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Achieving a Healthy Weight

Introduction  

Achieving and maintaining a healthy weight can improve your quality of life and enhance both your physical and mental well-being. Unhealthy weight is also commonly associated with musculoskeletal injury and conditions such as back and joint pain.  

For adults, the World Health Organisation defines overweight and obesity as follows: 

  • overweight is a Body Mass Index greater than or equal to 25; and 
  • obesity is a Body Mass Index greater than or equal to 30. 

Obesity results from a complex interplay of genetic, environmental, and lifestyle factors. Effectively managing this condition requires a personalised, multifaceted approach. It is crucial to work closely with healthcare professionals who can develop a weight management plan that best suits your individual needs, ensuring its effectiveness and sustainability. 

This guide takes you through the critical components of a successful weight management program. By understanding and applying these strategies, you can significantly enhance your health and well-being. Engaging with the right support and resources is vital for achieving and maintaining a healthy weight. 

(1) Dietary Management 

  • Introduction to Effective Dietary Management 
  • Key Components of Dietary Interventions 
  • Personalised Dietary Plans 
  • Continuous Glucose Monitoring Systems 

(2) Physical Activity 

  • Importance of Physical Activity in Weight Management 
  • Recommended Types of Physical Activity 
  • Benefits of Regular Exercise 

(3) Monitoring Progress 

  • Techniques for Monitoring Weight Loss and Health Progress 
  • Importance of Regular Health Assessments 

(4) Medication as an Adjunct to Weight Loss 

  • Overview of Available Medications 
  • Detailed Descriptions of Each Medication 
  • Expected Outcomes and Safety Information 

(5) Conclusion 

  • The Role of Multidisciplinary Teams 
  • Continuous Care and Support 
weight loss graphic 1 Achieving a Healthy Weight

Dietary Management  

Managing obesity effectively involves a multi-component strategy that includes a balanced and nutritionally complete diet, behavioural adjustments, and regular physical activity. This approach is designed to create a calorie deficit whilst ensuring nutritional needs are fully met, typically involving a reduction of about 600 calories per day from your usual intake. 

Components of Dietary Interventions:  

Balanced Nutrition: Focus on incorporating a diverse range of food groups, including fruits, vegetables, and whole grains. Aim to avoid high-fat and high-sugar foods to help manage calorie intake. 

Personalised Plans: Tailor dietary changes to suit individual food preferences and lifestyles, allowing for flexibility. This helps maintain the diet long-term without feeling deprived. 

Avoid Restrictive Diets: Extremely low-calorie diets are generally not recommended as they can be nutritionally inadequate and unsustainable. Opt instead for moderate calorie reduction combined with nutritional balance. 

Self-Monitoring: Keep track of dietary intake and progress through calorie tracking apps, which help monitor you’re eating habits and maintain accountability. 

Professional Guidance: Consulting with dietitians is highly recommended, as they can provide valuable insights into meal planning and ensuring that your diet is balanced and tailored to your specific health needs. They also play a crucial role in motivating and educating patients about healthy eating practices and lifestyle changes. 

Continuous Glucose Monitoring (CGM) Systems: Continuous glucose monitoring provides real-time insights into how dietary choices affect blood sugar levels. It allows for personalised adjustments to maintain stable glucose levels, which can influence appetite control and metabolic health. CGM systems offer immediate feedback, enabling informed dietary decisions and enhancing compliance with dietary plans. Through regular monitoring and interpretation of data, healthcare providers can tailor dietary advice, educate patients about glycaemic impact, and promote better glucose control, thereby supporting effective weight management strategies. 

nutrition Achieving a Healthy Weight

Physical Activity  

Physical activity plays a crucial role in managing obesity, offering numerous health benefits that go beyond weight loss. Regular exercise significantly enhances cardiovascular health, psychological well-being, bone health and reduces risk of diseases such as diabetes. 

Recommended Types of Physical Activity:  

Aerobic Exercise: Do physical activity you enjoy, with an aim to undertake at least 150 minutes per week at a moderate intensity or 75 minutes at a vigorous intensity. Pace yourself – start slowly and increase duration gradually. 

Resistance Training: Incorporating strength training exercises helps build muscle mass and support joint health. Aim to include muscle strengthening activities on 2 days per week. 

Flexibility and Balance Exercises: Practices like yoga and pilates improve flexibility, and support overall function. 

Use of Technology in Promoting Physical Activity: Digital tools and wearable devices can effectively promote engagement in physical activity. These tools can be beneficial in tracking progress, providing motivational support, and adjusting goals as needed. 

Role of Healthcare Providers: Sport and exercise medicine specialists can play a significant role in integrating physical activity into healthcare management for obese patients. They work within multidisciplinary teams to provide personalised exercise prescriptions and monitor progress. 

Incorporating regular physical activity into your weight management plan is not only crucial for your physical health but also significantly enhances mental well-being. When starting, choose activities that you enjoy, which could range from walking and cycling to more structured gym sessions, to ensure long-term engagement. Begin at a comfortable pace and gradually increase the intensity and duration as your fitness improves. This approach helps build a sustainable habit, making the health benefits more lasting. Immediate improvements often include enhanced mood, higher energy levels, and better sleep, all of which contribute positively to your overall quality of life. Tailoring the activities to fit your individual capabilities and preferences is key, as personalised plans tend to be more effective and enjoyable. 

excercise group Achieving a Healthy Weight

Monitoring Progress  

Monitoring progress in a weight management program is helps evaluate the effectiveness of the and guide necessary adjustments. Various methods can be used to track progress, each offering unique insights: 

Body Weight Measurements: The most direct method of monitoring progress is regular weighing. It’s recommended to weigh at the same time of day, preferably in the morning, to reduce variability.  

Body Composition Analysis: Tools like Dual-Energy X-ray Absorptiometry (DEXA) scans, bioelectrical impedance analysis (BIA), and skinfold measurements provide more detailed information about body composition, including fat mass, lean mass, and bone density. These metrics can show changes that are not reflected in body weight alone. 

Health Markers: Blood pressure, cholesterol levels, blood sugar levels, and other metabolic markers are crucial for understanding the health impact of weight loss, especially for those with or at risk for chronic diseases. 

Physical Fitness Tests: Assessments such as the six-minute walk test, step tests, or specific strength and flexibility tests can track improvements in physical fitness, which is an important aspect of health not always related directly to weight loss. 

Wearable Technology: Devices like fitness trackers and smartwatches can monitor physical activity levels, sleep quality, heart rate, and even provide estimates of calorie burn. These devices can help in setting and maintaining fitness goals. 

Psychological and Behavioural Assessments: Surveys and questionnaires can assess changes in dietary habits, physical activity, and psychological aspects such as motivation and self-esteem, which are important for long-term weight management success. 

Digital Applications: Many smartphone apps allow users to track their dietary intake, physical activity, and weight changes over time. They can offer personalised feedback and support adherence to dietary and activity recommendations. 

Medication  

For some individuals medication is used to aid weight loss when desired goal is not achieved through lifestyle measures alone. Medications should always be used under close medical supervision, with regular follow-ups to adjust doses and manage any side effects.  

Orlistat  

Introduction  

Orlistat is approved for adults with a body mass index (BMI) of 28 or more with associated health conditions or a BMI of 30 or more. It is taken orally, usually three times a day with each main meal that contains fat. 

How Orlistat Works  

Orlistat is a medication that helps with weight loss by acting in your stomach and small intestine. It targets the enzymes called lipases, which your body uses to break down fats in the foods you eat. 

Enzyme Inhibition: Orlistat attaches to the lipases, preventing them from breaking down fats into smaller, absorbable components. 

Fat Excretion: Because these fats cannot be broken down, they are not absorbed by your body. Instead, they pass through your system undigested. 

Calorie Reduction: By preventing fat absorption, Orlistat reduces the number of calories your body absorbs, helping to promote weight loss. 

Expected Weight Loss  

A typical dose of Orlistat can block about 30% of the fat from the food you eat from being absorbed. When using Orlistat as part of a weight management program that includes a reduced-calorie diet and regular physical activity, it is generally expected that you can lose about 5% of your body weight within the first three months.  

Side Effects Common side effects include: Fatty or oily stools, Urgent or increased need to open the bowels, Oily discharge, which may stain clothing 

Contraception: Women taking the oral contraceptive pill should use additional contraception if they experience severe diarrhoea, as Orlistat can affect the pill’s absorption. 

Other health conditions and medications: A review with healthcare professional is required as adjustments may be necessary. 

Tirzepatide  

Introduction   

Tirzepatide, available under the brand name Mounjaro is a medication licensed for weight loss in adults with a BMI 27-30 with health-related conditions or a BMI of 30 or more. It is self-administered as an injection once a week.  

How Tirzepatide Works  

Tirzepatide helps in weight management and blood sugar control by interacting with hormones known as incretins. Incretins, specifically GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide), are hormones released from your gut after eating. They play a crucial role in managing blood glucose levels. 

GLP-1 Activation : By mimicking GLP-1, Tirzepatide enhances the body’s natural response to high blood sugar. It boosts insulin production from the pancreas when blood sugar levels rise, which helps in transporting sugar into your cells, thus lowering blood sugar levels. 

GIP Activation : Tirzepatide also activates GIP receptors, which complement the actions of GLP-1. This dual activation leads to a more potent insulin release and additionally helps in reducing appetite and slowing gastric emptying, which makes you feel full longer after meals. 

Overall Benefits of Incretin Activation : The interaction with incretin hormones helps improve blood sugar control and promotes weight loss by reducing appetite and caloric intake. This mechanism makes Tirzepatide an effective treatment for managing obesity alongside type 2 diabetes. 

Expected Weight Loss  

Clinical trials, such as the SURMOUNT-1 and SURMOUNT-2 studies, have shown significant weight loss in patients using tirzepatide. For example, in the SURMOUNT-1 trial, average weight reductions of 16.0% for the 5 mg dose, 21.4% for the 10 mg dose, and 22.5% for the 15 mg dose were observed over 72 weeks compared to 2.4% weight loss with placebo. These trials indicate that a substantial proportion of patients can achieve clinically meaningful weight loss. 

Side Effects Common side effects include gastrointestinal issues such as nausea, diarrhoea, and vomiting, which generally subside over time.  

Contraception: Women who are using oral contraceptives should consider additional contraceptive methods due to potential interactions with tirzepatide 

Other health conditions and medications: A review with healthcare professional is required as adjustments may be necessary. Tirzepatide delays gastric emptying which may affect absorption of concomitant oral medicines 

Liraglutide  

Introduction  

Liraglutide, available under the brand name Saxenda, is a medication licensed for weight loss in adults with a BMI 27-30 with health-related conditions or a BMI of 30 or more. It is self-administered as an injection once daily. 

How Liraglutide Works  

Liraglutide mimics the action of the naturally occurring hormone GLP-1 (glucagon-like peptide-1). This hormone plays a critical role in regulating your body’s insulin levels and glucose metabolism. Liraglutide works in several ways: 

Appetite Regulation : By acting on receptors in the brain that control appetite, Liraglutide helps you feel fuller longer and reduces hunger, which leads to a decrease in overall calorie intake. 

Insulin Release : It promotes the release of insulin, a hormone that helps lower blood sugar levels, when there is an increase in blood glucose. 

Slows Digestion : Liraglutide slows down gastric emptying, meaning food passes more slowly through your stomach, which helps you feel full longer. 

Expected Weight Loss  

Liraglutide, when used for weight management, typically results in significant weight loss when accompanied by a reduced-calorie diet and increased physical activity. Clinical studies have shown that individuals using liraglutide may lose 5% to 10% of their body weight. In a substantial clinical study (SCALE trial), about 54.3% of participants lost at least 5% of their body weight, 

Side Effects Common side effects include gastrointestinal disturbances such as nausea, vomiting, diarrhoea, and constipation. Serious but less common side effects may include pancreatic inflammation (pancreatitis). 

Other health conditions and medications: A review with healthcare professional is required as adjustments may be necessary.  

Safety Precautions: Avoid use if there is a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2. 

Semaglutide  

Introduction  

Semaglutide, available under the brand name Wegovy, is a medication licensed for weight loss in adults with a BMI 27-30 with health-related conditions or a BMI of 30 or more. It is self-administered as an injection once a week. 

How Semaglutide Works  

Semaglutide mimics the action of the naturally occurring hormone GLP-1 (glucagon-like peptide-1). This hormone plays a critical role in regulating your body’s insulin levels and glucose metabolism. Liraglutide works in several ways: 

Appetite Regulation : By acting on receptors in the brain that control appetite, Liraglutide helps you feel fuller longer and reduces hunger, which leads to a decrease in overall calorie intake. 

Insulin Release : It promotes the release of insulin, a hormone that helps lower blood sugar levels, when there is an increase in blood glucose. 

Slows Digestion : Liraglutide slows down gastric emptying, meaning food passes more slowly through your stomach, which helps you feel full longer. 

Expected Weight Loss  

Semaglutide has been noted for its higher efficacy in reducing blood glucose levels and body weight in clinical comparisons to liraglutide. Significant weight loss is typically seen when accompanied by a reduced-calorie diet and increased physical activity. A high percentage of individuals in clinical trials have achieved at least 5% weight loss, with many reaching even higher thresholds. For example, in the STEP 5 trial, patients achieved an average weight loss of 15.2% at 104 weeks. Over 86% of patients lost at least 5% of their body weight and more than 55% lost at least 15% of their initial body weight. These figures represent some of the highest efficacy rates among currently available weight loss medications. 

Side Effects Common side effects include gastrointestinal disturbances such as nausea, vomiting, diarrhoea, and constipation. Serious but less common side effects may include pancreatic inflammation (pancreatitis). 

Other health conditions and medications: A review with healthcare professional is required as adjustments may be necessary.  

Safety Precautions: Regular monitoring is required.  

Emerging medications  

Several new weight loss medications will likely soon beavailable in the UK: 

Zepbound : This new weight-loss drug has been recently approved in the US and is expected to be available more widely in 2024.  

Amycretin : Has shown promising early results in clinical trials, potentially offering more effective weight loss outcomes than the company’s established treatments like semaglutide . 

Conclusion  

  • The London Bridge Weight Management Programme offers a comprehensive approach tailored to weight management.  
  • We combine tailored dietary and exercise advice with advanced monitoring techniques, like DEXA scans, to ensure effective weight loss while maintaining muscle strength.  
  • Medications are prescribed as needed to aid in achieving weight management objectives.  
  • With consistent reviews and adjustments, the programme is designed to provide long-term success in weight management and an enhanced quality of life. 

Please call the London Bridge Sports Medicine team if you require any further information.  

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    Orla Mulligan
    Administration and Social Media Manager
    Administration, LBSM

    Orla Mulligan is the administration and social media manager for LBSM. She has a strong background in sport having herself played netball at an elite standard for the U21s Northern Ireland team in the European Championships as well as the U21s competition for Saracen Mavericks.

    She understands youth sport pathways having herself played and training in the netball Kent regional pathway. She has a keen interest in most sports and a good understanding of how injury and illness can impact on the mind and body, as well as rehabilitation pathways.

    She looks forward to speaking and assisting LBSM patients and gives her best support to them during their treatment pathway.

    A day in the life of Orla involves communicating with patients via phone and email, managing and organising clinics, operations and media management.

    Outside of work, Orla is a gym enthusiast, enjoys tennis and still finds the time for an occasional game of netball.

    Maddie Tait
    BSc, MSc
    Associate, LBSM
    Musculoskeletal and Sports Podiatrist

    Maddie treats and manages complex foot and ankle injuries in London and Surrey.

    She is particularly interested in helping her patients improve their quality of life and achieve their personal goals, working closely with Foot and Ankle Consultants, Sports Medicine Doctors and Physiotherapists.

    Maddie has a sporting background herself having previously represented England in Hockey. She understands the demands of elite sport and the importance of physical and mental health. In her spare time, Maddie continues to enjoy an active lifestyle by running, cycling and attending a Pilates class.

    Having graduated from University of Brighton with a MSc (hons) in Podiatry, Maddie focused her career in Podiatric Sports Injuries and Biomechanics. Previously she completed a BSc (hons) in Sport Science at Loughborough University.

    A day in the life of Maddie involves consulting patients in clinic, performing gait and biomechanical assessments, measuring and fitting orthotics and braces. She also regularly teaches and presents at sports medicine and podiatry conferences.

    Outside of work, Maddie still finds time to play hockey and enjoys running and skiing.

    Mr Prakash Saha
    MBBS, PhD, FRCS
    Consultant Partner, LBSM
    Consultant in Vascular Surgery

    Mr Prakash Saha is a Consultant Vascular Surgeon at LBSM. He takes pride in providing the best possible results for his patients by using the most appropriate non-surgical and surgical methods based on clinical evidence, patient results and satisfaction.

    He treats fit and active people suffering with a range of cardiovascular issues, from painful leg swelling associated with exercise to venous insufficiency, post-thrombotic syndrome and leg ulcers. He also treats people with arterial system problems including poor circulation, compression syndromes and aneurysms. He carries out both endovascular and open aortic repair and has some of the best outcomes in the country.

    Mr Saha studied medicine at the United Medical & Dental Schools at Guy’s and St. Thomas’ Hospitals before completing his higher surgical training in London and the South East. During this time, he was awarded the prestigious NIHR Clinical Lectureship in Vascular Surgery at St. Thomas’ Hospital, giving him comprehensive training in open and endovascular techniques for treating arterial and venous disease. Prakash completed his aortic surgery training at the St. George’s Vascular Institute before carrying out a specialist fellowship at the Royal Prince Alfred Hospital, Sydney.

    Mr Saha regularly lectures and runs workshops across the globe on the latest surgical techniques to treat vascular disease. He has also been awarded a number of research grants from the Royal College of Surgeons, the Circulation Foundation, the Wellcome Trust, the Academy of Medical Sciences, and the British Heart Foundation, which has led to over 80 publications and the development of innovative technologies to help treat patients. For this work, Prakash has received a number of prizes, including the Venous Forum prize from the Vascular Society of Great Britain and Ireland, an International Young Investigator Award, and an Early Career Investigator Award from the American Heart Association.

    A day in the life of Mr Saha involves seeing patients in clinic, operating in surgical theatre or lecturing at his university. He also regularly teaches and presents at vascular and sports medicine conferences.

    Mr Saha is an avid cyclist and tennis player (although yet to get a set of Dr Seth!). Outside of work, he spends time with his family who consists of 3 children and enjoys travelling.

    Dr Gajan Rajeswaran
    MBBS, FRCR
    Consultant Partner, LBSM
    Consultant in Sports and Musculoskeletal Radiology

    Dr Gajan Rajeswaran is a Consultant Musculoskeletal Radiologist at LBSM, with an extensive background of working in elite sport. He is one of the most recognised radiologists in the sports medicine field. He provides top level imaging and medical diagnostic services for patients and athletes.

    Dr Gajan Rajeswaran completed his undergraduate medical training at Imperial College London and his radiology training at Chelsea & Westminster Hospital. He has obtained two post-CCT fellowships in musculoskeletal imaging. He was appointed as a consultant at Chelsea & Westminster Hospital in 2011.

    He has a passion for all sports having worked as a radiologist at the Glasgow Commonwealth Games and London World Athletic Championships and continues to support The Championships, Wimbledon. He also continues to work with a number of Premier League and Championship Football Clubs, Premier League Rugby Clubs, England Sevens Rugby, British Athletics and the Lawn Tennis Association.

    A day in the life of Dr Rajeswaran involves giving his expert opinion on investigations such as MRI and CT scans, x-rays and ultrasound. He also performs injection lists under ultrasound, CT and X-ray including spinal injections. He also regularly teaches and presents at sports medicine conferences.

    Dr Gajan Rajeswaran is an avid football fan and life-long fan of Tottenham Hotspur (for which he offers no apologies!). Outside of work, he spends time with his family and has a keen passion for photography.

    Dr Ajai Seth
    MBBS, BSc, MSc, MRCS, MRCGP, FFSEM
    Medical Director, LBSM
    Consultant in Sport and Exercise Medicine

    Dr Ajai Seth is a Sport and Exercise Medicine Physician. He has dedicated his career to helping people with sport and exercise related injury and illness. He consults and treats everyone from the elite athlete to the weekend warrior.

    Dr Ajai Seth is part of the British Tennis Sports Physician team at the LTA and has also provided cover to elite athletes at Wimbledon Tennis, European Tour Golf, Premier League Football, British Athletics, and the Men’s England Football academies as part of the FA.

    He also prides himself for working in disability sport and is currently the Chief Medical Officer for Team GB Wheelchair Tennis which has taken him to the Olympics and Paralympics.

    Dr Ajai Seth is dedicated to education, training and research and is a Senior Lecturer in Sports Medicine at King’s College London where he lectures in all aspects of Sports Medicine and Science.

    He also has a passion for travel and Expedition Medicine, which has seen him accompany medical, scientific and charity expeditions all around the world. He also has vast experience in treating musculoskeletal injuries from children and adolescents to veteran exercisers, both male and female.

    Dr Seth also has positions in leading Sport Medicine organisations, including the non-executive board for the UK’s largest Sports Medicine charity, BASEM and Past President for the Royal Society of Medicine. 

    A day in the working life of Dr Seth involves consulting his patients in clinic, performing diagnostics and ultrasound guided injections. He also regularly lectures and tutors students and presents at sports medicine conferences internationally. He also spends part of the working week at the National Tennis Centre, LTA, supporting British Tennis players.

    Outside of work, Dr Seth enjoys playing club tennis, triathlon, golf, running and skiing (but will give any sport a go!). He enjoys keeping fit and active and good quality family time with his wife and three children.