It is critical to educate your obese patients on what to eat and when to eat in order to sustain a healthy weight.
First, do not limit the amount of food you consume. This may seem counterintuitive to patients, but diets make you fat. Focus on the quality of the food and the timing instead. No snacking. Only eat at mealtimes and absolutely have nothing between dinner and bedtime. Instead of limiting food, put an end to empty calories. Diets simply don’t work. Oh, while you are at it, get a complete thyroid profile (not just TSH). Many times, thyroid is the problem
Why diets don’t work: Hormones get in the way
Fat cells are not inert; they produce a hormone called leptin. The hypothalamus monitors leptin levels. When you diet, you lose fat. This reduces the amount of leptin perceived by the hypothalamus. If the levels drop low enough, the body interprets it as starvation. People who carry around a lot of extra fat make a lot of extra leptin. The hypothalamus gets used to the high levels of leptin. This is known as leptin resistance, and it gets in the way of losing weight. So even if you are fat, losing too much weight is still perceived as starvation.1
A second hormone, ghrelin, is known as the hunger hormone. When we lose weight, the stomach releases greater amounts of a hormone called ghrelin. This hormone makes us feel hungry. Everyone has this hormone, but if you’ve been overweight and then lose weight, the hormone level increases.
Your body will do several things when it perceives it is starving:
Your metabolism slows down: Weight loss affects the thyroid, which is the thermostat of the body. You produce less T3, the active thyroid hormone. This means for any given activity, you will burn fewer calories.2,3
You become hungry: Your brain thinks you are starving because of the drop in leptin levels. Ghrelin levels increase after a diet.4 People who are overweight commonly have leptin resistance. Loss of fat causes a drop in leptin.
You crave high-calorie and (possibly) processed food: Processed food, which is high in sodium and high fructose corn syrup, may increase ghrelin levels,5-8 thus increasing hunger. In other words, processed foods interfere with feeling satisfied after a meal. So, it plays out like this: Your leptin levels drop, you get really hungry and eat a McMeal. The McMeal is high in calories but does not fully satisfy your hunger, so you crave more food.
This has nothing to do with will power
You may have noticed a pattern with your dieting patients. The first week usually goes well, with significant weight loss. The second week is harder, and there is less weight loss because the metabolism is slowing down. After some time, even basic discipline becomes difficult. They may be able to complete the diet, but the maintenance portion is too difficult. Sometimes the weight is lost but is regained over time. Most people fail at dieting because of the hormonal mechanisms mentioned above, not because they lack will power. For the most part, limiting food intake to lose weight is not successful. Rapid weight loss is especially disastrous. You can have rapid weight loss, or you can have permanent weight loss, but not both.
If dieting does not work, what does?
The goal should not be to lose weight, but to become healthy. If you are healthy, you will be at a healthy weight. The first and most important thing to do is to change what the patient eats. What you eat and when you eat are much more important than how much you eat.
The other thing to consider is that losing fat reduces leptin levels. This may cause hunger, or weight loss to slow down. Remember this is a marathon, not a sprint. Have them eat when hungry but continue to focus on what they eat and when they eat. No snacking and eat slowly at meal times. Also, addressing the following issues will help with natural weight loss:
Insulin insensitivity: The average American consumes more than 200 pounds of sugar each year (compared to about 10 pounds per year in the 18th century). Also, Americans eat too much refined carbohydrate. About half of our calories consist of refined carbohydrates, which the body treats the same way as sugar. A diet high in sugar and refined carbohydrates causes the body to produce a lot of insulin. Over time, the body becomes insensitive to insulin (sometimes called “prediabetes.”) If the situation persists, type 2 diabetes can develop. This is an issue for everyone who is overweight.
The microbiome: Microbiome refers to the bacteria growing in the intestines. Your GI tract is an ecosystem. The right kind of bacteria will help remove toxins, produce vitamins, nourish the intestinal lining and keep pathogens (bad bacteria and yeast) in check. If the wrong kind of bacteria grow, they produce toxins and irritate the GI lining. New research is showing the type of bacteria growing in the intestine can determine if you are overweight or not.
Toxins: Studies have shown an association between pollution and obesity. There may be a connection between persistent organic pollutants (POPs) and weight gain.
Final thoughts
It isn’t about losing weight — it is about getting healthy. When evaluating your patients, you should also consider the possibility of food sensitivity. Gluten and dairy are common culprits.
PAUL VARNAS, DC, DACBN, is a graduate of the National College of Chiropractic and has had a functional medicine practice for 34 years. He is the author of several books and has taught nutrition at the National University of Health Sciences. For a free PDF of “Instantly Have a Functional Medicine Practice” or a patient handout on the anti-inflammatory diet, email him at paulgvarnas@gmail.com.
References
- Molecular mechanisms of central leptin resistance in obesity. Arch Pharm Res. 2013;36(2):201-207. PubMed. https://pubmed.ncbi.nlm.nih.gov/23359004/. Accessed Jan. 9, 2024.
- Moderate weight loss is sufficient to affect thyroid hormone homeostasis and inhibit its peripheral conversion. Thyroid. 2014;24(1):19-26. PubMed. https://pubmed.ncbi.nlm.nih.gov/23902316/. Accessed Jan. 9, 2024.
- Effects of a very low calorie diet on weight, thyroid hormones and mood. Int J Obes. 1990;14(3):249-258. PubMed. https://pubmed.ncbi.nlm.nih.gov/2341229/. Accessed Jan. 9, 2024.
- Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346(21):1623-1630. PubMed. https://pubmed.ncbi.nlm.nih.gov/12023994/. Accessed Jan. 9, 2024.
- Elevation of Fasting Ghrelin in Healthy Human Subjects Consuming a High-Salt Diet: A Novel Mechanism of Obesity? Nutrients. 2016;8(6):323. PubMed. https://pubmed.ncbi.nlm.nih.gov/27240398/. Accessed Jan. 9, 2024.
- Effects of α-lipoic acid and eicosapentaenoic acid in overweight and obese women during weight loss. Obesity. 2015;23(2):313-321. PubMed. https://pubmed.ncbi.nlm.nih.gov/25594166/. Accessed Jan. 9, 2024.
- Ghrelin receptor regulates HFCS-induced adipose inflammation and insulin resistance. Nutr Diabetes. 2013;3(12):e99. PubMed. https://pubmed.ncbi.nlm.nih.gov/24366371/. Accessed Jan. 9, 2024.
- Dietary fructose reduces circulating insulin and leptin, attenuates postprandial suppression of ghrelin, and increases triglycerides in women. J Clin Endocrinol Metab. 2004;89(6):2963-2972. PubMed. https://pubmed.ncbi.nlm.nih.gov/15181085/. Accessed Jan. 9, 2024.
