Obesity/ Weight Loss
Obesity/ Weight Loss
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. Obese people are unable to achieve weight loss. It is a leading cause of preventable death worldwide. Obesity is a growing concern in both Australia and in Perth with the number of obese people increasing each year.
Body mass index (BMI), a measurement which compares weight and height, defines people as overweight (pre-obese) if their BMI is between 25 and 30, and obese when it is greater than 30. Obesity may also be defined as a total body fat percentage of > 25% in men and > 35% in women.
Causes / Risk factors of Obesity
- Poor diet: high in sugar, refined carbohydrates, unhealthy fats, junk food etc.
- Sedentary lifestyle
- Metabolic and endocrine disorders e.g. hypothyroidism, Cushing’s syndrome
- Binge-eating disorder
- Insufficient sleep
- Environmental endocrine disruptors
- Some medications
- Cardiovascular disease
- Type 2 diabetes
- Obstructive sleep apnea
TREATMENT STRATEGY FOR OBESITY
- Reduce overall body fat: gradual weight loss is healthier and more sustainable than drastic weight loss; current guidelines suggest aiming for 0.25-0.5 kg/week for people with BMI 25-30, and 0.5-1.0 kg/week for people with BMI of > 30.
- Maintain lower body weight long term
- Regulate blood sugars
- Address any underlying medical causes
- Address psychological factors
Diet plan guidelines for Obesity
- Reduce overall energy intake: energy intake per day should be no less than 5000 kJ for women and 6000 kJ for men. The use of very low calorie diets (VLCD’s) is not supported by evidence.
- If BMI is 25-30, reduce energy intake by 1200-2000 kJ /day
- If BMI is > 30, reduce energy intake by 2000-4000 kJ/day
- Empty calories must be avoided. Nutrient-dense rather than energy-dense foods should be emphasised.
- Intermittent fasting has been shown to be an effective weight loss strategy e.g. restricting energy intake by 75% twice weekly
- Carbohydrates: low-carbohydrate diets have been shown to be as or more effective than low-fat diets for weight loss. Alternatively, a low-glycemic load diet should be followed.
- During the weight loss phase, sugars, refined carbohydrates and starchy carbohydrates should be eliminated
- Carbohydrate intake should focus on non-starchy fruits and vegetables that are high in fibre, improving satiety
- Protein: adequate protein is the key to sustaining healthy weight loss under conditions of negative energy balance. Adequate protein helps to prevent loss of muscle tissue, add satiety to meals and regulate blood sugar balance, and increase the thermic effect of food. Protein should be included in all meals and snacks throughout the day.
- Fat should make up no more than 30% of energy intake. Emphasis should be on monounsaturated and essential fatty acids (especially omega-3). Refined, hydrogenated and trans fats should be avoided.
- The inclusion of extra fibre (e.g. psyllium) is often recommended to reduce energy density and promote satiety by delaying stomach emptying time
- Green tea: animal studies have shown that green tea consumption reduces food intake, decreases leptin levels and body weight and increases thermogenesis.
- Smaller portions eaten more frequently can help to balance blood sugars and insulin in obese people with insulin resistance
- Sufficient water intake is essential – water increases fullness & reduces hunger
- Eating within 3 hours of bedtime should be avoided
- Alcohol contributes 29kJ/g and makes up around 10% of the energy intake of the average individual. Metabolically, alcohol behaves like a fat as it prevents fat from being oxidised for energy.
- ‘Diet’ foods and drinks containing artificial sweeteners in place of sugar have been linked to weight gain and should be avoided.
Supplements that support Obesity
- Protein powder meal replacements: avoid supplements containing sugars, fillers, etc.
- Psyllium husks: regulates insulin levels, reduces hunger, delays gastric emptying and increases satiety
- L-Carnitine – assists in the processing of fats
- L-tryptophan with meals: effective in binge-eating associated with obesity
- Chromium: balance blood sugars
- Omega-3 EFA’s: assist with fat burning
- Zinc: may increase lean body mass and decrease fat
- Vitamin D (depending on status): obesity is associated with vitamin D deficiency
Herbal medicine treatment that supports Obesity
- Metabolic booster: green tea, bladderwrack, coleus, cayenne
- Blood sugar balancers: gymnema, cinnamon, goat’s rue
Lifestyle / physical measures that support Obesity
- Daily exercise for at least 30 minutes. A combination of strength training and aerobic exercise is best for weight loss.
- Behaviour modification strategies: the cornerstone of successful weight loss
- Self-monitoring: provides feedback on progress and places the responsibility for change on the patient. Involves:
- Daily recording of place and time of food intake as well as accompanying thoughts and feelings. This helps identify the physical and emotional settings in which eating occurs and gives clues to how relapses occur. Physical activity may also be recorded.
- Regular weigh-ins (at least once weekly) to assess weight loss
- Goal setting: involves setting short and long-term goals for intake, exercise and weight loss. Goals should be realistic and achievable:
- Most programs involve setting a goal of 0.5 -1 kg weight loss per week through the use of specific dietary and physical activity targets.
- Regular short-term goals should be set to gradually change habits e.g. Increase number of minutes walking on weekends; include 1 extra serve of non-starchy vegetables at dinner
- Stimulus control: involves removing cues for inappropriate behaviours and increasing cues for desirable behaviours. For example:
- Modifying the settings or the chain of events that precede eating e.g. shopping when not hungry and sticking to a shopping list; always eating in the same room and making eating a singular activity only (e.g. never in front of the TV)
- Modifying the kinds of foods consumed when eating does occur e.g. replacing unhealthy food options with healthy food options in the fridge and pantry
- Modifying the eating behaviour e.g. mindful eating; eating regularly to avoid hunger and subsequent binging; preparing and eating most meals at home; avoiding eating within 3 hours of bedtime
- Problem solving: defining the eating or weight problem, thinking of possible solutions, evaluating the solutions & choosing the best one, implementing the new behaviour, evaluating the outcome, and re-evaluating alternative solutions if the first one is not successful.
- Cognitive restructuring: teaches patients to identify, challenge and correct negative thoughts that frequently undermine their efforts for weight management, and to replace them with positive self-statements.
- For example, excessive self-criticism in response to a dietary lapse could lead to an abandonment of effort altogether.
- Positive self-talk (e.g. “that piece of birthday cake doesn’t mean I’ve failed. I’ll get back on track tomorrow”) can help patients stay on track
- Self-reinforcement: involves rewarding self for behavioural changes or achieving goals e.g. buying a new dress or going on a holiday
- Contingency contracts: signing a contract indicating a specific behaviour or weight loss goal with a specific reward if they achieve their goal.
- Stress management: meditation, yoga, progressive relaxation and visual imagery exercises
- Support systems: very important in facilitating weight loss. May involve organised, commercial support meetings or classes, weekly weigh-ins with practitioner, or the use of family, friends or co-workers as support systems
- Counselling / cognitive behavioural therapy
FUNCTIONAL MEDICINE TREATMENT OF OBESITY / WEIGHTLOSS
The above considerations can all help with dealing with obesity and supporting weight loss.
There are a range of physical and emotional factors that need to be considered for a long term resolution to occur. In addition to the above nutritional, herbal and lifestyle measures, a comprehensive assessment of underlying body systems such as the gut, liver, thyroid and other systems are required to optimize the body and ensure there are no blocks in place that may impair long term weight loss.
At our Perth clinic of Advanced Functional Medicine we treat patients with obesity and those that are looking to achieve weight loss. We have had excellent success in maintaining long term weight loss and have assisted individuals to overcome many physical and mental factors that were driving the condition.
If you or a family member are require assistance with obesity or weight loss we would love to hear from you. What have been the best changes you have made to assist weight loss? Tell us your weight loss story. Please write a comment below.