Obesity continues to be one of the most prevalent chronic diseases and rates continue to increase. 

Obesity continues to be one of the most prevalent chronic diseases and rates continue to increase.  The bias and stigma in the healthcare setting are often a barrier to prevention and treatment of weight related issues.  Weight is often a symptom of underlying issues.  I have addressed weight related issues for nearly 20 years and the approach is different because there are so many contributing factors. An integrative approach is to take the time to understand each person’s presentation and consider all the complex factors causing the weight gain. 

It would make sense that if you wanted to lose weight, you would just not eat. If the intake of food is strictly limited, then the body (thinking there is a crisis of starvation) hangs on to fat (for energy) while muscle is broken down. The goal is to change the body composition and lose mostly fat mass and gain or hold onto muscle mass.  Excess fat mass is what contributes to chronic disease. Weight changes involve nutritional changes, lifestyle changes, and behavior modifications. These changes are supported by considering any underlying issues.  Weight issues can have multiple causes and are often a symptom of an imbalance throughout the body. There is a strong correlation with obesity and genetics, stress, metabolism, hormones, environment, nutrition, and sleep disorders

Genetics can influence obesity but is not a direct cause. There are several genes that can influence how your body stores fat and utilizes glucose. An example is the TCF7L2 gene which is associated with diabetes as it influences how glucose is broken down.  Hunger is not always a self-control issue; it is correlated to hormone and genetic dysfunction. Another variant, LEPR (leptin receptor) regulates fat metabolism and hunger. Leptin is produced in the fat cells and works to control your appetite.  Stress affects the leptin levels also.

Stress is one of the biggest contributing factors to weight gain.  Chronic stress produces elevated levels of cortisol. Cortisol is what we need if we are racing to catch a flight at the airport. Cortisol raises your glucose level, so you have the energy to run to the gate.  Glucose that is constantly elevated results in an elevated insulin level, and you are not able to break down fat. Muscle is also broken-down during stress as the body is trying to conserve fat for energy. Chronic stress affects the motility of the gastrointestinal tract, and this affects how food is digested. Stress is not something you can just “turn off” like a faucet, but you can support how you handle stress.  Some genetic variants can influence how you prevent and manage stressful events.

Polycystic ovarian syndrome (PCOS) is a syndrome involving irregular cycling of ovarian hormones.  Although the pathology is still unclear, there are often cysts in the ovaries causing dysfunctional cycles and elevated testosterone. The elevated testosterone can present with excess facial hair, dark hair on arms, and acne.  PCOS is associated with elevated insulin which is a hormone produced by the pancreas to control the glucose.  Women with PCOS often have elevated insulin levels and this can make it difficult to breakdown excess fat. 

Gastrointestinal dysbiosis is the imbalance in the normal gut flora and can have harmful effects to the body and affect how calories from food are utilized.  You are only as healthy as what you can break down and digest. Gut bacteria affect how well you break down fats, carbohydrates, and protein. There are neurotransmitters along the gut wall that send signals to the brain regarding hunger and fullness. A diet high in fiber also feeds the good bacteria that help break down carbohydrates and influence how glucose is utilized.

Sleep apnea is often associated with excess body fat.  The common symptoms are morning headaches, snoring, fatigue, hypertension, and excess fat around the neck.  An average of 7-8 hours of uninterrupted sleep is vital for the body to function well.  The hormones that regulate hunger and fullness are regulated at night and insufficient sleep affects these levels. Studies have shown higher glucose levels with poor sleep.  Repeated awakening during the night can also raise the cortisol levels which increases the glucose levels. In studies addressing sleep quality, most people were not aware how many times their sleep was interrupted.

Developing an individual plan also involves consideration of underlying factors such as current medications, hormonal changes, or associated medical conditions, which might be contributing to weight gain. Excess weight affects every part of the body.  Weight loss and management is the consideration and integration of contributing factors.