NEW WAYS TO REWIRE BAD HABITS
Statistics suggest that food and alcohol were our go-to comforts during lockdown, but the link between excess weight and coronavirus complications should give us all an appetite to make some healthy lifestyle changes
Even for those of us still in stretchy loungewear, having spent so much more time at home recently, it’s clear that the shape of things changed in lockdown – especially our midriffs. Just over one-third of us ate more and one in five drank more as a result of the pandemic, according to a study by King’s College, London. But tight waistbands are the least of our worries. Carrying excess body fat raises the risk of developing type 2 diabetes, high blood pressure, heart disease and some cancers, and doubles the chance of complications from Covid-19.
The government is attempting to tackle the nation’s obesity problem (almost two-thirds of UK adults are obese or overweight), but ultimately, we all have to make our own decisions to help ourselves and our loved ones.
The key is targeting the brain, says food psychologist and nutritional therapist Dr Christy Fergusson. ‘It’s not about better willpower – it’s about shifting your thinking,’ she says.
With that in mind, here are a number of expert strategies to help rewire some of those bad habits.
Size up the problem
Fat around the middle is especially harmful and waist size is increasingly recognised to be a more important measurement than body mass index (BMI). Waist measurement should be less than 80cm for all women (around 31.5in) and less than 94cm for most men (around 37in), but less than 90cm (around 35in) for men of South Asian descent, who are at more risk of developing type 2 diabetes.
Blood pressure, blood sugar and cholesterol levels can also indicate whether excess body weight could be harmful to health, and can be checked at your local GP surgery. A free NHS healthcheck is still offered every five years for 40 to 74-year-olds, but may become more targeted in the future.
‘Up to 40% of people with normal BMI still have excess fat that’s harmful for metabolic health,’ says cardiologist Dr Aseem Malhotra, author of The 21-Day Immunity Plan and trustee of health charity The King’s Fund. ‘The conditions we’ve seen associated with the worst outcomes of Covid-19, and infections in general, are related to excess body fat.’
Plan for pleasure
‘We’re creatures of habit and often have a very narrow diet,’ says Dr Fergusson (thefoodpsychologist.com). ‘Instead of eliminating foods, focus on adding variety and getting more pleasure and goodness from better-quality food.’
Choose slow-release carbs, such as wholegrains and sweet potatoes, and pair protein and plants for healthy snacks to keep blood sugar stable.
Film director Gurinder Chadha, best known for Bend It Like Beckham, has talked inspiringly about putting type 2 diabetes into remission and losing weight by adapting favourite recipes – by using almond flour, for example, and cutting down on refined carbs and fried snacks.
On the risks of Covid-19, Chadha said: ‘My own relatives have died. Everyone I know who has died has been obese.’ Now she is urging people of South Asian ethnicity who, according to Diabetes UK (diabetes.org.uk), are up to six times more likely to develop type 2 diabetes, to change their diet.
It is inspiration we can all borrow.
Activate your day
Ordinary movements through the day, such as going upstairs, walking to the shops or doing household chores can burn up to 2,000 calories. Known as Non Exercise Activity Thermogenesis (NEAT), it is also better than doing a high-intensity workout and then sitting all day, according to a study by the Mayo Clinic. There’s a surprising amount of incidental movement in commuting to work, while shifting from bed to keyboard requires almost none. If that’s become your pattern, take a break every 20 minutes to change work station, run on the spot while the kettle boils, or do a chore, such as putting the washing on.
Recalculate portion size
Look on packets of rice or pasta and weigh out the recommended amount to remind yourself what a portion looks like, suggests dietitian Clare Thornton-wood (claretw.com). ‘It’s easy to forget that it’s actually very small,’ she says. ‘We have become used to being served far larger amounts in restaurants.’ She also advises filling half your plate with non-starchy vegetables and to eat slowly so that you notice when you’re no longer hungry.
Eat out without regret
‘Look for ways to be sociable without eating too much,’ suggests Susan Jebb, professor of diet and population health at the University of Oxford. ‘Perhaps you could share a dessert, or have a starter instead of a main course. Much of the enjoyment of eating out is about the atmosphere, the company, the wide choice – and no washing up! You don’t need to overeat to have a great time.’
Shop differently
Once you’ve planned healthy meals for the week, go shopping with a list and stick to it. Pick a quiet time to go, when you are not feeling hungry and can be your calm, rational self who wants to take control of your weight, says Professor Jebb, who thinks obesity should now be treated by the health services as a problem akin to smoking. ‘Also consider online shopping,’ she adds. ‘People tend to make healthier purchases when shopping online because they are less likely to buy on impulse.’
Find the right help
If a long-term weight problem has been exacerbated by the pandemic, or you want to find out how best to put type 2 diabetes into remission, your first port of call is your GP. ‘People with a long-term weight problem need support,’ explains dietitian Douglas Twenefour, deputy head of care at Diabetes UK. ‘There’s no one-size-fits-all approach, but GPS can advise on services available in your area. And the more information you get, the better.’
There are several NHS and Public Health England schemes (see previous page), but the two evidence-backed options to put type 2 diabetes into remission for most people are Low Calorie Diets (LCD) using meal replacement products, and weight-loss surgery. An NHS pilot study into LCD is restarting after being delayed by the pandemic, and some GPS are already advising patients to take this approach. If this sounds like something that could work for you, talk to your GP first, as your blood glucose levels need to be monitored and any medication adjusted.
Change your thinking
Weight-loss surgery is a scientifically proven treatment that puts type 2 diabetes into remission for most people, yet 98.8% of patients meeting the criteria for surgery set by the National Institute of Care and Excellence (NICE) are not referred by GPS, says Professor Francesco Rubino, chair of metabolic and bariatric surgery at King’s College, London.
Why? According to studies, including one by Professor Rubino published this year, most of us – including healthcare providers – mistakenly believe obesity is a lifestyle choice caused by greed and comfort eating.
‘In fact, there is a wealth of evidence that complex biological mechanisms regulating appetite, satiety and body weight are dysfunctional in obesity,’ says Professor Rubino. ‘Surgery has a direct and favourable influence on physiological mechanisms of body weight regulation.’
People with obesity have low levels of an appetite-suppressing hormone and high levels of ghrelin, the ‘hunger hormone’, which triggers appetite. Income, family background and ethnicity also play a part in obesity levels, and genetic factors influence whether we’re naturally slim or have a propensity to put weight on easily.
Rediscover real food
Don’t buy any products with more than five ingredients – that’s the simple advice from Dr Malhotra, who says, ‘Swapping ultra processed foods for real food is the first crucial step to changing our metabolism and gut hormones that control appetite.’