TOPIC · OBESITY - EVERYTHING YOU NEED TO KNOW

Every week I am posting about  everything you need to know about hormones. This weeks topic is about obesity.

Did you know – Obesity

  • Obesity is a global public health crisis
  • Its prevalence has now overtaken the underfed
  • Its prevalence has increased radically over the past three decades
  • If rates continue in this fashion, by 2030, 86.3% of adults will be overweight or obese and 51.1% will be obese
  • Obesity is a risk factor for the development of chronic diseases such as coronary heart disease, type 2 diabetes, hypertension, dyslipidemias, stroke and cancer
  • Obesity is a metabolic disease with multi-factorial causes, including genetics and environmental
  • The detrimental effects of obesity are greater than both smoking and drinking in terms of overall health conditions and health-related costs
  • In 2008, costs to treat obesity totalled $147 billion in the US
  • Over the past decades, much research has focused on the causes of obesity and how it could be prevented or treated.
  • It is not caused by a mere lack of willpower
  • The Obesity epidemic is bigger than individual responsibility
  • Modern eating habits and food culture must be changed if we are going to have a chance at reversing this problem on a global scale.

Meet Sally and get to know all about obesity

Intro obesity week

What is obesity

Measuring obesity

The cause of obesity

Hypothalamus

What is Obesity?

  • Obesity is an energy-balance disorder
  • An imbalance in the processes responsible for burning or storing energy
  • Fat is the primary way the body stores energy
  • WHO state that Obesity is a medical condition where there is abnormal or excessive fat accumulation that presents a risk to health.
  • The question that needs to be answered is what creates or triggers the imbalance as we are not born with Obesity?
  • The answer is multifactual and individual but fundamentally the human body has evolved to resist any loss of body fat. 
  • This biological drive to maintain weight is co-ordinated through hormonal, nervous, gut even immune systems involving many hormones and messaging molecules.
  • The co-ordination occurs through the area of the brain called the Hypothalamus – which I call the Commander in Chief
  • Perhaps the answer to both preventing and treating Obesity lies here.

Measuring obesity

There is no ONE way to measure Obesity and many measuring techniques focus on size.

As Obesity is a chronic disease state with multiple possible symptoms acquiring a comprehensive picture requires measuring more than just size.

Here are some of the standard ways Obesity is measured

BMI – Body Mass Index

BMI is a measure of size – not of health and unfortunately still used by the medical world

Divide your weight in kilograms by your height in metres squared.

  • Underweight <18.5
  • Normal range 18.5 –24.9
  • Overweight  25 –29.9
  • Obesity 30–39.9
  • Severe obesity ≥40

NB! Lower cut-offs apply to people of East or South Asian origin.

NB! BMI is not accurate as it’s based solely on weight and muscle weighs more than fat. Picture this you’re a body builder or a rugby player with lots of muscle and your weight is high. Your BMI will also be high but that will be due to muscle and not fat, so that doesn’t mean you have obesity. Having excess muscle is never unhealthy.

Waist sizes

Can be a measurement of health.

Health is not determined by the amount of body fat alone but also by where the fat is located.

Fat located inside your abdomen (belly-fat) is an important risk factor for diabetes, hypertension, heart disease, fatty liver and other metabolic problems

Fat on your hips and thighs you may think less attractive but it’s less associated with health problems.

Men

  • Normal weight: Under 94 cm / 37 inches
    Low risk for associated diseases
  • Moderately over weight: 94-102 cm / 37 – 40 inches
    Moderate risk for associated diseases
  • Severely over weight: Over 102 cm / 40 inches
    Severe risk for associated diseases.

Women

  • Normal weight: Under 80 cm / 31.5 inches
    Low risk for associated diseases
  • Moderately over weight: 80- 88 cm / 31.5 – 34.6 inches
    Moderate risk for associated diseases
  • Severely over weight: Over 88 cm / 34.6 inches
    Severe risk for associated diseases

Measuring abdominal fat

Accurate measure of abdominal fat is important related to health

  • Body Volume Index / BVI – 3D technology analyses overall body shape, identifying where fat is distributed
  • DEXA – Dual Energy X-ray Absorptiometry measures fat in the abdomen

The Edmonton Obesity Staging System (EOSS)

Can be a predictor of mortality

  • The impact of clinical assessments: The medical – which measurements such as size, abdominal fat, blood tests, etc., the mental and the functional
  • To determine obesity-related health risks  

Weight and Waist Measurement

The simple combi of Weight and Waist Measurements will give a size indication and these measurements are something you can do at home and use to monitor your progress.

Remember waist size is a better indication of progress as weight may sometimes increase if you are building muscle.

The Cause of Obesity is multifactual

Genetics
Obesity has a strong genetic component and some people are genetically more susceptible than others

Hormones
Like Insulin & Leptin Resistance and increased Gherlin, low Thyroid, high Cortisol, low Estrogen, low GLP-, etc

Engineered Junk Foods
Heavily processed foods are often little more than refined ingredients mixed with additives that promote overeating

Food Addiction
Reward centres in the brain are stimulated by sugar just like alcohol, cocaine, nicotine and cannabis.

Altered Gut Microbiome
High sugar foods decrease the diversity and increase the Firmicutes family of bacteria that get extra amounts of nutrients from the food in the gut

Sedentary life style
Muscle activity increases energy needs and production, thus the burning of nutrients

Aggressive Marketing
Food producers spend a lot of money marketing junk food, sometimes specifically targeting children

Certain Medications
Antidepressants, diabetes medication and antipsychotics can lead to weight gain not by decreasing willpower but by altering body and brain functions, reducing metabolic rate and or increasing appetite

Food Availability
Food, especially junk food, is everywhere now and junk food is cheap

Sugar
Added sugar may be the single worst aspect of the modern diet. Scientists believe that excessive sugar intake may be one of the main causes of obesity.

Misinformation
People all over the world are being misinformed about health and nutrition.

Obesity Treatments & Management

There is no quick fix for Obesity and it often requires multiple therapeutic strategies. Strategies must be individual and related to what is best for you. Long-term guidance and continuous support are critical to your success. Possible strategies can include a combination of the following:

Dietary modification, such as

  • Low carb
  • No food after 6pm
  • Intermittent fasting / OMAD

Increase in physical activity, such as

  • Minimum 30 minutes of movement / exercise daily
  • H:I:T strength exercise

Reduction in sedentary lifestyle, such as

  • Stand up whenever possible
  • 5 minutes movement every hour

Behaviour modification, such as

  • Change what needs to be changed
  • Support for success, such as counselling or support groups

Drug therapy options, such as

  • Orlistat (Alli, Xenical) – prevents fat absorption
  • Phentermine and topiramate (Qsymia) – affect mood
  • Bupropion and naltrexone (Contrave) – affect mood
  • Liraglutide (Saxenda, Victoza) – a GLP-1 agonist decreases drive for food

Weight loss Surgical interventions, such as

  • Vertical Sleeve Gastrectomy, which is cutting and stapling the stomach
  • Roux-en-Y gastric bypass, which is the creating of a small stomach pouch that is connected to a more distal end of the small intestine
  • Adjustable Gastric Banding, which is placing an externally compressive band on the upper portion of the stomach, which can limit stomach distention and food intake
  • Etc.

NB! Statistics show that long-term maintenance of weight loss is achieved by few individuals.

Weight Regain Causes and Solutions

It appears that weight regain is the typical long-term response to dieting, rather than the exception – Traci Mann Prof Psychology.

Why?

Is it because they are too weak-willed to continue restricting their food intake? Is it because their body physiologically defends a genetically-based set weight?

The answer is a combination of both and is easily misunderstood:

In short

Calorie deprivation leads to changes in hormones, metabolism, and cognitive/attentional functions that make it difficult to continue with the behaviours needed to keep weight off.

Possible Causes

1. HORMONES

An ever-expanding list of appetite-mediating hormones includes leptin, ghrelin, cholecystokinin, peptide YY, insulin, pancreatic polypeptide, glucagon-like peptide-1, etc.

These hormonal signals are integrated by the Hypothalamus, the Commander in Chief which is also Commander in Chief for various neuroendocrine (hormone) axes including the HPT hypothalamic-pituitary-thyroid axis and the HPA hypothalamic-pituitary-adrenal axis.

These axes also contribute to body weight homeostasis through hormones like Thyroid and Cortisol, even Estrogen and Testosterone

No surprise that this neuroendocrine milieu is profoundly altered first in response to Obesity and then to weight loss.

Therefore

Individuals in a deprived state experience more hunger, and feelings of hunger remain increased for deprived individuals even after eating a regular meal.

 

2. METABOLIC EFFECT

A reduction in energy expenditure / the amount of energy burned. Less energy is needed to “run” the smaller body. A decrease in energy expenditure is known as “adaptive thermogenesis”.  

Metabolism becomes more efficient, allowing the body to survive on less energy than similar sized bodies that were not calorie deprived.

Therefore, to continue losing weight, the individual must consume even fewer calories than during the initial stages of the diet.

Energy restriction and weight loss is believed to involve a shift in metabolism that favours fat burning over carbohydrate, with weight regain coinciding with a metabolic reversal back to carbohydrates.

Thus, a low carbohydrate diet may protect against weight regain by blocking this metabolic reversal. Cortisol levels increase markedly with energy restriction which increases weight gain. Stress increases Cortisol and weight gain, especially central fat storage.

 

3. GUT FUNCTION

Delayed gastric / stomach emptying in obesity may actually promote feeding through delayed delivery of nutrients to the duodenum and the associated release of satiety hormones.

Recently, new evidence has emerged that this may contribute to weight regain in obese patients

An association between the gut microbiota and obesity has been identified, such as overweight/obese humans have low bacterial diversity, fewer different types of bacteria

Gut microbiome influences how food is digested and absorbed and how dietary fats are stored in your body.

Gut microbiome may also impact the production of hunger hormones, such as Ghrelin, which control if you feel hungry or full

Mechanisms by which gut microbiota promote metabolic disturbances are not well understood. Leading theory is changes in molecular signaling chemicals / hormones released by bacteria in contact with local tissue or distant organs

Bacteroidetes prevalence is lower in obese people, and Firmicutes phylum increased associated with elevated energy harvesting from the diet

Lactobacillus and Clostridium species are associated with insulin resistance, both Firmicutes

The microbiota has effects way beyond the gut. Adipose tissue / fat cells are a primary target making fat cells resistant to insulin

This increases fat released into the blood stream which is sequestered by other organs (liver and skeletal muscles) that are not equipped to safely store excess fat

Multiple studies link gut dysbiosis to obesity related liver disease. Non-Alcoholic Fatty Liver Disease presents with intestinal-bacterial overgrowth and enhanced intestinal permeability.

Artificial sweeteners can change beneficial bacteria in your gut

 

4. PSYCHOLOGY

  • Due to lack of stimulation in the Hypothalamus people’s attention is biased toward food stimuli when they are calorie deprived
  • They have heightened food smell functioning
  • They have heightened food tastes
  • They have heightened drive to consume food

 

5. TIME

  • Effects of calorie deprivation last a long time.
  • Overly efficient metabolic rates and preoccupations with food can last a year or more after a starvation period has ended
  • After 10 weeks of dieting satiety hormones like Leptin measured at week 10, and again at week 62 measured significant and persistent reductions in levels of leptin, peptide YY, cholecystokinin, and insulin and increases in levels of ghrelin and pancreatic polypeptide.
  • All of these hormonal changes are believed to be permissive of weight regain and increased appetite.
  • Strong linear correlation between the decreases in Leptin and weight regain.
  • A significant decrease in Leptin levels following weight loss of over 5%, but not below 5%,
  • Contestants on the “The Biggest Loser,” who lost an average of 128 pounds in 30 weeks, still maintained a ‘disturbed’ metabolism even six years later

Solutions

  • Be patient and persistent
  • It takes a LONG time to reset metabolism

Change focus

  • Focus on gut health
  • Focus on health rather than weight / diet
  • Education regarding foods
  • Stop / limit unhealthy habits, such as smoking alcohol, excess glucose and processed carbs, late nights
  • Increase healthy habits, no food after 6pm, exercise / movement 30 mins every day, bed by 10pm
  • Keep a diary or log of your progress.

Eurobesity – ECPO – European Community Patient Obesity

Established in 2014, to help the European scientific and clinical community better understand the patient experience.

From this, the Patient Council developed into a strong voice for people living with Obesity & the patient community across Europe.

Is now an independent patient led, managed, and run organisation working collaboratively across Europe.

ECPO Patient Lounge – By patients, for EVERYBODY!

Interview Experts and Panel advice concerning specific topics related to obesity.

I was sitting on the panel Tuesday 6th July where the topic was Weight Regain – see the recording below.

Questions? Please don't hesitate to contact me