STOP PRESS: What You Need to Know About Michael Moseley's Lose a Stone in 21 Days

Channel Four in the UK this week aired Lose a Stone in 21 Days with Michael Mosley. Now I don't need to tell you what the main premise of the show was! At the time of writing, only one episode has been aired and so this article is based on its content, although I will add an amendment if appropriate after the second episode has aired. 

Since the title was released and especially since the programme's first episode has aired, various 'experts' have been jumping in to condemn the programme (some of which are basing their opinion on the title alone). I have been asked about my thoughts on the show since I work with clients who are looking to lose weight. So I thought I would capture my thoughts in a blog post. 

First off, there is something that you need to know about Doctor Michael Mosley, the presenter and  producer of the show. Wikipedia tells us that "Mosley studied Philosophy, Politics and Economics at New College, Oxford, before working for two years as a banker in the City of London. He then decided to move into medicine, intending to become a psychiatrist, studying at the Royal Free Hospital Medical School, now part of UCL Medical School." After he completed his studies he responded to an advertisement for a trainee assistant producer scheme at the BBC and having been disillusioned by his psychiatric placements he realised he was more interested in "what made people tick". So Michael went down the journalism route (naturally specialising in medical stories) rather than to practice medicine or psychiatry. In recent years, he has become known for looking into the effects of diet and exercise and has several highly successful books published. 

My reason for including part of Mr Mosley's biography, is to put his medical knowledge into context. He is a qualified doctor and of course is entitled to use the title. However, he has never been a practising doctor or psychiatrist - his knowledge is based on his studies and subsequent research. Therefore, I believe we need to be aware of the "White Coat Principle" when watching these programmes. Because Mr Mosley is presented (correctly) as Dr Mosley, many people will attach more credibility to his opinion on medical information given in the programme. Of course, this is what the programme makes (and no doubt Dr Mosley) trade off. Nevertheless, it's worth keeping in the back of our minds that effectively, Dr Mosley is fulfilling the role of television presenter and journalist rather than practising medic. 

The main thrust of the programme centres around the effects that a very low calorie diet, that begins with very few carbohydrates (to invoke a status of ketosis) have on the body and can you lose a significant amount of weight in three weeks. Dr Mosley is also interested in the health markers (blood sugars, body fat, lung capacity, risk of diabetes etc.) that this extreme diet will have. 

Maybe because of his medical background and (I suspect primarily) due to his own efforts in reversing his Type II diabetes, Dr Mosley is coming at this topic from a health perspective rather than an overall wellness or fitness perspective. Many of those "outraged" by the programme are coming from a fitness and weight loss background. 

Nevertheless, promoting a diet of 800 calories for weight loss is something not only the fitness world does not advise, the medical world does not advise it either - except in certain, medically controlled circumstances. For me this is where the problem with the programme lies. 

The concept is an interesting one, but the way the producers and the presenter have packaged it will inevitably lead to people drawing the conclusion that in order to lose weight, I have to go on a extremely low calorie diet. 

The participants were also given an exercise regime to follow, but little is made of that in the first programme - interesting!

There were no warnings in the programme about the risks in following a similar diet on your own. It was made clear that the participants in the programme were medically screened to check they were going to be safe on the diet, but your average person in the street, wanting to lose weight will not take the same precautions.  

By following such a restrictive diet, there are other consequences that, so far, have not been addressed in the programme. For many people, the reason why they are not the weight they would like to be is that their relationship and attitude to food isn't as good as it could be. Going on a restrictive diet isn't going to help that at all. The programme is effectively a "science experiment" rather than a "How to" programme (even if the programme's title suggests otherwise) and anyone who knows anything about coaching people in effective weight loss will know that it is important to address attitude, behaviours, knowledge as well as to  take into consideration mental health and state. It will be interesting to see in Episode 2 if any of these issues come up. 

So what do you do if you DO want to lose a stone in 21 days? Do you follow Dr Mosley's experiment? In my opinion - NO! Please don't!!

National Health recommendations say that to lose weight in a healthy way, a rough guide is one pound (about 0.5 kg) a week. To lose a stone will take most people about 14 - 16 weeks. 

Such a weight loss can be done in a manageable way and not ruin your relationship with food and give you a way of eating that is going to last beyond the end of your 'diet'. 

I predict that in episode 2 of the programme, all the participants will have lost weight. I suspect a good number will have lost a stone. I also imagine that many will have shown improvements in their health markers too. All will no doubt fell better, have more energy and will be sleeping better (cue montages of them playing with their children and laughing (socially distanced of course) with their friends. 

I also predict there will not be an episode where we follow them up six months later to see if the weight has stayed off. If we were to do that, I believe three quarters of the participants will have put weight back on and a few will be back where they started (and maybe even heavier) because their understanding of nutrition hasn't changed and their old behaviours and habits have not been eliminated. 

If you do have "Covid Calories" or "Lockdown Pounds" to lose, I do have a very clear way forward for you.

Follow a moderately reduced calorie diet (around 500 kcals less than your maintenance calories)  that reduces processed carbohydrates and includes a good amount of quality protein. Stay off the booze. Exercise daily - walks, cycling, exercise classes, I don't mind! Just get moving!

If you are wanting to moderate your eating habits and behaviours, take my FREE Five Day Food Freedom Challenge. Over the course of five days, I will give you a range of tips, strategies and resources to help you manage your eating and set you on the path to healthy eating habits. 

Or if you want to lose weight in a controlled way that also teaches you about healthy nutrition so you will never have to go on a 'diet' again, then check out my body fx programme - a scientifically rigorous, health optimised fat loss programme that gives you the support, the understanding and the know how to make a lifelong change for good. 

UPDATE - EPISODE 2

So I have just watched episode two and I have to say, Dr Mosley was much better at keeping things on a more even footing by not being so sensationalist, by keeping things in line with standard advice and promoting other aspects of weight loss, not just calorie deficit. 

This week's episode many focused on exercise which as he said, is not the most efficient way to lose weight (to burn off one pound of fat you need to use up around 3,500kcals - about six hours on the treadmill at 5 mph!) but it does have a role to play in helping to maintain muscle which in turn boosts your metabolism. For me, it also helps promote good heart and lung health which most of us could do with improving. 

Episode 2 also introduces the idea of flexibility training such as yoga which I also advise my clients to do and he takes a look at sugar, which is a confusing subject. Thankfully he avoids demonising bananas when he uses them to show that blood sugar levels rise rapidly after consuming one (which for most people in moderation is manageable). However, too much processed food which releases refined sugars quickly into the blood stream can be an issue and can lead to chronic inflammation. 

It turns out that our participants are still on a low carb diet to induce ketosis in week two which, to be fair, you need to be be in this state for a while to see the fat loss benefits (you'll also experience some of the side effects too - often dizziness and bad breath).

What was missing from the programme surprisingly was a focus on participants struggles. Although they were mentioned the impression we were left with is that, on the whole, the diet regime has been manageable and "pain free". If that is the case that is a credit to Clare Bailey (Dr Mosley's wife) for her recipes. I do like her 800 Calorie book she published to go with their fasting diet. They also touched on portion size which I thought was good since, to be honest, that's where most people can make adjustments - many of us are simply eating too much!

All in all, a better episode for my money, although I would have liked a bit more detail about the food strategies used to keep hunger at bay - but I guess they'll want you to buy the book for that! 

UPDATE - EPISODE 3

So after 21 days, have the participants made progress towards their goals. Warning - spoilers ahead! 

In this last programme we had some more information about the ways in which our behaviours can influence our weight, in particular alcohol consumption and snacking. Sadly, practical strategies were lacking even after we had a psychologist drafted in to give us some tips. Putting the chocolate out of sight is obvious - but then again, it is one that we need reminded of. 

So the results. Not surprisingly, one such a low calorie diet we saw some dramatic results in terms of body measurements, including some health markers. What was interesting to see was that changes can be seen in such a short space of time and lots of conditions can be reduced or stopped by living more healthily. Of course, this isn't ground breaking. We all know a healthier lifestyle is going to lead to healthier people. 

Regarding the headline "One Stone in 21 Days", three out of the five achieved a weight loss of a stone or more, with one coming close. This is great news especially since most participants came down a weight category (obese to overweight, overweight to healthy etc.). However, I would love to see where these participants are in six week's time. How much weight returned. Were they able to maintain a healthy weight and keep those good habits. 

800 kcals for an healthy weight person is not a sustainable daily calorie intake. These participants will need to increase their calories. The programme did not address how you safely return your calorie levels to a maintenance level - one that will keep you at the weight you want. Many people that go on a low calorie diet bounce back rapidly after the diet phase is over. Bringing calories back to a normal level needs just as much care and attention as reducing calories does. Sadly, the programme didn't address this. 

If you would like to know how to reduce your weight in a more manageable and sustainable way, please do get in touch - spencer@union.fitness.