Losing weight and then managing to keep it off for life is an arduous task. HEALTH meets with an expert who explained the key to weight loss is education and self-awareness.

Overview
When many of us want to shed some weight, we either cut out certain food groups or curb our portions altogether. However Dr. Rita Nawar Tobias, an endocrinologist, has a completely different approach in helping patients lose weight and keep it off. She explains: “Most experts usually prescribe a calorie restricted diet. However at our clinic, we follow a system developed by Dr. Naji Torbay – which has been around for more than 22 years. He has his own clinic in Lebanon and we are partners in this clinic. His method consists of dividing patients into two categories; one is patients who are hyperinsulinemic or insulin resistant and second, those who are non-insulin resistant.”

Carbohydrate Restrictive Eating
According to Dr. Nawar, following the macro nutrient restriction diet, people who are even insulin resistant or who are at the pre-diabetes stage or even diabetic, will respond more to carbohydrate restricted diets which is a low carb non-ketogenic diet. “What this means is that we have a minimum amount of carbs that can be consumed on a daily basis. Atkins on the other hand, is a very low carbohydrate ketogenic diet. The body needs a minimum amount of carbs so what we give to these types of patients who are insulin resistant is a low carb, non-ketogenic diet which gives them between  130 to 150 grams of carbs per day, which makes this type of diet for weight management practical and
sustainable. What we do is very sustainable. That’s the big difference in fact.”

Normal Insulin Dynamics
Once a patient has been tested completely to see which category he/she falls under using a full metabolic profile, and fasting and after glucose load test, Dr. Nawar explains that those patients who fall under the normal insulin dynamics and have no issues in carbohydrate metabolism are put on fat restricted diets. “70 percent of obese patents have insulin problem and they are on a low carb, non-ketogenic diet. 30 percent of people have normal insulin dynamics will respond well to a low fat diet or fat restricted diet,” she says.

Awareness is Key
Once you know what you have a problem metabolizing and you learn when you are on a diet with nutrients you can consume without any issues, the road to weight loss is more about self-awareness and understanding your food. “Once you understand what you can eat
all the time versus some foods you need to restrict, then you learn there’s no food restriction as in quantity so you don’t feel hungry. There is no starving. So you learn to eat wherever you are. We teach patients there are certain foods you can have all the time, you can choose wherever you are in a restaurant or anywhere else for that matter…it’s very practical. Then once the patient is successful in the weight loss phase from either the carb restrictive diet or the fat restrictive diet, you can re-introduce them but cautiously,” she explains. “In fact, obese patients are usually not lacking in will power but more a lack of education. When you educate them they respond even to the point of the equivalent of
undergoing bariatric surgery. We have a high success rate with both types of patients.”

The Role of Physical Activity
With obesity, Dr. Nawar points out that there is always genetic and epi-genetic factors and unfortunately we can’t change the genetic part. “That’s why if we have a tendency to gain weight we will always have it no matter what. We have to learn to control and master our food. We encourage our patients in general to increase their daily physical activity. However you need to exercise around 77 hours to lose 1 kilogram of fat so it does not really match. But yes physical activity is very important to be able to maintain the weight,” she tells.

The Problem with Many Diets
There are literally hundreds of diets out there, from the Southbeach and Atkins to Paleo. Science has proven
that traditional calories restricted diets work, indicates Dr. Nawar, adding, “The problem is that they are not always practical. This is the first problem with traditional diets. Secondly, they are not sustainable. A person can’t live their life starving. We are human beings and every now and then need to indulge. These kinds of diets restrict everything. Also they don’t really teach you the correct and incorrect foods for your particular system. Quite often with these kinds of diets, once the individual has lost the weight, 95 percent of people will regain the weight within one to two years.”

Sustainability
For Dr. Nawar, a patient’s weight loss journey is about teamwork. “The patient has to make the decision to change; the most important is to learn about food habits and a doctor will have to teach this to the individual along with the dietician’s role of course. It is a completely synergistic,” she says. “During the initial process of weight management we see our patients around once every three to six weeks. Once the progress is ongoing, it can be longer in between visits. Ideally for optimal maintenance, in the first year, it’s best to come every three to four
months then twice a year then once a year especially if there is a problem with insulin resistance or metabolism or high cholesterol and more often for diabetics. We need to keep on monitoring the patient regularly. The good news is that with the personalized program, the issues subside BIG TIME even in patients with early type 2 diabetes.”

Weight Loss Plateau
Many of us have suffered the dreaded weight loss plateau where the weight just refuses to budge despite our efforts. According to Dr. Nawar, this is a natural process after several months of dieting. “It might be stress, some hormonal changes in the body or even thyroid issues. We have to treat these issues and play around. But perseverance and physical activity can help. The problem with many patients when they hit this weight loss plateau is they get frustrated and this is when they start deviating or cheating from their diet plan,” she says. So instead of keeping it up to break the plateau, Dr. Nawar says that they leave their eating plan and in this situation, advises her patients to try
to remember her and call if required.

Emotional Eating
Grabbing a donut in times of stress or a chocolate bar when you feel down could be more than emotional eating, tells Dr. Nawar. “It’s not always emotional; we know now that depression is related to differences in neurotransmitters and emotions. We have an increase in cortisol and epinephrine under stress. These two hormones induce/stimulate the pancreas to secrete more insulin. Insulin basically increases one’s appetite,” she explains and this is why you will see a person who is depressed quite often start gaining weight. Words of Wisdom In particular, Dr. Nawar points out that for patients who are diabetic/insulin resistant, or pre-diabetic, they will benefit immensely from a carbohydrate restrictive meal plan and it can even subside their symptoms. She elaborates: “Even if the diabetes is in the advanced stages by doing a low carb diet–if other health parameters allow–even intermittently for a few months, can improve your condition a lot.”