Why do we gain weight so easily?
The body stores the excess energy when caloric intake is more than expenditure, and fat is the best energy source.
Aging starts at the age of 20!!! Starting with skin, brain and lung at 20, muscle at 30-40, then smell, hearing, vision, liver and kidneys after 50 years old. Metabolism slows down very gradually once adulthood is reached and a sharper decline after midlife or menopause for women. Solely with the reduced metabolic rate as we age, eating the same amount of food without increasing the exercise activities, will eventually lead to weight gain.
Humans are evolved to store energy. Throughout the history of mankind, people eat to survive and food was not as abundant and easily available as it is now. The body then became very efficient in keeping any excess calories and stored it as fat. With industrialization and modernization of the society, processed food, which is much higher in calories, becomes abundant and readily available. Lifestyle also changed from having lots of manual activities to a more sedentary one, mostly sitting at a desk all day long. Caloric intake is easily in excess of caloric output, leading to weight gain. I dare say, modernization is one of the causes of the obesity pandemic in the world.
There are also medications and medical conditions that cause weight gain, so please check with your doctor when you notice unusual weight gain.
How can we lose weight?
Weight loss is achieved when there is a caloric deficit, when caloric output is more than caloric intake.
Certain diseases cause unintentional weight loss, for example, hyperthyroidism and severe diabetes. The metabolic rate is increased in hyperthyroidism, while in severe diabetes, calories in the form of glucose, are lost in the urine; both cases thereby resulting in abnormally increased caloric output. Diet and exercise intends to create this caloric deficit normally.
The most important part of the diet is to find one that can last! So, the best diet is a "Forever Diet". Macronutrients are the nutrients the body needs in large quantities - fats, carbohydrates and proteins. They are the energy source and are essential for daily body functions. Micronutrients are needed in less amounts - vitamins and minerals. Most diets like Paleo, Atkins and South Beach, change the macronutrient composition, reducing or nearly eliminating carbohydrates and replacing them with fats. There are a lot of medical studies that have shown that these "popular" diets that limit any of these macronutrients do not impact long term weight loss. Keto or Ketogenic diet - a low carb high fat diet, has been shown to have significant weight loss at the end of its 6 months period. However, it is mainly water weight and the diet is not sustainable nor recommended for long term because of all the problems associated with having a high fat diet. These kinds of restrictive diets on the whole, limiting a whole group of macronutrients such as carbohydrates, are very hard to adhere to, and usually do not last and are not sustainable. Once they stop the diet, most people find themselves gaining all the weight, sometimes more. This is known as weight cycling, and the reason for this phenomenon is that the metabolic rate slows down permanently with weight loss. Exercise only increases it slightly but not significantly. So, when the diet is no longer adhered to, caloric intake then easily exceeds output, leading to weight gain again. At the end of the day, the most important thing about a diet is sustainability, it has to be a diet that can last forever so that you will not gain the weight back!
Intermittent fasting has also been shown to result in some weight loss. The "fasting" itself does not promote weight loss, it just shortens the hours in a day that you can eat. Therefore, this method will not lead to weight loss if someone eats a large amount of high caloric food during the non-fasting period. It is most effective for people who eat late, and to avoid the midnight snack which actually causes the most weight gain.
What is the best way to create a caloric deficit?
This is where a dietitian consultation will be beneficial and helpful. Besides having professional guidance to ensure sufficient nutrients, it also helps with monitoring. It is important to monitor daily and keep a food diary initially. It is usually recommended to start with a deficit of 500 calories a day, and the easiest calories to eliminate are liquid calories, such as juice, soda and alcohol.
Portion control is the best diet because it is a diet that can be adhered to longest. Charmain dietitian has mentioned in her previous blogs the Plate method and Harvard Healthy Eating Plate. These are simple ways to imagine what a healthy meal should contain and the website at Harvard Healthy Eating Plate gives examples of the different kinds of food in different languages. It even has food suggestions for those who are environmentally conscious!
What about exercise?
Exercise has minimal impact on initial weight loss, that is why the weight often stays the same when one starts exercising only without dieting. In fact, a lot of people complain that they gain weight after they start exercising! They are eating because they are hungrier and also feel that they have done the exercise to deserve more food. Eating less is the key for weight loss. Exercise is important for metabolic health and for maintenance of weight loss.
The most recent recommendations according to health.gov website are copied below, please go to the official website via the link for more details:
Key Guidelines for Adults
- Adults should move more and sit less throughout the day. Some physical activity is better than none. Adults who sit less and do any amount of moderate-to-vigorous physical activity gain some health benefits.
- For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week.
- Additional health benefits are gained by engaging in physical activity beyond the equivalent of 300 minutes (5 hours) of moderate-intensity physical activity a week.
- Adults should also do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits.
The key guidelines for adults also apply to older adults. In addition, the following key guidelines are just
for older adults:
- As part of their weekly physical activity, older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities.
- Older adults should determine their level of effort for physical activity relative to their level of fitness. • Older adults with chronic conditions should understand whether and how their conditions affect their ability to do regular physical activity safely.
- When older adults cannot do 150 minutes of moderate-intensity aerobic activity a week because of chronic conditions, they should be as physically active as their abilities and conditions allow.
When TLC fails.....
I will briefly discuss medications and surgeries that are FDA approved. These are prescribed by physicians when weight loss is medically necessary. All the medications have side effects and need to be discussed in detail with the physicians before initiating. All the weight loss below are average number. Lifestyle modification is still very important, otherwise all the weight will eventually be regained. Yes, even with surgeries!
- 5-7 lbs weight loss a year
- 3-5 % of initial body weight loss
- a capsule taken during or after the meal to block the fat from being absorbed, now available without prescriptions
- most common side effect is oily stool and fecal incontinence
- not useful if already on a low fat diet
- 9-13 lbs weight loss a year
- 5-7 % of initial body weight loss
- an injection of GLP-1 (glucagon like peptide-1) agonist
- GLP-1 agonist in lower dose is used for the treatment of diabetes
- patients feel full and satisfied with less food
- most common side effect is nausea
- can cause pancreatitis or gallstone
- NOT for people with history of or family history of medullary thyroid cancer
- 10 lbs weight loss
- 5% of initial body weight loss
- a combination pill taken twice daily that needs to be slowly titrated up
- patients feel full and have less appetite
- most common side effect is nausea, insomnia, dizziness and headache
- can cause mood disturbance
- NOT for people with uncontrolled hypertension, seizure or eating disorder
- 19.5 lbs weight loss
- 10% of initial body weight loss
- a combination medication taken daily
- suppress appetite
- common side effect is insomnia, dry mouth and constipation
- Need to monitor blood pressure
- NOT for people with glaucoma, hyperthyroidism
Last are the surgeries, most commonly:
- Sleeve gastrectomy - this is probably the more commonly done surgery at present
- Gastric band - not as popularly done now because of high rate of re-operation
- Roux-en-Y Gastric Bypass - complicated surgery, good weight loss but has a lot of nutritional issues
- Biliopancreatic Diversion with duodenal switch - very complicated surgery, but helps with metabolic disease as well like diabetes
Surgeries are only done when absolutely necessary. Most patients have to go through intense diet and exercise programs and extensive evaluations prior to even discussing surgical options.
The key point of this blog is that the diet for weight loss needs to be a sustainable one, something that can be done forever. Exercising portion control and learning to choose the right calories to put in the body is probably the best way. Maintaining a healthy weight CAN prevent a lot of medical issues and diseases!
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