Managing your weight if you have asthma

Who is the leaflet for? What is its aim?

This patient information leaflet is for those with asthma who are struggling with weight gain.

It can be much harder to manage your weight when you have severe asthma for many different reasons:

• You may feel too tired to make and eat healthy food.
• If you’re feeling unwell, you may not have much motivation.
• Long term steroid use can make you feel hungrier than usual, which can mean you eat more and gain weight. You may also gain weight due to increased fluid retention.
• You may experience low mood and/or stress due to the challenges of living with along term condition, and this can lead to emotional or comfort eating. Ask your team for support if this is happening.
• Your asthma symptoms may make it difficult to be physically active.

Why weight matters

Being overweight or obese can make your asthma symptoms worse, and make breathing much harder. This is why it’s incredibly important to do everything you can to stay at a healthy weight and keep as fit and active as possible.

Being overweight or obese can also increase your risk of high blood pressure; heart disease, stroke, type 2 diabetes, some types of cancers, osteoarthritis and back pain.

BMI is typically used to identify overweight and obesity. Your weight and height is required to work out your BMI. BMI is measured in kg/m2.

• below 18.5 – you're in the underweight range
• between 18.5 and 24.9 – you're in the healthy weight range
• between 25 and 29.9 – you're in the overweight range
• between 30 and 39.9 – you're in the obese range
• more than 40 – severely obese

Your ethnic group can also affect your risk of some health conditions. Adults of Asian origin may have a higher risk of health problems at BMI levels below 25:

• below 18.5 – you're in the underweight range
• between 18.5 and 22.9 – you're in the healthy weight range
• between 23 and 27.5 – you're in the overweight range
• between 27.6 and 39.9 – you're in the obese range
• more than 40 – severely obese

To calculate your BMI; weight (kg) ÷ height (m) squared.

For example, if a person weighed 90kg, with a height of 1.75m, their BMI would be:

90kg ÷ (1.75 x 1.75) = 25.7kg/m2. Their BMI is therefore 25.7.

Another measure of excess fat is waist circumference which can be used as an additional measure in people who are overweight. This is a good way to check you are not carrying too much fat around your abdomen which can increase the risk of conditions such as heart disease, Type 2 diabetes and stroke.

Regardless of your height or BMI, you should try to lose weight if your waist is:

• 94cm (37ins) or more for men
• 80cm (31.5ins) or more for women

You're at very high risk if your waist is:

• 102cm (40ins) or more for men
• 88cm (34ins) or more for women

To measure your waist:

1. Find the bottom of your ribs and the top of your hips.
2. Wrap a tape measure around your waist midway between these points.
3. Breathe out naturally before taking the measurement.

Making changes

Making sustained change in our lives is difficult. Replacing old habits with new ones requires time and perseverance. Your journey may be tough and it may not always go to plan! The key thing is not to let setbacks hinder your progress. Accepting and understanding the mistakes you have made is all part of the cycle of change.

The cycle of change is described as an ‘upward cycle’. Each time you go through it, you reach a higher level. You will have gained experience, new perspectives and you will have improved your ways of coping with triggers and vulnerabilities.

Below is the cycle that people go through when making behaviour changes.

Top tips for starting a weight loss plan

Social support

If you’re planning to make changes to your diet, tell the important people in your life what you’re doing, and why. Their support can make it easier for you when you need a little encouragement.

Make small changes

To lose weight and keep the weight you lose off, most experts say it’s best to make small, realistic changes to your diet and the amount of physical activity you do. It’s generally recommended to lose weight at a steady rate of between 0.5 and 1kg (1-2lb) a week, but talk to your asthma dietitian about whether your diagnosis of asthma means this is sensible for you.

Activities such as dancing, gardening, housework, chair aerobics and walking – whatever you can manage – can help to burn excess calories and boost your mood.

Research has shown that people lose on average 20% more weight if they exercise as well as diet, compared with those who only cut back on calories.

The trick is to find something that you love doing, preferably with friends or family. You could try the small changes, food swaps and activities in the NHS’s Better health - healthier families (opens in a new tab), or Better Health - Let's do this (opens in a new tab) for adults. Other ideas could be; joining friends for dog walking, or finding a local fitness class or club.

Find a plan that works for you

Keep a diary of all the food and drink (including snacks) that you have in a week ‒ the NHS has a weight-loss guide (opens in a new tab) that includes an app to help you track your weekly progress. There is also a calorie calculator and a free app to help you cook healthier versions of the foods you love. Use these tools to work out how you can make simple changes to your diet.

Plan ahead

It’s a good idea to cook big batches of healthy food such as veggie-packed stews, soups and chilli on your good days, so that you’ll always have something that’s delicious and nutritious in the freezer if you’re feeling too tired or unwell to cook from scratch. These also help you save money while staying on track with your weight loss goals.

Don’t let steroid hunger win

If you’re taking steroids in the long term, it’s common to feel hungrier than usual, which can lead to weight gain. It can help to eat foods that are high in fibre such as vegetables, brown rice, beans, lentils, wholegrain bread/wholegrains, and some lean protein (poultry, tofu, fish, or eggs) at each meal to keep you feeling fuller for longer. Also, make sure that you stay well-hydrated because your body can often mistake thirst for hunger.

Improving your eating habits

Eating regularly and the stages of hunger

Plan meal-times (and snacks if needed) in advance. This can help prevent spur of the moment snacking between meals. Allowing yourself to become starving or ravenous (Stage 0-1) can lead to overeating. The best time to eat is when you are moderately hungry (Stage 3) and try to finish eating when you are satisfied (Stage 5).

Take an honest look at your eating habits

Try to keep a record of everything you eat and drink in a notepad / diary / smartphone app and jot down your moods, feelings and activities associated with eating. Ask for our ‘My Food Diary’ leaflet to help you, or use an app such as ‘MyFitnessPal’ or ‘Lose It.’

This can make you aware of what you are eating and any patterns in your eating habits. Sometimes simply writing down what you eat, before you eat it, helps to control eating as it makes you think twice about eating certain foods.

Work out the times in the day when you feel the greatest urge to eat. Try to establish whether you are actually hungry at these times or whether you are eating for another reason such as boredom, habit, loneliness, or an emotional upset.

Be aware of triggers that are likely to make you feel like overeating – for example, being home alone, watching TV while eating, driving past fast food restaurants or preparing food.

Tips to help you to control your eating habits

When you are shopping

• Don’t shop on an empty stomach – go after eating or have plenty of calorie free fluids before you go. Shopping online may be a solution.
• Plan meals in advance so that healthy and low calorie meals / foods are always available. Write a shopping list and keep to it.
• Avoid ready-to-eat high-calorie foods such as crisps, biscuits and chocolates.
• Keep some healthy ready meals (400kcal / calorie or below) around for those times when you don't have time to cook. Bulk them up with extra salad/vegetables (tinned / frozen are just as nutritious as fresh; keep a stock).
• Please ask if you need any guidance with reading food labels.

Healthier cooking tips

• Bake, grill, microwave, stir fry, poach, boil or stew – instead of frying.
• Grill meat on a rack so the fat drips off.
• Use low fat / oil free dressings instead of creamy ones.
• Use non-stick cookware to reduce the fat needed.
• Choose lean meat and mince, trim fat off meat and remove skin from poultry (or buy skinless).
• Drain excess fat from food after cooking.
• Measure cooking oil with a teaspoon to help control the amount you add.
• Replace cream in recipes with low fat natural yogurt or low-fat crème fraiche.
• In casseroles and stews use less meat and add more beans and/or pulses and vegetables.

Mealtimes

• Plate up your meal in the kitchen and remove the serving dishes so that you are not tempted to have more. Put leftovers in the fridge.
• Try eating from a smaller plate.
• Avoid excessively tasting foods when cooking.
• Do not go back for seconds. If you find this difficult, only prepare the amount of food needed for your serving.
• Try drinking a glass of water / diet squash or having a low calorie / fat soup or salad before your meal to help fill you up before your main meal.
• Have two to three portions of salad / vegetables at your main meals – each portion is 80g (around three heaped tablespoons).
• Take your time to eat and enjoy your meal. Chew each mouthful leisurely and thoroughly.
• Pause in the middle of your meal to assess your hunger – it takes at least 20 minutes for your stomach to tell your brain you are full.
• Try putting your knife and fork down between mouthfuls, to encourage you to eat more slowly.
• Try not to eat whilst reading or watching TV as this can very easily lead to eating more than you realise.
• Remember it is OK to leave food on your plate when you feel full.
• Aim to be the last to finish if / when you eat with others.
• Have desserts less often; when you do, a good choice is to have a fruit based dessert with low fat yogurt or sugar free jelly.

What is an appropriate portion?

Below are easy ways to estimate appropriate portions using only your hand.

As a general rule of thumb, your plate should include:

General healthy eating plate

• One third vegetables and salad
• One third protein
• One third carbohydrates

Healthy eating plate aiming for weight loss

• One half vegetables and salads
• One quarter protein
• One quarter carbohydrates

Snacking

• Avoid snacking unnecessarily.
• Learn to distinguish real hunger (stomach) from cravings (head). When you experience the urge to eat, ask yourself:
  • Am I really hungry? Am I thirsty? OR is it a craving?
• If you do get hungry between meals, snacks between meals are fine, as long as they are healthy for you. They should be low energy (less than 100kcal) and provide you with healthy nutrients such as fibre, protein, vitamins and minerals (ask for our ‘Healthy Snack Ideas’ sheet).
• If you get a craving, distractions might be useful. The craving may die away after 15-20 minutes. Make a list of things you could do that distract you and make it impossible to eat at the same time (ask for our ‘Dealing with cravings tip sheet’).
• Plan to keep healthy snacks in places where you think you will need them most, so something is at hand.
• Do not buy high calorie tempting snacks.
• Avoid foods that you feel trigger overeating, but don't ban any foods. Try to plan for them occasionally / on special occasions.

The importance of sleep

The importance of sleep is often underestimated when it comes to managing weight.

If you are sleep deprived, the body produces more stress hormones, which make it harder to lose weight. The body also produces more ghrelin, which is a hunger hormone, and this can lead to cravings for high sugar / high fat foods.

Being tired also reduces motivation and willpower, which therefore means you are less likely to stick to your plan.

If you are struggling with sleep on a regular basis, speak to your team for advice. You may need to be assessed for a condition called sleep apnoea.

Also ensure you have good ‘sleep hygiene’ habits:

Keep to regular sleeping hours

• Most adults need at least six hours of sleep every night.
• It is also important to try and wake up at the same time every day. You may want to catch up on sleep after a bad night, but doing so on a regular basis can disrupt your sleep routine.

Take time to wind down

• Avoid using smartphones, tablets, TV, or other electronic devices at least an hour before going to bed – the blue light from the screen can prevent sleep.
• Take some time to unwind from the day, some ideas are:
  • Take a gentle walk o Have a warm bath
  • Listen to calming music
  • Write a ‘to do’ list to organise your thoughts and clear your mind
  • Relaxation exercises such as light yoga stretches
  • Read a book or listen to a podcast

There are a range of apps and online courses available (all endorsed by the NHS) designed to help with sleep (many are free):

Pzizz – free app This app uses ‘dreamscapes’ – a mix of music, voiceovers and sound effects to help you sleep better at night.

Sleepio – free in Oxfordshire, Berkshire and Buckinghamshire. This is an online programme based on cognitive behavioural therapy for insomnia (CBTi). You can learn behavioural strategies to help tackle the racing mind and reset sleeping patterns naturally.

Sleepstation – free with GP referral This is a six week online course tailored to your needs. It gives you access to a team of sleep experts.

Bedroom environment

• Make sure your bedroom is just for sleep.
• Remove TVs and other electronic devices.
• Ensure your mattress is comfortable.
• Make sure the room is quiet and at a temperature of between 18 and 24°C.
• Have thick curtains or a blind to keep it dark.
• Use earplugs if you sleep lightly.

Additional resources

• NHS Better Health - Weight loss plan (opens in a new tab)
• NHS Better Health - Families (opens in a new tab)
• NHS Better Health - Adults (opens in a new tab)

Online and smartphone apps / websites

Apps

• My Fitness Pal (opens in a new tab) - to track calorie intake and physical activity (App)
• Lose it (opens in a new tab) - Weight loss

Websites

• Recipies - Healthier families - NHS Better Health (opens in a new tab)
• Healthy eating recipe ideas - BBC Good Food (opens in a new tab)
• Healthy recipe finder- British Heart Foundation (opens in a new tab)

Additional patient information leaflets

• Food labels made easy (Diabetes UK)
• My food diary
• Goal setting
• Dealing with cravings
• Healthy snack ideas

Please ask us if you would like copies of these.