The ‘science’ behind sustained weight loss and management

Being a fan of the keto — low carb, high fat — diet, I was interested to read what an endocrinologist at Imperial College London’s Weight Centre discovered about weight loss and maintenance over the past six years, particularly during lockdown.

On March 28, 2022, The Telegraph featured Dr Saira Hameed’s findings: ‘How to lose weight — according to science’.

She developed the Imperial Satiety Protocol, the I-SatPro, six years ago. Her new book, The Full Diet, describes the protocol in detail. It involves more than food, delving into gut bacteria, sleep and exercise, too (emphases mine):

… she set up the I-SatPro (Imperial Satiety Protocol) six years ago, a fortnightly programme at her clinic, convinced that “if you share the science,” being able to “understand how your body works” could lead to lasting physical change. That programme is recreated in her new book, The Full Diet, which she believes can match the 14 per cent weight loss rate at her in-patient clinic.

The programme’s approach is both full and full-on: from food to movement, sleep, gut bacteria and exercise, all bases are covered. Like everything else in the world, I-SatPro went virtual when Covid hit – which was something of a blessing, Dr Hameed says, because the 14 fortnightly sessions, previously restricted to whatever room wasn’t booked up at Imperial, had their reach expanded significantly. There is no typical patient in each 15-strong cohort, though three-quarters are women (reflective of referrals generally for weight loss): their ages run from late teens to those in their 80s, from all walks of life, with a BMI upwards of 35. Dr Hameed says she stopped reading fiction two decades ago, when she became a doctor, because “my patients’ stories are more interesting”. 

It turns out that Dr Hameed’s findings on food are remarkably similar to the keto diet:

One of the reasons we have got fat, she thinks, is by cutting out fat (which is “delicious. Wouldn’t you rather eat the crispy skin as well as the roast chicken or sauté your vegetables in butter rather than eating them with a low-fat dressing?”), and “satisfying”. Eating creamy Greek yogurt, full of natural fats, both can’t be overdone and feels substantial; fullness being a key trait for stopping overeating.

Awareness of ghrelin, the hunger hormone, demonstrates the importance of the relationship between gut and brain – one modern ultra-processed foods are designed to derail even more. High sugar, high salt products with unrecognisable ingredient lists are the go-to for emotionally-driven eating – which Dr Hameed describes as “one of the biggest burdens” to all weight-loss treatments – and the fact it now makes up more than 50 per cent of our diets is a major cause for concern. Stick with one-ingredient foods, such as eggs, fish and nuts, and that issue goes away.

That said, she advocates eating only when hungry, because consuming anything too often — including protein — will lead to high insulin levels that convert fuel into fat storage:

Dr Hameed was on the Covid frontline until the summer of 2020 when she became pregnant with her fourth child: she believes most people “want to do the right thing” when it comes to protecting their health – particularly since the pandemic – but are often battling a tide of misinformation. One of the most common is around breakfast – which her patients routinely tell her they “know” is the most important meal of the day, and thus eat in spite of not being hungry. She tells them instead to wait until biology causes their hunger hormone to kick in, and to see each day’s food intake through the lens of an “eating window”.

Consuming anything – even the approved foods listed in the book – means sugar ending up in the blood, upping insulin levels that will convert fuel into fat storage; if we get up at 7am and are in bed by 11pm, that could mean 16 hours of food going in. Those following the programme can choose what their window looks like; either it opens or closes at a certain hour of the day, or lasts for a defined period of time. Not only does this keep insulin levels low – breaking down fat and assisting weight loss, as well as reducing the risk of insulin-driven diseases (such as type 2 diabetes)but it will “give your body the time to carry out essential repairs and resets”

That is so true. Being retired, I eat only once a day, in the evening. I have a normal one-course meal and rarely have dessert.

Hameed has a list of approved and forbidden foodstuffs. That said, there is enough variety for those following the protocol, preventing boredom:

the book’s “Choose Not to Eat List” includes offenders such as bananas, mangoes and grapes, “bread of any kind”, couscous and porridge. But Dr Hameed sees the book as a science-driven sum of parts; at the end of each chapter, like I-SatPro, “you get given a series of choices” which enable readers to decide what to do for themselves. “That element of choice is so, so, so important,” Dr Hameed, 43, says. People need “agency and ownership” over their health – and a plethora of rules “is probably counterproductiveif you give people information about anything, they should be free, then, to make choices about how they implement that in their everyday life. I think that’s the only way it can work, long-term.”

I agree.

However, I do disagree with the prohibition of ‘bread of any kind’. I am a keen bread baker and maintain my own sourdough mix. As long as the bread is fermented — allowed to rise once on the countertop, knocked back, then given time to rise again in the fridge (3°C) for one or two days — it will be fine. The result is a French-style, aerated artisan loaf, which is quite filling, given the holes. Weekend nights are sandwich nights in my house. I haven’t had any problem with weight control with fermented bread.

I do think that commercial bakery bread is a problem, though. That I would avoid.

So, the best bet is to learn how to bake bread at home. It’s cheaper and more satisfying.

But I digress.

Dr Hameed’s book includes simple exercise tips and her patients’ stories, which make it more interesting than a standard diet book:

She prescribes Neat or non-exercise activity thermogenesis; essentially, adding bits of movement to otherwise sedentary tasks. That can be standing on the train (even if there’s a seat); walking around when on a phone call, or offering to fetch something left elsewhere in the house. These are the kinds of small additions on which you can “build until it becomes just a natural part of how you’re living”.

Dr Hameed believes that where The Full Diet has the edge is that it features her patients’ stories. “These are real people with jobs, families, commitments, or with busy, busy lives, who have made it work. And I think that should really encourage the readers that if other real-life people can do it, then I can too”.

I would also recommend drinking three to four glasses of water a day to flush out the system. Incredibly, it will help with weight loss and maintenance.

Dr Hameed’s book goes on sale on March 31. I hope it is a great success.

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