Do you make New Year’s resolutions?
Although I stopped actually writing them down many years ago, I do admit to quietly hoping for a few personal changes that I might be able to make by this time next year. As long as I can remember this list has started with either dieting to deal with my weight gain or exercising more. Even though I am now keenly aware that diets only work while you’re on them and the inevitable return of the lost weight begins the moment I go back to anything resembling my old eating habits, I still hope that I will find some secret to get and stay slim forever. I’ve always felt that losing weight was relatively easy; it’s keeping it off that has failed me. Notice I say I failed me and not where I have failed. Studies on obesity have made great strides in putting less and less blame and shame on the overweight person and more on other factors.
We all understand that consuming more calories than you expend in a day will make you gain weight and that we have some control over. Let’s take a look at the factors that are beyond our control.
Genetics
- Over 400 different genes have a part in the development of obesity. Genes can affect appetite, a sense of fullness, cravings, where your body fat is distributed, metabolism and the use of food as a coping mechanism.
- People who have two copies of a specific gene variant (called Insig-2) were 22% more likely to have a BMI (Body Mass Index) higher than 30.
- For some people, genes account for just 25% of the predisposition to be overweight, while for others the genetic influence is as high as 70% to 80%.
- A person is more likely to develop obesity if one or both parents are obese.
Hormones
Leptin
A hormone that is significant in obesity is Leptin.
It is produced by the fat cells and is supposed to send signals to the part of our brain that controls food intake. The part that tells us we’re full and need to stop eating. If, for some reason, the body cannot produce enough leptin or leptin cannot signal the brain to eat less, this control is lost, and obesity occurs.
This is called leptin resistance and is believed to be a leading factor in the cause of obesity.
GLP 1 (glucagon-like peptide 1)
It has been suggested that too little glucagon-like peptide 1 released after a meal may increase the likelihood of, or worsen, obesity. Approximately 40% of obese people are deficient in this hormone.
Since GLP 1 reduces appetite after a meal, if the body releases less of this hormone, individuals may eat more during a meal and are more likely to snack between meals. Dieting, or natural weight loss, is linked to a decrease in GLP 1. The result may be an increased appetite and tendency to regain weight. There is no current test for a deficiency of the hormone but weight loss as a result of replenishing GLP1 can mean that a deficiency is present.
Medications associated with weight gain
The reason for the weight gain with the medications differs for each medication. If this is a concern for you, you should discuss your medications with your physician rather than discontinuing the medication.
- Certain tricyclic antidepressants, such as amitriptyline, imipramine (Tofranil) and doxepin
- Anticonvulsants (medications used in controlling seizures such as carbamazepine [Tegretol, Tegretol XR, Equetro, Carbatrol] and valproate [Depacon, Depakene]),
- Some diabetes medications (medications used in lowering blood sugar such as insulin, sulfonylureas, and thiazolidinediones),
- Certain monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil)
- Paroxetine (Paxil, Pexeva), a selective serotonin reuptake inhibitor (SSRI)
- Mirtazapine (Remeron), which is an atypical antidepressant — a medication that doesn’t fit neatly into another antidepressant category
- Certain hormones such as oral contraceptives, and most corticosteroids such as prednisone.
- Weight gain may also be seen with some high blood pressure medications and antihistamines.
Environmental influences
These come into play very early, even before you’re born. Researchers sometimes call these in-utero exposures “fetal programming.”
Babies of mothers who smoked during pregnancy are more likely to become overweight than those whose mothers didn’t smoke. The same is true for babies born to mothers who had diabetes. Researchers believe these conditions may somehow alter the growing baby’s metabolism in ways that show up later in life. After birth, babies who are breastfed for more than three months are less likely to have obesity as adolescents compared with infants who are breastfed for less than three months.
Other contributing medical issues
- Certain medical conditions such as binge eating disorder (BED), BED is an eating disorder where a person has recurrent episodes of binge eating. During these episodes, the individual eats a large amount of food quickly and feels a lack of control over this eating.
- Cushing’s disease and polycystic ovary syndrome can also lead to weight gain and obesity.
- Under-active Thyroid Gland (hypothyroidism)
What we can control
Frequency of eating
There are many reports of overweight people eating less often than people with normal weight. Scientists have observed that people who eat small meals four or five times daily have lower cholesterol levels and lower and/or more stable blood sugar levels than people who eat less frequently (two or three large meals daily). One possible explanation is that small frequent meals produce stable insulin levels, whereas large meals cause large spikes of insulin after meals.
Avoid a diet high in simple carbohydrates
Carbohydrates increase blood glucose levels, which in turn stimulate insulin release by the pancreas, and insulin promotes the growth of fat tissue and can cause weight gain. Some scientists believe that simple carbohydrates (sugars, fructose, desserts, soft drinks, beer, wine, etc.) contribute to weight gain because they are more rapidly absorbed into the bloodstream than complex carbohydrates (pasta, brown rice, grains, vegetables, raw fruits, etc.) and therefore cause a more pronounced insulin release after meals than complex carbohydrates. This higher insulin release, some scientists believe, contributes to weight gain.
The Western diet causes insulin resistance in many individuals. This elevates insulin levels all over the body, making energy selectively get stored in the fat cells instead of being available for use.
The best way to lower insulin is to cut back on carbohydrates, which usually leads to an automatic reduction in calorie intake and effortless weight loss. No calorie counting or portion control required.
Emotional eating
Have you heard the term “eating your feelings?” Many of us don’t realize how often we eat when we are under stress, need comfort, feel unsafe, and avoiding difficult or negative feelings. Finding a therapist to help deal with emotional issues can give us guidance on how to handle uncomfortable emotions and past trauma so they don’t sabotage our health.
Medical intervention
Talk to your doctor or ask for a referral to a doctor who specializes in obesity treatment. There are options out there to help and give you hope.
Orlistat is a medicine which can help you to lose weight if you are obese or overweight. It works by blocking chemicals (enzymes) in your gut which digest fat. Nearly a third of the fat that you eat is blocked by orlistat. The undigested fat is not absorbed into your body and is passed out with your stools.
Victoza works in 3 ways like the hormone GLP-1 (7-37) to help control blood sugar:
- Slows food leaving your stomach. GLP-1 is normally released from your small intestine when you eat. This slows down the process of food leaving your stomach, which helps control your blood sugar after meals.
- Helps prevent your liver from making too much sugar.
- Helps the pancreas produce more insulin when your blood sugar levels are high. Victoza® does this by helping important cells work the way they should. These cells are called beta cells and they help control blood sugar by making and releasing insulin.
Surgery
Considered only when other weight management options have not been successful.
There are many forms of obesity surgery, but often surgery reduces the size of the stomach so that only a small amount of food can be eaten comfortably. Some of the terms used to describe the surgeries used to treat obesity include:
- gastric bypass surgery
- laparoscopic band surgery
- Roux-en-Y gastric bypass
- stomach “stapling”
When reviewing suitable management options, it’s important to consider the risks and benefits of each option. Your doctor and other healthcare professionals can provide you with the information you need to make an informed choice about what options are best for you.
Conclusion
It’s important to remember that you are not alone. The rate of adults who reported height and weight that classified them as overweight in 2014 was 40.0% for men and 27.5% for women.
Obesity is an epidemic and it needs to be treated as a disease with compassion. Don’t suffer in silence; find a doctor who can work with you to get to a place of healthy, permanent lifestyle changes. No more fad diets. We know that they disrupt Leptin and GLP1 levels which will only make it more difficult to lose weight and keep it off. Pay attention to improving the quality of the food you eat and even 30 minutes of walking a day will change how you feel and significantly improve your overall health.
So sure, make that New Year’s resolution but differently this time. Get assistance from trained professionals who have tools to make this easier for you. You deserve to be healthy and you deserve not to suffer getting there.
