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Intensive lifestyle management for obesity has limited value
January 06, 2024

Intensive lifestyle management for obesity has limited value

Intensive lifestyle management for obesity has limited value states the literature categorically; doctors in the main have given up trying to convince their patients of the need to shed those pounds through exercise and eating more healthily.

It's a waste of breath and they lose patients; clients become angry and seek out other doctors.

Welcome to the world of Cyan Zones; creating little havens intent on protecting both ourselves and Mother Earth in this world hostile to wellness and careless of preserving the planet in its once pristine state.

This is a long and difficult page; it's definitely not for skimming through. It is written for those who have given up all hope of ever losing weight and dealing with type 2 diabetes.

There is hope. I have overcome and you can too; without the use of drugs that are very expensive, have to be taken indefinitely and have some very serious side effects.

Read on if you are at the end of your tether; but expect to be stretched mentally and challenged if you want to reach that higher place where the dirty four-letter word "diet" is banished for ever.

When I read the headlines coming in from Obesity Week 2023 I'll admit to becoming quite depressed. It was all about data and questions about Semaglutide, Tirzepatide, and Retatrutide; weight-loss drugs. Little credence is given to lifestyle management any longer.

Then adding grist to the mill there is the cost of these drugs. Wegovy and Saxenda for example cost about $16000 a year and have to be taken long term. Insurance in the main won't pay. That is way out of reach for the majority of people.

Loss of muscle mass

When we lose weight, roughly 25% is muscle; known as "lean body mass."

Of great concern is that when we rebound as most do, the muscle mass is not regained, only the adipose tissue. We would have been better off not having gone on any programme to lose weight in the first place.

That applies whether it is an intensive lifestyle management programme for obesity, medication like Tirzepatide or even one of the more sensible tools like the Longevity Diet.

So exercise absolutely must be central to intentional weight loss, firstly to mitigate against that loss of muscle mass; and secondly to help keep blood glucose down.


Firmly in our minds should be the grim determination to keep to this for ever; or don't start at all.

Dieting in the main is a complete and utter waste of time; they don't work and we become depressed and despairing.

So what are the alternatives?

True wholegrain bread is rarely found in grocery stores.

Our own journeys

If you read this column with any regularity you will know that it reflects my own journey with wellness and creating a green bubble around us in our dark world.

This particular newsletter in many ways reflects my own journey with diabetes. I was once 25 pounds heavier than I am now but it was the chance discovery that my blood glucose shot into orbit after a starchy meal that set the cat amongst the pigeons. Working daily with obese patients I knew it meant the beginning of a slow decline into poor health.

Nearly 50% of those enjoying typical grocery store food are insulin-resistant; and are on the edge of the same precipice I was facing twenty years ago.

This is the science; frankly it's complex so I have tried to simplify what is really deep stuff. If you are wrestling with your weight as I was, then grasping that prickly nettle, understanding the alternatives and what will happen if you do nothing is at the heart of the matter.

I won't pretend it is simple; but if I did it, so can you.

True wholegrain grits will be difficult to find.

The incretin hormones

There are two "incretin" hormones, GIP and GLI-1 that are secreted by cells in the stomach and small intestine. Their actions are highly complex but might briefly be summarised as follows.

1. They stimulate the pancreas to start producing insulin after we consume food; the so-called "incretin effect."

2. GIP plays another critical role by storing fat in adipose tissue; taking blood glucose out of the circulation.

3. GIP stimulates bone formation and GLI-1 inhibits the osteoclasts; keeping the balance in the turnover of new tissue.

4. In the brain they reduce appetite, the desire for more food.

5. In the stomach GLI-1 delays gastric emptying thus increasing a sense of satiety.

6. They play an important role in memory formation.

7. GLP-1 suppresses glucagon secretion by the pancreas which normally stimulates the liver to turn glycogen into blood sugar; to make sure we never go into a diabetic coma.

GLP-1 secretion in the lower gut is impaired in the obese; gastric emptying happens more quickly than it should. Consequently to achieve satiety we have to keep eating; and osteoclast activity is not limited causing bone destruction. Protein digestion, particularly of that from plants is incomplete; short chains of amino acids may be assimilated causing other complications such as allergies and bloating.

Intensive diet and exercise

It is now beyond debate; these new front line drugs that influence the incretin hormones are very effective. So is there still a place for intensive diet and exercise considering that almost no one can stick with these lifestyle changes?


We humans are driven by the need to see results; and to experience them fast. So the word is "intensive;" and therein lies the failure. Weight that is lost quickly returns with a vengeance when we take the foot off the accelerator.

And which of us has the time and energy to sustain any intensive activity for ever? It is little wonder that attempts to change diet and increase exercise so often fail miserably.

So intensive lifestyle management for obesity has limited value; forget it and do not even make a start, they say. You are programmed to fail. But where does that leave us?

Osteoporosis and the obese

As stated above GLP-1 secretion from the lower gut seems to be reduced in the obese. Since one of its function is to inhibit osteoclast activity, the cells that break down bone normally during remodeling, that might explain why those who are overweight are more prone to skeletal weakness and fracture; much pain, expense and worst of all ultimately disability.


These "agonist" drugs as they are being called, bind to certain hormone sites activating an increased response.

So a GLP-1 agonist prolongs and enhances the normal action of the hormone. It encourages the pancreas to go on producing more insulin for longer in order to lower blood glucose.

But it would also encourage osteoclasts to break down more bone than would normally occur; it could also affect memory.

A GIP agonist would lower blood glucose by storing yet more fat in adipose tissue. On the positive side it would also encourage the bone-forming osteoblasts to build new cells.

They would both reduce the desire to eat more food, by delaying gastric emptying and influencing the hunger centre in the brain.

Clearly these drugs have wide-ranging, complex actions in the body; many probably are still not yet known. They obviously affect the gut in different ways having diverse side effects.

Side effects of the weight loss drugs

The incretin hormones, GLP-1 and GIP have very short half lives; their actions last only for minutes. If the response continued for too long they might dangerously lower blood glucose causing us to go into comas.

So the body produces another enzyme called DPP4 that rapidly degrades GLP-1 and GIP.

Another group of drugs used to manage type 2 diabetes inhibits the action of this DPP-4, prolonging the action of the incretin hormones. These medications have unexpected side effects including sinus and urinary tract infections, joint pains and acute pancreatitis.

In 2023 the label for the drug Ozempic was updated to acknowledge reports of intestinal obstructions, CBS News reported.


The pancreas is a gland that has a dual function. It produces enzymes that help digest our food and hormones that manage our blood glucose.

Pancreatitis is a very serious condition in which the tissues of the gland itself are attacked by the digestive enzymes it produces for the gut. Thereafter there is a four times greater chance of developing cancer of the ducts.

Pancreatic cancer is incurable, in part because it is usually diagnosed very late in the disease. I am typing on an Apple Mac; Steve Jobs, one of the richest men in the world died of the disease at 56. It has the highest mortality rate of all major malignant tumours.

These weight-loss drugs target the pancreas so it comes as no surprise that side effects are encountered. Clearly the alpha and beta cells that produce the hormones glucagon and insulin are not the only ones influenced; those that synthesise the digestive enzymes are affected too.

"Pancreatic cancer is projected to become the No. 2 cause of cancer-related death in the United States, surpassing malignant colorectal and breast tumours."

- Cedars Sinai

Other common side effects

Since these weight-loss drugs target cells in the gut it comes as no surprise that many of these side effects occur in the GI tract; nausea, vomiting and changes in bowel habits like diarrhoea.

These side effects are not uncommon but it was the discovery that these agonists also cause a nine fold increase in the risk of pancreatitis that was centre stage at the conference. Nevertheless it is still relatively rare; but a 36-times greater chance of cancer of the gland is scary.

What Is the Dark Side of GLP-1 Receptor Agonists?

"There are three manageable risk factors for pancreatic cancer.

1. Smoking.

2. Obesity.

3. Lack of physical exercise."

- Cedars Sinai

Slow and determined lifestyle management for obesity has great value

Slow and determined lifestyle management for obesity on the other hand has great value; in fact it is the only way that makes sense to me and a great many others.

By mistake I pasted the foods that we sell at a local organic market into this newsletter. I was about to delete the error when I realised it reflected the changes we made in our lifestyle on discovering I was prediabetic; and the loss of all those unwanted kilogrammes and a new lease on life. My mobility has improved to such an extent that in my mid seventies I have just been clambering around on the roof of our home installing more solar panels.

This site is about preserving not only our own wellness but also that of the planet; what we call a Cyan Zone issue. We have used only 43kWh of electricity from the grid in the last four years.

What is a cyan zone?

Reko Hilton


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Raw honey has a low glycemic index; it even lowers the fasting blood glucose of diabetics.

So what can we do?

If you are overweight as I was, are insulin-resistant or suffer from type 2 diabetes, scientists have shown that you can put the disease completely into remission using food as medicine; dinkum.


But some lifestyle issues have to be faced with fortitude and determination. If you cannot do this for the rest of your life, don't start.

First of all you simply have to pull the sweet tooth; permanently. And do not turn to artificial sweeteners. I have done it, so you can too; for ever. Use only raw honey for sweetening.

Keep treats for high and holy days.

Pull the sweet tooth

Secondly make the decision to take a short walk after any starchy meal; perhaps just five or ten minutes. Swimming or cycling would be equally good. The glucose is instead turned into glycogen.

Thirdly cake flour, white rice and refined cornmeal simply have to go; for ever. You can enjoy them occasionally; we do.

Most difficult of all, commercial loaves have to come under the spotlight. We made the decision to eat only 100% wholegrain bread.

It meant buying a mill and a bread machine; on the plus side loaves baked from freshly-ground flour taste unbelievably good. Have you not also discovered that the commercial slice has no flavour?

"Walking significantly decreased glycosylated haemoglobin A1c by 0.50%."

- A meta analysis

Baby steps

Rome was not built in a day; nor was all this achieved in a flash in our lives. Each journey begins with a single step.

I would suggest starting with a short walk after every starchy meal. You decide how long; perhaps just a few minutes. That alone would have a profound affect on your HbA1c test. To make it happen researchers found it has to be supervised.

Could you be your own supervisor? Start with baby steps. Without a profound desire to be more healthy, have less pain and disability none of this will happen.

And secondly cut out the refined carb you are least fond of. Could you give up white rice for ever? It has no taste in any case.

Impact of Walking on Glycemic Control in Type 2 Diabetes


There is absolutely no point in choosing any one of these options unless you plan to do it for the rest of your life. So take your time and make wise decisions that are sustainable.

Rendered lost

With nearly fifty percent of those enjoying typical grocery store food finding themselves insulin resistant, overweight and obese as I was, having tried diverse diets, many of us feel "rendered lost." There's nothing new about that the bard doth remind us.

"There is a remedy, approved, set down to cure the desperate languishings whereof the king is rendered lost."

- William Shakespeare


The take-home from this essay is that type 2 diabetes is the greatest health challenge of our time; far worse than the recent pandemic, for example. In fact more than half of those who died from Covid suffered from raised blood sugar.

Change is always difficult; the temptation is to pretend that we would never be one of those who will have a stroke, heart attack or die from pancreatic cancer.

Yet all is not lost; the remedy lies within us.

"Our remedies oft in ourselves do lie, which we ascribe to heaven. The fated sky gives us free scope; only doth backward pull our slow designs when we ourselves are dull."

- All's well that ends well.

I do indeed hope that having found that intensive lifestyle management for obesity has limited value that you discover the slow and determined path to wellness. It will mean severely limiting all refined carbs; then all will end well.

Create your own Cyan Zone

Care for the planet in whatever way you can. Look after yourself and the family in every possible manner; not only other people get these preventable diseases.

It will mean a total overhaul of every aspect of your lifestyle; it has in fact been the most rewarding facet of my whole being.

We look upon caring for our bodies as a spiritual duty, on a par with reading of the scriptures and prayer. This human frame is the dwelling place of Almighty God; it behooves us to look after it.

Till next month,


Create a cyan zone at your home

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1. Bernard Preston Homepage.

2. Back Issues for Create a Cyan Zone at your home.

x A world largely devoid of Parkinson's Disease

x The impact of friendly bacteria in the tum on the prevention of cancer

x There's a hole in the bucket

x Everyone is talking about weight loss drugs

x Pull the sweet tooth

x If you suffer from heartburn plant a susu

x Refined maize meal and stunting

x Should agriculture and industry get priority for electricity and water?

x Nature is calling

x Mill your own flour

x Bake your own sourdough bread

x Alternative types of water storage

x Wear your clothes out

x Comfort foods

x Create a bee-friendly environment

x Go to bed slightly hungry

x Keep bees

x Blue zone folk are religious

x Reduce plastic waste

x Family is important

x What can go in compost?

x Grow broad beans for longevity

x Harvest and store sunshine

x Blue zone exercise

x Harvest and store your rainwater

x Create a cyan zone at your home

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