The goal during active treatment is to maintain a stable weight, even if you are overweight. Intentional weight loss can have implications for treatment effectiveness and susceptibility to infection. Post active-treatment, however, it may be important to strive to achieve or maintain a healthy weight for your height and age. You may wish to discuss with your doctor what would be a good weight for you.
There are numerous reasons for weight gain during and after treatment. These include: side effects of steroid and hormone therapy drugs; being less physically active, possibly because of the side effects of treatment; comfort eating; getting your appetite back after treatment; fluid retention due to drugs or surgery; the menopause and subsequent metabolic and hormonal changes. Another factor influencing weight is consistent lack of sleep (because of medication, stress or other issues). The hormones -ghrelin and leptin – that influence appetite are disrupted when we don’t get enough sleep.
Although deliberately losing weight during treatment is discouraged, eating a healthy low-fat diet and taking some exercise can help maintain your weight, as well as help with some treatment-related side effects. If after treatment you and your doctor decide that it would be helpful to lose weight, do so slowly. Quick weight loss, although satisfying, can bring on fatigue and increase the likelihood that you aren’t getting an adequate level of nutrients. Weight loss due to crash dieting is mainly water, not fat and will be quickly regained when normal eating is resumed. The ‘easiest’ way to successfully and safely lose weight is to consider the following:
•Planning – healthy and nutritious eating doesn’t come by accident. Make a weekly plan and try to stick to it. Give yourself non-food rewards for weight loss.
•Cut down or out processed food (even so-called diet foods). If you really want a bag of chips or chocolate bar go out to get it (walk there?) instead of having it in the house.
•Be mindful of salt, sugar and fat in prepared dishes.
•Beware of fat-free prepared foods: they are usually sugar-loaded to make up for lack of fat ‘mouthfeel’. Naturally fat-free foods are of course fine.
•Eat more plant foods (fruit, veg, pulses, beans, whole grains) – health experts suggest 3/4 of the diet should be plant foods and 1/4 of animal origin (including dairy).
•Lower dietary fat (cooking with less oil; choosing leaner meats and dairy products/cutting down on these foods).
•Avoid skipping meals (especially breakfast). Studies have shown that around 90% of successful dieters (and those who keep weight off) eat breakfast.
•Control portion sizes – this can make a real difference; smaller plates and glasses are a good idea, too. This may be the best tip for most people as all of us generally eat larger portion sizes than are necessary for weight control.
•Eat only when hungry not out of habit or visual/olfactory stimulation (e.g. smelling freshly baked bread in the supermarket).
•Make healthy choices the first choice, leaving less room for nutritionally inferior foods.
•To resist second helpings store or freeze leftovers as soon as they are cool.
•Serve smaller portions of favourite and indulgent foods, and really enjoy each mouthful. If you ‘have’ to have a pudding (you are out for a meal and everyone is having one) split one with someone else and just eat a couple of mouthfuls.
•Increase physical activity: aim to build up to 30-45 minute sessions at least 4 days a week.
•Join a slimming club if you would benefit from the outside support. Beware of the diet food that is often flogged through these groups though – eat real food but less of it instead of ‘diet’ biscuits and processed cheese things. There are quite a few on-line slimming clubs that offer tailored support and menu ideas.
•Drink enough non-alcoholic fluids, especially good old water. Sometimes we get our hunger and thirst signals confused. Sparkling water (not fizzy drinks!) can suppress your appetite if you get hunger before a meal. Try it!
•Choose foods that are nutritious but also fill you up. Most protein-rich foods are satisfying. Below are a few food tips to help you.
Foods to Fill You Up
Eat a small salad or slowly sup a bowl of vegetable-based soup before eating your main course. Research shows that you will probably eat less and still be satisfied.
Have protein at breakfast, lunch and dinner. An American study showed that women who had 2 boiled eggs for breakfast went on to eat on average 400 calories less during the day than those who ate a bread/cereal-based breakfast of equivalent calories. However, don’t eat two eggs every day!
Low glycemic carbohydrates reduce hunger as they are digested slowly and keep a steady supply of blood sugar (which influences appetite and fat storage). Glycemic load (GL) is a way of measuring how our bodies digest, absorb and use different carbohydrates and is based on serving sizes (unlike the GI - glycemic index – diet). There are plenty of GL cookbooks on Amazon and in bookshops to give you guidance and inspiration, including ones for vegetarians. In general the less processed the food the lower the GL. For example, an apple will have a lower GL than stewed apple and both have less than apple juice. Most veg and pulses are low GL. If you stay away from the faddier approaches to GL you’ll gradually lose weight and feel great too. The meal ideas at the end of this paper are based on the principles of glycemic load. Three good websites explaining GL are at the end of this article.
Learn to distinguish between true hunger and appetite. After a meal go four hours before eating, even if you feel a bit peckish; let your tummy start to rumble so that you know what true hunger feels like. Do this a few times, jotting down the circumstances and times that you were tempted to eat during the four hours. What brought food to mind? Were you bored, did you detect a nice smell, did your soap come on and you reached for the usual packet of crisps? Can you identify any patterns? How long did it take for the desire to pass? Keep track for a few days and note down the things that you would have eaten had you ‘given in’. Tot up the calories and fat if possible. This can be a real eye-opener. It is said that breaking ingrained habits takes as little as six weeks. For a month and a half challenge yourself to say no to unneeded snacks and second helpings. See if you can break any long-standing unhelpful eating patterns. This can help with weight loss without resorting to boring diets. Sustained weight loss can be achieved most successfully by permanently altering our eating habits rather than going on so-called bikini diets and the like.
Introduce Physical Activity
Physical activity coupled with a balanced, varied diet is the best way to successful lose weight – and keep it off. Diet alone is usually not enough for most people. The two combined efforts really work together to keep blood sugar levels even and to burn fat. Fifteen minutes everyday or 30 minutes three times a week are a minimum for helping with weight loss, but if you are still tired from treatment or have had surgery it is best to seek your doctor’s advice before beginning any physical activity. Notice how I’m not saying exercise? Well, it is partly psychological: the word exercise conjures up an image of sweating on a treadmill. But it is also because many things that we do can contribute to weight loss but we don’t think of them as proper exercise. Examples of physical activity that can help us lose weight are: walking (include some gentle inclines if possible for extra ‘burn’), rambling, swimming (when you have the doctor’s okay to do so), dancing (especially something like salsa), cycling, gardening (all that digging and bending), team sports, Zumba, badminton or other racquet sports, cleaning (vacuuming and cleaning windows can really make you sweat!), DVD workouts, horse riding. I am sure you can think of other activities that raise your pulse and get you glowing!
Low ‘GL’ Foods
Now it gets down to the nitty gritty. Below is a sample list of some the best foods (and the gram serving weight) to include in a low GL, blood sugar-balancing way of eating. This is a very abbreviated list derived from Patrick Holford’s book ‘The Low GL Diet Cookbook’. Additionally most GL cookbooks have a comprehensive list of foods rated by glycemic impact. Be sure to read about how to interpret the scoring of foods as it applies to serving sizes because some foods seem out of bounds but when taking into account the portion size to be eaten are perfectly fine. Basically all starches and sugars are not created equal and the serving sizes reflect impact of blood sugar levels.
Best Fruits per serving: all berries (up to 600 g); cherries and grapefruit (200g); pears and melons (150 g); other stone fruit (120 g); orange, apple, kiwi, pineapple (120-100 g); grapes and mango (75 g); banana (1/2 small); dried fruits (30-5 g depending on type). The Holford book gives details of what the portion looks like (e.g. big slice, 4 pieces)
Starchy Vegetables: these have a higher impact on blood sugar levels than non-starchy, ‘unlimited’ vegetables. Pumpkin/squash (185 g); carrot (160 g); swede (150); beetroot (110); boiled potato (3 small); sweet potato (1/2 potato; 60 g); corn on cob (1/2 cob; 60 g); baked potato (1/2 potato; 60 g); broad beans (30 g). To aid weight loss either have grain starches (bread, rice, pasta) or vegetable starches (potatoes, parsnips), not covering more than a quarter of your plate.
Unlimited Vegetables: Cover half of your plate with unlimited non-starchy vegetables – lots of minerals, vitamins and help to fill you up. Basically anything that is not a root vegetable or a squash vegetable is considered unlimited, so load up your plate! Make it as colourful as possible.
Best Grains (dry weight): quinoa (65 g); cornmeal/maizemeal (60); wholemeal pasta (50) pearl barley (45); bulghur wheat (45); brown basmati rice (45); brown rice (35); buckwheat (30); white rice,white basmati, couscous (25).
Best Lentils and Beans (in descending order): soya beans/edamame, peas, pinto beans, borlotti beans, lentils, butter beans, split peas, baked beans, kidney beans, chickpeas, chestnuts, flageolot, haricot, black-eye beans. Those with hormone-related cancer may want to avoid to frequent servings of soy beans and edamame (unripened soy beans).
Protein: Protein – eggs, meat, tofu, fish, cheese, nuts, chicken – have almost no impact on blood sugar whatsoever. And they fill us up. We of course cannot eat just protein; we need the fibre, vitamins, minerals and other nutrients contained in plant foods to keep us healthy. In fact, high protein diets are potentially dangerous. The best way to eat protein is with low-GL carbohydrates. They work together to sort blood sugar, satisfy hunger, keep us healthy – and help us to lose weight. Meat and chicken in general should be about the thickness of size of a deck of cards, fish about the size of a chequebook. Use low fat cooking methods to help with weight loss – poach, grill, stir/steam-fry, roast on a trivet, steam, stew with vegetables…
The Carbohydrate and Protein Duet: Make sure every meal and snack contains both protein and carbohydrate. At ‘proper’ meal times have protein, a starchy carb and lots of vegetables.; for snacks have a piece of fruit and some nuts, a small homemade muffin that contains some fruit and nuts (e.g. carrot and walnut), or seedy flatbread with a bean pate.
Your Plate: Fill half of your plate with non-starchy vegetables, one-quarter with protein and one quarter with starchy carbohydrates. You may want to use a smaller plate than normal: our plate sizes as well as our portion sizes have grown over the years. Use minimal amounts of fat, preferring olive oil and rapeseed oil for cooking and extra virgin olive oil for dressings, if necessary. Try a light drizzle of quality balsamic vinegar on salads instead of a dressing (even a low fat one); get ‘good’ fats, protein and fibre from a sprinkling of toasted seeds.
Examples on a Plate:
Breakfast: porridge made with skimmed milk or soy milk + berries + dessertspoon of flaxseeds or pumpkin seeds; 2 scrambled eggs (use non-stick spray rather than fat), grilled or stir-fried mushrooms, 1 slice wholemeal toast, some cherry tomatoes (this is a very filling breakfast!); 2 thin slices of pumpernickel bread spread with pumpkin seed butter (from health food stores) or no-sugar added peanut butter and topped with either slices of tomato (sounds weird but it is good) or half of a banana; low sugar granola (more nuts, less fruit kind) with grated or diced apple and skimmed milk. My cookbook gives a lower-fat recipe for granola.
Lunch: Greek-style salad (lettuce, tomato, cuke, red onion, herbs, olives and a little feta cheese, sprinkled with olive oil and red wine vinegar) + 2 rough oatcakes or small wholemeal roll; grilled chicken in a small wholemeal tortilla wrap with lots of salady bits; bean-based salad with lots of veg + yogurt, lemon and herb dressing; 2 small wedges of egg, red pepper and potato frittata (using leftover boiled potatoes from another meal; keep leftover frittata for another meal) with salad or steamed non-starchy veg; tuna salad made with ½ tin tuna, 1 tsp low-fat mayo and 1 tbsp no fat yogurt, chopped celery, gherkin and spring onion + small wholemeal pitta or 2 oatcakes; ½ pot vegetable and bean soup + pear and a yogurt.
Dinner: Grilled tuna or salmon steak + quinoa or brown basmati rice + steam-fried vegetables; spaghetti Bolognese using low fat mince (drain after cooking and before adding other ingredients) or Quorn mince, lots of finely chopped onion, celery, carrots and mushrooms, plus tomatoes, tomato paste and herbs + wholemeal pasta + green salad; Vegetable curry with tofu, prawns or 50 grams of chopped cashew nuts + brown basmati rice and chopped coriander.
Snacks: apple and 5 walnut halves; 1 thin slice of pumpernickel + thin spread of hummus topped with sliced tomato or cucumber; sugar snap peas, carrot and celery sticks with bean dip; small homemade muffin or wholemeal scone; small punnet blueberries with tbsp yogurt and a good sprinkle of cinnamon (cinnamon temporarily raises metabolism, aiding weight loss).
Drinks: Lots of water, herbal tea, redbush tea, green tea, pu’er tea (alleged fat burner), decaf coffee; 1 serving of freshly pressed juice (200 ml) diluted with water. Remember that green tea and pu-er tea contain caffeine and other stimulants, which is okay for weight loss and neutral for cancer, but not so great for high blood pressure. Smoothies are generally a no-no for weight loss as they tend to contain bananas and are high in sugar. Make your own without bananas and with non-fat dairy or non-dairy milk/yogurt. Homemade smoothies and juices are a good way of getting the nutrients from fruits ff you are not keen on eating fruit, but try and limit yourself to one breakfast juice glass-size a day of either. Too much of a good thing, and all that!
5aday.nhs.uk – advice on healthy eating, recipes, obesity
bdaweightwise.com – looks at how to calculate your body mass index (bmi)
nhs.uk/livewell/goodfood – excellent information and topics, including cancer, weight and portion sizes
blog.fatfreevegan.com – not as ‘worthy’ as it sounds, lots of lovely recipes
vegbox-recipes.co.uk – highly readable and great for finding out what to do with
‘mystery’ fruit and veg
wcrf-uk.org and aicr.org (twinned organisations but the latter is more comprehensive, although US)