Weight problems FAQs

• See also: The lazy man's guide to weight-loss

What are they?

Weight problems can develop if you put on excess amounts of body fat and become overweight or obese — or if you lose too much body fat and become underweight. Excess fat around the abdomen (often described as a "beer belly" or "beer gut") can be a particular health risk.

What are the main symptoms

Having a Body Mass Index (BMI) outside of the healthy range.

The BMI is currently the international standard for assessing weight. It's based on the observation of a Belgian astronomer, in 1869, that in people of a normal build (e.g. not muscle bound), their weight is proportional to the square of their height.

how you can calculate your BMI

However, because fat stored around the waist is a particular health risk, it's probably more useful simply to take your waist measurement.

Use a tape measure (it's easiest if you get someone to help you) to measure your waist at the belly button and compare it with these values:

• 37 in (94 cm) to 39.9 in (101 cm) — overweight
• 40 in (102 cm) or more — obese

There is no single healthy weight for a given height, but instead there is a broad weight range which reflects the lowest risk of ill health. Worryingly, a slim, firm physique, usually at the lowest end of the healthy weight range, is very much admired in today's culture. This is increasingly causing men to believe they are overweight, when their weight is in fact healthy. It is also generally OK to be in the overweight (but not obese range) range, especially if you exercise and don't smoke.

The health risks of being overweight or obese.

The health risks of being underweight.

What's the risk?

• Currently in the UK around 6 in 10 men are medically defined as overweight and 1 in 6 as obese.
• Obesity in the UK has more than doubled in the past 18 years, and the greatest increase has been amongst men. In fact, the number of obese men has tripled in this period.
• Only 1 man in 25 is medically defined as being underweight.
• Anyone is at risk of becoming obese, but your risk is increased if you:
  • have overweight or obese parents
  • gained excess weight during teenage years or early 20s
  • eat a high-fat diet and do little physical activity.
• Some people are genetically vulnerable, but our environment (lifestyle, eating and exercise habits) has the biggest influence on our risk of becoming obese.
• The risk of being underweight is lower, and is more frequently linked to illness or an eating disorder. But some men will naturally be very slim and quite healthy.

Assess your risk of becoming obese

What causes them?

• There are many possible reasons for the development of weight problems. These may involve a change in work pattern, stress, illness, medication, genetic vulnerability, changing exercise routines — or simply too much of the good life.
• Whatever the reason, weight gain cannot occur unless energy intake (from food and drink) is greater than energy expenditure (via metabolism and physical activity). This extra energy is stored in the body as fat. The opposite is true for weight loss. This basic law of thermodynamics has been thoroughly researched and cannot be disputed!
• People generally gain weight gradually over the years, due to a continuous small energy imbalance. More dramatic weight gain (or loss) is usually associated with a major life change, illness or emotional upheaval, and the effects they can have on food intake and activity levels.
• People who smoke, regularly exceed healthy alcohol limits and/or are inactive increase their risk of abdominal obesity (or a "gut"). Most people gain weight with age (mostly due to being less active and losing muscle mass), and this tends to be mostly extra abdominal fat.
• Research suggests that there is a genetic basis to somewhere between 25% and 40% of obesity. Most of the genes identified to date are linked to regulating appetite, not metabolism. Genes may also influence spontaneous activity levels, food preferences and eating behaviour. However, these genetic factors cannot explain the rapid increase in obesity in the past 20 years.
• Obesity experts consider that a combination of convenient and affordable high-fat diets, and less active lifestyles (thanks to desk jobs, labour-saving devices, cars, and even remote controls) lie behind the nation's ever-expanding waistline.
• Fat promotes weight gain because it makes food tasty and is "energy dense" — it has more than twice the calories of protein and carbohydrate but is not as good at regulating appetite. This means that a high-fat meal or snack does not make you feel as full as quickly as one high in carbohydrate and/or protein, making it easy to overeat high-fat foods.
• An inability to control your eating habits, leading to gross obesity, can be a symptom of deep-seated psychological problems. If this is the case it's impossible to reduce your weight solely by trying to follow a calorie-controlled diet. Ask your GP to refer you to a counseller or clinical psychologist — there's no shame in trying to control your eating habits by any means necessary, and the health and self-esteem benefits are great.

How can I prevent them?

• If you are at high risk of becoming obese then have a think about what you might be able to change. You can't change your genes, but you can change your lifestyle.
• If you are already overweight consider as a main goal not gaining any more weight. Aim to be active and to eat healthily, and even if you don't lose much weight these lifestyle changes will be beneficial for your overall health.
• Staying active helps prevent weight gain by keeping up energy expenditure (to balance energy intake), maintaining or building muscle mass (which optimises metabolic rate), helping manage stress (instead of using food for comfort) and boosting self esteem.
• Move more by:
  • taking the stairs instead of the lift.
  • putting more energy into daily tasks (e.g. simply walking faster or dumping the TV remote).
  • if you work sitting down, getting up for a quick walk around whenever you can.
  • leaving the car and walking or cycling for short trips.
  • achieving a minimum exercise level that benefits health, then gradually building in active leisure time. Choose something you enjoy and that's practical — for example brisk walks, dancing, swimming, cycling, tennis, gardening, martial arts. Aim for 30 minutes of moderate intensity activity (that makes you feel warm and breathe more heavily, but still allows you to hold a conversation), on at least five days a week. If you have a medical condition check with your doctor before changing your level of exercise.
• For more tips on exercise, visit malehealth.co.uk's Healthy Living Centre.
• Eat a lower-fat, fruit- and vegetable-rich diet.
  • Have regular meals — it helps regulate appetite
  • Eat at least five portions of fruit and vegetables each day
  • Base your meals on healthy, carbohydrate-rich foods such as cereals, bread, rice, potatoes, pasta, noodles, and include wholewheat or wholegrain varieties
  • Use low-fat cooking methods — grill, bake, microwave, barbecue, stir-fry, steam, chargrill
  • Buy reduced-fat milk, dairy products, spreads and salad dressings
  • Trim fat from meat, limit fatty processed meat and choose lower-fat ready meals
  • Keep fresh fruit handy for snacks
  • Keep to healthy alcohol limits and take care with sugary drinks and juices
• For more tips on improving your diet, visit malehealth.co.uk's Healthy Living Centre.
• Get in tune with your eating habits. Most people don't simply eat when they are hungry, but do it out of habit (for example, you always sit down to watch TV with a snack) or boredom, or in response to an emotion or situation (for example anger, anxiety, being alone, feeling a bit useless).
• Some people eat so quickly, or on the run, that they eat more than they really want or need.
• Keep a food diary for a week to learn more about your eating habits. Use it to identify problem areas you would like to change and tackle them one at a time. For example, if you always have a large bag of crisps with a can of cola in the afternoon, change to a smaller pack of crisps and a diet cola — then consider having fruit instead sometimes.
• If you are concerned that you eat a lot, or binge, or restrict what you eat to help you get through the day, consider seeking professional help.

Should I see a doctor?

• If you would like general lifestyle advice to help prevent obesity you could arrange to see the practice nurse at your local GP's surgery.
• If you are overweight or obese, and have a family history of heart disease, high blood pressure or diabetes, it's wise to have a general check-up. Ask for a fasting blood glucose test, cholesterol test and blood pressure check.
• If you decide you need to lose or gain weight for your health's sake, and are finding it difficult, ask your doctor to refer you to the local state-registered dietitian or practice nurse for individualised advice and support.
• If you feel you have an eating disorder, or are very distressed by your eating habits, do talk to your doctor. The longer you suffer in silence, the harder it can be to recover. They can keep an eye on any relevant medical problems, and also refer you to local specialists, for example dietitians, counsellors, psychologists or support groups.

What are the main treatments?

• Obesity is now viewed as a medical condition that must be taken seriously.
• Losing large amounts of weight, then keeping it off, is notoriously difficult. Research clearly shows that a modest weight loss of 5—10% of initial body weight brings definite health benefits. It may be easier for people to maintain smaller losses, too. This treatment approach is increasingly used by health professionals. If people then want to lose more weight, they can aim for another 5% step, maintain this for a while, then review.
• The health benefits of losing weight.
• Treatment for obesity addresses three main areas, and should be tailor-made to suit individual needs. Weight-loss goals vary, but typically people aim to lose 1—2 lbs (0.5—1 kg) per week.
  1. Dietary change could involve day-to-day changes, like eating less fat and more fruit and vegetables, and watching portion size. In some cases of extreme obesity milk or formula diets may be used under medical guidance.
  2. Physical activity goals can be set to increase general activity as well as fitness levels, according to people's abilities. Research suggests that the best time to start an exercise programme to enhance your diet is normally about some 6—8 weeks after dieting commences.
  3. A change in eating behaviour is essential to help people make the long-term changes needed to lose weight and keep it off. This can involve help with: knowledge about buying and preparing healthier food; strategies for changing eating habits; maintaining a positive attitude and challenging negative thoughts.
• Other possible treatment options include:
  • Cognitive behavioural therapy, which is a structured approach to re-learning healthy eating behaviours and helping improve self-esteem and personal effectiveness. This is especially useful for people who binge or chronically diet (without long-term success).
  • Prescription weight-control drugs are available for people who are obese, and have not been successful with more conventional approaches. These drugs are not magic answers in themselves, and must be used alongside diet and lifestyle change. Currently only Xenical is available, and this works by blocking absorption of dietary fat by one-third. To avoid side-effects like diarrhoea and bloating, it must be used with a low-fat diet.
  • Surgery is an option for severely obese people with serious health risks, who have not been able to lose weight with other approaches. Stomach "banding" — where a band is wrapped around the stomach using keyhole surgery to reduce the stomach's volume — is now preferred to stomach "stapling". Both methods are not without risk, however, and require people to eat small amounts of food due to the reduced stomach capacity. It doesn't remove the need for willpower either — continuing to eat small volumes of high-calorie foods will not lead to weight loss. People generally lose about one-third of their weight in a year, although long-term success rates are very variable.
• Help with weight maintenance — including relapse prevention techniques — is the next vital step in treatment, and is very often overlooked. This may help explain why so many people regain weight they have lost.

How can I help myself?

• Preventing an unhealthy level of weight gain in the first place is the best aim. It takes some thought, as we live in an "obesogenic" environment — one which encourages us to eat badly and do little!
• If you are overweight or obese, use the information on malehealth.co.uk to assess any potential health risks, your activity level and your lifestyle habits. You have a number of options to choose from: for example, do nothing, get or stay fit, lose some weight, don't gain weight. Work out what's best for you, and use malehealth.co.uk's guidance to give it a go.
• Be realistic about what is a healthy body weight for you. Remember, weight loss of 5—10% brings big health benefits. People are all different shapes and sizes (body shape tends to run in families), and that helps make us unique individuals.
• It's not realistic, for example, to plan to look like the men on the covers of health magazines, or in aftershave ads. Most men don't look like that, and those that do have their own unique body shape, work out constantly (their livelihood depends on it) and may well have their images air-brushed.
• Remember the benefits of staying fit, for both your physical health and youe mental well-being. In fact, being fit improves your health even if you're overweight. Researchers in the USA followed 25,389 men over 19 years and found that men with moderate or high fitness had a lower risk of dying from any cause than men with low fitness, regardless of their BMI.
• If you think you may have an eating disorder seek specialist help. Your doctor or a recognised support group are the best places to start.
• The slimming industry is big business, and comprises books, magazines, clubs, videos, calorie-counted foods, liquid diets and over-the-counter pills and potions. Many are in it for the money, so don't waste yours on them. Beware of any claims that you can lose weight without changing your eating or exercise habits (they don't work), and diets based on weird food restrictions or combinations (they're just low-calorie diets).
• Responsible self-help books or slimming clubs do exist and can be very helpful, but one problem for men is that most are written or designed for women.
• Gaining weight if you are underweight needs the same level of commitment as losing weight, as it too involves sustained lifestyle change. If you are underweight because you intentionally restrict what you eat, or purge in some way, you really need specialist help.

What's the outlook?

• Preventing weight gain can be done. Many men are overweight, but on the positive side, four in ten men are a healthy weight and five in six men aren't obese. Be part of, or help increase, these positive statistics with some simple lifestyle adjustments, and reap the benefits.
• Losing weight and keeping it off is a difficult task, but it can be done. The best indicators for long-term success are to:
  • Have the right motivation — you want to change for you, not for others
  • Think long term and set yourself realistic targets
  • Be more active, and stay that way
  • Know how to choose and prepare a healthy, lower-fat diet that fits your lifestyle
  • Stay on top of negative thoughts that can throw you off course
  • Learn to manage problems without turning to food
  • Address weight increases before they get out of control
  • Have some ongoing support, e.g. from a friend, partner, health professional, health club or weight control group

Who else can help?

• More on losing that gut from the NHS
• More links on weight
• Your doctor or practice nurse for advice and referral to local specialist health professionals or support groups.
• Local health clubs and gyms.

First drafted by Lyndel Costain, a state registered dietitian and nutritionist.