How to lose weight QUICK and escape type 2

Could losing weight rapidly be the key to overcoming type 2 diabetes? In this edited extract, Professor Roy Taylor explains.

This is a simple programme, with clearly defined stages – first, lose weight rapidly with a clear end point; second, reintroduce ordinary foods step by step; third, keep the weight down long term.

A rapid weight-loss phase followed by a stepped return to normal eating is very different from the standard advice of ‘slow and prolonged’ of recent years. The 1, 2, 3 approach recognises that losing weight is a distinct activity, separate from the matter of keeping the weight steady in the long term, and that there are many benefits from losing weight fast in the first instance. There are other approaches to losing weight. However, several high-quality studies have shown that going on an intensive rapid weight-loss diet for a period is not only effective for most people, but extraordinarily motivating.

1 Recognise the problem

For centuries, type 2 diabetes has been thought of as a lifelong condition. Despite being advised to lose some weight, people recently diagnosed with type 2 diabetes find that their weight creeps up over ensuing years. Even if guideline-based advice from a dietitian is available, this is often frustratingly ineffective. Most people’s steady increase in weight after being diagnosed with type 2 does not surprise doctors either, as they know that some of the tablets prescribed to manage the condition actually hamper weight loss.

If body weight stays as high as it has become by the time type 2 diabetes is diagnosed – then the diabetes does not go away and will get worse. If you lose a lot of weight, though, the very opposite is true.

Your type 2 diabetes has been caused by less than half a gram of fat inside your pancreas. That small amount of excess fat is inside the cells, preventing the proper manufacture and release of insulin. There is not only excess fat within the cells of the pancreas, but too much in the blood, continuously arriving and adding to the burden. The only way of decreasing this burden of fat is to decrease the total amount of fat accumulated in your body – not just by a few kilograms, but by a lot. Once this is crystal clear, escape from type 2 diabetes is within your grasp. You need to lose weight and keep it off.

2 Write down your target weight

However much fat you may have in your body, the development of type 2 diabetes is telling you that you have too much. Too much for your personal constitution. Don’t compare your size with that of others. You are yourself.

How much is too much fat? As a rule of thumb, decreasing your body weight by 15kg will correct the excess of fat. It is the same whether you weigh 80kg or 160kg, as this is highly likely to take you below your Personal Fat Threshold. Losing so much weight may sound an impossible task, but it is easier than you may think. Cutting calorie intake to around 700 calories (2929kJ) daily was found to be surprisingly straightforward. It was certainly not easy – but far less difficult than people expect. What helps is that the average weight loss after one week is around 3.5kg – and this makes a profound difference to how people feel day to day. All daily activities suddenly become very much easier when you are lighter. You will soon feel so much better that your motivation will be reinforced.

Yes, you will feel very hungry for the first 36 hours, but hardly at all after that. The ongoing problems are more about adjusting daily life around some major changes. Compared with the miserable and often ineffective rigmarole of trying to lose weight over six months or a year, losing substantial amounts of weight rapidly is so much easier.

So, if you weigh 80kg, weight loss of about 15kg, to 65kg, is likely to return glucose control to normal – provided you have not had type 2 diabetes for ➤

Decreasing weight by 15kg will correct the fat excess

too long. The only way to know whether your diabetes has gone too far to be reversed is to lose the weight and see.

It is worth repeating that the aim is not the usual, unfocused one of becoming non-obese. ‘Obesity’ itself is not relevant. What is important is to get yourself below your Personal Fat Threshold. And 15kg is the magic number to lose, whether you start at 160kg or 80kg. Of course, there may be other health gains to be had from losing even more weight, but this book is about returning to metabolic health, not becoming slim.

The 15kg rule of thumb works fine for most people, but may be too much if you are not a big person. At a lower starting weight, say below 80kg, it is better to think about losing 15 per cent of your body weight. So, Mrs Sixty Kilograms could reasonably aim to lose 9kg.

The first step: write down your target weight. Don’t be put off by the seeming difficulty – hundreds of people like you have achieved similar weight loss. It can be done. Write it down. Then it is a real target.

3 Recognise that food intake has to be decreased for 2–3 months

When will you start on your escape diet? Certainly not instantaneously – as you need to plan ahead. This is not an invitation to put it off, then put it off again, but rather to encourage you to take a cool look ahead to check that you are making things as easy as possible for yourself.

Choose your time. Many people struggle to find two to three months when there are no social occasions, upheavals at work, holidays etc. So plans need to be laid for how you will manage to stay on course. Enlisting support from everyone close to you will be extremely helpful.

4 Discuss with friends and family

I can’t stress this point enough. Obviously, it is important to enlist the support of family and friends to help during all the difficulties that crop up as part of life. But contemplating major weight loss is a far more pervasive thing. Eating is a social activity, and usually involves your nearest and dearest. Therefore, any change you make to what and how much you eat will impinge upon everyone else in the house.

What does your spouse/ partner/close friend think about you embarking on this challenge to get rid of your diabetes? Will they be happy or less than happy to see you at a lighter weight and feeling 10 years younger?

There is much talk these days about the ‘obesogenic environment’ in which we live.

However, the obesogenic microenvironment of the home is easily overlooked. That microenvironment can be changed if the family is willing. Many of our research volunteers have described such a revolution.

Beware the excuses you may make to yourself and others, for example: ‘I need to keep some treats in the cupboards for the children/grandchildren.’ Firstly, remember that type 2 diabetes runs in families, and families will share the genes that determine the risk for type 2 diabetes. So, setting up your youngsters to have treats as a routine will do them no favours in the long term. Far better would be to actively help them avoid having to make the same escape effort that you are contemplating just now. Secondly, if you are tempted to eat the treats, then they were probably never really for the grandchildren anyway. If you are unable to resist them, they will have to go.

5 Decide

How do you make a decision? Imagine if, instead of diabetes, you had developed a life-threatening disease that could only be cured by an operation, and that your doctor said to you that this would mean taking three months off work and stopping all normal activities of life. Faced with a life-threatening condition, you would not hesitate to accept this. You would plan for the operation and work out how to fit your life around this period of down time.

Given that type 2 diabetes causes misery and shortening of life, the same thinking should be applied. It is a serious condition that threatens your eyesight, your feet and your heart, not to mention doubling the risk of a stroke at any age.

With the 1, 2, 3 approach, your route to fixing this is much less disruptive than taking, say, three months off work for surgery. During your period of low-calorie dieting, work and everyday life will continue. You may worry that you won’t have enough energy to do your usual work, but do not fear – most people report feeling more energetic than usual while dieting.

It has to be a personal choice. But in my experience, many folk would really like their health back – as soon as possible. Health is one of those things that never seems precious until it has been lost.

A decision needs to be taken. You will know when you have decided. And provided you have been given the information about the alternatives, no one can tell you that your decision is ‘wrong’ or ‘right’ – it is your decision.

6 Prepare for action

Check those cupboards. Are they clear of biscuits, cakes and chips? Do you have all the supplies you need? It is essential to plan ahead so you don’t get scuppered by hunger pangs and end up buying a snack that is bulging with calories.

One curious thing must be considered. You may have friends, relatives or acquaintances who do not seem to want you to lose weight and may actively engage in what could be called sabotage. This can be particularly difficult to deal with when you are trying to keep to a strict regimen. It is a good idea to think through how you might respond to this sort of thing before you start.

7 Action!

All our research work on reversing type 2 diabetes has depended upon a method for losing weight that can be achieved by all the participants within a defined period of time – a combination of low-calorie soups and shakes to maintain a daily intake around the 800-calorie mark. In a research study, it is vital to have a uniform, reproducible way of bringing about change that is acceptable to most people.

You need to plan for long-term weight control right from the beginning. And then, once you have shed the 15kg, and after you have congratulated yourself (and your supporters), you need to be prepared for the fact that you will need less food than you previously ate. In practice, this will be around three quarters of the amount you habitually put on your plate and swallowed. Remember, this marks the beginning of the rest of your life. And eating less will be the only way to maintain your new, healthy, comparatively svelte form. Knowing this from the outset is important.

THE 1, 2, 3 APPROACH

First get the weight down, focusing entirely on that. Secondly, reintroduce ordinary foods step by step. Then thirdly, keep the weight down long term.

Recognising that these stages are three clear-cut operations is important. Careful research has shown that major weight loss can be achieved by this clear separation of a relatively short, but intense, period of weight loss from the long-term keepit-down phase. However, a word of caution is needed: the best studies to date have lasted for only two years, and weight regain must be avoided for life. Phase 3 is the most challenging. ➤

Food vs liquid formula

Having a packet of one of the many commercially available liquid formula diets per meal is by far the easier option for most people. Add in some non-starchy veg at mealtimes, partly for something to chew on, but mainly because veg helps to avoid constipation.

And, if you can’t bear the idea of going on liquid formula drinks for several weeks with or without vegetables, you can, of course, use ordinary foods. If you go for real foods to provide approximately 800 calories (3347kJ) per day, you would need a high proportion of protein foods (fish, meat), both to meet your daily need for protein and to keep you satisfied for longer. Plenty of non- starchy vegetables are important to fill you up and keep your bowels regular. It may take you a bit longer to cruise down to your target weight – about three to four months as opposed to two to three months on the liquid formula.

Step 1 in practice

Choose your low-calorie diet. If it is to be a liquid diet, then you must decide which brand and which flavours you like. Whichever brand you choose, it must be described as ‘complete nutrition’ (as opposed to just a ‘meal replacement’) – in other words, that it contains all the vitamins, minerals and trace elements in addition to protein, sugar and fat.

You may be surprised by the high sugar content of some brands, but don’t worry as this is low compared with what your liver makes every day. The protein content will be high: around 25 per cent and much higher than you might usually eat in a meal. It must come as one packet per meal (no decisions or room for inadvertently adjusted doses). Each packet will contain around 200 calories (837kJ).

Liquid diets are easier for most people, and bear in mind that this is what was used in the research that showed major weight loss and lasting remission of type 2 diabetes. To maintain an adequate intake of fibre, you have the option of either taking a fibre supplement or eating a single helping of non-starchy vegetables each day, in addition to your shakes.

Do not embark on an exercise programme during Step 1. Perhaps, surprisingly, this can seriously impede weight loss, especially in very overweight people. This may be the best-kept secret in the weight-loss field, and I came across it only from listening to participants in one of our exercise studies. They described ‘compensatory eating’ (part-conscious and part-subconscious). So just remain normally active during Step 1.

• Write down why you are doing this.

• During a liquid diet, you will have lots of time on your hands, so plan ahead as to what you are going to do with that time.

• Then plan what you are going to do if you feel tempted to eat

something off-limits.

• You also need to plan for how to supply yourself with your special meals when out of the house.

• No alcohol during the weightloss phase.

• Continue to enjoy tea and coffee, with skimmed milk if preferred (not more than 50ml per day).

• Discuss your plans with your doctor or diabetes nurse.

Step 2 in practice

Moving from the weight-loss phase back to eating ordinary foods needs some careful planning.

• Start with the evening meal, going back to eating a normal (but smaller than usual) plate of food instead of the shake, but continuing your weight-loss diet during the rest of the day.

• It is sensible to do some advance planning here, too: a ‘normal’ meal should still be relatively low in carbohydrates and contain plenty of veg. Avoid sweet or starchy foods.

• After two weeks, you can add in a lunchtime meal, stopping the shake but, again, exercising portion control.

• After four weeks, you can be back into a fairly normal pattern of eating that is sustainable for life – without regaining weight. And drink alcohol if you wish.

Step 3 in practice

By this stage you should feel very proud of yourself. You will have lost a substantial amount of weight, you will hopefully have achieved remission of your type 2 diabetes and you will be feeling dramatically better, both in mind and body: more energised, confident and motivated. Welcome to the beginning of your new life.

• As a rough guide, you will need to eat only three quarters of the amount that you used to eat.

• Write down your weight each week. This is essential.

• If your weight rises by 3kg above target, take immediate action. Whatever you do, don’t abandon all your hard work in regaining health. Make sure it is only a temporary blip.

• Beware of activities that often involve communal snacking, such as watching television.

• Take pride in your written record of weekly weight so you can say: ‘I’m the same weight as I was at the age of [25?] and have been for a year.’ And the last couple of words will eventually become five years... 10 years... 20 years.

• And, finally, ensure that life is enjoyable.

WHY LOSE WEIGHT RAPIDLY?

If food intake is decreased to around 800 calories (3347kJ) per day for a two-month period, there are several advantages. Once under way, you are unlikely to feel very hungry. This is possibly a survival mechanism that evolved during our huntergatherer millennia. It would have been difficult to hunt successfully if all you could think about was being ravenously hungry. A second major advantage is that you start feeling so much better in a short period of time that you will want to keep going. You’ll find you move around more easily and you sleep much more soundly. You will start feeling more energetic.

In the first week of a 700-800 calorie (2929-3347kJ) diet, the average weight loss is 3.5kg. During the whole eight weeks it is just over 15kg. This might sound rather alarming: is it healthy to cut back so much on eating? Sudden weight loss is usually thought of as an indicator of serious disease.

But the hard evidence is that for anyone who has increased their weight during adult life, or has always been overweight, losing the extra weight and then eating less long-term is of huge benefit to health. In our overfed society, fasting is not usually dangerous, but eating is.

As I mentioned above, if you opt for total food replacement using a liquid product to lose weight, there are some additional advantages. The first is that it is easy to have a high proportion of protein at each meal, and this helps to control hunger. The second is that there are no difficult choices about what and how much to eat. Freeing yourself from the cumulative burden of decisions, decisions, decisions makes weight loss genuinely easier.

You don’t have to lose weight fast to reverse your diabetes, but for most people it’s the easiest way of losing the requisite number of kilos. Overall, the 1, 2, 3 approach works because the defined goals of each stage are humanly possible, and the early wins increase motivation to succeed.