Eating half is obsolete

... today the golden standard is losing weight with assistance.

Maren S. and Uta N. have successfully lost weight. They come regulary to the IFB Outpatient Clinic.

Even IFB AdiposityDiseases cannot do magic to make patients loose weight. Obese people who want to shed pounds are instead counseled continuously. Especially motivation is crucial. The method “eating half as much” (in German coll.: “Friss die Hälfte”) may be effective, but in the long term it is not feasible. However, a lot of staying power is necessary: “Losing one kilogram of weight per month means already success for us”, so Prof. Matthias Blüher, an internationally accepted obesity expert from Leipzig. “The main problems of patients are excessive expectations how much and how fast they will lose weight”. Discipline wanes if the expectations do not come true fast enough. Therefore, it is important that doctors, nutritionists and coaches speak regularly with the patients, adjust the diet and excercise plan, and above all motivate them to go on. The demand for that support is high. About 300 obese patients come monthly to the Adiposity Outpatient Clinic in Leipzig’s University Hospital.

Eating less but better

„We work without any restrictions in eating. The nutrition plan is being established together with the patient”, says Blüher. A calorie-reduced and healthy mixed nutrition is intended  that can include even the favourite dish of the patient, as long as calories are saved. About 1500 calories for women and 1800 calories for men should cover daily basal metabolism but are under the caloric requirement with the result that the body gets its energy out of reserves. A calorimeter can calculate the basal metabolism beforehand. Also, minor nutrition rules as eating less in the evening or eating no more carbohydrates for dinner often haven a big effect.

Take obese patients seriously

The 41 years old Uta N. describes her experiences in the treatment of the IFB Adiposity Outpatient Clinic: “For the very first time I felt to be understood and taken seriously. I have gone through a lot of diets. Doctors fobbed me off with sentences like ‘First you have to lose weight!’. But exactly this is the most difficult thing without help. As many affected people Uta was already overweight as a kid. She fleshed out rapidly in the past years and developed problems with her spinal discs. Having over 100 kilograms at a body height of 1.65 meter she could not even „take a look in the mirror”. So she looked for help at the IFB. Thanks to changing nutrition, more exercise and medical help she managed to lose 20 kilos.  Uta N. is also supporting obesity research by taking part in a study of Prof. Blüher (Effects of strength training compared to endurance training on the visceral fat mass and the basal metabolism in patients with obesity). The Objective of the study is to find out which form of exercise is faster and more sustainable to reduce the dangerous inner (visceral) abdominal fat and can improve diverse metabolic and cardiovascular risk factors.

More exercise in daily routine

After a detailed examination and inquiry of the patient in the outpatient clinic a special exercise program is being drafted with the help of sport scientists. It is important to intensify the activities step by step once the patients have managed to reduce their weight and to improve their fitness. Here, the IFB doctors cooperate with the rehabilitation sports club “leichter leben e.V.” Furthermore, a simple step counter (pedometer) can show how more exercises can be integrated into daily routine. Nevertheless, there can be stagnation in losing weight. In this stage it is really important to go on, so Blüher, “because losing weight, keeping the reduced weight and changing lifestyle are a lifetime job.” Maren S. also can tell you a thing or two about it.  The 49 years old administration secretary is treated at the IFB since January 2011. After losing 13 kilograms, the weighing scale seems to stand still. “Nevertheless, I feel good and I am being addressed on my better look. That encourages me and helps fight my weaker self”, says the mother of two daughters.

Limits of conservative obesity therapy

Unlike the two women mentioned, people with a high BMI have to loose 30, 50 or more kilos. The success rate in this group is low, but there are still “particular cases in which people managed to lose 50 kilogram in the long term”, so Blüher, who is also chairman of the Obesity Foundation and board member of the German Obesity Association. A big study in Sweden (1) showed that conservative therapy can lead only to a weight reduction of about 2 percent. However, obesity operations like gastric banding or bypasses led up to a loss of 28 percent. However, these operations call for a lifetime change of one's eating behaviour.  Blüher hopes that the activities of the numerous IFB research projects bear fruit in the future and that an effective therapy for losing weight can be found. Maren S. and Uta N. advice people concerned not to hide, but to look for professional help and accept it.

Doris Gabel

(1) Sjostrom l et al (2007). Effects of baraitric surgery on mortality in Swedish obese subjects. N Egl J Med 357:741-752

Keywords: nutrition & diet, obesity treatment