Have you tried a string of fad diets or extreme exercise routines but still struggle with your weight? If so, you’re not alone. Nearly 1 billion people worldwide live with obesity. And shedding the pounds can be more complicated than simply eating less and moving more.
In a recent webinar, primary care and board-certified obesity medicine specialist Monika Moni, MD; pulmonologist and sleep medicine specialist Karthikeyan Kanagarajan, MD; social worker and behavioral health consultant Michelle Box, MSW, LISW-S ; endocrinologist and board-certified obesity medicine specialist Jennifer Wittwer, MD; and integrative medicine dietitian Jaime Sanzere, MS, RDN, discussed the science behind obesity and effective treatment and management strategies.
If you’re struggling with your weight, here’s what these experts from The Christ Hospital Health Network want you to know.
The science of weight loss and metabolism
According to Dr. Moni, obesity is a chronic condition like diabetes or high blood pressure. You can modify some behaviors that lead to obesity, but it’s largely rooted in several body processes you can’t directly control.
“No one should feel ashamed for struggling with something that is truly and deeply biological,” she says. “Genetics, brain regulation, hormones, environmental life factors, energy, and balance control obesity. We simply don’t have conscious control over these factors.”
Contributors to obesity
According to Dr. Moni, here’s what modern science tells us contributes to obesity:
Brain-gut loop: This communication system between your brain and gut controls your feelings of hunger and fullness. When this loop breaks down or is disrupted, you stay hungry even after you’ve eaten a full meal.
Dopamine-food reward: Foods that are high in sugar and fat, like processed foods, can trigger your body to release dopamine, your brain’s “feel good” chemical. This feeling can create intense cravings for unhealthy foods that encourage weight gain.
Environmental and lifestyle factors: Lack of exercise, increased stress, large meal portions, and too much screen time have impacted our biological processes, encouraging unhealthy eating habits.
Metabolic flexibility: This is your body’s ability to know when to switch between burning carbs and fats to create energy. Insulin resistance and a lack of exercise push your body into fat-storage mode.
Microbiome: If you have an imbalance in good and bad bacteria in your gut, you can develop insulin resistance and cravings that inhibit weight loss.
Muscles: Your muscles are your biggest calorie-burning source. When you don’t exercise enough or lose muscle, your insulin resistance increases and your metabolism slows down.
Set point/settling point: From birth, you have a set point for a particular weight. It works like a thermostat, helping keep your body in a healthy range. Environmental and lifestyle factors can drive your set point up, creating a new, higher weight settling point. Over time, your body adjusts to the settling point, making weight loss more difficult.
Stress: Increased levels of cortisol – your stress hormone – boost your hunger level and fat storage in your belly.
Obesity-related body changes
When you develop obesity, your body may change in many ways, Dr. Moni says. You can expect:
Insulin resistance: As you gain weight, your body produces more - and larger – fat cells. As a result, your body has difficulty processing glucose.
New settling point: It’s harder to lose weight and easier to regain weight after your body adapts to a new settling point.
Slower metabolism: When you have a healthy metabolism, you burn a predictable number of calories every day. With obesity, you store more fat, tricking your brain into thinking you’re in survival mode. As a result, your body becomes more energy efficient, and you burn fewer calories.
Stronger hunger signals: Your body develops resistance to leptin, the hormone that tells your brain that you’ve stored enough energy from food. So, you’ll feel hungrier faster and are less likely to feel full after eating.
“The good news is that we can treat each physiological change with the right tools,” Dr. Moni says.
She recommends these steps to control your hunger cravings, build muscle, kickstart your metabolism, and improve insulin resistance:
Adopt a diet filled with anti-inflammatory foods, like the Mediterranean diet
Consume 25 to 30 grams of fiber at least twice daily
Eat between 120 and 140 grams of protein daily
Eat smaller amounts several times a day instead of skipping meals
Move more (walk during phone calls, stand up at your desk or take the stairs)
Prepare meals ahead of time to control portion size
Strength train with resistance bands, dumbbells, or body-weight training for at least 10 to 15 minutes every other day
Sleep and weight loss
Even though you don’t do a lot during sleep, it plays a significant role in weight management, Dr. Kanagarajan says.
“Sleep is not a passive endeavor. It’s active,” he says. “During sleep, our body is repairing, resetting hormones, and managing our metabolism. When sleep is broken, weight loss becomes an uphill battle.”
Poor sleep has several weight-related consequences:
Increased hunger: When you don’t sleep well, ghrelin, the hunger hormone, increases and leptin declines. Your brain thinks you’re starving, so you crave more food.
Insulin resistance: Poor sleep also increases your risk of insulin resistance and diabetes. Glucose lingers in your blood and is eventually stored as fat.
Sleep-related conditions: The additional weight may lead to sleep apnea. This condition disrupts your nighttime breathing, creating a cycle of daytime fatigue and increased hunger.
Dr. Kanagarajan recommends treating sleep like medication and getting at least seven hours of rest every night.
Behavior and weight management
While nutrition and physical activity are important for weight loss, your behavior plays an equally vital role, Box says. In fact, your emotions and environmental influences can help shape new habits.
Anxiety, boredom, childhood trauma, sadness, or stress drive eating habits for many people. Identifying triggers for overeating and building good coping skills can help fight weight gain. But the key to effective weight loss is motivation, she says.
“Research shows that it’s easier to sustain healthy behaviors when you feel supported emotionally. That’s when you feel like you can achieve your goals,” Box says. “Motivation plays a big role in behavior change, and it’s influenced by how we see ourselves mentally, emotionally, and physically.”
Box says small behavior changes can make weight loss seem more manageable and attainable. You may not feel motivated at first, but little progressive steps can be encouraging. She recommends these strategies:
Mindful eating: Pay close attention to hunger and fullness cues. Notice how food looks, smells, tastes, and feels in your mouth. Acknowledge any emotional reactions you have to food. Savor each bite and eat slowly so you can recognize when you’re satisfied.
Joyful movements: Turn exercise into something fun. Choose activities you enjoy that give you an opportunity for creativity and self-expression. When you enjoy exercise, your body produces more endorphins – those “happy hormones.” You’re more likely to stick with a new workout routine and less likely to get tired or experience burnout.
Obesity treatment options
Healthy lifestyle behaviors and nutrition can go a long way to improving obesity. But sometimes you need additional help. Based on your weight goals and current health status, Dr. Wittwer says your doctor may recommend a weight-loss medication or procedure.
Medication
The U.S. Food and Drug Administration has approved many weight-loss medications, including several that mimic GLP-1. GLP-1 is a hormone that regulates your blood sugar and appetite. Your doctor can help you choose the medication that’s right for you. Several other medications are in development, but current options include:
Procedures
Several minimally invasive, outpatient procedures can help you lose weight. Many of these procedures implant temporary devices. If your doctor thinks you may benefit from a procedure, they will refer you to a gastroenterologist.
The most common weight-loss procedures include:
Apollo endoscopic sleeve gastroplasty: This minimally invasive procedure stitches your stomach into a smaller shape, reducing its size by 70 percent. It can achieve roughly 15 percent weight loss within a year.
Intragastric balloon system: This silicone, saline-filled balloon is placed in your stomach to create a feeling of fullness. It results in 10 to 15 percent weight loss over six to 12 months.
Obalon balloon system: This swallowable, gas-filled balloon triggers a feeling of fullness and leads to roughly 10 percent weight loss over six to 12 months.
Sensor monitored alimentary restriction therapy (SMART) device: The retainer-like device is worn during meals to limit biting and slow eating over time. It leads to a 2 percent weight change over 16 weeks.
Spatz3 adjustable balloon system: This balloon system lets doctors adjust the amount of saline in the balloon to manage your weight loss.
TransPyloric Shuttle delivery device: A bulb sits at the opening between your stomach and small intestine, slowing down your digestion. You don’t feel as hungry, and you can lose roughly 30 percent of extra body weight in three to six months.
Surgery
If other treatment options don’t work, your doctor may recommend bariatric surgery. They will talk with you about the risks and complications of each procedure to help you decide which is right for you.
Based on your needs, they may recommend:
Adjustable gastric banding: This minimally invasive, reversible procedure places a silicone ring around your upper stomach to restrict your food intake.
Bariatric reoperative procedures: These procedures correct problems or reverse previous bariatric surgeries.
Biliopancreatic diversion with duodenal switch: This complex weight-loss surgery combines a sleeve gastrectomy with a procedure that bypasses roughly 75 percent of your small intestines.
One anastomosis gastric bypass: Like a traditional gastric bypass, this procedure reduces the size of your stomach and connects it to a spot further along the small intestine. As a result, your body absorbs less food and fewer calories.
Single-anastomosis duodeno ileostomy with sleeve: This procedure is like the one anastomosis gastric bypass, but it lets you absorb more nutrients.
Sleeve gastrectomy: This gastric bypass procedure is the most common bariatric procedure. It removes 80 percent of your stomach, leaving you with a small banana-shaped pouch. It can produce a 30 percent change in body weight and reduce your risk of type 2 diabetes.
Integrative nutrition program at AIM
Many factors contribute to weight gain and obesity. So, creating the right treatment plan can be complicated. According to Sanzere, dietitians and nutritional specialists at AIM for Wellbeing, a partner of The Christ Hospital Health Network, work with your doctor to find the best approach for you.
“No two people who walk into a nutritional appointment with us desiring weight loss walk away with the same plan of action,” she says. “We consider the whole person when making recommendations.”
To help you reach your weight management goals, Sanzere says these services are available:
- Group nutrition classes
- InBody scans that measure your body fat percentage, skeletal muscle mass, and water balance
- In-depth food coaching that helps you build better habits around eating
- In-depth lab testing to reveal factors that may explain why you can’t lose weight
- Personalized supplement recommendations
Schedule an appointment
You deserve a compassionate team that listens and works together to help you feel your best from the inside out. Our specialists provide guidance through science-based, sustainable strategies to influence healthy, lasting weight loss. If you need help finding a provider, please call our free ezCare Concierge Service at 513-450-2380 or complete this form to request a call back.