Weight Loss

Being slightly overweight does not automatically mean that a person is unhealthy. However, the higher the excess weight, the more likely health complications become. If a person is severely overweight, they are described as obese. The NHS describes obesity as simply a term used to describe someone who is very overweight, with a lot of body fat. ^[2] Obesity is associated with various health complications that could occur as a result of excess fat in the body. This is especially relevant for a person's cardiovascular health and liver function.

Obesity is a gradual process that you may often be aware of in terms of your clothes getting tighter and fitness levels deteriorating, but it can still feel like you have a lack of control. Obesity can affect a person's self-confidence as well as posing serious risks to your health - often a vicious circle with a lack of self-esteem leading to binge eating and additional weight gain. Those looking to adopt a healthier lifestyle can seek support from various professionals sources, such as a nutritionist or their GP.

Obesity in the UK

Obesity is a growing problem in the UK. According to statistics published by NHS Digital, obesity prevalence has increased from 15% in 1993 to 27% in 2015^[3], with the North East having the highest rate of overweight people in the country. But why is there such a boom in increasing obesity? There are various suggestions and reasons as to why this is the case, some being^[4]:

• the majority of adults do not eat the recommended minimum of five portions of fruit and vegetables per day
• 'Amercianisation' and globalisation of easily accessible fast foods
• sedentary lifestyles
• the average proportion of food energy obtained from saturated fat is higher than the maximum recommended
• increased sugar intake

Obesity can often run in families suggesting a hereditary link, however a lack of physical exercise and lifestyle habits results in a similar attitude running through families, so there has been no concrete evidence to prove it is hereditary. If parents have poor dietary and exercise habits, this has been recorded to seep through the younger generations.

Most people have a vague indication whether they are overweight or obese based on physical appearance. A commonly used method to determine which weight group a person belongs to is by calculating their BMI (Body Mass Index). The BMI assesses a person's weight in relation to their height and separates different weight groups into scores.

Your body mass index is the primary indicator for medical professionals to check your weight in comparison to your height. Your GP can also calculate your body mass index accurately and swiftly. The algorithm determines whether you are within a healthy ratio. Whilst this is very important, other factors should be considered, and should be considered by your doctor before any real figure is given. The standard scale suggests that your BMI score should be between 18.5 and 24.9 which is deemed an acceptable 'health' range, according to the World Health Organisation (WHO)^[3]. If it is over 25, the individual is classed as overweight and if over 28, then the individual may fall into the 'obese' category.

The classification is the same for both sexes, however these figures can be age dependant.

A BMI score over 30 is clinically classed as obese, and individuals are liable for additional help in the form of weight loss medication, to be taken in conjunction with a healthy lifestyle. If you are unsure where on this scale you sit, you can calculate your BMI using the calculator below before seeking further medical help.

Calculate Your BMI

There can be many causes of obesity that will vary from person-to-person dependant on lifestyle choices and possible hereditary links. It all comes down a healthy balance of calorie intake and energy use over a long period of time. The two most significant factors are poor eating habits – a diet consisting of low nutrient and high-calorie food – as well as a lack of exercise. but there are other contributing factors too.

Obesity is a long-term - or chronic - condition, and any one or a number of these factors could be contributing:

	Binge eating - overeating is one of the most common causes for obesity. Those that tend to binge eat frequently, and especially on a daily basis, often do so with fatty, sugary foods that produce a sugary high, but then a sudden low that needs refilling with more of the same.
	Food frequency - there has been much debate about how many times you eat a day being linked to obesity. Studies have shown that eating smaller meals more frequently will reduce cholesterol and blood sugar levels, however there is no concrete proof your food frequency rate has a significant effect on your size.
	Psychological factors - do you tend to eat when sad, angry or stressed? Just like smoking or alcohol, your relationship with food can become an addiction often leading to obesity.
	Lack of exercise - this can include the smaller aspects such as walking up the stairs instead of taking the escalator as well as more physical exercise such as heading to the gym or playing sports. The majority of us have jobs with minimal movement required, meaning it can be difficult to find the time to exercise our calorie intake away.
	Hereditary - it is not 100% proven that obesity runs through genetics or if it is just a lifestyle factor, but research has shown that children of obese parents tend to develop the same condition. This can be due to genetic deficiency such as a lack of the hormone leptin that controls your weight by telling you when you are full.
	Social factors - in particular if your parents or close family members are overweight or obese, the likelihood that you are is much higher. The influence of your peers filters through to many aspects of your life, including your dietary habits.
	Medication - certain medications such as antidepressants can cause weight gain that, when teamed with other weight gain causes, can lead to obesity.
	Hormones - an underactive thyroid and polycystic ovarian syndrome can both contribute to your weight gain.

Binge eating

Binge eating is when a person overeats in a short time period. Those who binge on food will often have no control over what they are doing, or a limited urge to stop, until after they have finished.

According to the NHS binge eating is when 'a person feels compelled to overeat on a regular basis'. This means an individual may consume a large amount of food in one sitting, even if they are not hungry. Studies estimate that 1.3 million Brits are affected by binge eating, which is approximately 1 in 30 to 1 in 50. Young adults tend to be affected the most but delay treatment until they reach their 30s and 40s.

Why Do People Binge Eat?

Some researchers believe it's a reaction to stress and emotional upset, others think it may be a genetic issue, whilst some believe it's due to how easily available food has become. Binge eating may be caused by:

• Depression or anxiety
• Low self-esteem
• Feelings of stress, anger, boredom or loneliness
• A past history of stressful or traumatic events
• A family history of eating disorders
• Dissatisfaction with their body

If you are unsure whether you tend to binge eat, the following factors can be an indicator for unhealthy eating habits:

• Feeling out of control when eating
• Feeling powerless to stop even when you're full and uncomfortable
• Eating until you're sick
• Thinking about food constantly
• Eating in secret
• Feeling ashamed and angry after you've binged
• Eating to deal with emotions

Tips for combating binge eating

It is important to seek help if you regularly binge eat and there are different treatment options available. The basic treatment is often to begin disassociating food with emotions and learning to treat food simply as nutrition.

Treatments include self-help programs, medications such as SSRI's, or psychological treatments. Some self-help programs are available online, which is beneficial for those suffering from anxiety or depression. Some easy steps you can take from your home:

• Clear out the cupboards removing foods such as crisps, ice-cream and desserts.
• Figure out the difference between hunger and emotional need. Tummy rumbling indicates real hunger. Drinking a big glass of water and waiting for the craving to pass will help to identify the difference.
• Keep a diary of emotions and binge responses to identify what emotion, if any, results in a binge.
• Pay attention to food and enjoy the flavours. Bingers should eat slowly, without the distraction of TV or the internet.
• Eat regularly because hunger can trigger a binge. Stock up on healthy snacks such as fruit.
• Avoid strict diets that cut out regular meal times.
• Boredom can trigger bingeing. A new hobby, phoning a friend and reading are good distractions.
• Exercise and make sure you get enough sleep to ensure good body health.
• Manage stress levels at home and work. Stress and pressure are binge eating triggers.
• Be kind to yourself. A slip up does not mean it's game over. Identify what went wrong and start over again.

Being overweight can have a detrimental effect both physically and mentally. Other than certain psychological effects, such as a severe dip in your self-esteem and confidence levels, obesity can have a significant and serious effect on your health that shouldn't be ignored. It is estimated that severe obesity reduces life expectancy by an average of 10 years. The following health issues are connected to being overweight:

• Breathlessness
• Difficulty sleeping
• Aches and pains (especially in the back & joints)
• Type 2 diabetes
• High blood pressure
• High cholesterol and atherosclerosis potentially leading to coronary heart disease or stroke
• Reduced fertility
• Pregnancy complications
• Cancer (endometrial, breast and colon)
• Chest pain
• Tiredness
• Increased sweating
• Gastro-oesophageal reflux disease (GORD)
• Gall stones
• Liver or kidney disease

Obesity and fertility

Excess weight and fat tissue can alter the hormone levels in both the male and female body, which may influence the fertility of both men and women. This means, that the sperm of obese men may be less fertile and obese women may find it harder to conceive.

Risks of cancer linked to obesity

Research shows that certain cancers are directly linked to excess weight and its strains on the body. This includes colon cancer and breast cancer.

Obesity and mental health

Being overweight can also impact a person's mental health. Low-confidence and a lack of self-esteem can also have an influence on a person's social life and negatively impact relationships with a partner, friends and family. Without a stable support network, people quickly feel isolated and may be more prone to anxiety and depression.

"Obesity is the norm with depression, so it is pretty hard to separate the two. It is akin to saying that people who are depressed have more marital problems and people with more marital problems have more depression. You would need a pretty sharp knife to separate the two." Gregory E. Simon, MD, MPH, Seattle psychiatrist

At the same time, people with an existing mental health condition have a higher risk of weight gain and are more likely to fall into the obese category after struggling with depression and other mental health issues. This is often a side effect of medication prescribed to treat mental health disorders. At the same time, many people suffering from bad mental health often struggle to practice self-care as consciously as people without psychological problems which may lead to an unhealthier diet and decreased physical activity.

A 19-year study conducted by study researcher Mika Kivimaki, PhD, of the University College London followed over 4,000 British civil servants between the ages of 35 and 55 when they first enrolled in the study during the mid-to-late eighties. The study looked to discover if there was a link between mental health disorder (including depression) and obesity. The study found that the participants who showed symptoms of one or more mental health disorders three times during the course of the study were twice as likely to be classed as obese during the final screening.

Mika Kivimaki, PHD followed this conclusion up by stating that; "The more times mental health symptoms were reported, the greater the risk of becoming obese by the end of the study. This points to a dose-response association between mental disorders and weight gain."

Successfully losing weight can lead to a number of benefits, both physical and psychological. If you maintain a healthy weight after your initial weight loss, all of the benefits below can be achieved and will help you accomplish a better quality of life.

• Breathing is eased
• Sleep patterns improved
• Blood pressure decreases
• Confidence improved
• Improvements in body image/self esteem
• Immune system improved

Some research has been conducted into the improvement of memory when losing weight. Shedding extra pounds can make your brain more active and improve memory. Some individuals that have seen a dramatic change in their weight loss have found that their taste buds have improved whilst others have reported their eyesight improving due to lower levels of antioxidants and zeaxanthin in the eye tissue.

Weight loss can also lower the risk of cancer, including breast cancer and bowel cancer, due to cell changes. It also reduces the risk of diabetes, stroke and heart disease.

When deciding to fully commit to losing weight, it is important to weigh up the available options and decide which option is the most effective. Below you can find some effective ways to achieve weight loss long term.

Lifestyle changes

The undoubtedly most successful method to lose weight is through a change in lifestyle. You should consider adjusting your diet by eating healthier and practicing better portion and calorie control. For best and lasting results, it is important that you don't starve yourself or rely on an overly one-sided diet as this will make a relapse into old habits more likely. Instead, find nutritious yet healthy alternatives, stick to the recommended 5 portions of fruit and vegetables a day and eat well-balanced and versatile meals.

In addition to a healthy diet, regular exercise is crucial for your bodily health and fitness. This should be matched to your physical abilities and current fitness to avoid over-exertion or injuries. This can range from taking up running to joining a gym or simply walking parts of your commute. Little steps such as keeping up a higher pace and taking the stairs over the elevator can go a long way. Have you considered joining a club or exercising with a friend? Many people benefit from combining social interaction with their fitness regime as it makes time pass more quickly and helps to motivate yourself.

Talk to your doctor or a nutritionist to create a diet and exercise plan tailored to your personal needs. Counselling can also be an effective way to figure out which treatment option may work best for you. Here are some additional exercise and diet tips you can incorporate into your daily routine:

Diet

• Don't deny yourself the little pleasures - cutting out chocolate when you're the ultimate sweet tooth will have your sugar cravings hitting the roof. Allowing yourself time to enjoy your vices within moderation will help you to maintain your motivation for weight loss in the long run.
• Spring clean your cupboards - clear all fatty, sugary foods from your cupboard for a fresh start.
• Adjust your portion sizes - get savvy and reduce your portion sizes to up to half your original diet. With the right exercise plan, you'll find your stomach will get used to less food resulting in you being fuller for longer.
• Drink plenty of calorie-free drinks - when your stomach starts grumbling, this could be a call for water, not food.
• Snack wisely - swap the sugary chocolates, fatty crisps and other alternatives with tasty low-calorie options that don't rely on carbs. Nuts and fruits, whole grain bread or raw carrots with hummus are delicious substitutes.
• Pack up on protein and fibre - create a balanced diet plan full of recipes that aim for these two categories, as well as eating your five-a-day.

Exercise

• Increase your physical exercise - the recommended amount of exercise for adults is 30 minutes every day to help speed up your metabolism and lose weight – adjust depending on your calorie intake.
• Create a relatable exercise plan - the majority of us claim we don't like the gym or exercising, but there is bound to be a workout regime out there best suited to you. Grab your personal trainer to tailor fit a plan best suited to your needs and objectives.
• Pace yourself - there is no quick fix to losing weight, and rapid weight loss simply isn't achievable. It takes time and determination. You will start to see the difference soon enough.

Over-the-counter medicines and mental therapies

There are over-the-counter medicines, pills and herbal remedies that can help with your weight loss. However, there hasn't been much conclusive research to prove that they are sufficient in achieving weight loss. Over-the-counter medicines are not proven to be effective, therefore money could be spent on medication that has little-to-no effect on weight loss. Similarly, mental therapies, such as hypnotherapy, haven't been studied enough to definitively state that they can help people to successfully lose weight. Therefore, these treatments and therapies (e.g. hypnosis) aren't the most reliable treatment for obesity and could turn out to be a waste of money.

Weight loss surgery

Surgery is always an extreme measure when it comes to your body, however, if your obesity is causing you health complications then it could be an option for you. For weight loss surgery, a gastric band can be fitted to restrict the amount of food you eat by limiting the size of your stomach, making you feel full more quickly. Other common weight loss surgery includes a gastric bypass, biliopancreatic diversion and sleeve gastrectomy. Any surgical procedures will have to be discussed with your doctor who will be able to refer you to a specialist should this treatment option be considered for you. While these operations can be expensive, they also come with risks and side effects including scarring, bruising and swelling and should only be considered if all other weight loss methods have failed.

Prescription weight loss treatment

If you feel like changes in your diet and exercise regime are not having the desired effect, you can order prescription weight loss treatment online to support your efforts. The prescription treatments Xenical and Saxenda are available at HealthExpress.

Xenical with the active ingredient orlistat is suitable for patients with a BMI of at least 30 or 28 if an underlying health issue such as diabetes exists. This oral medication works in the digestive system by blocking the absorption of fat in the body. A course of treatment normally lasts for 12 weeks, throughout which the patient's weight should be closely monitored.

Saxenda is administered as an injection once daily and works by regulating appetite and calorie intake. It also allows an improved glycemic control. Saxenda contains the active agent liraglutide and is recommended for obese patients with a BMI of 30 or more or overweight patients with a BMI over 27 if there is at least one weight-related condition present, such as hypertension or diabetes.

Before committing to purchasing weight loss medication online, you should check over the precautions when taking the treatment. It is vital that you are aware of the side effects of the drug and they may occur when using the treatment. All medication should only be used alongside diet and exercise plans to increase your chances of treating obesity successfully and achieving sustained weight loss.

If you are overweight or obese, losing weight will ultimately always be beneficial for you and your general health. However, especially quick and extreme weight loss can have some side effects. It is always recommended to lose weight slowly but steadily in order to minimise any risks.

Skin Sagging

When you put on weight your skin stretches to accommodate it. Once you have lost a lot of weight again, stretched skin may appear to be less elastic and start to sag in certain areas of your body. This also happens during pregnancy. Building up muscles beneath sagging skin can help to sculpt your body, and surgery can also remove excess skin folds if they are excessive.

Mood Changes

Some research has been conducted regarding the link to weight loss and depression. They found that those who lost at least 5% of their overall body weight were 78% more likely to report depression. This could be because people may view weight loss as a key to happiness. The underlying reasons for unhappiness should be addressed alongside weight loss.

Relationship Changes

Weight loss can display some possible changes in your attitude, lifestyle choices and behaviour that could impact negatively on your relationships, whether this is romantic or platonic. You may also find you skip social occasions based on food and alcohol you don't wish to consume, or because plans clash with your fitness routine.

Gallstones

An abrupt change in weight can lead to the formation of gallstones due to the gallbladder not working as frequently as it is used to. The gallbladder works by removing bile from your body due to excess fat.