Q: I have a 67-year-old aunt who is overweight. She has had surgery on one knee. Her doctor told her to lose weight and she would like a diet. She isn’t too active and she needs surgery in the other knee so she can’t stand up too long or walk too far. Could you please suggest a diet for her?
A: It is hard to keep the weight off when you are not active. Her weight has probably crept up gradually over the years and may not be due to really bad eating habits. The main culprits causing weight gain are pastries and baked goods. They contain a lot of sugar and fat. In younger people it is more often due to sweet drinks like pop.
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I am not a fan of fad diets that cause rapid weight loss because the weight usually goes straight back on as soon as the person stops dieting. It is better for your aunt to make some permanent lifestyle changes in the way she eats and exercises. This can be achieved by cutting portions at every meal.
Meat or fish servings should be about four ounces, which is approximately the size of the palm of your hand and half an inch (one centimetre) thick. Putting the food on a smaller plate makes it look like more. She can eat as many green leafy vegetables as she wants, but watch the salad dressings. If she has a sweet tooth, it will be difficult for her to restrict sweets altogether, so tell her to try to limit them to one serving a day.
Even with a bad knee she may be able to do some sort of aquacise because the water takes away some of the pull of gravity and makes it easier on the joints. A physiotherapist could advise her in some gentle exercises.
If she still needs a diet to help her plan menus, the Weight Watchers system or the diabetic diets are the best. The latter does not allow sugar and limits fats, so it may be too restrictive for your aunt. Weight Watchers is a private group so she will have to join to get its diet plan, but the group pressure and reward system might be good for her.
I do not recommend the Atkins or high fat, high protein, low carbohydrate diet. Neither do most Canadian doctors. It can be useful for a short term such as a week to get a person started, but after that these diets are not healthy because they cause the body to convert fats into ketones, which will make you feel nauseous. Ketosis is what happens to diabetics when they aren’t getting enough insulin. The breath and urine smell like acetone (nail polish remover).
If it is urgent that your aunt lose weight before surgery, and she is more than 25 pounds overweight, she could ask her family doctor to put her on the medication Xenical, which basically makes the fat go straight through the system. This is not addictive like the stimulant type of weight loss drugs that are similar to amphetamines or speed.
Clare Rowson is a medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
