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Week 12

Welcome to the twelfth week of the BTF weight loss and wellbeing programme.

To read the advice, tips and suggestions from our experts please follow the links to this week’s articles below. The other resources you can use are:

  • Expert advice - learn more about thyroid disease and weight management from our medical experts
  • Patient stories – find out about how other thyroid patients have managed to successfully lose weight and improve their wellbeing
  • Community - share your weight loss journey with other people who are taking part in this programme by joining our closed Facebook group

Sleep

When it comes to weight loss, sleep is probably not the first thing we think of. Instead we focus on the food we eat and try to increase our exercise. However weight loss is holistic as you’ll have read in the previous articles and sleep is another piece of the puzzle.

How would you rate the quality of your sleep now? Poor? Average? Great? Take some time to reflect on it. Here are some questions you might want to ask yourself:

  • What time do you go to bed?
  • What time do you get up?
  • Are these times consistent?
  • Are you up during the night?
  • What time do you stop looking at devices before bed?
  • Do you wake feeling refreshed or do you feel tired?

Sleep is a natural behaviour and it is part of everyone's life. When we are asleep we have a reduced awareness to our environment and surroundings but sleep is dynamic. Lots of important processes take place while we sleep, such as restoring and re-charging our bodies (allowing us to recover from physical and mental fatigue), maintaining our immune system and clearing out toxins, and consolidating our memory.

What affects our sleep?

  • Environmental agents or events that provide the stimulus to set or reset our body clock. These include light, blue light from devices like mobile phones, meal times, social activity, and exercise.
  • Hormones:
    • Melatonin: referred to as the ‘sleepy hormone’ is released in response to darkness and works by telling the body to get prepared to go to sleep.
    • Cortisol: commonly known as the ‘stress hormone’ is released in the morning to help us wake up and get on with our day. When we feel under pressure or stressed about something we can release cortisol when we are trying to sleep which in turn makes it more difficult to get to sleep. Lack of sleep also increases levels of cortisol in our bodies, which makes us crave foods that are energy dense when we are stressed. These foods break down quickly during digestion, giving us a glucose boost, which is then followed by an energy slump. This in turn creates a cycle where we crave more energy-dense food to give us another boost.
    • Leptin and ghrelin: hormones that affect weight gain. Leptin suppresses our appetites and ghrelin increases our appetites. If we don’t get enough sleep then the levels of leptin are reduced and the levels of ghrelin increases making us feel hungrier.

What happens if we don’t get enough sleep?

  • The part of the brain that helps us plan, make decisions, evaluate danger and manage behaviour is the part mostly effected by lack of sleep. This reduces our daytime function and we may feel fatigued as well.
  • Our brains are very active during sleep and things we have learnt during the day are processed while we are asleep. New learning moves from the short term to long term memory so if we don’t get enough sleep it impacts on our ability to retain information.
  • Our immune systems are very complex and can be impaired by sleep deprivation.
  • Changes in mood are one of the first things we notice when we have sleep problems. This is because sleep deprivation affects the part of our brains that regulates our emotions and can make us feel irritable, groggy, short-tempered and easily upset.
  • Weight changes in relation to hormone balance. Levels of leptin (the chemical that makes you feel full) are reduced and levels of ghrelin (the hunger-stimulating hormone) are increased.

You can see how poor sleep indirectly impacts weight loss. From the hormone changes that could lead to choosing more energy dense foods, to the tiredness you feel that means you don’t go to that exercise class you had planned. So as we’ve discussed with other topics, if you think sleep is an area you’ve identified to work on, look at what you want to change and set yourself some goals related to these. For example, not using electronic devices half an hour before bed, using a sleep app with calming meditations to help you relax in the evening, or setting a consistent bed-time or wake-up time.

Maintenance

As we come to the end of this programme just as you have been planning on how to lose weight it is also important to consider how to maintain it. Maintenance is about maintaining the weight loss and the changes you have made. There will inevitably be some weight regain, so don’t get too disheartened when this happens. More important is how you get back on track after experiencing lapses or plateaus, and how you push yourself to keep going. This poem, Autobiography in Five Chapters, by Portia Nelson sums up the stages of change:

Chapter I
I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost… I am hopeless.
It isn’t my fault.
It takes forever to find a way out.

Chapter II
I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I am in this same place.
But it isn’t my fault.
It still takes a long time to get out.

Chapter III
I see it there.
I I walk down the same street.
There is a deep hole in the sidewalk.
still fall in… it’s a habit… but,
my eyes are open.
I know where I am.
It is my fault.
I get out immediately.

Chapter IV
I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.

Chapter V
I walk down another street.

Tips for getting back on track

As we have discussed throughout this programme, getting back on track is not easy. But the following tips may be helpful:

  • Don’t over-react when things go badly. Stop. Breathe and reflect.
  • Look at what you've achieved so far and how your life is now.
  • Remind yourself of all the reasons for wanting to change.
  • Remember to give yourself a non-food reward or treat for achieving your goals.
  • Keep your expectations realistic. You may want to lose another two stone but what difference will that add to your quality of life?
  • Continue to make achievable and measurable goals.
  • Seek support – what support do you need to be successful?

And finally some key messages for sustainable weight loss…

  • Eat regular, balanced meals
  • Try to ensure good variety in your diet
  • Make sure to stay well hydrated
  • Be kind to yourself – practice self-care
  • Try to practice mindfulness
  • Increase your physical activity levels – every minute counts and this is important for maintenance
  • Keep monitoring

Further information

Mindfulness apps:
There are many good apps, such as Calm, Insight Timer and Smiling Mind. Most offer free elements with paid subscription for the rest. Smiling mind is funded by the Australian government and is free.

Good books about mindfulness include:
Mindfulness. A Practical Guide to Finding Peace in a Frantic World by Danny Penman and Mark Williams (2011)
Overcoming Weight Problems: a self-help guide using cognitive behavioural techniques by Clare Grace, Vicky Lawson and Jeremy Gauntlett-Gilbert

How can I start to make changes?

The best way to work towards better health is to set goals in the short, medium, and long term. One tried and tested way of setting goals is through the SMART technique.

SMART goal setting helps us to set goals purposefully. They provide detailed goals which helps us to follow them closely. This can bring real change to our behaviours. If we use a short-term goal (1-4 weeks) as an example: I will do 30 minutes of fast walking at an effort of 4-6 out of 10, 5 times per week.

Let’s break this down to see why this this a SMART goal

The SMART acronym stands for:

Specific – Is the goal specific enough to identify clearly so it can be worked toward? The goal of fast walking, 4-6 out of 10 for 30 minutes is specific.

Measurable - Can the goal be measured? i.e. 30 minutes of walking can be measured through timing, 5 times per week can be measured through keeping a diary.

Achievable – If we had not been active for a while, it would be unrealistic to run a marathon. Fast walking however would be a great start to building up activity and would therefore be achievable.

Realistic – 30 minutes per day can be done throughout the day to fit in with people’s schedules. So it’s therefore realistic even for the busiest of people.

Time – This goal is time-bound; the time frame for achievement is a duration 30 mins per day with a frequency of 5 times per week.

SMART goal setting can help us achieve our goals in the short, medium, and long-term. As we begin our new behaviours to improve our fitness and weight management, it’s very important that we have real tangible goals to work towards over time. It can sometimes take a long time to see improvement to the symptoms of thyroid disease. But the process can be made easier through effective goal-setting to improve our lifestyle related health.

We have already looked at short-term goals, so the following are some examples of medium and long-term goals. Have a look at them and see how they line up with the SMART principles.

Medium (12 weeks): I will achieve 150 minutes jogging per week through 5 x 30-minute sessions per week after 12 weeks

Long-term (6 months): I will complete a 5k run in under 30 minutes within 6 months

By setting goals, we are making a step towards tangible and long-lasting behaviour change. By progressing goals we can ensure that behaviour change can become habit. This means we can repeat the behaviours without too much conscious effort. It can also be beneficial to make a ‘promise’ or ‘contract’ with ourselves which details our goals. This will help to ensure we stay on the right path and can remind ourselves of our goals and what we are hoping to achieve. This can have a huge impact long-term and prevent us from swaying from our target if we become demotivated and tempted to choose an unhealthy behaviour, such as being sedentary or eating high calorie foods. Ultimately, goal-setting will ensure we can stay on track for the long-haul, developing new healthy behaviours, maintaining, and ultimately progressing to, a improved quality of life as we navigate life with thyroid disease better.

Watch

Chartered psychologist, Dr Sue Jackson, talks about how keeping a ‘Goals Book’ can help you stay on track.

Week 11 info Feedback