Obesity

Claims of an obesity 'epidemic' are largely driven by media hype and are not supported by the evidence, but for individuals entering late middle age in particular, weight management can be a serious problem. Increasing weight from middle age has been associated with an increased risk of heart problems, diabetes and even dementia, and excess fat is often associated with decreased mobility and even physical disablement.

Sadly, no ‘magic formula’ has yet emerged for avoiding weight gain as you get older, although the new drug Rimonabant (see below) may be an early indication of the way ahead. The non-drug strategies for maintaining a healthy weight at any age remain the same: Watch what you eat and get moving.

The most effective approach to reversing weight gain in middle age include a combination of the following:

Exercise

Increase your level of physical activity. Aerobic exercise boosts your metabolism and helps you burn fat. Strength training exercises increase muscle mass, boost your metabolism and strengthen your bones. It has recently been discovered that short bursts (just 15 seconds or so) of intense physical activity are highly effective in promoting weight loss.

You can be more physically active even without starting a formal exercise program (which not many people stick to, anyway). Just spend more time doing the things you like to do that also get you moving. Gardening can be surprisingly physical, and taking walks in the country (especially over rough terrain) is a very enjoyable way to get some exercise. Or you might just take ‘Rover’ for some ball play in the park, and maybe get there on your bike! Make it your goal to be active for a total of 30 minutes or more a day on most days.

Increased physical activity, including strength training, may be the single most important factor for maintaining a healthy body composition — more lean muscle mass and less body fat — as you get older.

Improved diet

Because of changing hormone levels, your metabolism slows as you get older. This means that you need fewer calories a day to maintain your weight as you get into your mid- to late 40s. However, because we all develop rather fixed eating habits, this can mean that we are eating 200 calories or so per day more than we need from middle age onwards - with the inevitable consequences.

Aim to reduce your calorie intake by just a few percent. Increase the proportion of fruit and vegetables and cut back the fatty biscuits and cake. There is no need to go on a ‘diet’ and in fact this would probably be counter-productive because your body is likely to respond by reducing your metabolic rate to conserve energy, making it much harder to lose weight.

Increase your protein intake at the expense of dietary fat and ‘high GI’ carbs such as sugar or starch. Proteins satisfy hunger, help build muscles and promote hormone production, and take a lot of energy to digest. Eggs are an excellent and cheap source of protein (the advice you will sometimes come across about the ‘dangers’ of cholesterol in eggs is nutritional nonsense). Try to introduce some saturated plant fats such as cocoa butter or palm oil into your diet. Contrary to much ill-informed advice, such fats and oils are nutritionally excellent and may even assist weight loss.

Psychological factors

The need for calorie control and exercise are obvious, yet many people have immense problems making the changes automatically. The reason for this is that to make changes of this kind requires changes of habit, and this is profoundly difficult for most people. After four or five decades of adult life (the time when many people realise the need to make urgent changes if they are to live to see old age), habits are deeply engrained and enormously difficult to alter by ‘willpower’ alone.

This means that there is a need to bypass the conscious mind in some way and access the ‘subconscious’, where habits are stored. Commonly adopted approaches to this include use of affirmations, either consciously spoken, or recorded, and self-hypnosis using recordings. Both approaches can produce good results.

Diet pills

Generally speaking, ‘diet pills’ tend to represent the triumph of hope over experience. In particular, the idea of ‘thermogenesis’, while sounding convincing, is simply a non-runner, as tens of thousands of disappointed buyers will testify (with the possible exception of ephedra-based drugs whose side effects outweigh the possible advantages). Appetite suppressants such as Hoodia gordonii extracts may be partially effective, but there is some danger of triggering the ‘starvation response’ if you fall below a minimum calorie intake - and it doesn’t work for everyone.

The new drug Rimonabant, sold under the brand names Acomplia (Europe) and Zimulti (US), went on sale during summer, 2006 and is nominally only available on prescription at present (in fact it can be purchased online for around £120 for a 4-week, 20 mg/day course).

This drug, manufactured by Sanofi-Aventis, reduces the craving for food by targeting the same part of the brain that is stimulated by cannabis. A review of four controlled trials of the drug found it helped people shed a limited amount of weight (typically less than 5kg (11lb) in one year) when they were given a course of 20 mg/day. However the most useful effect of Rimonabant was that most of the weight loss occurred around the waist, where an accumulation of fat is known to be particularly dangerous to health. The review noted some side effects, including nausea, dizziness, headaches, joint pain and diarrhoea.

The drug costs £55 per patient per month, and it is likely that financial constraints will prevent large-scale prescription by GPs. It is likely that Rimonabant will herald the introduction of a number of similar and perhaps more effective drugs in the near future, and if they are not fairly easily available on prescription, a ‘black market’ will become inevitable.

Update: June 2010

New ‘weight loss’ products based on extracts of Irvingia gaboniensis are now becoming available. Unlike many similar botanicals, there is mounting evidence, both clinical and from ‘real life’ experience, that irvingia really can help the overweight shed surplus fat without diet change or exercise. The author of this article (approx. 5 stone overweight!) is in the process of trying a UK product (Vitagetics Vita-Lean, a combination of irvingia and cissus extracts) and has lost around 10lbs in ten days. If progress continues, this may be the first product tried so far that has actually performed as claimed. Please follow the lnk above for more information on this site.

Water Intake and Fat Loss

Water suppresses the appetite naturally and helps the body metabolize stored fat. Studies show that a decrease in water intake will cause fat deposits to increase, while an increase in water intake can actually reduce fat deposits.

This is due to the fact that the kidneys can’t function properly without enough water. When the kidneys don’t function at full capacity, waste products such as urea accumulate in the bloodstream, and the liver has to take over part of the job of removing this waste. One of the liver’s primary functions is to convert stored fat into usable energy. If the liver has to do some of the kidney’s work, it can’t function at it’s optimal capacity. As a result, it metabolizes less fat, and so more fat remains stored in the body than otherwise.

Another factor is oedema (odema) or swelling due to retained water. A proportion of excess weight may be simply stored water, which the body will not release because it is conserving what it considers a limited resource - a basic survival response. Excess salt in the diet may also give rise to water retention. This is diluted in the cells of the body by retaining excess water, because the cells can only tolerate a limited concentration of salt. Therefore, the more salt you eat (read your nutrition labels) the more water your body will hold onto.

To get rid of retained water, simply drink more water! If the body is in ‘drought mode’ - conserving water automatically because not enough appears to be available - drinking more regularly and over a period of time will ‘switch off’ this drought survival response and excess water will then be released. If the problem is excess sodium from salt, drinking more water will allow the body to eject the surplus. It should be noted that this process ‘costs’ potassium, which is involved in the sodium removal system. Because potassium levels may already be limited, it may be helpful to add salt substitute (potassium chloride) to foods at the same time as water intake is increased.

If there is inadequate water in the body, you may also experience a loss of muscle tone, resulting in weakness.

On average an adult needs about eight 8-ounce glasses of water every day, although of course this will need to be increased in hot climates or if physical work or exercise is being performed. If you are significantly overweight, this ‘baseline’ needs to be increased by about one additional glass/day for every 25 pounds of excess weight. Don't try to force water down - just make sure a bottle or glass of water is handy most of the time, and take sips every few minutes. If you are dehydrated you will often find that your natural thirst increases enormously when water is always available.