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Too Much to Lose?
O the Oprah Magazine (South Africa edition)

Eat less, exercise more? If it were that easy we’d all be size 8. Here we offer weight loss tools for women who need to drop a lot more than a dress size.

AS HAS BEEN HER habit for the past 16 months, Melanie Moodley, a 36-year-old mother of three, arrives at her weight-loss support group meeting on a Wednesday morning in Cape Town’s southern suburbs. She takes her shoes off and steps onto  the scale. Her friend Lorraine Brown high-fives her; when it’s Lorraine’s turn, they laugh and clap.

The women’s enthusiasm is genuine–they’re safely within their target maintenance zones, and have been for more than a month. Lorraine receives a tiny key for successfully completing six weeks of maintenance, which she snaps on to her key ring as a reminder of the 52 kilograms that she has shed. Melanie will earn hers next week, for the 28 kilograms she has lost.

You could say that a year ago the women were normal–obesity is, after all, the new big thing in South Africa. One out of two South African women is overweight, according to the South African Society for Obesity and Metabolism. With more than a billion overweight adults worldwide, the World Health Organization has declared the situation a global epidemic.

Traditional African cultures in particular are more accepting of, and even encourage, a bit more meat on the bones as a sign of health and wealth. But the health consequences of obesity–defined as a body mass index (BMI) of more than 30–affect us all, regardless of ethnicity. A study by Oxford University researchers published in The Lancet says the seriously obese will die a decade earlier. And those last 10 years of life are likely to be marked by complications like diabetes or hypertension. The good news is that, in most cases, the condition can be addressed by natural means. Although the basic approach – eat less, move more – is simple, it’s clearly not easy. We’ve put together some strategies that are particularly useful for those who have more than a dress size (or two) to lose.

Get to the root of what’s really eating you

For the obese, tackling major lifestyle changes requires a clarity of purpose as well as continued motivation. To maintain major weight loss, the underlying psychological issues that trigger overeating need to be addressed. As Graham Alexander, a Cape Town psychologist who specialises in eating disorders, explains, “Binge eating is not motivated purely by physical motives. There is an emotional hunger that is not eliminated by weight loss.” He routinely sees a profound emptiness and an element of depression in his obese patients. “Eating is about trying to fill a psychological hole.”

Jabulile Zondi, a 49-year-old senior project manager, felt this hole, and began filling it with food when her relationship hit a rocky patch. “I had problems in my marriage during my third pregnancy. I’d go to a restaurant and buy anything just to console myself,” says Jabulile. She’d get takeaways, send out for pizzas and snack on voetkoek. “I didn’t see anything wrong. But after I had my baby, the habit remained. I’m trying to change all those things in my subconscious mind.”

Melanie has a gleam in her eye when she talks about examining her feelings during her weight loss. The process not only led her to make different choices about vegetables – she always made them available to her kids, but didn’t put them on her own plate – but different social choices, too. “I hid my shyness by eating. Then I lost weight, it wasn’t just about cleaning up the outside, but the inside as well. I have made more friends and I go out a lot more now as a result.”

Find support

When The Biggest Loser SA, a reality-TV show with obese contestants competing to see who can lose the most body fat, called Lisa Raleigh to be its personal trainer, she was working with clients at her Durban gym who wanted to lose a few kilograms of baby fat. Suddenly, she was training seven of the largest clients she’d ever had, at once. She spent up to 12 hours per day with them, forging bonds and learning what worked best.

That experience led her to recognise the need for programmes tailored to the unique issues obese men and women face, so she created an obesity clinic. It offers a group course so participants will have support, not only from experts, but also from friends who are sweating it out with them.

“When you get an SMS from your trainer and the others, it’s not so easy to miss the group session,” says Raleigh. However, a trainer doesn’t need to be involved to implement this kind of accountability. Scheduling a walk with a partner has the same effect.

Sense of abundance

One of the classic mistakes dieters make is to limit their food intake too severely – and then overeat a bit later. Long-term results from quickie solutions are not positive. In fact, it wreaks havoc with your metabolism.

“Restrictive dieting is threatening to a healthy metabolic rate and leads to weight gain,” says Alexander. Yo-you dieters who go for quick fixes are the ones who often lose 20 kilograms, then gain back 23, lose 10, gain 12 … you can see how this adds up in the end.

Ellas Moran, who went from a size 26 to a 12, knows first-hand how curbing foods early in the day leads to overeating later. When she was obese, she “could go days with just coffee in the morning and a few sweets during the day.”

Ellas has since learnt to fortify herself with wholesome foods throughout the day. It’s usually eggs and toast, mid-morning yoghurt and fruit, veggies and sala–and on and on. “I don’t think I’ve ever eaten so much!”

Shifting the focus from exclusion to inclusion is a kinder and more successful way to treat yourself. If you want something sweet, for example, rather than reaching for a diet fizzy drink, opt for a juicy mango. Not only does it taste better, it gives your body fibre and antioxidant nutrients. Physically and psychologically, the message is that you’re taking care of yourself.

When Wendy Bazilian, dietician and author of The SuperFoodsRx Diet, starts working with an obese patient, she is most likely to suggest simply adding fruit and vegetables. Ironically, many overweight people are malnourished. Introducing more fresh produce helps address the body’s lack of nutrients.

Use markers other than the scale

Ultimately, it’s important to develop a wide array of ways to measure your progress and stay motivated. The scale is useful, but kilograms are only one indicator. Dress size and BMI are reliable benchmarks, as is looking in the mirror to see your body shape change. Having a repertoire of indicators is the best way to evaluate your success.

But being focused on numbers can be demoralising, especially for the obese. “It’s discouraging when you see the distance, but not the journey,” says Bazilian. For those who like visual reminders, she suggests marking a piece of string with a pen, rather than using a tape measure, to check waist size.

“Real weight loss is only going to happen if you really do want it,” says Melanie. Having made it through the most dramatic part of the process, she is confident that she has addressed the underlying issues that caused her to overeat in the first place. “After all,” she says, “there will always be more food tomorrow.”