Evolving insights continue to advance our capabilities to intervene in the onset of numerous degenerative diseases, as well as offering steps that we can all take to prolong our wellness. Medical societies like the ASBP (American Society of Bariatric Physicians) continually work, through their symposiums and conferences, to further the scope of service of health care professionals, as well as heighten public awareness of measures that can be taken to address conditions such as obesity that have a profound and wide-ranging effect on wellness and quality of life.
For context, obesity accounts for 10% of the healthcare spending in the United States. Among adults aged 20 and over, obesity is estimated at 39.8% (2015-2016) and in adults aged 20 and over, overweight, including obesity is put at 71.6% (2015-2016).
The characterization of obesity is split into two camps. The American Medical Association (AMA) and other establishment cohorts label obesity as a disease, citing that it meets the definition because it decreases life expectancy, impairs normal functioning of the body and can be caused by genetic factors. Opposing opinions refute the “disease” label, arguing that it is a preventable risk factor to other disease and can be mitigated, to the largest extent, by behavioral changes, such as eating and exercise habits.
Regardless of classification or terminology, the market is vast and the explosion of commercial weight loss programs ranging from work-outs to meal plans has become mind-numbing; yet often of questionable value for the long haul, Extreme changes in routine, nutritional intake, or other measures often designed for rapid weight loss short-term, largely fail over time, as people are apt to resume previous behavior. Rather, observing certain basics more closely compatible with an individual’s day to day reality can help constitute an enduring and healthier lifestyle. In resistant cases, considering and testing for possible underlying causes (which must be ameliorated before common sense lifestyle changes can be of benefit) is a prudent first measure.
Are you actually overweight or obese?
While sensible lifestyle habits are a good thing for anyone, determining your personal weight situation to establish a realistic baseline and goals will help plan your way forward. There are two predominant means of going about it. The AMA uses Body Mass Index, or BMI, as their metric. This is a broadly applied formula taking a person’s weight in kilograms (kg) and dividing it by his or her height in meters, squared. According to this scale, overweight is a BMI of 27.3, or greater, for women and 27.8, or greater, for men. So, for example, a man 5’7” (1.7 meters) tall, weighing185 pounds (83.9kg) would automatically be considered obese, having a BMI of 29.0.
The other means is using Body Fat Composition, which scores a person on their fat composition as a percent of their total body makeup; muscle, fat, bone, etc. Using Body Fat Composition as a criterion, obese is 32% for women and 28% for men. So, that same person in our earlier BMI example, moderately fit, could have a body fat composition of 18% or 20%, owing to his overall physical structure. In other words, people with dense bones, well developed muscles (muscle mass) or large body frames might inaccurately be classified as overweight or obese by BMI standards, but in reality, be perfectly fit.
Here are things to keep in mind and some simple steps to guide your own weight management/wellness regime.
● Glycemic Index (GI):
High GI foods are quickly digested and absorbed, resulting in high glycemic response, which in turn stimulates higher insulin secretion. High glycemic and insulinemic responses can affect appetite and energy metabolism, favoring body weight and body fat gain. On the other hand, low GI foods are digested and absorbed at slower rates, leading to lower glycemic and insulinemic responses, which in turn reduces satiety, food intake and increases adipose tissue mobilization. Thus, GI is a simple tool in obesity control.
The consumption of two low GI daily meals may lead to beneficial effects on body weight and body composition. Making some sensible food swaps such as switching from white rice to brown, instant oatmeal to steel-cut oats, white bread to whole grain, corn to peas, leafy vegetables or quinoa, can play a simple but effective role in driving behavioral changes. Hi carb breakfasts lead to increased fat storage all day.
● Protein is the most important macronutrient. Its consumption leads to satiety, thermogenesis* and improved body composition. Protein should be consumed throughout the day in doses of 20-30 grams per intake. Protein sources should be rotated.
*The process of energy production in the body caused directly by the metabolizing of food consumed. High dietary thermogenisis may help promote weight loss while a low dietary thermogenisis may help promote weight gain
● All individuals, especially those on low carb diets should include Omega3 fatty acids, probiotics and medium chain triglycerides in their intake.
Oil-rich fish, such as salmon, sardines, anchovies and mackerel are a great source of protein, omega3 and “good fats”. If you fancy grilling, (and who doesn’t) consider microwaving your fish, chicken and meat first, then finishing it on the grill. The goal is to limit charring and still being able to enjoy that grilled taste. Charring food, (meats, fowl and fish in particular) causes chemical alterations in the food which are carcinogenic.
● Olives are anti-inflammatory and a great snack while dieting. The best olive oil in the U.S. comes from Spain and Greece.
‘No Time for an exercise regime?
● Non-exercise Activity Thermogenesis (NEAT) can assist with weight loss over time. NEAT is non-volitioned physical activity that is part of our daily lives (i.e. running errands, yard work, shopping, using stairs whenever possible, etc.). Taking a 20 minute walk after eating, (Post Prandial Exercised Induced Thermogenesis) is another ideal habit to develop for accelerating metabolic activity, particularly following evening meals.
● New studies suggest that a typically early morning breakfast may impede optimal health and that delaying your first meal of the day for 15-17 hours after your last meal, (which is best consumed before 8pm) is significant in helping the body function more efficiently, and can contribute to longevity.
We also know that environmental toxicity can be a hidden barrier to weight loss. Our bodies store toxins in fat cells to spare our central nervous system. These toxins interrupt mitochondrial, hormonal and liver functions.
During weight loss, toxins are released from fat cells and can cause depression, mood swings and anger. This can lead to poor compliance with a weight loss program, hence the value of undergoing a detox as part of your plan. Common toxic exposures occur from lawn chemicals, recreational drugs, air freshener plug-ins, food that isn’t organic and water that isn’t pure, among others.
Self-detoxification can be assisted by drinking water out of a glass as opposed to plastic bottles, consuming “green drinks”, eating sunflower seeds and blueberries. The intake of choline, inositol and other Phase II nutrients, (one of the two means by which the liver breaks down fat soluble toxins into water soluble toxins for easy excretion) can be of great help. Phase II nutrients can be found in “cleansing foods”; cruciferous vegetables such as broccoli, cabbage, cauliflower kale and brussel sprouts.
Mitochondria: Your Body’s Energy SourceMitochondria are tiny inclusions in your cell, originally thought to be derived from bacteria. Most cells have several thousand of them comprising 15 to 50 percent of the cell volume. They’re the source of over 90 percent of your body’s energy
Important nutrients and co-factors for mitochondrial function include all B vitamins, magnesium, omega-3 fat, CoQ10, acetyl L-carnitine, D-ribose, and alpha lipoic acid. Exercise and robust oxygenation is also important for mitochondrial health and function. Additionally, a periodic fast can be stimulative to mitochondrial activity.
A normally function thyroid is vital to permit proper and consistent weight loss. This is accomplished by appropriate thyroid hormone and iodine replacement, when necessary, and optimization of adrenal function.
Many obese people have difficulty converting T4 to T3. Selenium, zinc, chromium, iodine, growth hormone, tyrosine, testosterone, melatonin and high protein diets can be of help. Splenda over-consumption can cause iodine deficiency.
Low T3 syndrome, (which slows your metabolism) can be seen in people on T4 only due to TSH suppression. Some people have RTH (Resistance to Thyroid Hormone) and may need larger doses of thyroid hormone. These individuals have elevated free-T4 and free-T3 with non-suppressed TSH. If you are having trouble losing weight, despite your best efforts, checking out your thyroid function as part of a comprehensive medical evaluation should be your first stop However, recognize that even after accurate diagnosis and commencement of therapy, achieving optimal thyroid status can take 1-3 years.