Page 36 - The SA Journal Diabetes & Vascular Disease Volume 9 No 4 (November 2012)

178 VOLUME 9 NUMBER 4 • NOVEMBER 2012
PREVENTION IN PRACTICE SA JOURNAL OF DIABETES & VASCULAR DISEASE
this does not sound a lot, until we explain that, if they do this every week,
they will lose 2 kg every month, or 6 kg every three months, or 24 kg
every year.
Unfortunately, we also need to explain that a ‘day off the diet’ should
mean exactly that, ie a day of eating the correct amount of calories that
the body requires.
A ‘day off’ that includes breakfast, lunch, snacks, a restaurant or take-
away meal, and potentially a copious amount of alcohol, will result in ex-
cess calories that cancel out those saved by a week of sticking religiously
to a hypocaloric diet (Fig. 1).
At RIO we invite patients to see any/all appropriate members of the multi-
disciplinary team as often as they need to. But we only weigh and measure
every four weeks. This is specifically to overcome the confusing effect of
hormonal fluid retention. For example, a pre-menstrual woman, who has
stuck to her hypocaloric diet and lost 500 g in a week, may become dis-
heartened if the scales suggest she is 2.5 kg heavier because she has
retained the equivalent of 3 kg of fluid that will be lost the following week.
Furthermore, if we want to improve a patient’s health, we need to con-
centrate on actual fat loss, in particular visceral fat, rather than chase
numbers on scales that reflect only overall weight, and not fluid retention
Table 4. Saving 500 kcal a day – simple tips for patients
• Reduce portion sizes: eg choose standard, not large-sized, portions in fast-
food restaurants
• Choose lower-calorie snacks
• Substitute lower-calorie foods in meals, eg boiled potatoes for chips
• Switch from sugary drinks to ‘diet’ drinks or water
• Reduce alcohol intake: each alcoholic drink has the same number of
calories as a chocolate bar
• Check food labels: ‘low fat’ or ‘premium’ does not always mean low
calorie
• Remember that all types of sugar (eg sucrose, fructose, glucose, dextrose)
have the same number of calories (4 kcal/g)
• Remember that all types of fat (eg saturated, polyunsaturated,
unsaturated) have the same number of calories (9 kcal/g)
Fig. 1. Taking one ‘night off’ can undo a week of calorie deficits.
Fig. 2. Measuring waist circumference.
Measure waist circumference at the mid-point between the lowest rib and
the anterior superior iliac spine, or hip bone, on expiration
or lean muscle changes. So we encourage simple and straightforward
waist circumference measurement (at the mid-point between the lowest
rib and the anterior superior iliac spine, or hip bone, on expiration) in ad-
dition to all other measurements (Fig. 2).
MISCONCEPTIONS
We also aim to dispel any confusion between ‘healthy’ eating and eating
for weight loss. Obviously, in an overweight or obese patient, who is cur-
rently eating an unhealthy diet, we would aim for a hypocaloric diet that
is nutritionally more balanced and ‘healthy’. But many patients do not re-
alise that they can put on weight by eating too much of any healthy foods,
and that conversely they can lose weight even when eating typically ‘un-
healthy’ foods if they eat fewer calories than their body requires.
Patients also often get caught out at the supermarket by choosing ‘low
fat’ options. These foods might be ‘healthier’, especially if the patient has
been advised to reduce their fat intake, but will result in weight gain if
they contain more calories than the standard option. Similarly, patients
may regard premium food products as ‘healthier’, when these are pre-
mium because they taste better, possibly because of a higher fat, sugar
and/or salt content.
Other mistakes that patients make relate to the different types of sug-
ars and fats. Patients do not appreciate that all types of sugar have the
same amount of calories. This also applies to fats. When cooking, un-
saturated fats are preferable to saturated fats, but if patients use more oil
they may increase the overall calorific value of their food. Any resulting
weight gain will cancel out any health benefit of swapping to unsaturated
cooking fats.