When I saw the photos of Pauline Quirke showing off the results of her six-stone weight loss, I have to admit, I thought she looked great. But my heart sank when the Birds Of A Feather actress admitted it was thanks to the LighterLife plan.
For the uninitiated, this is the cult diet with more than 150,000 followers that claims to help obese, serial dieters shed huge amounts of weight in record time (Pauline did it in just six months).
Light as a feather: Pauline Quirke (left) before and (right) after her diet, where she lost six stone
But business success does not correlate to its effectiveness as a long-term obesity cure: you will lose weight on the programme, but I certainly question whether it can be maintained.
With more and more of my patients struggling with expanding waistlines, and knowing the serious impact that can have on their physical health and life expectancy, I am frequently asked about diets.
In my opinion, sustainable weight loss does not involve a crash diet or extreme exercise regime but a long-term, realistic change in lifestyle.
Here are a few of the questions I am often asked in my surgery on the subject.
Q. What is LighterLife and can it help me lose weight?
LighterLife is medically termed as a very low-calorie diet (VLCD). All normal food is banned and replaced with food packs - fortified drinks, soups, desserts and bars - providing 530 calories daily. You follow this until you reach your weight-loss goal, at which point LighterLife gives you a tailor-made eating plan. Or as its phone operator told me: 'You can go back to your normal food.' Participants are also involved in group meetings for support, which can help with motivation.
There is no doubt that people lose weight on LighterLife and other meal-replacement equivalents. But there seems to be no independent data to prove how much of this is maintained. The health benefits do not come from transient weight loss but from long-term maintenance of a healthy waist measurement of less than 37 for men and 32 for women, and a body mass index (BMI) score - a ratio of height to weight used by medics to calculate a healthy weight for an individual - of under 25.
Q. So do people regain the weight they lose on LighterLife?
Yes. LighterLife publishes data on long-term effectiveness up to three years and the studies show that people do keep off a percentage of the weight, but even it admits that most keep off less than half what they originally lost. Considering that the programme was established 15 years ago, the fact that they have followed people for such a short time after their initial weight loss makes me sceptical about longer-term results.
Dawn French lost three stone on a regime of regular walking and less regular chocolate and chips
Q. I've tried all sorts of diets but I can't keep the weight off. Why?
Crash diets trigger a cycle of weight loss that is temporarily sustained, then rapidly regained until the next diet is started and the cycle starts over. In the early stages of starvation - which is essentially what these diets induce - the body cannibalises muscle as well as fat to provide energy not being gained via food, and this contributes to a dramatic weight loss.
In all crash diets, because the severe restriction is not sustainable, when a person starts eating normally again, the weight goes on quickly as fat. In 2007 an analysis of 31 clinical weight-loss studies (the biggest analysis ever carried out) found that more than two-thirds of dieters eventually put on more than they lost.
One study carried out by the University of California found that 83 per cent of people who lost ten per cent of their body weight within six months put on more than they lost two years later, while another showed that half of dieters put on an additional 11 lb five years after coming off their diet.
Q. Could crash-dieting alter my metabolism, making it slower?
Contrary to common belief, yo-yo dieting has never been scientifically proven to be detrimental to physical health or to cause your metabolism to slow down. But it has damaging psychological effects of stress, depression and poor self-esteem.
The sustainability of the diet and weight loss is not a problem simply of LighterLife but of any programme that is extreme compared with an individual's normal lifestyle, including excessive exercise regimes that are the focus of many celebrity-exercise DVDs.
Q. What about diet pills?
A recent study found that the most common drug recommended for long-term use - orlistat, also known as Xenical or Alli - reduced weight by less than 11lb, equating to a loss of less than five per cent of total body weight. And with the tablets, there is no healthy change in lifestyle as you are relying on the medication to do the work. When patients stop taking them, weight is generally regained.
Q. So what is the answer - how can I lose weight?
Pauline revealed her weight loss in Woman magazine
There is no quick fix. In order to maintain a healthy BMI, any dietary changes must be realistic. The changes have to be viable on holiday, at work, when with the children, and so on. You need to imagine yourself continuing with any plan indefinitely.
The same goes for exercise. The novelty of pitching up at the gym four times a week soon wears off. Striking the happy medium of doing enough to make a difference, but also so it's practical in terms of your lifestyle, is the long-term answer. I'm a big fan of comedian Dawn French's approach - she recently lost three stone on a regime of regular walking and less regular chocolate and chips.
Pauline has done well with her weight loss and she will be reaping the health benefits - hopefully avoiding problems with arthritis in her hips.
I look forward to the follow-up piece in five years' time that shows she has kept the weight off.
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