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Diving Medicine Opinion

Lose Weight Forever!

It’s a simple formula: burn more calories than you absorb

By Dr. David Sawatzky


In the last column I wrote about obesity, the advantages and disadvantages in relation to diving.  The bottom line was that obesity significantly increases the risks in a diver.  The problem is that most people who have stored too much energy as fat seem to be incapable of losing it and keeping it off.  In this column I will share my observations and opinions on this problem.  These are not based on ‘hard science’ but on several decades of observation and a reasonably good understanding of physiology (I have a M.Sc. in Exercise Physiology).

So what is the problem?  Why do people gain excessive amounts of weight and why do they have so much trouble losing it and keeping it off?

The bottom line is that a person’s weight is determined by only two things: the number of calories they eat (absorb) and the number of calories they burn.  The number of calories you burn is determined by the metabolic activity of your body and the amount of activity/exercise you perform.

“I Have a Glandular Problem”

For my entire life I have heard, “I’m fat because I have a glandular problem,” so let’s deal with that one right up front.  Your basic metabolic rate, or the amount of energy you burn when you are doing nothing, is determined by the level of thyroxin in your body. This hormone is produced by the thyroid gland.

If your thyroid produces less of this hormone than you need, you can gain a lot of weight in a short period of time.  You will also be sleepy, lethargic, very sensitive to the cold, etc. (see my column in this magazine, Nov 2002). This problem can come on quite suddenly. One of my friends gained 50 pounds (22 kg) in a few months before she was diagnosed with hypothyroidism and treated.

Hypothyroidism is relatively common but it is easy to diagnose (simple blood test) and it is usually easy to treat by taking a pill containing the hormone thyroxin once a day. Once a person who is hypothyroid has been diagnosed and treated, the level of thyroxin in their bodies will be normal. Therefore, “I’m fat because I have a glandular problem” is NEVER a valid reason to be overweight.

At the same time, excessive thyroxin will make you quite ill (usually worse than too little thyroxin). Taking stimulants like caffeine, ephedrine, etc. to try to lose weight is also a very bad idea and not healthy.

“I Can’t Exercise”

Another common excuse I hear from obese people is “I’m fat because I can’t exercise” or “I gained the weight when I stopped exercising”.  Exercise is very important and we should all get as much exercise as we can. However, the fact is that most of us cannot or will not exercise enough to have much of an effect on our weight.

Don’t get me wrong, I strongly support exercise and personally try to get 30-45 minutes of aerobic exercise plus stretching and resistance training every day.  However, the number of calories we burn doing this amount of exercise is unlikely to have much effect on our weight.  It is VERY easy to eat the number of calories we burn exercising and therefore not lose a pound.

For example, the average person who is fit enough to run for an hour will burn approximately the same number of calories as are contained in one hamburger (no fries, no drink and no desert). Stated the other way around, depending on how fast you can run, you will have to run for five to ten hours to burn the number of calories stored in one pound (0.5 kg) of fat!  If I go to the gym and work out, hard, for an hour every work day I will burn roughly the same number of calories as are stored in one pound (0.5 kg) of fat, in a week.

Habits Hijack Diets

There are thousands of diets and books on how to lose weight.  So how come most people are unsuccessful?  I offer the following opinions.

How we live is a habit.  Habits take two to three years to change.  We weigh what we weigh because of how we live. Almost no one starts a diet planning on following it for more than three years. Therefore, even if they manage to lose weight, as soon as they go off the diet they instinctively go back to living the way they used to and as a result their weight returns to the pre-diet level, or more. The final result of most diets is no change in weight or an increase in weight. So what do we do?

I am a strong believer in “what works, works”. Therefore, if you have found a way to take off the pounds and keep them off that works for you, fantastic, keep at it. The diet that diabetics should follow is the healthiest way to eat that I know of. If you educate yourself and follow it, you should lose weight. Weight Watchers and other similar programs provide advice, peer pressure and support in weight loss. If this works for you, awesome.  However, be prepared to continue with the program for the rest of your life.  If these approaches don’t work for you, consider the following:

The majority of people who are overweight don’t eat breakfast. Calories consumed early in the day tend to get burned, those being metabolized while we are asleep go straight into storage as fat. Therefore, eat something when you get up in the morning (bowl of non-sweet cereal and a glass of juice) and more importantly, don’t consume any calories within five hours of going to bed at night. Ideally the noon meal should be the largest of the day but for most of us that does not fit our lifestyles. Either way, the evening meal should be small and early.

The Bad News

What should you eat? Simple sugars are bad news. If it tastes sweet it is almost certainly not good for you.  Simple sugars are rapidly absorbed and result in a swift rise in the level of glucose in the blood. Our bodies respond by releasing insulin into the blood to allow our cells to use the glucose and lower the level. The problem is that simple sugars are rapidly cleared but the insulin remains and drives the level of glucose in our blood to a low level.  As a result we feel very hungry and eat more. The solution is to never have things that taste sweet in the house and to very seldom buy them when you are out.

What tastes good is what we have been eating for the previous three years. If you avoid simple sugars for three years, they will stop tasting good. I cannot eat many common breakfast cereals (Alphabets, Multigrain Cheerios, etc. because they taste way too sweet). If you don’t eat sweets at home, you can eat a few when you are at a party, etc. as that should not happen often enough to matter.

Most of us eat four to five times more protein than we can use as amino acid building blocks. When protein is metabolized to generate energy, many waste products are produced that our bodies have to get rid of.  Protein always contains fat and fat has three times as many calories per unit weight as carbohydrates and protein. Therefore, eat whatever kind of meat you want but keep the servings small. It is healthy to have a few days in the week where you don’t eat any meat.

Complex carbohydrates (bread, pasta, cereals, vegetables, etc.) are molecules made up of hundreds or thousands of simple sugars all hooked together. Our bodies metabolize them by cutting one sugar off at a time.  As a result the sugar trickles into the blood, the levels in the blood do not rise quickly and our bodies only add a very small amount of insulin. In addition, carbohydrates are the perfect food in that we metabolize them into carbon-dioxide (that we breathe out), water, and energy.  The only problem is that complex carbohydrates do contain quite a few calories so you need to keep the serving sizes reasonable. Vegetables are an excellent source of complex carbohydrates and fiber. Fruits are also a good source of fiber but they do contain simple sugars, so too much fruit is not healthy.

Weight and Loss

How much should you weigh? There are lots of scales and charts but the easiest benchmark I have found is the thickness of the largest skinfold near the umbilicus (belly button). It should be under an inch (2.5 cm) in men and less than 1.5 inches (3.5 cm) in women.  A perfect weight is likely a bit less but this is a reasonable and highly achievable goal for most people.  I started telling this to patients several months ago when I returned to full-time clinical practice. The problem was that my own ‘jelly roll’ was just over an inch.  I try very hard to ‘practice what I preach’ so I lost weight until my own ‘jellyroll’ was less than an inch by following the advice in this column.  I will maintain my current weight for now (three months so far) but may decide to become even lighter in the future.

The final problem is how quickly should we lose weight?  The answer is one pound (0.5 kg) a week.  Losing weight at that rate allows our bodies to adapt and is consistent with a change in the way we live that we can continue forever.  The most effective way I have found to do this is to jump on the scale every morning when I get out of the shower.  Every week I have a target weight, and I recommend writing it on a calendar.  If my morning weight is higher than my target weight, I have to eat less.  If my morning weight is my target weight, life is good.  If my weight is less than my target weight for that week, I can eat a little more.  I follow the same process to maintain my target weight.  After three years this way of living will become a habit.

Losing weight and keeping it off does not have to be complicated.  Eat breakfast, don’t eat anything within five hours of going to bed (water is good).  Avoid things that taste sweet and don’t have them in the house.  Reduce the amount of protein and fat in your diet and eat complex carbohydrates, vegetables, and fruit (in moderation).  Weigh yourself every morning and ensure you hit your target weight at least once every week.  Finally, get as much exercise as you can and don’t forget: diving is good exercise!



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