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Naturopath Teresa Mitchell-Paterson shines a light on the real reasons you can't lose weight. Many clients are adamant that they cannot lose weight. However, as a practitioner I can honestly say I’ve never had a patient who – once we get down to the nitty-gritty and uncover the reason why they’re having difficulty – cannot achieve weight loss.

1. Portion size Weigh your food as it’s too easy to overeat when you don’t. Meat and fish should be about the size of your palm, or around 100 grams, says Barbara J. Rolls PhD, Professor of Nutritional Sciences at Pennsylvania State University. Fill the rest of your plate with vegetables and salad – and ideally downsize to a smaller plate. Or to put it another way: your plate should be one-third protein and two-thirds vegetables. Vegetables are very satisfying because they contain fibre, which helps us feel full. Use a measured amount of olive oil and boost flavour with herbs, spices and lemon juice.
A lean protein portion – less than 10 percent fat – can save hundreds of kilojoules when you consider one gram of carbohydrate and protein contains 17kJ, compared to 39kJ for one gram of fat. Vegetarians and or vegans should ensure their bean and grain combinations are also low fat. If attending an event where finger food or a buffet is served, eat before you leave home: a small bowl of vegetable soup, a salad, or a piece of fruit will take the edge off your appetite, and Rolls’ research suggests you’ll eat up to 20 percent less.

2. Alcohol That cheeky little red you enjoy with dinner may be sneakily super-glueing those extra centimetres to your hips. The 520 kilojoules ingested from a 150ml glass of wine can take 20 minutes of high-impact aerobics to burn. However, alcohol slows the process by which your body burns fat: alcohol kilojoules are not stored but converted to acetate, something the human body will preferentially burn before it burns fat, which negates your dieting and exercise efforts. There’s more. When you drink alcohol you may become uninhibited, which can lessen your willpower, stimulate your appetite and prompt you to eat the wrong food or eat more than you planned. A Danish study reported in International Journal of Obesity and Related Metabolic Disorders looked at two groups of men: one group was given a meal, the other a meal and alcohol – and the group drinking alcohol ate much more.

3. Macronutrient intake Most research confirms that reducing overall kilojoules and increasing exercise is the key to weight loss. However, a recent trial suggests the type of food eaten improves other body functions as well as encouraging weight loss. A high-protein, low-carbohydrate regimen lowers total and waist fat mass; it also improves fasting glucose and therefore insulin sensitivity, lowers cholesterol and improves triglycerides. Higher protein kilojoules and reduced carbohydrate kilojoules improve total and lean body mass and - importantly in postmenopausal women - reduce visceral fat and increase muscle tissue.

4. Exercise It’s critical! Research suggests that body mass index (BMI), waist circumference, and body fat percentage are reduced with lifestyle changes involving both diet and exercise. While there are many views as to which exercise is best, a 10 percent weight loss can be achieved with a gradual escalation over a year of 45 minutes of aerobic exercise five days per week. The expected weight loss over four months can be as much as 11kg when diet and exercise are combined, and this combination leads to more fat loss and reduced waist circumference.

5. Sleep: When you lack sleep your body believes it’s facing additional waking hours and signals the brain to eat more to fuel those extra hours! By sleeping less you program your body to eat more, according to Deborah Malkoff-Cohen, registered dietitian and certified diabetes educator. To prove the point, people with sleep apnoea are generally overweight, particularly around the waist. While the mechanism is poorly understood, it is known that poor sleep affects insulin, leading to resistance. When you’re tired you may grab unhealthy food because it’s quick and the body is demanding extra kilojoules. And in a vicious cycle, you eat more but are too tired to exercise.

6. Age The older we get the fewer kilojoules we need. This is largely due to a loss of muscle mass (sarcopenia), which is normal with the ageing process. From age 40, we need to reduce our kilojoule intake by five to 10 percent every decade, or increase our exercise routine by five to 10 percent to compensate.

7. Gut microbe diversity It appears the diversity of our gut microbes influences our weight. In animal trials, those with gut bacteria associated with the Ruminococcaceae and Lachnospiraceae species had less weight gain, while the Bacteriodes and low diversity of other species were associated with weight gain, independent of energy intake. A diet that includes a broad range of probiotics, nourished with prebiotics (higher fibre intake), can boost weight loss.

8. Smoking It’s a lose-lose situation: women who smoke may shed weight, but tend to put on more fat around their waist compared to women who don't smoke. Often weight gain occurs after giving up smoking due to a slower metabolism, as smoking increases the metabolic rate by approximately 418 kilojoules per day. Weight gain is typically about one kilogram per month in the first three months, but slows over time provided a sensible diet and exercise routine is followed.

9. Neuropeptide Y This hormone is switched on with the consumption of refined carbohydrates as a survival technique to make you eat more and store energy (fat). Protein, fat, fibre, and whole fruit and vegetables don't have this impact on neuropeptide Y.

10. Rushed meal times Setting the scene for a relaxed lunch or dinner can reduce your food intake by up to 18 percent. A research team led by Brian Wansink PhD looked at two types of restaurants, one with mellow music and dim lights, the other with loud music and bright lights. While the participants did not change what they ordered, the relaxed diners ate less, ate for longer, and enjoyed their meal more.

Teresa Mitchell-Paterson BHSc(CompSci) MHSc(HumNut) AdvDipNat is a member of the Australian Traditional Medicine Society. www.atms.com.au