Weight loss – what works, and what to ignore

Most of the health benefit of losing weight arrives early. Losing five to ten percent of body weight measurably improves blood pressure, blood sugar, cholesterol, sleep apnoea and joint pain — long before anyone would call the result slim.

That matters because a target set at a dress size usually fails, while a target set at five percent usually does not, and delivers most of the medical gain either way.

• Eating somewhat less than you use, sustained. Which specific eating pattern you use to get there matters far less than whether you can keep it up.
• Cutting liquid sugar first. It is the easiest large reduction most people can make without feeling deprived.
• More protein and more fibre at each meal — both increase fullness, so you eat less without trying to.
• Physical activity, mainly for keeping weight off and protecting muscle rather than for the loss itself.
• Sleep. Short sleep raises appetite and makes control harder; this is one of the more reliably reproduced findings in the area.
• Regular self-weighing and some form of tracking, which predicts success better than most diet features.

South African pharmacy shelves, spaza shops and social media carry a large market in weight-loss products. Almost none of them work, and a few are genuinely dangerous.

• Detox and slimming teas. These are usually laxatives. They shift water and bowel contents, not fat, and long-term laxative use damages the bowel.
• 'Fat burner' supplements. Unregulated stimulant mixtures that have caused heart rhythm problems and liver injury.
• Injections and pills sold on social media without a prescription. You cannot know what is in them, and some have contained banned appetite suppressants.
• Waist trainers, wraps and slimming belts, which change the shape of the body only while worn.
• Any product promising a specific weight loss in a specific number of days.

There are prescription medicines for obesity, and some are available in South Africa. They are real medicines with real effects and real side effects, prescribed for people who meet specific criteria, usually alongside changes to eating and activity rather than instead of them.

The version to avoid is the same medicine bought without a prescription from an unverified seller, which is now common and carries a genuine risk of a counterfeit product or the wrong dose.