More than 63 per cent of Britons are now overweight or obese.
You may not have heard of Roy Taylor, but his work in the area of weight loss and health is revolutionary.
As a professor at Newcastle University, he was the first to prove that type 2 diabetes can be reversed through rapid weight loss. His research has inspired some of our most popular diets.
Who isn’t on the 5:2 plan these days – eating whatever they want for five days, while reducing calories for the rest? But the stakes now couldn’t be higher: 63.9 per cent of Britons are overweight or obese, a crisis that puts incredible strain on the NHS.
Type 2 diabetes costs the NHS £10 billion (NZ$20.2b) per year – roughly 10 per cent of its overall budget. And in an era where weight-loss drugs like Ozempic may offer a quick fix, Professor Taylor proves that the old-fashioned approach to weight loss could be best.
Back in 2011, Taylor proved that a low-calorie plan that triggers weight loss restores the body’s ability to control blood sugar levels and puts type 2 diabetes in remission. He conducted a small study on a group of 11 people with a recent diagnosis.
All participants reversed their diabetes in eight weeks of adhering to the reduced-calorie diet. A follow-up study published last month showed that, at the five-year mark, study participants who had remained in remission had maintained an average weight loss of 8.9 kilograms.
However, compared with the new generation of rapid-action weight loss drugs such as Ozempic, Taylor’s method for reversing type 2 diabetes seems old-school: a short period on an extremely calorie-restricted diet of soups, shakes and vegetables. But this year, a crop of injectable weight-loss drugs seem to have offered a miraculous new solution.
Ozempic has been dominating headlines: it has rapid results and has been endorsed by celebrities including Jeremy Clarkson and Elon Musk. In the UK, a similar branded drug called Wegovy is available on the NHS for the treatment of obesity, and another weight loss injection called Tirzepatide is set to be approved.
Like Ozempic, these contain a substance called semaglutide, which mimics a naturally occurring hormone called GLP-1 to reduce appetite.
These drugs have been welcomed by some as a “game-changer” in treating prediabetes and type 2 diabetes in people with a high BMI.
Professor Taylor welcomes new treatments, but says we can’t drug ourselves out of Britain’s mounting obesity crisis. “I find it difficult to think that the NHS will be able to treat its way out of the severe problem we have with people getting heavier,” he says, primarily because when someone stops taking a weight loss drug, they usually gain back the weight they’ve lost.
“Many people would prefer to get healthy without [drugs], and I would very much be in favour of that as the best overall solution.
“At the moment, these drugs are extremely expensive – the cost will drop, but they’re still going to be associated with nausea and vomiting at the start of treatment, and to maintain the weight loss, the drug needs to be continued. When the drug is stopped, we go back to baseline.”
We can all learn something from this, as Taylor believes type 2 diabetes can creep up on people who believe they aren’t at risk.
The stark truth is, “most adults in Britain would benefit from losing at least 10 per cent of their weight”, he says. “Many people who have been told they’re in the ‘normal’ body mass index range are in fact carrying around a bit too much weight,” he says.
So what are the alternatives in the era of the Ozempic quick fix?
Professor Taylor believes a short, sharp calorie deficit is best. This approach has fallen out of favour in some circles, as research shows that what you eat matters more than how much.
One 2019 study published in Cell Metabolism found that eating processed foods resulted in people consuming more calories compared with unprocessed foods.
But when it comes to weight loss, the simple maths of energy in vs energy out still counts. Reducing your energy intake might be initially challenging, but Taylor insists it isn’t hazardous. He doesn’t advocate an “open-ended severe restriction of calories”, but a targeted deficit over the course of three to five months, which could “bring about the weight loss that most of us could benefit from”.
“The matter of losing weight is sometimes seen as a life sentence of constantly restricting and that’s very difficult to sustain,” he says. “The approach we’ve taken is completely different. There’s a short, sharp period of severe calorie restriction [to lose weight], and then it’s simply a matter of keeping weight steady.”
According to Taylor, although it sounds punitive, a bigger deficit over a shorter period is more effective as “most attempts at weight loss are gradual, painful and not too successful”.
“Losing weight rapidly is more acceptable as people feel so much better at a lower weight,” he says.
The NHS uses Professor Taylor’s approach to treat type 2 diabetes: a calorie-restricted diet of three meal replacement soups or shakes a day, which amounts to 600 calories, plus 200 calories of vegetables and an optional 100ml of skimmed or semi-skimmed milk to use in teas and coffees, followed by a phased re-introduction of food and ongoing maintenance.
“This approach is a packet of liquid food at each meal, and we always use some non-starchy vegetables such as spinach, broccoli, peppers and aubergine to add variety. Nothing else is eaten, and no alcohol. People are quite able to stick to that,” Taylor says.
He doesn’t deny that it can be challenging, especially in the first 36 to 48 hours, but insists only “one in 10″ participants struggle with fatigue for the duration, and the benefits soon outweigh the cost.
For the average person, the NHS recommends a smaller deficit of 600 calories per day for weight loss. But Taylor hopes his 800-calorie-a-day-diet will be used elsewhere in primary care: “If you wanted to prepare sensibly for an operation, [like] a hip replacement or a knee replacement, the time you spent in the hospital, your risk of wound infections, the overall problems that you might run into are likely to be dramatically lessened by being 10 to 15kg lighter,” he says. “For specific events that require a lower weight, preparing for surgery is a classic.”
There are hundreds of diet plans and products on the market, but the reason Taylor’s diet is so effective in triggering weight loss is its simplicity, he says.
As a caveat, he says anyone overweight or obese could try this approach, but insists that he’s not saying everyone should. Any calorie-cutting plan will work, but the reason he selected a liquid diet of 800 calories a day, in nutritionally complete soups and shakes for three months, is that there’s very little margin for error.
“Those who had manual jobs and participated in our studies were able to continue, and they noticed no fall off in performance during this weight loss,” he says.
“If we looked at elite athletes, yes, they would notice their sprinting fell off considerably, but ... most people are not elite athletes.”
In the longer term, exactly what you eat can be determined by the approach that works best for you: there’s no silver bullet. Study participants were given “advice about portion size” and told to “expect to eat much less than they did previously”. Professor Taylor also suggests maintenance could be achieved by “halving the amount of potato on your plate”, or intermittent fasting.
“There is variety in how a reduction in total energy intake could be achieved,” he says. “I just [want to] emphasise that our expectation shouldn’t be that there’s one best way for all. Some people do quite well on a low carbohydrate diet [and maintain weight loss] but many people find that difficult to sustain long-term.”
However, there are some golden rules. Even “cutting out alcohol on, say, a few days per week, if people are drinking alcohol every day, makes a big difference”, says Taylor.
The NHS recommends drinking no more than 14 units per week spread over three days or more, with at least two consecutive alcohol-free days.
Alcohol is high in sugar and calories: there are approximately 120 calories in 150ml of white wine or 250 calories in a pint of beer, roughly the same as four biscuits.
“Avoiding eating between meals is another strategy,” says Taylor. One of the best things you can do for weight loss is un-learn the idea that you need to graze all day.
“We need to break this idea that you need to have food before exercise, and after exercise, to reward yourself with food. This [myth] is stimulated by the food industry, which wants to advertise its products.”
Exercise alone is unlikely to be an effective tool for weight loss, although it has myriad other benefits for overall health and well-being: one study published in Current Biology showed that our bodies reach a plateau where increasing exercise does not necessarily burn more calories.
“There’s a lot of reticence about not eating ‘normally’ – the message is so pervasive that you must eat for energy levels, but actually one can manage perfectly well without eating for a spell and still be able to perform normally,” Taylor says.
"I do feel kind of stuck. And I feel like a lot of people feel that way."