Dr Fran Ramsay, a bariatric medical practitioner based in Hobart, Tasmania, has specialised in non-surgical and surgical weight management since 2001, practising in Brisbane, QLD, and Hobart, TAS. She spent over a decade (2003–2015) working in a multidisciplinary weight loss clinic utilising a low calorie model with meal replacements. Since 2010, she has also worked in clinics advocating the low carb, healthy fat and protein-based approach to sustainable weight management—an invaluable opportunity to compare both dietary models firsthand.

Through this unique experience, Dr Fran has observed superior long-term weight maintenance and metabolic health in patients following the low carb, healthy fats and protein approach compared to traditional low calorie diets. However, implementing lasting behavioural change remains a challenge. In her clinical practice, she has found Defeat Diabetes to be one of the most effective tools for helping patients successfully adopt and sustain lifestyle changes.

Case Study: Patient NB

Patient: NB, 35-year-old female
Occupation: Teacher
Medical History:

• 2018: Diagnosed with fatty liver disease
• 2018: Underwent gastric band surgery
• Medications: None

Weight history and initial interventions

NB’s highest recorded non-pregnant weight was 143.9 kg. Before surgery, she had attempted multiple weight loss methods, including Weight Watchers, very low-energy diet (VLED) meal replacements, gym programs and medications such as Xenical and Duromine.

Following gastric band surgery in 2018, she lost 13.5 kg (9%) over 18 months. However, after a successful pregnancy in 2020 and a lapse in follow-up care, her weight rebounded to 142.4 kg by January 2021.

Introduction of low carb, healthy fats and protein approach 

NB began a low carb, healthy fats and protein diet and attended 15 appointments over 12 months. By early 2022, she had lost 42.2 kg (30%), bringing her weight down to between 100.5 kg and 106 kg, which she successfully maintained for 18 months.

Weight fluctuation and dietary lapse

Between August 2023 and August 2024, NB’s weight fluctuated between 108 kg and 114 kg (21%-25% total weight loss). This period coincided with a job change and a shift to a diet higher in sugars and processed carbohydrates.

During a consultation, we watched the Defeat Diabetes video “Diets, So Confusing”. I introduced her to the Defeat Diabetes Program as a structured way to help her re-engage with a sustainable, nutrient-dense diet.

Addressing metabolic health

Routine blood tests in August 2024 revealed:

• Vitamin D: 42 nmol/L (Low)
• HbA1c: 5.9% (Normal)
• HOMA Index: 3.1 (Elevated, indicating insulin resistance)

I explained to NB that her results suggested insulin resistance, a marker for metabolic dysfunction and an increased risk of chronic disease. We watched the Defeat Diabetes video “Insulin Resistance”, reinforcing the importance of minimising processed carbohydrates and prioritising nutrient-dense whole foods.

Re-engagement and outcomes

Between August and October 2024, NB lost 7.9 kg (29% total weight loss from her heaviest weight), reporting higher energy levels and an overall improvement in well-being.

By February 2025, follow-up blood tests revealed:

• HOMA Index: Normal at 1.2 (Reversal of insulin resistance)
• Weight: Maintained between 101.8 kg and 103.2 kg (28%-29% total weight loss)

Conclusion

NB’s case highlights the challenges of long-term weight maintenance and the impact of dietary relapse. However, through education, support, and structured guidance—particularly with resources like Defeat Diabetes—she successfully re-engaged with a low carb, healthy fats, and protein-based approach, leading to sustained weight loss and reversal of insulin resistance.

This case underscores the importance of ongoing follow-up, behavioural support, and education in achieving long-term metabolic health and sustainable weight management.

Key Takeaways

✅ Low carb, healthy fats, and protein-based eating led to superior long-term weight loss compared to previous interventions.
✅ The structured guidance from Defeat Diabetes played a key role in patient re-engagement.
✅ Blood markers improved significantly, including the reversal of insulin resistance.
✅ Sustained weight loss (28%-29%) was achieved through long-term dietary adherence.