are doing during the day. (This will help in the evening when trying to determine why a daughter/son/spouse is out of sorts and visa versa.)
“The critical period in marriage is breakfast time.”
A. P. HerbertCereals high in fibre with low-fat milk and low-fat yoghurt, perhaps with a few nuts added are a great start to the day. So is fruit and wholegrain bread. Try to ensure that food selections have a low glycaemic index.
People should have an alternative breakfast plan for when they are running late. This may mean taking breakfast to work. (A piece of fruit with perhaps some nuts and a small tub of low fat yoghurt would do the trick.) Remember, people who do not have time for breakfast at home certainly do not have time to drop into fast-food chains or the local muffin and coffee outlet for breakfast. Also it is best to avoid muesli-type bars as they often have lots of added sugar and sometimes added saturated fat. Most are really confectionary food items.
People who regularly have breakfast provided at early morning work meetings should request healthy options to be provided. (The same goes for those who have regular ‘in house’ lunch meetings where the employer provides the food.)
Between breakfast and lunch
There is often a considerable period between breakfast and lunch and hunger may occur during this time. On working days this is not a time when food can easily be purchased and people will usually need to rely on food they bring to work. Fresh fruit is a great option. Biscuits are not.
Lunch
People usually have more time to eat at lunch than at morning tea and therefore there are more options available. Try to make lunch a reasonably substantial meal. Bringing lunch has several advantages in that it is almost always cheaper and is always available. Try to use foods that keep well and store them in a fridge if one is available.
The local food bar is a popular alternative and has the advantage of providing a greater variety of fresher foods. If it doesn’t, change food bars. Foods should be chosen carefully as almost all food bars will have plenty of high-fat, high-sugar options to choose, especially as little extras. This is a great time to purchase some fresh fruit for afternoon tea.
Another alternative is to have lunch delivered and providing the food quality is satisfactory, this option is fine. Try to have a regular ‘standby’ lunch that can be ordered when you haven’t got the time to think about food alternatives.
If in-house lunch meetings are common ask for healthy alternatives to be offered and those fortunate enough to have restaurant lunches reasonably regularly should ensure that restaurant chosen offers healthy food choices. When making meal choices, healthy options include salads, dishes based on rice or pasta with plenty of vegetables, dishes that are steamed, grilled, stir-fried or baked, and perhaps fruit or sorbets for dessert. Avoid fried foods, foods coated with batter, and creamy sauces. Eat breads with a little margarine or olive oil and avoid butter wherever possible. Limit alcohol to one glass (if any) and ensure that there is plenty of water on the table. Avoid soft drinks.
Between lunch and dinner
The same comments that were made for mid morning also apply here.
Dinner
Dinner will often be the main meal of the day and it deserves some forward planning. This planning will avoid having to take the easy take-away option. It is always worth having some prepared meals in the freezer for those days when an easy option is required. As stated previously, dinner is usually preparing us for a low-activity period. Therefore, try to reduce the size of portions. Dinner can still be a place of lively conversation without the huge servings. When dining out, the same rules apply as for lunch.
Socialising after work / weekend socializing / celebrating
Socializing after work or on the weekend is the time we like to enjoy ourselves. In moderation, it does not significantly influence the benefits of healthy lifestyle practices. However, as in most things, moderation is the key. If socializing involves excessive food and alcohol, it should probably be restricted to once a week where possible.
Excessive alcohol consumption has historically been a problem in Australia and remains so today. When people relax with friends or celebrate they need to ensure that they don’t significantly depart from their optimum levels of alcohol consumption for good health. Exceeding six standard drinks in one day for males and four for females puts people at increased risk. Its associated problems go well beyond putting on a few extra kilos and waking up feeling less than perfect.
Excess consumption of high-calorie fatty food goes hand in hand with relaxation time, and is exacerbated by alcohol. If moderation is not practiced, all the good work during the rest of the week will be undone. This will hurt self-esteem and create an unhealthy diet cycle. People who commonly socializing in this manner may need to consider changing their social activities. Perhaps try playing sport with friends; Saturday afternoon tennis for example?
C. 'Diets' – Do they work and which is best
Firstly, it needs to be stressed that ‘diet’ is being discussed in the context of long-term changes in eating behaviours; not short term attempts at weight loss. It also needs to be stressed that the principle aim in attempting such changes should be improved health. For many people, an integral part of this will be fat (weight) loss. However, there are numerous other issues to be considered, such as lowering blood cholesterol, cancer prevention, lowering elevated blood pressure, and providing enjoyable food alternatives that increase life enjoyment.
There has been considerable discussion in the media recently about which type of diet is best at achieving long term fat loss. This debate has been hindered by the limited amount of good research on this topic. In reality our knowledge of what people really eat is poor and recommendations that are offered are usually based on small, short-term studies. There are, however, many of these poor studies and because of this almost any weight loss recommendation can be supported by the findings of at least a few studies.
Unfortunately, it has to be said that very few people (about 10 to 15 per cent) are successful in their attempts at long term fat loss, no matter which diet they adopt. General advice, such as that provided in health promotion programs, is rarely successful unless it is accompanied by dietary counselling, or better still, supervised dietary therapy. However, do not despair. Fat loss can be achieved.
With regard to weight loss it does not really matters what type of food is in the diet so long as the diet restricts energy intake so that it is less than body energy use. The greater the difference between the intake and use, the greater the weight loss that will occur.
However, the problem most people encounter is that they are not able to maintain the dietary change in the short term and especially in the long term. Very few are able to maintain weigh loss after 3 to 5 years.
Low fat diets are not the cause of the recent obesity epidemic
Over recent years three factors have contributed heavily to the development of Australia's obesity epidemic. They are:
- An increasingly sedentary lifestyle
- A significant increase in meal / portion sizes
- A dramatic increase in the availability of take away foods and convenient, prepared foods that usually have a significantly higher energy content than similar foods prepared in the home.
Recently, low-fat diets have been accused by some as being the cause of this epidemic. This criticism is unfair as a reduction in dietary fat content was never going to be enough to compensate for the changes in eating habits and physical activity levels mentioned above. Making available ‘supposedly-healthy’ low-fat food alternatives that are in fact packed full of energy (as sugar), such as low-fat muffins and ice cream, is a good example of why the low-fat diets that the food industry has offered Australians has not helped.
What are the secrets of success?
A review of 4000 people* in the USA who have successfully lost weight (at an average of 33kg each) and kept it off (for an average of five years) found several factors that were common to the weight loss strategies of most individuals. These were as follows.
- They consumed a low-fat, low-energy (kilojoule) diet. On average they consumed 7,500 kilojoules per day and only about 24 per cent of this was from fat. (The average Australian diet contains about 13,500 kilojoules, with close to 40 per cent of this coming from fat.) Most ate less than one takeaway meal a week. Less than one per cent followed a low-carbohydrate diet.
- They ate (a healthy) breakfast each day. This probably helped by stopping snacking later in the day.
- Most did an hour of moderate intensity exercise per day. Three-quarters did brisk walking and other common activities were cycling, aerobics or weightlifting. They walked an average of 11,000 steps per day.
- They maintained a consistent eating pattern.
- Over half sought help from a health professional.
- Most regularly checked their weight (either daily or weekly) to see if weight was being regained.
These last two factors are important in preventing regaining weight, the main problem for anyone seriously attempting weight loss. Another factor that has been shown to be helpful in this respect is group support.
(*These people were on a database called the National Weight Control Registry, operated by doctors at Brown University in Providence, Rhode Island, USA.)
Part 2 - Looking generally at food / energy intake
A preferred weight (fat) loss 'diet' - It must restrict energy (calorie / kilojoule) intake
Restricting dietary energy intake is absolutely essential for weight loss to occur.
Energy from the diet is provided mostly by fats, carbohydrates and proteins, with alcohol also making a significant contribution in some people. The carbohydrate, protein and fat content of a diet is expressed as the percentage of the diet’s total energy content that each provides. For example, saying a diet contains 30 per cent fat means that fat contained in that diet contributes 30 per cent of the total energy provided by the diet.
Weight loss diets need to be low in fat
Fat contains about twice as much energy per gram as protein and carbohydrates (and alcohol). Thus, a low fat content is almost always a necessary component of a low-energy weigh-loss diet. Low fat generally means about 25% to 30% of dietary energy being provided by the diet’s fat content. (Eating the healthy types of fat is also an important general health consideration.)
A detailed discussion regarding achieving a low energy / low fat diet follows shortly.
The important components of a healthy weight-loss diet are as follws.
A. Regulating energy intake
B. Restrict fat intake
C. Provide a wide range of nutritious food options that are enjoyable to eat
D. Maintain alcohol consumption at healthy levels
Each of these components will now be examined in detail.
A. Regulating energy intake
Energy is stored mostly as fat (with some as glycogen). To maintain the body’s energy (fat) stores, the energy provided by the food we eat must be equal to the energy we use each day; that is, an energy balanced diet.
For overweight people to achieve and maintain a healthy weight, their dietary energy intake needs to be reduced to and kept at the level he or she would require to keep in a healthy weight range (i.e. a BMI of 20 to 25). This will cause fat to be slowly ‘burnt off’ until this healthy weight is achieved. Reducing energy consumption requires:
- Modifying the food groups eaten by
- Reducing fat intake
- Moderating alcohol intake
- Reducing intake of foods rich in carbohydrates, especially those with a high glycaemic index. Foods high in sugar should be avoided.
- Increasing fibre intake (especially vegetables)
- Reducing the volume of food eaten by reducing portion size
(See 'Recommended food intake for a healthy low-fat diet' detailed in boxed section below.)
If weight loss is very slow, the consumption of energy in the diet can be reduced further. However, as explained previously, too great a restriction in energy intake may lead to a diet that is too hard to keep to, thus resulting in failure.
The table below gives a rough guide to healthy energy intake levels for adult men and women according to activity levels. (Tables that provide an appropriate energy intake for people wishing to maintain their weight in the middle of the healthy weight range (i.e. a BMI of 22) are provided at the end of this section but it needs to be emphasised that all these tables are a guide only. Click here to access additional energy intake tables.)
Approximate energy intake needed to maintain a healthy weight |
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Energy intake in kilojoules (calories) |
Fat intake in a diet with 25% of energy intake as fat (g per day) |
Women |
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Moderately active |
8,400 (2,000) |
54 |
Sedentary |
6,300 (1,500) |
40 |
Attempting weight loss |
5,000 (about 1,200) |
*See below. |
Men |
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Moderately active |
10,500 (2,500) |
70 |
Sedentary |
8,400 (2,000) |
54 |
Attempting weight loss |
6,300 (1,500) |
*See below. |
*When attempting to lose body fat, try to keep total fat intake to about 40 g a day (30 g if you are small and inactive). Do not reduce levels below these as the body requires an intake of some fat and very low-fat diets are hard to maintain. |
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*When attempting to lose body fat, try to keep total fat intake to about 40 g a day (30 g if you are small and inactive). Do not reduce levels below these as the body requires an intake of some fat and very low-fat diets are hard to maintain.
Reducing energy intake to normal levels requires people to calculate their daily energy intake. This can be done with the aid of information provided on packaging and food calorie charts. An even easier option is to use recipes where the energy content has already been calculated. Many modern recipe books (including those mentioned at the end of this chapter) have such information. These calculations will initially take some time. However, the calculation only needs to be done for each meal. Planning the energy content of diets is an area where an experienced health professional can be of great benefit. Of course, such calculations are only useful when suggested serving sizes are kept to!
Energy density of food
As stated earlier in this section, one way to reduce energy consumption is to choose foods that have relatively few kilojoules per gram of food, i.e. a low energy density.
How much carbohydrate and protein should a healthy weight-loss diet contain? The proportion of carbohydrates verses protein contained in an ideal weight-loss diet has been a hot discussion topic for many years. Both are obviously required for a healthy well-balanced diet. However, with respect to weight loss this balance is not overly important. What matters is whether the diet is one that reduces energy. It is however a consideration in regard to the provision of a healthy diet and maintaining already achieved weight loss. The overall health benefits provided by the wide variety of nutritious foods available in low fat / high carbohydrate diets mean that these diets are still the clear preference of most dietitians in Australia. Fat levels should be between 25 and 30 per cent of energy intake and carbohydrate levels can vary from about 50 to 60 per cent. Protein provides the remainder; about 15 to 25 per cent. It needs to be emphasised that these levels are approximate; we are eating, not studying maths. High protein diets have been around for a long time and are certainly becoming more popular at the moment. There is a wide variety of such diets and the protein and fat they contain can vary significantly. Diets with very high protein levels have been shown in the past to be difficult to keep to. This is a very important point as regaining weight due to the resumption of past eating habits is the main cause for failure. Most people can lose a few kilograms if they try hard. It is keeping it off that is the problem!!!! Also, high protein diets are not generally a less healthy choice because their fat content also tends to be high and because they can cause calcium loss and thus osteoporosis. Diets containing a moderate amount of protein that are also low in fat are a much better dietary option and in fact are not greatly dissimilar to low fat / high carbohydrate diets. They just have a bit more protein and a bit less carbohydrate. These diets are being intensively investigated at present and may in the end prove to be another dietary option for fat loss. The very popular CSIRO* diet is one such diet. It recommends about 200g of red meat about 3 to 4 times a week. This is more than is recommended by authorities such as the World Health Organisation and is probably more than is needed. The main problem with this level of meat consumption is that good quality lean red meat is expensive and this recommendation will unnecessarily increase the family’s food budget. It should be noted that for those not overweight, a diet may contain a slightly higher level of fat (up to 35 per cent) as long as the fat is mostly healthy unsaturated fats; the Mediterranean type diet. Losing weight is more difficult with this level of fat intake. |
B. Reduce fat intake (and eat better types of fats)
Fat is eaten to excess by most Australians. The reasons so many fatty foods are consumed is that they can be eaten quickly, they taste good, they are readily available, they are conveniently packaged (ready-to-eat), and they are profitable and well marketed. To reduce fat intake to optimum levels, people need to know the amount of fat they are allowed in their diet and the amount of fat in the food they wish to consume. From a cardiovascular disease viewpoint, people also need to know the type of fat present in each food.
The optimum amount of fat you need in your diet.
Dietary fat intakes for most people should be between 25 per cent and 30 per cent of total energy intake. (One gram of fat equates to about 38 kilojoules.)
Example – Calculate the fat content of a 8000kJ diet that obtains 25 per cent of its energy from fat.
Energy content in 25 per cent of a 8000kJ diet = 8000kJ x 0.25 = 2000kJ
Number of grams of fat needed to give 2000kJ = 2000kJ divided by 38kJ/g = 53g.
Thus, a 8000kJ diet obtaining 25% of its energy from fat should contain 53g of fat.
Dietary fat intakes that are equivalent to 25 per cent of total energy intake are shown in the Table 14. A fat intake of 25 per cent of total energy intake will probably be a significant reduction in fat intake as, on average, Australian men consume (at least) 100g of fat per day and women 68g per day. As mentioned in this table, peoplea trying to lose weight can reduce their intake below these levels but 30 to 40 g of fat per day should be a minimum as everyone needs some fat in their diet.
The amount of fat in each food eaten.
Working out the fat content of a meal can be done in several ways. The easiest is to use recipes that have the fat content (and energy content) already calculated. Such information is available in many modern cookbooks, especially those promoting low-fat meals. The recipe books suggested at the end of this chapter provide such information.
For other meals, people will need to work out the fat content of the individual ingredients that used. This need only be done for the products that contain significant amounts of fat. The amount of fat in almost all packaged foods, such as breakfast cereals, is displayed in the nutritional information panel provided. The fat content of unpackaged foods, such as meats, can be calculated from figures given in from fat guides that are available in most bookstores. The weight of the serving needs to be known to calculate the amount of fat in a serving,
Weight of fat per serve = fat content (in g of fat/100g of food) x weight of food (in g)
100
For example, the fat content of 80 grams of avocado would be determined as follows.
(There is 22.6g of fat in 100g of avocado.)
Weight of fat in avocado = 22.6 g/100g x 80 g = 18.1grams of fat
100
This process may take a little time, but, as with energy content, it will only have to be done once for each recipe and people soon get a rough feel for the amount of fat in the foods that they like to eat and can adjust their diet accordingly. A list of foods that are major contributors to fat in Australian diets in this web site . Click here to access table 'Major foods contributing to fat intake in Australian diet'
What type of fat is present in each food?
Information regarding the types of fat that are present in foods is presented elsewhere in this web site. (Click here.) Generally speaking we consume too much saturated fat and its intake should be restricted so that it provides no more than about 7 per cent of total energy intake. On the other hand, we tend to eat too little omega-3s and monounsaturated fats, and they are dietary fats that should be increased; keeping in mind the total overall fat intake recommendation mentioned above.
All foods containing fat will have a combination of several types of fat, including saturated fat. For example, olive oil contains 75 per cent monounsaturated, 13 per cent polyunsaturated and 12 per cent saturated fat. It is saturated fat that people need to watch and they should try to keep this to no more than 30 per cent of their total fat intake.
Some practical advice on ways to reduce your fat intake
- Reduce the use of spreads on bread etc or try using some avocado.
- Use low-fat dairy products; for example skimmed milk, reduced-fat cheese.
- Reduce red meat intake and use only lean cuts of meat. All visible fat should be removed from the meat. Restrict using red meat to two to three times a week and increase the amount of fish eaten. Red meat is still useful in the diet as it is an important source of proteins, iron and other nutrients. A piece the size of a pack of cards is a good indication of an appropriate serving size for red meat (about 80g.).
- When using chicken, use lean cuts such as the breast and remove the skin.
- Grill, stir fry or steam foods; and avoid fried foods.
- Don’t skip meals as this increases snacking.
- Don’t snack. Make sure nutritious foods are available for morning and afternoon tea.
- Use some foods with a low glycaemic index in each meal to delay the onset of hunger.
- Avoid purchasing fatty foods when shopping. (Remember that commercially prepared foods labeled as low-fat often have a high energy content and can still be a poor choice. Check the label or prepare meals from low-fat, low-energy foods.)
- Plan meals! Much of the fat consumed is contained in food prepared outside the home, either purchased as takeaway food or eaten in restaurants. This can be avoided by ensuring adequate appropriate food are available at home to prepare quick nutritious meals when needed.
- Take low-fat food to work.
- Frequent restaurants known have low-fat meal options.
Please also remember that recipes in cook books are not cast in stone and they can often be significantly altered to reduce fat content without detrimentally affecting taste. Some easy changes include reducing the quantity of meat (substitute another vegetable instead); using cuts of meat with a minimal fat content; reducing the use of cooking oils; and substituting low-fat alternative ingredients where available. Recipes that require large amounts of full-fat dairy products, coconut products or other foods high in saturated fats should be avoided.
C. Provide a wide variety of nutritious food options that are enjoyable to eat.
The boxed section below sets out a strategy for creating a healthy low fat diet.
Recommended food intake for a healthy low fat dietBread, pasta, potatoes (prepared without fat), grains
Meat, fish, chicken, eggs, legumes: Meat must be lean with all visible fat removed and chicken should be skinless.
Vegetables
Fruit
Nuts
Milk products
Fats and oils
Indulgences
Fluids
|
D. Maintain a healthy alcohol consumption
In people whom consume large amounts of alcohol, reducing consumption may be a very important part of achieving weight loss. This is because it contributes significantly to energy intake and because excessive alcohol consumption can reduce motivation to change. (People who consume excess alcohol put themselves at risk from numerous other diseases and from short-term harm associated with consumption.) See separate section on alcohol use and abuse.
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Part 3 - Implementing dietary change
A. Deciding to make changes
Before commencing dietary modification, people need to have decided they want to change. There are several stages that people need to progress through to be ready.
Stage 1 – Not interested
Stage 2 – The matter has been given some thought, but the person is not committed and has made no plans to proceed.
Stage 3 – A decision to change has been made and active steps have been taken towards this goal, such as assessing dietary problems. People are much more likely to succeed if they take an active role in planning rather than just being told what they should do; although good advice is obviously a great help.
Hopefully reading the earlier material in this chapter has helped people progress through these stages.
B. Preparations for change
Losing weight is a very complex and difficult task and the help of a dietitian (or GP) will be a great asset. Each situation is different and having a dietitan (or GP) tailor a program specifically for an individual is likely to provide the best results.
As mentioned previously, it is important to emphasise that required dietary change is usually best accomplished in several small steps. Changing lifetime eating habits is not easy and attempting to change everything at once is for most people an unrealistic expectation; a recipe for failure. With the help of a GP or dietitian, people can pick a few problems that they think they can handle modifying and address these first.
It is important to remember that problems are not always obvious and a dietitian can help identify existing problems and devise solutions. Remeber that these problems are often psychological in nature and require a psychologically-based approach to treatment. Most people require the help of a health professional with this.
Once the first group of problems have been addressed, a process that will probably take several months (at least), he or she can move on to the next group of changes.
People should have a definite starting date and ensure they have suitable meals ready to choose from / have some prepared meals already in the freezer. Reducing alcohol intake for the first few weeks helps as alcohol tends to reduce ‘resolve’. This may be a goal anyway.
Regular visits to your dititian to monitor progress will provide positive feedback when things are going well and help with any problems being faced.
Quality shared care programs, such as Weight Watchers and Gutbusters, can also be useful in helping with weight loss. Also, for those with more significant psychological problems affecting their weight, referral to a psychologist may be beneficial.
C. Maintaining your dietary change
Hopefully, good planning will have made initial dietary change relatively easy. Now the program needs to be monitored for progress and there are several issues that need to be considered.
Weight loss from a maintainable long-term diet will be slow, especially for women. Losses of one to two kilograms per month or waist measurement reductions of one to two centimetres per month are common and are a good result long-term.
Monitoring fat loss is often best done by measuring your waist circumference rather than actual weight loss, especially early on i.e. your clothes and belt will become looser. (In pre-menopausal women, fat loss can occur from sites other than the waist first and a better assessment of initial fat loss may be gained from arm, thigh, buttocks or bust measurement.)
D. Plateauing
After a period of three to six months, people will usually notice that their weight stops reducing; they will have reached a plateau. Maintaining this plateau is one of the most important tasks in any weight loss program. It is a sign that the initial weight loss program has succeeded, not a sign of failure. People may even have reached an acceptable weight for you.
For most people, however, reaching their first plateau will not coincide with reaching a healthy weight. After maintaining a plateau for two to three months, further changes to diet or exercise routines can be planned in order to stimulate further weight loss. These more challenging changes will be easier to embrace as the person will be more confident following their initial success and fitter from increased exercise. Also, as discussed previously, change usually needs to be done in a step-by-step fashion, and part of the initial weight loss program should have encompassed this approach to planning. Good ways of breaking through a plateau include trying new foods, reducing the amount of food eaten, changing eating times, changing eating patterns such as being a vegetarian for a few days a week, or changing to your exercise regimen.
Overall weight reduction should be a pattern of weight loss and plateau. People will find that their rate of weight loss becomes slower as their weight diminishes and that plateau periods become progressively longer. This is normal. This overall pattern will be slower for women and people who have been obese for a long time. However, weight loss is a long-term goal and it is getting there that is important, not how fast it occurs. Slow weight loss is not a sign of failure.
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Part 4 - Relapse and long-term weight loss maintenance
Very few people who achieve initial weight loss can maintain it, with most regaining all the lost weight by 3 to 5 years.
For this reason, a fundamental task in any weight loss program is to prevent relapse. Some strategies that can help include the following.
- Monitor weight forever. Any weight gain, even a kilogram or two, needs to be taken very seriously. Immediate steps need to be taken to lose the weight again and a dietitian’s help needs to be sought!!
- Maintain relationship with dietary therapist, either a dietitian of GP. This acts as incentive to maintain weight loss and provides a resource to help when problems occur. It also helps plan for the future as exercise and eating programs need to change as people get older.
- Maintain other relationships that have helped with achieving weight loss. These might be relationships with others who have lost weight, sporting clubs, gyms etc.
- Anticipate and prepare for potential weigh gain problems.
Some causes of weigh gain can be anticipated and steps can be taken before weight gain occurs. Talking to a dietitian about common problems and devising plans to combat these problems before they occur is a great strategy. Some examples include:
- Planning a special lower energy diet to use when illness or injury restricts usual physical activity.
- Planning an increased activity program that can be used when on holiday and eating more. (It can also be used before going on holiday.)
- Have an emergency diet that can be used if weight gain is suddenly noticed.
Problems also occur due to long term changes in circumstances, such as moving home, changing jobs, permanent illness. Such changes require program modification with the help of a dietitian and, where possible, these should occur before the change does. Life is continually evolving and it is important that people have a weight maintenance plan that is flexible.
Factors that increase the likelihood of relapse occurring
While everyone who loses weight needs to be very aware of relapse problems, some factors make relapse more likely, including the following.
- Longer term psychological / behavioural / environmental factors
- A history of failure at losing weight. People with a past history of failed attempts at weight loss need to be very carefully monitored, especially during the initial stages of weight loss.
- Excess alcohol or other drug consumption.
- Psychological problems including depression, sleep problems.
- Lack of support at home from family.
- Hours of TV watched. The amount of weight regained after weight loss increases with the number of hours of TV watched.
- Changes in circumstances
- Employment changes
- Health problems, both long and short term, such as injury. Sometimes these may be caused by increasing activity levels too quickly.
- Moving home
- Problems incurred while losing weight
- Failure to attain anticipated results. This may be due to unrealistic expectations or a weight loss program that was incorrectly planned with respect to reducing energy intake. More commonly, it is due to non-compliance with the diet.
- Food craving. These last about three weeks after dietary change and can be overcome by eating low-fat, low-energy snacks, such as fruit.
- Physical problems. Some physical problems, such as sore feet or joints or chafing between the upper legs, may be directly attributable to increasing physical activity levels. They can be prevented or treated by proper attention to footwear, increasing the amount of non-weight bearing exercise such as swimming, and the use of lycra bicycle shorts. Problems such as excess alcohol consumption are best addressed before weight reduction programs are commenced.
Life is never stress free and times of increased stress act to reduce resolve. Some actions that may help at such times include avoiding alcohol as it further reduces resolve, giving extra rewards such as going to the pictures, and avoiding ‘eating or drinking too much’ situations. A stress management program should be considered by those suffer from stress.
Most importantly, do not give up. There is always a solution!
Relapse of fellow dieters
Family and friends who join in with dieting will often lose weight. However, as they are not the primary subjects of the program, they are usually not given individual advice, support or follow up. Thus, while they may initially lose weight, they may not be able to maintain this weight loss. The message in this situation is to encourage others joining in the weight loss program to have their own program worked out at the same time and to ensure they are also continually monitored during their program and afterwards. The failure of one member of a weight loss group may affect the whole group and reduce everyone’s chance of success.
Additional information
Some problem dietsHigh protein / low carbohydrate diets (for example, the Atkins diet): These diets have been fashionable on and off for years and are being promoted actively at present. They tend to restrict foods such as fruit, grains, and some vegetables. They therefore tend to lack fibre and some nutrients, which is bad for the bowel, the heart, and cancer protection. They also often have no fat restrictions, allowing the consumption of saturated fat which can raise LDL cholesterol and increase vascular disease. Their high protein content can lead to several other medical problems including; high uric acid levels, which may cause gout; dehydration due to the need to excrete larger quantities of water to dispose of the extra urea and uric acid; and osteoporosis, due to excess calcium loss. On diets such as these, people initially lose a few kilograms due to water loss, but in the long term few people can maintain the dietary restrictions and the diet fails. Finally, protein deficiency is very rare in Western diets, so consuming more does not make a lot of sense. Liver cleansing diet: This diet is not factually well founded. The diet does not cleanse the liver and in fact the liver does not need to be cleansed as it does this by itself. The diet, however, is low in fat and follows many accepted dietary principles. (It does however recommend ‘natural’ liver-proactive remedies that are unnecessary.) Pritiken diet: This diet is very low in fat and very high in high fibre vegetables. It suits some people but many find it too strict to keep to. Fit for life diet: This diet has many rules about which foods can be mixed together and when certain foods can be eaten. None of these rules has any basis in fact and the diet is best avoided. Programs offering prepared diet foods: While many of these programs are well planned nutritionally, they suffer from two problems. Firstly, the food offered is usually relatively expensive. Secondly, they do not teach the overweight person how to choose and prepare a well balanced diet for themselves. Thus, when they stop using the prepared foods, they usually revert to their old eating habits and fail in the long term. |
Approximate* daily dietary energy intake in kilojoules (kJ) necessary to maintain a BMI of 22
The tables below assist in providing the appropriate energy intake for people wishing to maintain their weight in the middle of the healthy weight range (i.e. a BMI of 22).
Approximate* daily dietary energy intake in kilojoules (kJ) necessary to maintain a BMI of 22 (according to height and age)
MALES |
|||||
|
BMI = 22 |
Daily energy intake (kJ) |
|||
Age (yrs) |
Height (m) |
Weight for a BMI of 22** (kg) |
Activity Level*** |
||
Very sedentary |
Moderate activity |
Very active |
|||
19 to 30
|
1.6 |
56.3 |
9,000 |
11,600 |
14,200 |
1.7 |
63.6 |
9,700 |
12,400 |
15,200 |
|
1.8 |
71.3 |
10,300 |
13,300 |
16,300 |
|
1.9 |
79.4 |
11,100 |
14,200 |
17,400 |
|
2.0 |
88.0 |
11,800 |
15,200 |
18,600 |
|
31 to 50
|
1.6 |
56.3 |
8,900 |
11,400 |
14,000 |
1.7 |
63.6 |
9,400 |
12,100 |
14,800 |
|
1.8 |
71.3 |
9,900 |
12,700 |
15,600 |
|
1.9 |
79.4 |
10,400 |
13,400 |
16,400 |
|
2.0 |
88.0 |
11,000 |
14,200 |
17,300 |
|
51 to 70 |
1.6 |
56.3 |
8,200 |
10,400 |
12,700 |
1.7 |
63.6 |
8,600 |
11,100 |
13,600 |
|
1.8 |
71.3 |
9,100 |
11,700 |
14,400 |
|
1.9 |
79.4 |
9,600 |
12,400 |
15,200 |
|
2.0 |
88.0 |
10,200 |
13,200 |
16,100 |
|
Over 70 |
1.6 |
56.3 |
7,300 |
9,400 |
11,500 |
1.7 |
63.6 |
7,800 |
10,000 |
12,300 |
|
1.8 |
71.3 |
8,300 |
10,700 |
13,100 |
|
1.9 |
79.4 |
8,900 |
11,400 |
14,000 |
|
2.0 |
88.0 |
9,500 |
12,200 |
14,900 |
|
How to use this chart Use height, age and activity level to work out desired energy intake level. If people keep to this energy intake their weight will eventually reduce to that shown in the table. (This is the weight that represents a BMI of 22 for the person’s height.) This weight loss may take six months or more. Note that a BMI of 22 may not be achievable for some people and others may quite reasonably choose not to lose this much weight; a BMI of 25 is still normal and even slightly higher BMIs may not cause too much illness in people with no other cardiovascular disease risk factors. Remember that any weight loss in an overweight individual is good and maintaining a weight loss of 10 per cent is an excellent result for most people. |
|||||
* These figures can only be very approximate as there is considerable individual variability. |
|||||
** To have a BMI of 22, a person would need to this weight for the corresponding height. People with a higher BMI will have a higher energy intake. |
|||||
*** Very sedentary: Exclusively sedentary activity with little or no strenuous leisure activity. (e,g, office work) Moderate activity: Predominantly standing or walking work (e.g. waiter, mechanic) Very active: Heavy occupational work or highly active leisure (e.g. farmer, construction workers, miners, elite athletes) |
|||||
Approximate* daily dietary energy intake in kilojoules (kJ) necessary to maintain a BMI of 22 (according to height and age)
FEMALES |
|||||
Age (yrs) |
BMI = 22 |
Daily energy intake (kJ) |
|||
Height (m) |
Weight for a BMI of 22** (kg) |
Activity Level*** |
|||
Very sedentary |
Moderate activity |
Very active |
|||
19 to 30 |
1.5 |
49.5 |
7,100 |
9,200 |
11,200 |
1.6 |
56.3 |
7,700 |
9,900 |
12,200 |
|
1.7 |
63.6 |
8,400 |
10,800 |
13,200 |
|
1.8 |
71.3 |
9,000 |
11,600 |
14,200 |
|
1.9 |
79.4 |
9,700 |
12,500 |
15,300 |
|
31 to 50 |
1.5 |
49.5 |
7,300 |
9,400 |
11,500 |
1.6 |
56.3 |
7,600 |
9,800 |
12,000 |
|
1.7 |
63.6 |
8,000 |
10,300 |
12,500 |
|
1.8 |
71.3 |
8,300 |
10,700 |
13,100 |
|
1.9 |
79.4 |
8,700 |
11,200 |
13,700 |
|
51 to 70 |
1.5 |
49.5 |
6,900 |
8,900 |
10,900 |
1.6 |
56.3 |
7,300 |
9,300 |
11,400 |
|
1.7 |
63.6 |
7,600 |
9,800 |
12,000 |
|
1.8 |
71.3 |
8,000 |
10,300 |
12,600 |
|
1.9 |
79.4 |
8,400 |
10,800 |
13,,200 |
|
Over 70 |
1.5 |
49.5 |
6,500 |
8,300 |
10,200 |
1.6 |
56.3 |
6,900 |
8,800 |
10,800 |
|
1.7 |
63.6 |
7,200 |
9,300 |
11,400 |
|
1.8 |
71.3 |
7,700 |
9,800 |
12,000 |
|
1.9 |
79.4 |
8,100 |
10,400 |
12,700 |
|
How to use this chart: Use height, age and activity level to work out your desired energy intake level. If people keep to this energy intake their weight will eventually reduce to that shown in the table. (This is the weight that represents a BMI of 22 for the person’s height.) This weight loss may take six months or more. Note that a BMI of 22 may not be achievable for some people and others may quite reasonably choose not to lose this much weight; a BMI of 25 is still normal and even slightly higher BMIs may not cause too much illness in people with no other cardiovascular disease risk factors. Remember that any weight loss in an overweight individual is good and maintaining a weight loss of 10 per cent is an excellent result for most people. Pregnancy and lactation: No change in first trimester. Add 1400kJ per day in second trimester and 1900kJ per day in third trimester and 2000kJ when lactating. |
|||||
* These figures can only be very approximate as there is considerable individual variability. |
|||||
** To have a BMI of 22, a person would need to this weight for the corresponding height. People with a higher BMI will have a higher energy intake. |
|||||
*** Very sedentary: Exclusively sedentary activity with little or no strenuous leisure activity. (e.g. office employee) Moderate activity: Predominantly standing or walking at work (e.g. waiter, mechanic) or regular moderately active leisure activity Very active: Heavy occupational work or highly active leisure (e.g. farmer, construction workers, miners, high performance athletes) |
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Source: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n36.pdf? Adapted from Nutrient reference values for Australia and New Zealand including recommended dietary intakes, pp27 |
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Further information
Weight watchers
www.weightwatchers.com.au
Parents Jury
The Parents Jury is a web-based network of parents who wish to improve the food and physical activity environments for children in Australia
www.parentsjury.org.au