Need for New Approaches to Weight-loss
May 10, 2016 at 2:48 a.m.
Recently the media was all a buzz over new research which concluded that “The Biggest Loser” contestants not only gained their weight back but now had slower resting body metabolism.1 This of course is not the reality which those struggling to lose weight would like to achieve, especially after all of the grueling hours spent exercising and dieting. The weight-loss and dieting problems experienced by “The Biggest Loser” contestants bring attention to the need for new approaches to weight-loss and control.
Kevin Hall, a federal research scientist, decided to follow the contestants of the reality TV show for six years to discover their fate.1 He found that not only did they have slower resting body metabolism, but they also had lower levels of leptin, an appetite suppressing hormone. The change in body chemistry caused the former contestants to be constantly hungry. However, now with slower resting body metabolism, they also required far fewer calories to maintain their goal weight than a typical person their size. Additionally, Hall discovered that the body works very hard to get back to its original weight before the weight was lost. This is not that surprising since the body has many mechanisms to maintain homeostasis. Unfortunately, maintaining weight ultimately proved to be a losing battle for the contestants. Not only did they gain the weight back, but some now weigh even more.
Prior to Hall’s study, it had actually been known that “The Biggest Loser” contestants where not able to maintain the weight they had lost during the show. This is a prime example of what happens when people diet. The fact is, diets ultimately don’t work. The majority of people eventually go back to their same negative diet and lifestyle behaviors.
Obesity and weight-loss is very complex, and even after many years of scientific research we still don’t have all of the answers. The pathogenesis of obesity is considered to be overeating (greater energy input than output).2(364) It seems to be this simple, but it isn’t. Often for weight-loss, the emphasis is placed on the amount of calories a person consumes. But, this is not completely accurate because not all calories are created equal. They are absorbed and burned by the body differently. For success in overcoming obesity, a treatment protocol should include medical, nutritional, emotional, physical exercise and lifestyle. The sole focus should not be on losing weight. 2(366)
There can be many causes of obesity. Factors that can cause obesity include genetic, behavioral, environmental which includes food allergies and toxins, various health conditions such as Diabetes, Hypothyroidism, Stress Induced High Cortisol, Cushing’s Disease, PCOS, Hypothalamic Defects, Growth Hormone Deficiency, Immobility, Sarcopenia (Muscle Loss), and also iatrogenic causes from medications such as antidepressants, antipsychotics, steroids, contraceptives and others. Imbalances in the gut microbiome are also being linked as a cause of obesity. It is very important to identify or rule out any underlying causes of obesity.
Based on the Centers for Disease Control and Prevention’s National Center for Health Statistics, more than two-thirds of Americans are either overweight or obese. 3(1108) In the past 20 years, obesity has increased 50% in adults and doubled in children. This is primarily caused by diet and lifestyle factors and not by genetic polymorphisms. However, there can be monogenic (single defects) in genes involving the production of leptin, the appetite regulating hormone, but this would be extremely rare. A more common genetic influence of obesity is polygenetic where various polymorphisms or gene mutations can predispose an increased risk of obesity. However this is only likely to be expressed when other factors are involved such as the consumption of excess calories. Genetic factors can play a role but they are typically not the direct cause of obesity.
Obesity is a proinflammatory condition. Many health conditions are linked to obesity such as insulin resistance, Type 2 Diabetes, metabolic syndrome, heart disease, hypertension, dyslipidemia, hypothyroidism, polycystic ovarian syndrome (PCOS), Cushing Syndrome, cancer, bone and joint disorders, breathing disorders such as asthma and sleep apnea, osteoarthritis, gallstone formation, fatty liver disease, gastroesophageal reflux (GERD), menstrual abnormalities, infertility and gout. 3(1108), 2(364)
Type 2 Diabetes is significantly linked to being overweight. In fact, 80% of people with Type 2 Diabetes are overweight. An important factor to note about fat cells is that they are endocrine-producing cells and not just cells that store fat. An abundance of these fat cells in turn overproduce hormones such as estrogen, leptin and resistin as well as cytokins, such as tumor necrosis factor alpha (TNFa), that can lead to elevated free fatty acids, very low density lipoproteins or VLDL particles and increased triacylglycerol synthesis. 3(1109) Abnormal lipid levels are often associated with obesity and increased risk of cardiovascular disease. The elevated lipids in turn interfere with insulin and its ability to stimulate the protein kinase B (PKB) signaling pathway and the GLUT4 transporter of cells. This reduces insulin’s ability to lower blood glucose levels. The primary cause of Type 2 Diabetes is insulin resistance caused by obesity. 3(1110) Another health risk involved in obesity is cancer. The same insulin-signaling pathways involved in increased levels of insulin needed to maintain blood glucose homeostasis also can increase cell proliferation. High blood pressure also can result from hyperinsulinemia which causes sodium and water retention as well as the vasoconstriction of blood vessels. With increased weight gain, cells will begin to hypertrophy or increase in size. As more weight is gained hyperplasia occurs which is an increase in the number of fat cells. Excess fat will then accumulate in other areas such as that seen in fatty liver disease, Sarcopenic obesity and elevated blood lipids. As you can see, obesity can disrupt the body’s function leading to many health issues and diseases. There is no such thing as healthy obesity.
Instead of a fad diet and quick weight-loss plans, focus should be on
making healthy lifestyle and diet changes that are lasting. A weight
loss of 5%-10% over 3 to 4 months can improve blood glucose, abnormal
lipids, high blood pressure, joint pain, breathing, and stop the
progression of diabetes and heart disease. 2(366)
Some Key Areas of Focus for Weight-Loss:
1) Reduce Stress
Stress causes increased levels of the glucocorticoid hormone cortisol. Excess cortisol causes sugar cravings, abdominal obesity, insulin resistance, weakness, shakiness between meals, irritability, hypertension, amenorrhea, impotence, sleep disturbance and more. 4(559-560)
2) Get 7 to 8 Hours of Sleep Each Night
People with less sleep also can have increased appetite because they have lower leptin levels which controls satiety along with elevated ghrelin, a hunger hormone. Lack of sleep appears to also affect food choices causing people to eat more high calorie foods that are also high in carbohydrates.5(549) Sleep deprivation can cause weight gain. Research studies have shown that people who sleep the least weigh more.
3) Drink Plenty of Water and Stay Hydrated
Obesity causes an imbalance of body water because fat does not contain water. 5(351) Water is extremely important and is needed to remove metabolic reaction by products to maintain homeostasis. An imbalance of body water will cause the body to prioritize physiologic functions such as pH and temperature while suppressing acid-producing pathways like fat oxidation.
4) Increase Fiber
Fiber can aid in regulation of blood glucose, help create satiety, act as a prebiotic for GI microflora which reduces inflammation and helps build and maintain a healthy microbiome. Fiber also removes excess hormones. Fiber consumption should be between 25-38 grams a day for weight-loss. 5(364)
5) Address Nutrition Deficiencies
Nutrition is vital to the body’s biological functioning which includes the metabolism of fats, carbohydrates and protein and the production of energy. For example B1, B2, B3, B5 and lipoate are important in carbohydrate and amino acid metabolism. 4(216) Low vitamin D levels are often linked with obesity. This is because excess fat can impair the transport of fat-soluble vitamins and nutrients such as Vitamin D, lutein, xeoxanthin and lycopene. The thyroid for example requires nutrients such as iodine, selenium, zinc, iron, niacin (B3) and amino acids such as phenylalanine and tyrosine. 4(216) As previously mentioned, hypothyroidism can cause obesity so it is very important to make sure that the thyroid is properly supported with the essential nutrients that it needs to produce active thyroid hormones.
6) Focus on a Quality Whole Food Low Glycemic Diet
In obese conditions, there is a high need for alkalinizing foods such as fruit (apples, pears, berries, citrus fruits, avocado) and vegetables (especially leafy greens and green vegetables), fat-soluble vitamins and other phytonutrients. Focus should be on increased plant fiber and a reduction in foods that are high calorie energy dense processed foods that elevate insulin levels. As previously mentioned, Insulin is a hormone that increases growth, DNA synthesis and cell replication. Its main function is the regulation and uptake of blood glucose into cells. This stimulates lipogenesis and increases the synthesis of fatty acids and triacylglycerol for fat storage. 4(556)
7) Address Behavioral and Emotional Issues, Including Food Addiction
Consider partnering with an experienced Nutrition and Lifestyle Coach who can provide ongoing support and education for lasting health and nutrition changes.
8) Get Regular Physical Exercise and Sunshine!
Thank you very much for reading my blog!
I wish you good health, happiness and love!
Danielle Heard, MS, MS, HHC
Clinical & Functional Nutritionist
Artemis in the City, LLC
1. Kolata G. After ‘The Biggest Loser,’ Their Bodies Fought to Regain Weight. The New York Times; May 2, 2016. http://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html. Accessed May 9, 2016.
2. Rakel D. Integrative Medicine, Third Edition. Philadelphia, PA: Elsevier Saunders; 2012: 364.
3. Devlin T. Textbook of Biochemistry with Clinical Correlations, 7th Edition. Hoboken, NJ: John Wiley & Sons, Inc; 2011: 1107.
4. Lord R. Bralley J. Laboratory Evaluations for Integrative and Functional Medicine, 2nd Edition. Duluth, GA: Genova Diagnostics; 2012: 559-560.
5. Kohlstadt I. Advancing Medicine with Food and Nutrients, Second Edition. Boca Raton, FL: Taylor and Francis Group; 2013: 549.