New Year, New You - The Weight Loss Challenge

As we enter into a new year, few points to consider in regard to weight.

In the US the estimated Annual health care cost of obesity-related illness is $190.2 Billion or nearly 21% of annual medical spending (Cawley J Meyerhoefer C. The Medicare cost of obesity: an instrumental variable approach. Journal of Health Econ,2013:31:219-30

In spite of this staggering statistics, most insurances do not cover medical costs related to weight loss visit to provider’s office, weight loss medications and or weight loss surgery. The burden of the disease treatment lies heavily on the patient, due mainly to the “perception of obesity as a disorder of will power”

Obesity is a chronic, relapsing, multifactorial, neurobehavioral, disease medical condition wherein an increase in body fat promotes adipose tissues dysfunction ad abnormal fat mass physical forces, resulting in adverse metabolic, biochemical, and psychosocial, health consequences.

Weight loss must be about losing only fat and maintaining Muscle mass, therefore seek to get body composition analysis with your weight loss this year.

Treatment therefore must be individualized as each individual is unique and includes:

1. Nutrition
   
2. Behavior
   
3. Physical activity
   
4. Medication
   

Nutrition

Recent medical research shows that energy storage is controlled mainly by hormona l signals that regulate fat storage vs fat burning example after meals the body releases insulin and when we are fasting , the insulin level decrease, consequently Insulin release into the body promotes fat storage and inhibits fat breakdown, therefore consuming a diet that minimizes the amount of insulin in circulation is likely to benefit weight loss example carbohydrates stimulate insulin more than any other food group and the degree of response depends on the simplicity of carbohydrates, processed food such as pizza, ice cream, confectionaries have high glycemic index thus stimulates high insulin secretion whereas secrete foods with high fiber content though high in carbohydrate may have low glycemic index and stimulate insulin secretion less example, beans, sweet potatoes.

Proteins like meat, also stimulate insulin secretion but to a lesser degree than carbohydrates but fat does not stimulate insulin at all.

Before you choose a diet, think long term changes as obesity is a chronic disease and in order to be successful, one has to think of a lifelong eating plan. Some diets require you to buy food that are packaged, ask yourself before you start, can I sustain myself on buying already pre-packaged meals or shakes for the rest of my life? Can I make do with what I can afford?

Examples of current dietary protocols include;

Very low-calorie diets often defined as 400-800 calories per day, usually done under physician supervision and typically low in carbohydrates and fat but tends to meet the needs of the body’s protein need at 1.2-1.8 gram/kg of ideal weight. Examples of this diet include Hcg diet, Ideal protein diet to mention a few.

• Due to very low-calorie intake, you will be advised strongly on vitamins and mineral supplementation to improve cellular function and overall health.
  
• Benefit of a very low-calorie diet; reduces fasting glucose, and insulin levels, reduces triglycerides, modestly decreases LDL cholesterol and increase HDL cholesterol and reduces blood pressure
  
• Expected weight loss 15-22 pounds in 4 weeks, 44 pounds in 12 weeks and 68-90 pounds in 20 weeks.
  
• Side effects include fatigue, nausea, diarrhea, hair loss, brittle nails, cold intolerance, gall stones, kidney stones and gout.
  

Fat restricted diets; in which dietary intake of fat is reduced to less than 10-35%

• Weight loss effects after six months, produce same amount of weight loss as a low carbohydrate diet with benefit of some reduction in fasting glucose and insulin levels, modest decrease in LDL and HDL cholesterol, as well as modest reduction in blood pressure. One problem with this diet is possible under control challenges leading to hyperglycemia, hyperinsulinemia, hypertriglyceridemia and reduced levels of HDL cholesterol. Examples include Ornish diet and the American Heart association diet.
  

Carbohydrate-restricted diets; often defined as containing less than 150 grams of total carbohydrates per day and in ketogenic diet contains between 15-50 grams of carbohydrates per day

• Weight loss effects; usually produces slightly greater weight loss compared to fat restricted dietary intake in first six months. Usually produces less cravings than other interventions. May produce reduction in fasting glucose and insulin, reduces triglycerides, modestly increases HDL cholesterol levels, increases LDL cholesterol levels, modest reduction in blood pressure, patients with seizure may have reduction in seizures.
  
• Ketogenic diets may improve diabetic complications such as nephropathy and this type of diet may significantly improve glucose control and may reverse type 2 diabetes
  
• Examples of these diets include Atkins and Paleo.
  

Physical activity:

Recommendations for exercise per the U.S Health and Human services for general health benefit, we require moderate aerobic exercise of about 150 minute/week and strength training.

In order to prevent weight gain, we require 150 -300 minutes per week and to prevent weight regain, 200-420 minutes per week;

Studies have consistently shown that we lose weight more efficiently with proper diet, but we are more successful in maintaining our weight loss if we exercise at least 150 -300 minutes per week.

Behavior:

Think of behavior change as unlearning most if not all the processes that led you to gain weight.

Think of this scenario; buy chocolate, leave chocolate on table, home on Sunday, alone, bored and tired, urge to eat, go to dining area, bring chocolate to living room, eat while watching tv, eat fat, feel guilty like a failure, more eating.

Our behaviors may be related to the Neurotransmitters and neuromodulators

Dopamine is none of the most addictive substances known. Example with the sight of a food, dopamine flushes your brain and it literally takes 2.5 seconds to make a fast decision (Buyer’s remorse)

Strategies to improve success with weight loss strategies should include Daily record of food intake, avoidance or use of inhibitory stimuli to reduce triggers that prompt eating.

Goal setting develop recovery method from over eating or weight gain like the steak day with HCG diet.

Though counter intuitive, one should expect setbacks while dieting and must be prepared and view it as temporary, keep on going contact with your supervisor

Use smaller plates, and practice mindfulness, eat only when hungry instead of the three times a day we were thought and eat only to you are just full then step away. Resist the urge for seconds for about thirty minutes before going for seconds. Completely avoid trigger foods. If your trigger is Bread do not eat it and after a while, you will notice the urge goes away.

Medication:

We use medication in weight loss because weight loss provokes a complex set of neuroendocrine physiologic adaptations that becomes more intense with greater weight loss. These work to slow, then eventually halt weight loss and eventually may induce weight gain. However, clients must show a 5% weight loss in 3 months to continue on medication.

Different studies show that combination of medication, behavior modification and meal replacements is more effective in promoting weight loss over a course of twelve months.

Medications function to reduce appetite/cravings, decrease leptin resistance, increase energy expenditure, increase adherence by mitigating biological factire.

Examples of medications include Phentermine, Orlistat, Belviq, Contrave and Saxenda.

Weight loss for treatment of obesity or overweight is often slower than patients expect, plateaus are common, maintaining weight loss is difficult without an intervention or plan.

Many patients will lose 8-15% in the first year and then plateau, some plateau occur at 6 - 9 months or earlier, ultimately a patient may get to a weight that they cannot get below due to physiology of weight reduced state, most clients are disappointed that they are still overweight. Drop outs almost always regain the weight loss and more but repeat weight loss efforts are almost always less successful.

Dr Adanna Amechi-Obigwe works in Hillcrest wellness center and has assisted a number of people in weight loss as well as reversing type 2 diabetics.