Weight Loss Does Not Equal Calories In vs Calories Out

    Calories In vs Calories Out Welcome to part 1 of our Weight Loss Does Not Equal Calories In Versus Calories out series where we look to debunk the long held belief that weight loss has always just been about calories in matching calories outs. When we look at low fat, low sugar, low carb diets and more recently the intermittent fasting fad, a lot of this centres around this concept. Dietitians know this is not the case and now we’re looking to educate everyone on what IT IS about over this series.

PART 1 – Biology

It is often touted that weight loss is as simple as eating less and exercising more, and that with sufficient willpower all people can achieve this. Unfortunately, this is not the case. Weight is extremely complicated as it is influenced by a large number of interconnected factors, many beyond an individual’s control. As dietitians, we frequently witness frustration expressed by clients who have tried all sorts of diets with no success, and understand that a holistic weight-neutral approach to nutrition creates the best results. This can start by understanding the role that biology plays in determining a person’s weight.

Genetics

Genetics play a major role in the size and shape of our body. It is estimated that 40-80% of weight is contributed to by genes, with over 300 single nucleotide polymorphisms (SNPs) associated with adiposity. These genes and SNPs influence our bone structure, musculature, metabolism and more. This means that if we had people following the same diet and exercise regimes, their bodies would all look extremely different.

Set point theory refers to all people having a weight their body prefers to be at. When people sit above or below this point, their body will regulate intake and energy expenditure to return to this weight – in other words, via homeostasis. For example, weight loss at a rapid rate increases ghrelin secretion, increasing feelings of hunger to promote weight gain to an individual’s set point. Additionally, if we consume more energy than we require, our body will increase its temperature to increase the metabolic rate. A person’s set point is not fixed, however, and can be increased or decreased. If a person is seeking to lower their set point, we know that slow and sustained weight loss (0.5-1kg/week) allows the body to adapt to the reduced energy intake. This can’t be achieved by crash dieting or dramatically limiting calories, thus this is where an accredited dietitian can assist.

Hormones

Hormones play an enormous role in appetite, metabolism and fat storage. We know that fat cells produce leptin, a hormone that signals satiety. Individuals with larger bodies produce higher levels of leptin however display resistance to its hunger-regulating mechanism. Rapid weight loss can decrease leptin production, thereby increasing appetite and causing weight gain. Gradual lifestyle changes prevent this rapid shift in hormone production, creating sustainable and effective changes in the long-term. Furthermore, sex hormones greatly impact body fat distribution. Changes to these hormone levels, such as during menopause, can greatly impact one’s body shape without changing their diet or exercise. Insulin is another hormone that greatly impacts one’s carbohydrate and fat metabolism.

Health conditions and medications

Numerous health conditions impact our weight and should be investigated prior to prescribing low-calorie diets. Hypothyroidism and Cushing’s syndrome impact hormone production associated with weight gain and obesity, which can’t be rectified with diet alone. Mental illness can also greatly impact an individual’s ability to maintain their healthiest weight.

There are a number of medications that may affect a person’s weight. For example, antipsychotics, antidepressants and corticosteroids are associated with weight gain. There are a number of reasons for this, such as by increasing lethargy, decreasing resting metabolic rate and fluid retention. It is beneficial to set goals surrounding cardiometabolic health for these individuals, as their weight may not be in their control whilst on certain medications. Again, an empathetic and weight-neutral approach can assist with increasing motivation to make positive dietary changes.

How a dietitian can help

At Healthfix, our dietitians assess all of these factors and more in the initial consultation. We see weight as complicated and stigmatised, and work with our clients on health goals greater than just the number on the scale. We work with, rather than against, a person’s biology.

This article was written by Ashley Maiden and reviewed by Melissa Juergens (Healthfix’s Dietetics Department). Should you have any follow up questions regarding this information our dietitians will be more than happy to assist you.

From a COVID disrupted 2020 to thriving in 2021.

COVID Distrupted 2020

Covid disrupted 2020 Written by Sean Cooney
 
The Past
If you caught our January internal newsletter I discussed how we adapted when severe COVID restrictions hit New South Wales. We knew there was going to be a continued need for good health care but we had to concern ourselves with the best way to deliver it. There was also a need to educate patients on how looking after their health was one thing that was in their control in a world that was seemingly changing by the day, sometimes by the hour (depending on the next press conference).
 
We connected with the mantra of Reconnecting to Purpose both for our patients and for our clinical and exercise teams. Why did patients value their health and the time spent working on caring for their health? If they could connect with what their long-term goals were then it made more sense to keep working in that space and enjoy all the mental clarity that comes from being in a good state of health. Most who connected with this found that they had more time considering that commutes and the access to “bad health choice options” were removed. For our Healthfix team, reconnecting to why they became a health professional allowed us to focus on the actionable solutions that were in place to deliver effective health care – outdoor sessions, telehealth, better communication, more teamwork and integrating.
 
The Present
We’ve always had a strong focus on the person and not just the presentation as per our biopsychosocial approach teaching but this is so much more at the forefront of people’s minds now. The vernacular around coaches and mentors, thriving instead of surviving, looking after oneself holistically and making enough time down time is so much more of a prominent discussion. Patients are wanting meaningful engagement and to be on a path that works for them with a clinician who can be flexible and adaptable to their changing needs. I think our patients like to know that they have a team behind them for support but they want care that is simple and makes sense. I can see more of our patients ready to get to work on health care issues that have been around for a while and happy to chip away at getting a long-term, sustainable result.
 
The Future
Who knows? Do we go back to a fast-paced life and take our health for granted OR does that freeze in time that the global pandemic offered to reflect and check where our lives and our health was going lead to happier and healthier humans? With consideration to how some areas of health care strengthened whilst others were used less, perhaps due to being seen more as a discretional spend or ineffective, I can see good health care operators will continue to thrive within a more discerning crowd of patients. Ones who can embrace the holistic nature of good health and how it impacts mental, physical and emotional wellbeing as well as our work productivity and social relationships may be in a better position. But then again Nassim Nicholas Taleb has won a lot of praise from teaching us not to be fooled by randomness and a “black swan robust” so effectively who really knows what the future holds but there’s a good chance that we can get through it! Either way we’re looking forward to helping even more people in 2021 than in 2020 with what we’ve learned and with collaborating with awesome GP’s.
Mel Jeurgens

5 Quick Questions With Our Dietitian On Starting Your Diet Well in 2021!

Mel Juergens 5 quick questions

Written by Sean Cooney

Our dietitian Mel and I sat down to have a conversation about the early influx of GP and non GP referred patients that we tend to see in the months of January and February. Here’s some key take away points.


You say that a lot of people come into your consults after having visited their GP’s for blood work in the earlier months of the year, what do you think is behind this trend?

People seem to have that “New Year, new me” feeling. They’re wanting to start the new year fresh and kick start their health with an understanding of where they currently sit.

Why do they come to see a dietitian and what conditions are you seeing mostly?

Weight loss is a big one. Many have tried and failed at multiple diet fads or they’re after a long term solution and not a fad. They want to do it the right way.

For some they can feel it’s their last resort coming to see a diet professional. There’s a lot of confusing information out there online and they’re, well, confused. Others have regrettably tried the fad diets and failed to stick to it which has wound up resulting in weight gain as we now know research shows can often happen.

What else do you see at this time of year?

People with diabetes and cholesterol issues. Ultimately at this time of year there are just a lot of people wanting to focus on their health and they have the time to act as they haven’t got too busy at work just yet. They are in a better position to make time for their health.

How have dietetic patients presented post COIVD?

During COVID there seemed to be a lot of people just surviving, not necessarily thriving. Now there seems to be a different attitude. The people that I am seeing now are wanting to work on their health and get great, long term outcomes from learning good habit and diet behaviours.

What would one expect when seeing you?

What most might find surprising is that we only spend 10-15 minutes talking about what you’re eating. 40 minutes or more are spent on truly understanding the person and their dietary choices. We look to understand their upbringing around food, their family history and a lot about their work and life now. Once knowing their history and all the factors that will impact on their diet and food choices we begin to forge a plan around what is realistic for the person and where is the best place to start.


What else?

GP’s wanting to know more about how our dietetics department, with Mel and Ash, are helping with general and more speciality based diet clientele please get in contact. We are always happy to arrange a visit to our clinics, come and visit you or set up a time to get on the phone (as we know how busy you are!).

Setting Up For A Prosperous Year With Medicare’s Chronic Disease Management and Team Care Arrangement Initiatives

Medicare’s Chronic Disease Management

Medicare Chronic Disease Management
Written by Sean Cooney
 
With the chronic disease management and team care arrangements offering such a wide scope of practice for a wide variety of people, no two patients are really the same. But, of course, there are some key similarities.
 
Patients who see multiple allied health professionals on one referral
When the five sessions are spread across 2-3 practitioners we find that the first practitioners’ initial assessment is really important. The GP referral is so valuable at providing the history of the presenting illness or ailment and the goal setting section is instrumental. Where the patient decides to start the allied health care approach, ie which practitioner they see first, normally dictates the approach that they want to take.
For example, seeing a physio before the AEP may mean that there could be a level of fear avoidance behaviours that are present due to the length or severity (or both) of the patient’s condition. Seeing the AEP before the physio may mean that they’re more keen to get started with exercise and wanting to top up on education around their previous injury or refresh their self management strategies. Seeing the dietitian before an AEP or the physio may mean that they know that their food choices are impacting their ability or willingness to move. It can also mean that this is what they’ve identified as the best place to start forming better habits or routines around a healthy living – considering that we can eat 3-5 times per day whereas we might only exercise once.
 
5 sessions or more?
The premise of the CDM program being about setting goals and then setting a plan to achieve these goals means that we need to have an early conversation around how much they’re expecting to achieve in the 12 months that the sessions are valid. Some like to use their sessions and move straight onto the private healthfunds but for others they can only afford the 5 or only want the 5 sessions. When the person is requesting to continue beyond the 5 sessions, these initial sessions serve really well to get a thorough assessment of where the patient’s condition is at, how they have been managing, educate them on updates to evidenced based practice that are applicable to their condition and then getting started with a meaningful intervention. When the person is only wanting the 5 sessions from Medicare it is much more about educating on self management strategies and tools for reassessment from day 1. Patient’s can feel they didn’t get value out of the sessions if they’ve started on a plan of intervention that there wasn’t adequate follow up to reassess whether this was effective for them or not.
 
The value in a health spend
Working in CBD areas in North Sydney and Broadway, sometimes the reliance on a Medicare subsidy isn’t so great which can bring into question one’s value on the contribution. I think it stills gives the opportunity to set the person up for success and moving towards a happier and healthier existence. The premise of the management plan, to have the GP integrating with allied health professionals, mandating that we communicate, including the use of objective measures, health care plan and goal setting with time frames is no doubt the structure that is required to deliver long term outcomes and reduce the “burden of disease”. If this gives a person the first taste of this approach, it can surely do no harm.   Whichever is the patient preferred approach to their healthcare, the program is awesome and can be so effective. We’re truly lucky to live in Australia. As long as expectations are clearly communicated and smart planning is discussed from the initial appointment then we can truly chip away year on year, helping the patient adopt good management strategies to manage their chronic conditions.