As we get more and more educated about obesity as a chronic disease, we realize that one’s weight is determined by far more factors than “calories in and calories out”. When I treat patients for excess weight, “the weight loss prescription” incorporates a multi-faceted approach to address a number of these factors.
1. Food: Even though food is NOT THE ONLY FACTOR that determines our weight, it is a very important factor. Our obesity epidemic is, in a large part, a result of eating the wrong foods in a wrong way.
Start by journaling the food you eat on paper or an app on your smartphone. There is something eye-opening about seeing everything that you eat in a day on a list. We frequently underestimate how much we eat.
*Eating 500–750 Cals less than your current intake may be a good point to start. In general, I am not a fan of calorie counting. For most people, the process is daunting and intimidating. But some of us are number people and counting calories can be very motivating.
*It’s also important to recognize that not all calories are the same. 100 calories from a piece of cake are processed very differently than 100 calories from, let’s say, carrots.
*For the most part, eat wholesome foods as close to their natural forms as possible. Avoid processed grains like bread, pasta, chips.
2. Drink: Liquid calories are sneaky. They make us gain weight without satisfying the hunger.
*Drink plenty of water everyday. Some people require less or more than the usually recommended 64 oz a day. A good parameter is the color of your urine which should be light yellow. Too dark or too clear urine may mean that you are drinking too little or too much water.
*Avoid any drinks with natural or artificial sweeteners. They include soda, juice, sports drinks, sweet tea etc.
*Consume alcohol only occasionally, if at all and avoid beer, sugary wines and cocktails.
3. Sleep: Quality sleep is important for healthy body functioning. Sleep disruption affects the hunger and satiety hormones and also raises cortisol (stress hormone) level which causes weight gain.
*Try to get 7–8 hours of sleep every night. *Go to bed and get up at the same time everyday. *If you work night or swing shifts, try to get good quality sleep in a cool, dark room. Seek medical treatment if you suspect sleep disorders like sleep apnea, restless legs etc.
4. Exercise: If the sign-up for gym memberships in January was any indication, one would think that exercise would be a sure-shot way to lose weight. Studies have, however, found that exercise by itself causes modest weight loss at best. While exercise is a great way to achieve physical fitness in our often sedentary lives, it has to be combined with dietary modification to achieve weight loss. *Start low, go slow. Spending one hour in gym on your first day of exercising in years is a recipe for discouragement. Start with an activity you enjoy for the time you can reasonably afford and build up slowly. *HIIT or high intensity interval training is a great option for some individuals. It involves short bursts of intense activity. *Be consistent. *The goal is to participate in high intensity exercise for 75–150 minutes a week or moderate intensity exercise for 150–300 minutes a week. *Exercise should include both strength training and aerobic exercise. *Increase your NEAT (non exercise activity thermogenesis). NEAT refers to the calories we burn while not formally exercising e.g. taking stairs instead of elevators, using standing desks etc.
5. Your gut bacteria: Research has shown that the bacteria living in our gut affect how we absorb our food. Two people eating the exact same food may absorb drastically different amount of calories from it. There is no simple solution available such as taking a probiotic to solve our weight crisis, but research is underway. We do know that eating clean healthy foods promotes the growth of “good bacteria” in the intestine.
6. Medications: Several weight loss medications are available these days which affect our food intake in various ways, acting on neurotransmitters that affect our hunger and satiety. There is still a stigma around using weight loss medications among patients and physicians alike who view obesity as a personal failure. Talk to a knowledgeable health professional about whether you are a candidate for a weight loss medication and which one would work the best for you. Many medications are approved for chronic use as obesity is a chronic disease. The following medications are currently approved by FDA for weight loss. *Phentermine *Contrave *Xenical *Qsymia *Saxenda
* Wegovy Several prescription medications cause weight gain as a side effect. Ask your doctor if you are taking any such medication and if there is an alternative medication you could take instead.
7. Emotional Health: A lot of times, we eat to avoid dealing with emotions like sadness, loneliness, boredom. Pay attention to why you eat. It may be for many different reasons other than being hungry. Address these emotions in healthier ways like talking to a therapist, exercising, meditation, journaling etc.
8. Surgery: Weight loss surgery is a highly effective tool to lose weight in people with severe obesity. Minimally invasive techniques make surgeries like gastric bypass much safer with much less downtime and low risk of complications. Resolution of type 2 diabetes is also seen after weight loss surgery. Discuss with your doctor if you are a candidate for surgical treatment of obesity. However, please remember that weight loss surgery is merely a tool and not a solution to your weight problems.
9. Intermittent fasting: Intermittent fasting is a great way to lose or maintain weight. There are many different schedules to choose from depending on your unique life situation. Daily time restricted eating, alternate day fasting, one meal a day method are just a few examples. The main idea is to eat in parallel with your circadian rhythm and give your body a break from food for 16–36 hours at a stretch. This, done on a regular basis, has many health benefits in addition to weight loss.
Excess weight is an issue which is an much a consequence of societal factors as it is of individual factors. A weight loss prescription for the society in general would likely be more impactful in improving our collective health, but that’s a topic for another day. Change starts with one person and let’s start working on the only one person we can change- our own self.
Disclaimer: The intent of above article is information and education. It is not meant for medical advice. Please discuss the information with your personal physician to determine if the recommendations are appropriate for you.