Expert Explains | ‘Weight loss is a long journey. There is no quick fix’

Dr Anoop Misra is the executive chairman of Fortis C-DOC Hospital for Diabetes and Allied Sciences. He is also the director of the National Diabetes, Obesity and Cholesterol Foundation, President of the Diabetes Foundation (India), and a former professor of medicine at AIIMS, New Delhi. He has authored two books, his most recent one being Smart Calories and Common Sense. He was a guest on Explained Live, a series where The Indian Express invites domain experts for video conversations on major events unfolding in their domain. Edited excerpts follow. 

What is it that Indians do wrong when it comes to their meals?

Food has not gone wrong for Indians overnight. It has been almost the story of three to four decades now and especially when the market economy was open in the 1990s…. This did not just happen as floodgates to economic betterment of the country, but also floodgates to many other multinational companies which came into India.

And that is where the problem lies at this point of time. What we are not eating is home food (but) outside food. In 10 minutes, every food is available in your house and most of it has plenty of sugar, saturated fat, and salt.

But if you look at the macronutrients in the food which have actually changed over the last three decades, then there are a couple of things which stand out. One thing is that the carbohydrate content of our diet has gone up. They were already high but they have gone up and especially refined carbohydrates. For example, rice is a refined carbohydrate. 

Saturated fat also has gone up: two reasons for that are that home food continues to be laden with saturated fat, and of course outside food. 

Somehow, we should have been able to increase our protein intake, but we have been unable to do so. Percentage wise in our diet, it remains 12% only — much less than what Western figures are, say 18 to 20%.

At the same time, our fibre intake has gone down. Traditionally, we are low on some of the good fats, which are monounsaturated fats and omega-3 fatty acids.

So, look at the number of problems that we have, and each one is somewhat related to either insulin pathway, liver, heart, blood pressure, or cholesterol. And all have been going wrong for more than two decades now in the Indian population.

Even when Indians don’t look or aren’t overweight, Indians have a body type where the fat mass is more than the lean muscle mass: we have a lot of abdominal obesity or “belly fat”. This kind of fat accumulation is very dangerous because it leads to all these metabolic diseases that we all suffer from: diabetes, fatty liver, cardiovascular problems. How important is it to develop lean mass, and how can that be done by dietary correction? 

You’ve hit the nail on the head — that we have high body fat. This was actually first shown by us almost three decades back, when we changed the definition of obesity in the Indian population and we said that obesity in the Indian population was defined by lower BMI (body mass index).

We are not that big as people in the US are, yet we are internally obese. Now people have talked about fat, but what they have not talked about much is muscle. And one of the studies shows that lower the muscle mass — which Indians have lower than Britishers and Black people — the higher the chances of diabetes, regardless of your weight and body fat.

So, muscle is of equal importance, if not more. An imbalance of fat and muscle is what is driving our metabolism.

Weight training and resistance exercises are good ways to increase one’s muscle mass. Photo: Unsplash

Now, there are a number of ways to increase our muscle mass. One is diet, two is exercise. That’s where protein intake comes in, as protein is the building block of the muscle. And if we don’t take enough protein, our muscles are likely to be thin.

Then, we should have resistance exercises. Just walking is not going to be enough.

I myself do weights every day. So when people say “oh I don’t have time for walking and weight training”, I say “you walk 40 minutes a day and 5 to 10 minutes of weight training or resistance bands”.

Once your muscles are good, not only diabetes will be better, your bones will be better, your heart will be better. So, several organs will benefit by the strengthening of the muscles alone.

Can you explain why eating less does not automatically translate into weight loss?

It depends on your energy expenditure. It depends on your physiological state.

If I am eating, say, a 1,400 or 1,200-kilocalorie diet, to lose weight, I have to overall spend more calories so that I’m minus 500 or 600 calories every day, which will ideally lead to weight loss. But that is something mathematical. The body is a physiological system and our own studies have shown that genetic makeup of individuals is extremely important and there are some genes which direct weight loss and some genes impede block the weight loss. So, genetic makeup is extremely important.

Everybody is different. Some people with the same diet will lose more weight and some people won’t. Then the physiological state: for example, somebody who has a polycystic ovarian disease or more importantly, if a woman is undergoing menopause or postmenopause, then there’s resistance to weight loss and that’s because of change in the hormones. Similarly, for men, after a certain age they go into so-called andropause.

Then, there are multiple other things like thyroid hormones, cortisol hormone, their stress levels, their sleep pattern. So, a number of other factors may impede weight loss.

There are a lot of myths around weight loss injections. People think that if you’re on a weight loss drug, your discipline for food needs to go down. But that isn’t the case, is it?

Absolutely. Some of it is taken care of by decreasing appetite, some by decrease in craving. Because the patient is able to sleep well after weight loss, it doesn’t have interruption of the sleep at night because of massive weight — the fat accumulation over the neck and so on. Often, these people get up at night and eat snacks. So, this is the help being provided by this drug, and some of it has to be discipline from the patient.

So, it has to go both ways and it is a long journey. And if they’re looking at quick fixes, there is no quick fix.

AUDIENCE QUESTIONS

These various weight loss pills seem to have been developed recently, and people are taking them and showing lovely results. Are there any long-term effects we should be worried about?

Let me tell you a little bit of history here: These weight loss pills are not new at all. We have been using some version of it for the last 25 years. The only thing is that they were a weaker version.

Only recently, more powerful versions have appeared. So, the same type of drugs were available earlier.

We have known about the side effects for a long time, (which are) mostly gastrointestinal. In fact, if you lose weight, then cancers, heart disease, liver disease, kidney disease, obstructive sleep apnea all will go down — too many benefits.

So these new drugs, at the moment, with up to four years of follow-up have done very well. And we in India have two years of follow-up with these drugs and we have seen, as you rightly said, excellent results. As of yet, nothing great as far as any long-term effect is concerned has appeared.

However, when we start the drug — these are not something over-the-counter — we have to be extremely careful. We take the family history. We examine the patient, do some tests, and then only decide how to give this drug. 

How can one feel good about their weight loss journey, as people are prone to depression when they’re changing from one way of living to another?

Most people who have chosen the weight loss journey in a proper manner — whether it’s a diet, exercise, or drugs — over a period of time, 90% have become better in terms of their happiness, in terms of their mood, their approach to life, their appearance, their interaction with friends and in social gatherings.

Those who were depressed actually became better. Depression was partly due to their image and their weight. So, there are positives all around physical positivity and psychological positivity. And the moment you start doing a good amount of exercise, the blood not only circulates through your heart but also to your brain. You will feel a sort of a kick after a good exercise session.

So, this is all good. And if you are looking for such a journey, you will not be disappointed.