Approximately 75% of Americans make a New Year’s resolution. Health improvement is the top category and weight loss is the driver. Popular weight-loss diets require either a reduction of total calories or manipulation of one or more macronutrients such as carbohydrate, fat, and protein. At the beginning of a diet, resolution is strong, and excitement is high. You are highly motivated during the first two weeks when you step on the scale and it rewards you with a fewer pounds. You dream of wearing the pants that have been languishing in your closet, and you smile pleasantly when your glucose values are right on target. It feels so good to be you! Four weeks later, cravings overpower you and after being so good, you rationalize that you deserve a cheat day. And just like that, the scale refuses to inch down. You are disillusioned. There are more cheat days and the numbers on the scale creep up. What was wrong with the diet? The testimonials were real and convincing. You self-flagellate and convince yourself you have no willpower and low self-esteem.
Obesity is a chronic disease
Obesity is a chronic disease, like other chronic conditions such as diabetes and hypertension. Like any other chronic disease, obesity must be managed for a lifetime. Overweight and obesity are calculated using the adult body mass index or BMI. BMI is calculated when a person’s body weight in kilograms is divided by the square of body height in meters. The categories are:
Underweight - BMI less than 18.5
Normal - BMI 8.5 to <25
Overweight - 25-30
Class 1 Obesity - 30 to <35
Class 2 Obesity - 35 to <40
Class 3 Obesity - >40
Losing weight until you reach your goal weight does not cure obesity. A person with overweight or obesity must manage it continuously. Losing weight is not a precise mathematical equation that only considers two elements: eating less and moving more. Otherwise, permanent weight loss would be achievable. There are other key factors in weight management, and many are in our heads.
What if your weight was in your head?
Leptin is a hormone discovered in 1994. It is secreted by white adipocytes also known as white fat. White adipocytes release leptin into the circulation to control appetite and burn calories. Leptin levels decrease during fasting, low-calorie diet, and poorly managed type 1 diabetes. Low leptin levels increase hunger and slow the number of calories burned. When fat cells increase, leptin increases suggesting that a person with overweight/obesity should experience poor appetite and increases energy expenditure. It does not occur leading experts to believe that people with overweight/obesity are resistant to leptin.
Adiponectin is a fat derived hormone. It is produced in adipose (fat) tissue but is also in muscle and the brain. It regulates the metabolism of lipids (fats) and glucose (sugar). Lower levels of adiponectin are associated with insulin resistance, dyslipidemia (unhealthy levels of fats in the blood), and atherosclerosis (the buildup of fats and cholesterols in the artery walls). Studies in both humans and rodents have shown that increasing adiponectin resulted in insulin sensitivity, decrease in atherosclerosis, inflammation, and in certain cases it decreased body weight.
Ghrelin was discovered in 1999. It is released in the stomach cells and travels to the brain to make us hungry. Ghrelin fluctuates throughout the day. It rises before a meal and plunges after eating. Do individuals with overweight/obesity produce more ghrelin? Not necessarily. Persons with overweight/obesity seem to have lower ghrelin levels than those with a lower body weight. It has been speculated that persons with obesity have more ghrelin receptors compared to leaner persons, thus they do not need as much ghrelin to stimulate hunger. Some studies have found that individuals who lose weight and try to keep the weight off produce more ghrelin than they did prior to losing weight. This shows that the body is trying to regain the weight lost.
PYY (Peptide YY) is a hormone that regulates satiety and hunger. The cells in the small intestine secrete PYY, which then acts on the central nervous system. During the fasting state, PYY levels are low. PYY rises quickly during the fed state and reaches its peak 1-2 after eating. Study findings propose that PYY regulates weight by decreasing hunger and increasing calories burned. Animal and human studies found that PYY levels were low after consuming a high-fat diet. A study showed that individuals with obesity decrease calorie intake by 30% and lean individuals by 31% after they received a PYY infusion. Eating foods high in protein (i.e. beef, fish, chicken, etc) boosts PYY levels. PYY levels in persons with obesity have shown mixed results. Some have lower levels of PYY after eating, while others have normal sensitivity to PYY leading some researchers to believe that PYY resistance may not be the cause. Patients who have undergone gastric bypass patients show an increase in PYY and another hormone called glucagon-like-peptide-1 (GLP1) which contributes to weight loss.
Glucagon-like peptide-1 or GLP1 is another hormone that reduces hunger, increases satiety, and promotes weight loss. GLP1 is secreted by the intestinal cells. GLP1 affects movement of the digestive system, prevents gastric acid and glucagon secretion. Glucagon is a hormone that breaks down stored glucose and releases it into the circulation. It stimulates insulin secretion in response to blood glucose (sugar).
Studies have shown that insufficient sleep increases fatty acids (fats) and impairs insulin sensitivity. Impaired insulin sensitivity may lead to higher blood glucose (sugar). Observational studies have also found an association between insufficient sleep and obesity. One potential explanation is that lack of sleep disrupts ghrelin and leptin hormones.
Weighing the Options
Weight management requires lifelong treatment and support. These tips will help you in your health journey:
1. Identify the root causes of obesity. Address the environmental factors that contribute to success.
- Learning to prepare healthy and affordable meals
- Fill your house, car, work with nutrient-dense foods
- Hydrate with unsweetened beverages.
- Find space and time to engage in physical activity (Exercise videos, exercise classes).
- Remove all electronic devices from your bedroom to encourage a good night's sleep
- Connect to hunger and satiety levels.
- Understand how your emotions (fear, anxiety, depression, joy, boredom) affect the type and quantity of food you eat.
- Focus on what you eat. Savor and enjoy your food without distractions.
3. Discard food moral values
- You are not what you eat. You are not good because you ate kale, and you are not bad because you had chocolate.
- Reject the words that associate food with morality such as cheat food or cheat days. There are nutrient-dense and nutrient-empty foods. We eat foods for different reasons at different times.
- Select foods that meet your body’s needs. These are whole grains, fruits, vegetables, nuts and seeds, legumes, and lean animal protein
- Select foods that help you prevent and/or manage your health conditions
- Minimize ultra-processed foods and added sweets
- Choose a diet that you can live with for the rest of your life
- Focus on adopting healthy behaviors
- What you do consistently will show you results over time
- Consult with a registered dietitian to help you choose a plan that will work long term
- Our bodies defend against weight loss. You may not achieve the weight you dream, but you may achieve your best weight.