a detailed guide to help you lose weightpublicdocuments.sth.nhs.uk/pil4354.pdf · †...

PROUD TO MAKE A DIFFERENCESHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST

A detailed guide to help you lose weightFor kidney (renal) patients

Information for patientsSheffield Dietetics

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Why do I need to lose weight?

Being overweight or obese can lead to many health problems including:

• Type 2 diabetes• High blood pressure• Stroke• Heart disease• Osteoarthritis

If you are overweight or obese and have chronic kidney disease (CKD), your kidneys may worsen at a quicker rate, you may also not be able to go on the list for a kidney transplant until you are at a safe weight for the operation.

How do I know if I am overweight or obese?

One way to tell if you are the correct weight for your height is to use a calculation called Body Mass Index (BMI).

You can calculate your BMI using the sum below:

BMI (Kg/m2) = Weight (Kilograms) ÷ (height x height (meters))

Body Mass Index (BMI)

20 - 25kg/m2 Healthy weight

25 - 30kg/m2 Overweight

30kg/m2 or more Obese

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Weight loss goals

You might hope to lose a lot of weight, but we recommend having a goal of 5-10% weight loss to begin with. Weight loss does not happen overnight, a healthy weight loss is 1-2lbs (pounds) or ½-1kg per week. Losing weight this way helps you to keep the weight off in the future.

If you are on peritoneal dialysis, you may find losing weight more difficult. This is because you may absorb some calories from your dialysis fluid. You can still lose weight but you may need a dietary assessment with your renal dietitian to check what the main changes to your diet need to be.

Remember, advice about weight loss that you may find on the internet, in magazines or at commercial weight loss groups may not be right for you due to your CKD. This booklet is specifically designed for people with CKD.

If you wish to join a weight loss group for support, please discuss this with your renal dietitian.

In order to lose weight you need to eat and drink fewer calories (energy) than you burn each day. To make sure this happens, you will need to make changes to your diet. Try to eat regular, well balanced meals and reduce your overall calorie intake by eating less high fat or high sugar foods.

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The Eat Well Guide

The Eat Well Guide shows you how much of each food group you should eat each day.

The next few pages will show you healthy portion sizes for each food group in the Eat Well Guide. To help you to lose weight, it is best to choose low fat, low sugar versions within each food group and avoid adding unnecessary fat to your meals. This will help you to reduce your overall calorie intake which will help you to lose weight.

Sometimes our meals can be healthy and balanced but our portion sizes are too large. Check the recommended portion sizes in this booklet and compare it to your own meals. Using a smaller plate is an easy way to stop you from over-eating at mealtimes.

It is important to not cut out a whole food group (section of the Eat Well guide); each food group is needed in your diet for different reasons.

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Fruits, Vegetables and Salad

Fill up approximately half of your plate with vegetables or salad.

Aim to eat 5 portions of fruit and vegetables per day.

If you are following a low potassium diet as advised by your dietitian, you should limit your fruit and vegetables to 4 portions per day.

A portion of fruit, vegetables and salad will fit comfortably in your cupped hand (80g).

For example:

• 1 apple, pear or peach• 2 satsumas or small plums• 2 tablespoons of boiled vegetables• A handful of mixed salad• A handful of grapes

Top Tips:

• Avoid adding butter or margarine to vegetables• Avoid full fat salad dressings, choose ‘reduced fat’ or ‘light’

dressings instead• Fruit juice is high in natural sugars so limit your serving to 150ml

per day. Lower potassium options are apple or pineapple

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Starchy carbohydrates

Starchy carbohydrates include bread, cereal, pasta and rice. Include some high fibre options, for example wholegrain bread, brown rice and pasta (unless you have been told not to by your dietitian). If you are on a potassium restriction, remember to boil all your potatoes and throw away the water.

Choose a fist- sized amount of starchy carbohydrates to go with your meal.

Top Tips:

• Avoid adding lots of butter, oil, cream or cheese to these foods

Protein foods

This food group includes meat and fish, for example chicken, turkey, cod, tuna, salmon, pork, beef and lamb, along with meat free options, for example tofu, soya, ‘Quorn’, eggs, beans and pulses.

A portion of protein foods should be the size of your palm and the thickness of your little finger. Aim for two portions of these foods each day.

Top Tips:

• Trim fat and skin off meat before cooking

• Limit red meat, such as beef or lamb to twice per week, as these are higher in fat. Instead choose meat-free alternatives such as ‘Quorn’, tofu or soy mince, white meat such as turkey or chicken, white fish such as cod or haddock, or eggs

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Milk and dairy foods

Dairy foods contain essential vitamins and minerals as well as some protein so are important to keep in your diet but are often high in fat. Aim for no more than 2-3 portions of dairy foods per day. If you have been advised to limit these foods by a dietitian, please continue to follow this advice.

One portion of a dairy food is:

• 1 glass (200ml) of milk• 1 small pot of yoghurt (125g)• A small matchbox-sized piece of cheese (30g)

Top Tips:

• Choose semi-skimmed or skimmed milk instead of full fat milk• Choose low fat soft cheese such as cottage cheese or reduced fat

cream cheese rather than Cheddar or other hard cheeses• Choose yoghurts labelled ‘diet’ or ‘light’ (yoghurts labelled ‘low

fat’ may be high in sugar so may contain just as many calories)

Fats

Having too much fat can add unnecessary calories to your meals, so use fats sparingly.

Top Tips:

• Use an oil spray instead of a bottle of oil• Rather than frying food, try baking,

boiling, steaming, poaching or using a microwave or health grill. Avoid using a deep fat fryer

• Choose reduced fat margarine, butters and salad dressings and limit the amount you use to the size of the tip of your thumb

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Foods high in fat and sugar

This includes cakes, chocolates, sweets, biscuits, pastries, crisps, takeaways, sugary and alcoholic drinks.

These foods are not needed for a healthy balanced diet. Eating these foods regularly or in large quantities will increase your overall calorie intake and will cause you to gain weight or stop you from losing weight.

Top Tips:

• Swap sugar for artificial sweeteners• Choose 'diet' or 'no added sugar' drinks instead of full sugar

versions• Add less sugar to drinks, baking or breakfast cereals. Try using

artificial sweeteners instead• Choose wholegrain cereals instead of sugar coated varieties, for

example Weetabix, Shredded Wheat or porridge made with water• Avoid buying high fat and high sugar foods such as crisps, biscuits,

cakes, chocolate, and sweets. Not having them around may make it easier to resist

• Have plenty of healthy snack options available (see page 12 for more information on snacking)

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Improving your eating habits

The next few pages give ideas to improve your eating habits. We can easily develop habits without realising; this can cause us to gain weight or stop us from losing weight. It may take some time to build new habits so we suggest making changes one at a time.

Slow down at mealtimes

There is a 20 minute delay between you eating a meal and your brain telling you that you have eaten enough food. During this time you may eat more food so by the time your brain knows you are full, you may have eaten much more than you needed. If you teach yourself to eat more slowly your brain will have chance to tell your body when you have eaten enough food and overall you will eat less.

Other ways to improve your eating habits• Use cutlery instead of your hands• Sit down when you eat, preferably at a table• Avoid eating in front of the television or at your desk at work• Avoid eating on your own where possible• Chew your food slowly• If you are having a cold meal, take a break midway through

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Learn to recognise when you are hungry

We often snack for the wrong reasons. Ask yourself if you choose to snack out of habit, because you are bored or stressed, because you crave the food or because you are actually hungry.

Hunger

Signs of hunger include an empty feeling or gurgling in your stomach, lack of concentration, dizziness or headache. These symptoms won’t go away with time so make sure you have a healthy snack to combat your hunger.

Sometimes people think they are hungry but they are actually just thirsty. If you do not need to follow a fluid restriction, try having a drink before choosing to snack.

Boredom

People often eat more when they are bored. Try to fill your time to help distract you from your food cravings.

Activities could include; reading, going on the internet, keeping busy with an old or new hobby, going for a walk, housework or having a bath.

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Stress

Sometimes we eat more when we feel stressed or emotional. When you are feeling stressed, your body releases hormones which can leave you feeling hungry.

Just being aware that stress can cause you to overeat may help you to stop eating in these situations. Try having some alternative activities to turn to before food during stressful times.

Cravings

You usually crave food when you are not hungry. Work out which foods you crave the most, try to plan treat foods into your diet in moderate portions to stop you from over-indulging later on.

Avoid the temptation; don’t walk past the bakery or down the snack aisle of the supermarket.

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Learn to snack well

If chosen carefully, snacking can be a healthy part of your diet. However, some snacks can be an extra source of fat and sugar which can stop you from losing weight.

Top tips for snacking:

• Avoid snacking in between your meals unless you are truly hungry, get out of the habit of snacking just for the sake of it

• If you struggle to resist some snack foods, don’t have them in the house to tempt you. Have healthy snack alternatives available at home and at work

• Buy individual packs of crisps, popcorn or biscuits so you are not tempted to have more than one serving

Healthy snack swaps

Swap some of your less healthy snacks for better alternatives to help reduce your overall calorie intake.

Unhealthy snack Healthier alternative

Chocolate biscuit Plain biscuit, for example rich tea or arrowroot

Chocolate bar Rice cakes, for example caramel, plain or cheese

Doughnut or cream cake Tinned fruit (drained) with reduced fat crème fraiche

Trifle Sugar free jelly, 'diet' or 'light' yoghurts

Crisps Plain popcorn or breadsticks

Sausage roll or pork pie Crackers with reduced fat cream cheese

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Increase your physical activity

It is recommended that we aim for 150 minutes of moderate physical activity per week.

Activities could include:

Any physical activity is better than none and it is never too late to start getting active!

If you are new to exercise or activities, check with your GP before starting. Start your exercise slowly and build it up over time as you become fitter and more able.

• Walking• Dancing• Swimming• Cycling• Jogging

• Gardening• Hiking• Recreational sport• Gym classes

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Useful apps and websites

There are some websites and applications for your smart phone which give you extra information to help you to lose weight. Some help you to track what you have eaten and your overall calorie intake for each day. They can also track your weight loss for you.

Please note that these websites and apps are not specifically designed for patients with kidney disease. If you have received any contradictory information then chose to follow the advice of your dietitian.

Websites:• https://www.myfitnesspal.com

• http://www.nationalobesityforum.org.uk

• https://www.nhs.uk/change4life

Apps:• MyFitnessPal

MyFitnessPal website and smart phone app is useful to help you track your calorie intake but it is not an accurate way to track your potassium intake. If you are following a low potassium diet, continue to use the information provided by your dietitian rather than MyFitnessPal.

https://www.myfitnesspal.com

http://www.nationalobesityforum.org.uk

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To finish, here are some general tips to help you along your weight loss journey

Accept that the occasional slip up is normal and that it’s not the end of the world. Try to get back on track as quickly as you can.

There will always be a celebration or an excuse to eat unhealthy food, for example birthdays, Christmas, work parties, holidays. Often these events are unavoidable so it is best to plan ahead and decide what you will have to eat to stop you from over eating.

Weight loss can be slow and sometimes feel disappointing. Reward yourself with something that is not related to food and eating, for example new clothes, a cinema trip, a magazine or book.

It is a good idea to track your weight loss; you can do this by weighing yourself or measuring your waist circumference once a week and keeping a record.

Do you have regular haemodialysis?

If you have regular haemodialysis, your weight will usually go up in between dialysis sessions and then down again during your dialysis session. This weight gain and loss is caused by a build-up and then loss of fluid rather than flesh. It is important to not gain too much fluid weight between dialysis sessions as this makes dialysis more difficult for your body to deal with. Your overall aim is to be losing flesh weight. The best way to monitor your loss of flesh weight is by keeping a record of your weight after dialysis. It is important to talk to the staff who help you to connect to the dialysis machine and tell them you are trying to lose flesh weight as they will need to monitor how much weight you lose to make sure the right amount is taken off on dialysis. Your loss of flesh weight through eating less can sometimes be hidden by fluid that your dialysis does not get rid of.

PD10184-PIL4354 v1 Issue Date: February 2020. Review Date: February 2023

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