By Aaron Morse, MD
Sleep Health MD, Sleep Medicine Specialists
Anyone who has tried to lose weight understands what a challenge it can be. Here are a few things to keep in mind if you are working toward that goal:
It’s Not Your Fault
First of all, it’s not your fault! Multiple studies have demonstrated that 75% of obesity is genetic. So why are we experiencing an “obesity epidemic” that is so much in the news? For some genes to be “expressed”, that is, to actually cause a problem, they may need to be “triggered” by environmental factors and there are some very powerful ones that contribute to weight gain.
The Western Diet
The first one is diet. For complicated reasons, the Western diet has shifted to one that causes weight gain. In my opinion, the main villain is carbohydrate. There is profit in calories and powerful economic forces have contributed to a diet rich in carbohydrates, sugar and fat. It tastes good and it triggers an appetite for more.
Think sodas, French fries and high fructose corn syrup (which is in almost everything). This is the basis for a huge industry, and industry sponsored “research” years ago led to the obsession with fat, which was replaced in our diets by carbohydrates. Carbohydrates cause insulin to spike, which is very effective at dropping the blood sugar (resulting in hunger) and pushing carbohydrate calories into fat storage. Fat does not affect insulin, so consuming carbohydrates is more effective at causing increased fat storage than consuming fat.
Why do some people gain weight when others do not, even though their diets may be similar? The answer is in the genetic susceptibility to these environmental factors.
The Role of Physical Activity
The second factor is physical activity. Notice, I did not say exercise. The plethora of labor saving devices has gradually reduced the amount of activity necessary to go about our lives.
In the past, people walked more, or worked all day on the farm, so even those who might be genetically susceptible to obesity or had poor diets did not gain weight because of continuous calorie expenditure throughout the day. I’m not talking about ½ hour per day on a treadmill, but continuous movement throughout the day.
Why Is Weight Loss So Hard?
Weight loss is very difficult because the body resists losing weight. When our ancestors lost weight, it was due to lack of access to food, so the body developed mechanisms to protect itself from starvation. With weight loss, hunger hormones increase and the metabolism slows down and becomes more efficient so fewer calories are burned. The evolutionary advantage of conserving calories may have improved survival in the past, but now works against us when trying to lose weight.
Another challenge to weight loss is that the brain has a weight “set point”. That is, it wants you to maintain your weight, almost like a temperature setting on a thermostat. With weight loss, it can take a year or more to reach a lower set point, so close attention must be paid to diet during this time.
How to Start
Approaches to weight loss are highly individual, and the details outlined below may not be appropriate for everyone, but they are a good starting point.
1. Cut Back on Carbs
Point one: Carbohydrates are poison! (Well, this may be a slight exaggeration). When we were hunter gatherers, we had very little access to carbohydrates and lived on animal protein along with fruits and vegetables that were foraged. As a result, our bodies were not programmed to deal with carbohydrates, so consumed carbohydrates are efficiently converted to fat.
The purpose of fat is energy storage for emergencies. The body first wants to metabolize carbohydrates and only burns fat when carbohydrates are depleted. Bottom line, before you can lose fat, you must reduce your body’s access to carbohydrates.
In addition to sugar and alcohol, which are major no no’s for those losing weight, the “big four” are bread, pasta, rice and potatoes. The first thing to do is try to eliminate or markedly reduce your intake of this stuff. And don’t forget that fruits tend to be very high in sugar, so it is important to watch your fruit intake.
2. Bump Up the Protein
Protein is the best appetite suppressant there is, so a high protein diet can be helpful for weight loss. The use of high protein meal substitutes for several meals per day has been demonstrated to contribute to successful weight loss. There are many different brands and forms of these substances that can be found in grocery and health food stores and are usually available as powders or liquids. One example is Premier Protein. I like this because it is premixed (less hassle and mess), inexpensive ($24 for 18 boxes at Costco) and (in my opinion) fairly tasty. It has 30 grams of protein ( a lot: about the same as a 6 ounce hamburger), 1 gram of sugar (hardly any) and only 160 calories Using Premier Protein (or something similar) for breakfast and lunch and having a healthy high protein low carbohydrate dinner is highly likely to produce weight loss.
3. Play the Waiting Game
When one is trying to lose weight, the enemy is hunger. While high protein drinks are fairly good at suppressing hunger, mid morning and mid afternoon snacks (again high protein, low carbohydrate) can be very useful in keeping hunger under control. Examples include a handful of nuts, a piece of chicken or fish, or a small amount cottage cheese or plain yogurt. So a weight loss diet may mean eating 5 times per day: two high protein drinks, two snacks and dinner.
It is also important to know is that there is a hunger suppressing hormone produced in the intestine that is activated when you eat. It takes about 20 minutes, however, for this hormone to go from your intestine to your brain to signal that you are no longer hungry. Therefore, EAT SLOWLY! If you finish your meal and are still hungry, try to wait 20 minutes before eating more.
Chances are, you won’t want it.
4. The Role of Exercise
What about exercise? The bad news is that you can’t exercise your way to weight loss. Getting on the treadmill for an hour and burning 300 calories can’t make up for taking in 2500 calories per day, so diet is the most important factor in weight loss.
The good news is that the health benefits of moderate exercise are enormous.
Walking 150 minutes per week (i.e., 30 minutes per day 5 days per week) cuts the risk of cardiovascular disease in half. Obese people who exercise regularly live longer than non obese sedentary individuals.
Exercise is more important for weight maintenance after weight loss. Studies have suggested that those who exercise (walking is all you need to do), 60 minutes per day are more likely to maintain their weight.
Remember, the Tortoise Won the Race
Slow and steady is the smart way to go. Losing weight can take time, but even small improvements can have a positive and long-lasting impact on your health and in your life. We hope these tips are helpful, and remember to always check with your doctor before starting any type of weight loss or exercise program.