MARIE is struggling to lose weight. we help her achieve her goals. Name: Marie Michael, 25, personal banker. Weight-loss goal: Lose 25 kilograms.

First impressions

Clinical psychologist Louise Adams says: At her initial appointment, Marie’s lack of confidence was striking. She described how for years she had felt frustrated on various diets where she had initially lost weight but then always regained it all (and more).

She believed that it was her fault that she had regained the weight – that she had “failed”. Marie was relieved when we discussed why diets don’t work.

Dietitian says:

Marie confessed that she has been frustrated with her weight for as long as she can remember. Although she was the first to admit that her eating wasn’t perfect (and nor should it be, as no-one is perfect), she couldn’t understand why her weight was so difficult to control given the amount of exercise she did.

In her first appointment we discussed the concept of her healthiest, most comfortable weight, with the emphasis not on dieting, but on making small, positive and enjoyable changes to her eating and exercise habits.

We discussed that her healthiest weight will be the size that she can sustain over the long term, without being preoccupied with thoughts of fat, food, size and shape.

Exercise scientist says:

At first glance, Marie’s exercise program looks excellent. She’s been a regular at the gym since she was 14. In more recent times she’s had the assistance of personal trainers, but at no stage has she sustained successful weight loss.

There are two possible reasons we’ll investigate. The first is that the exercise choices she is making may not be the most beneficial for her needs, and the second is that her energy output, which may be quite high, may still not be enough to compensate for the amount of food she is consuming. This is a classic example of not being able to out-train a bad diet.

Marie sees a personal trainer twice a week, attends two to three power yoga classes a week and one Pilates reformer class and walks for 45 minutes to an hour three times a week.

What to do

Trainer says:

It’s no wonder Marie had such low confidence in her ability to achieve her healthiest weight. Marie felt like she was “failing”, when in fact, dieting itself is the failure.

We discussed a plan to help her get back in contact with what her body felt like eating, overcome thinking patterns about “good” and “bad” food, and build confidence.

We also planned to tackle body image and emotional eating. Marie was excited to start working on a non-diet approach to achieving a healthy weight.

Trainer says:

I worked with Marie to shift her focus away from the “weight” figure and towards the process of nourishing and enjoying her strong body.

We discussed the components of her body (bone, fluid, muscle and fat) which contribute to weight, and how deceptive and demoralising the scales can be when we pin our hopes on the number they display. A Dexa body composition scan will ascertain where Marie is holding her weight, what her ideal weight is and how much she ideally needs to lose.

I sent Marie away with a diary to document her food intake for the week, not so much to see what she was eating, but to enable her to gain an awareness of her hunger and fullness before and after meals and snacks. In particular, I asked her to be aware of what we call “non-hungry” eating – the major contributing factor to why many people are above their healthiest weight.

Damien says:

Marie is spending the majority of her exercise time doing yoga and Pilates. We need to shift her focus to other types of strength training and high-intensity cardio to ramp up her energy output. If we can build up or maintain her levels of muscle mass, and also take her training to a higher intensity level, this will help her to achieve her results.

High-intensity training, with or without strength training, has been found to be the most effective exercise method for weight loss. Marie’s training history will allow her to train at a greater intensity than others in her situation.

Her strength circuits will be either with a trainer or by herself in the gym, and her high-intensity interval training will be done predominantly outdoors in a local reserve.

Dexa scans

A Dexa scan provides a state-of-the-art way to assess your body composition. It gives an accurate assessment of your fat and your fat-free mass (muscle mass). Marie’s scan showed that she participated in substantial amounts of physical activity; she had over 54 kilograms of muscle!

The scan also showed that she was aiming for a weight that was unrealistic and too low for her healthiest weight. The Dexa found Marie’s healthiest weight to be 76 to 81 kilograms. She had come to her first appointment with a goal weight of 70 to 75 kilograms in mind.

Marie’s weekly exercise schedule
• Monday – Strength circuit
• Tuesday - High-intensity interval
• Wednesday - Strength circuit
• Thursday – walk
• Friday - High-intensity Interval
• Saturday – Strength circuit
• Sunday – walk

Are you trying to train your way out of a bad diet?
• You do a hard exercise session and buy a muffin as a reward.
• You think that if you train regularly you can eat what you want.
• You eat a lot of energy-dense food to compensate for your hard training.