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PETER VASH MD, MPH
INTERNIST & ENDOCRINOLOGIST
SPECIALTY IN OBESITY MEDICINE
LOS ANGELES, CA
UNDERSTANDING
THE OVERWEIGHT CONDITION
and
WEIGHT LOSS PROCESS
FREQUENTLY ASKED QUESTIONS
Being overweight is damaging to your health, quality of life and wellbeing. Excess weight is closely linked to numerous medical conditions, such as type 2 diabetes, heart disease, degenerative osteoarthritis and more than 20 other disease conditions. While obesity is a medical disease condition that may not kill you outright it will, in time, maim you.
Fat is a necessary part of a healthy and well balanced diet. However, foods containing saturated fats and trans-fats,such as cheese, ice cream, red meats, deep-fried foods, many fast foods, and commercial baked goods, etc., should be eaten in minimal amounts or avoided. It is healthier to eat foods which contain fats from virgin olive oil, avocados, nuts, salmon, tuna, and small amounts of butter.
No, when you eat does not matter. What matters is what you eat at the time and how much you eat at that time. When people snack after dinner and latter in the evening they tend to eat more, not really because they are hungry but because it is a habit, a diversion, and a calming soothing satisfying behavior that helps people feel better. Eating later in the evening is one of the most common problems that causes weight gain and makes losing weight so difficult. Think about it, if food is a fuel for the engine does it make any difference when you put gas in your car?
Adequate sleep is an important part of an effective obesity treatment program. For example, research has shown that with two days of sleep deprivation in healthy normal-weight men there was about an 70% increase in the Ghrelin-to-Leptin ratio, which associated with a direct increase in hunger. Clinical research shows that when an individual does not get enough sleep,suggested amounts are from 5-9 hours depending on the individual's situation and make up, they tend to compensate by using food, especially refined sugary foods, as a substitute for sleep. It was also found that the stomach producing hunger hormone Ghrelin is increased with decreased amounts of sleep. Adequate sleep may not directly cause you to lose weight, but it can certainly help prevent you from gaining weight.
A usual medical and metabolic explanation is that for each pound of fat that is to be metabolized and consumed by the body, a calorie deficit of about 3,500 needs to occur. So if a person is in a stable metabolic state and eating 2000 calories a day, without any gain or loss of weight, and they decide to lose weight by reducing their calorie intake down by 500 calories to a daily intake of 1500 calories, then at the end of a week they will theoretically lose one (1) pound of fat. Since 500 calories X 7 days equals 3,500 calories, or one pound of fat. However because some people may have a slightly higher or lower metabolic rate, their rate of weight loss may be faster or slower. But the concept is that it takes about a 3,500 calorie reduction to lose a pound of fat, and this takes some time to accomplish.
The diet and eating plan that you follow and stay on. It doesn't really matter that much from which food groups the calories come from, what matters most is the amount of calories that you eat. While eating refined sugar laden snack and fast foods will cause you to crave more of those same foods, as opposed to protein rich foods (lean meats, fish, sea foods, poultry, nuts), it is the amount of calories not where they come from that matters the most.
There is usually a weight regain following a period of weight loss because of several 'counter regulatory' metabolic and hormonal changes which were developed through evolutionary adaptations to prevent starvation. Following weight loss, the hunger stimulating hormone Ghrelin increases to increase appetite; muscle efficiency increases to allow more movement with fewer calories; thyroid hormone secretion decreases to cause a reduction in Metabolic rate; Leptin levels decrease which signals the brain that the body's energy reserves are low and stimulates the brain to seek out and eat more food. In addition, individuals tend to return to their prior eating habits and social patterns of eating behaviors.
No, refined sugar is not addicting, but it addictive-like. While it has the ability to stimulate certain ares of the brain and is associated with the neurotransmitter dopamine, it does not have the intensity of stimulation like truly addictive substances such as amphetamines, alcohol, nicotine, and opioïdes. Also there are no classic withdrawal symptoms experienced when an individual stops eating or drinking refined sugar products.
This is often thought by many overweight individuals as their cause for weight gain. However, I believe that only about 5-8% of the overweight population suffer from a low metabolic rate or hypothyroidism. A simple blood test to measure the level of thyroid hormone can easily answer the question. While I doubt that a low thyroid level is the cause for weight gain in most individuals, I believe that every overweight person who wants to lose weight should have their levels tested and rule this out.
When food is used as an emotional coping mechanism, to relieve psychic stress, discomfort and pain then weight gain can occur, and often very quickly. Refined sugar has been found to reduce the feelings of anxiety, and reduce the stress hormone cortisol. So if an individual eats and snacks on high carbohydrate snacks and high fat foods like ice cream, cakes, cookies and pastries the weight gain is sure to follow. However it is not the emotional feelings that by themselves cause a metabolic reason for weight gain, but it is the response to that emotional and upsetting situation with eating that causes a weight gain.
Drinking adequate water (depending on a person's weight, usually 65-100 oz. per day) helps to reduce hunger, give a sense of feeling full, and help with the metabolism of fat. Many individuals who think they are hungry and snack on fast foods are actually thirsty, and drinking water can reduce their desire to eat. The dietary weight loss supplement, Attenuate, was developed to mix the maximum recommended weight loss ingredient, Garcinia cambogia, into a large bottle of water, recommended 24-32 oz., and taken between breakfast and lunch and again between lunch and dinner. In this way the person receives help getting adequate hydration while having their appetite reduced, their hunger decreased, and less of a desire to snack. With adequate hydration overweight individuals usually have fewer headaches, more energy and a reduced hunger, and have an easier time losing weight.
Clinical studies and experience have repeatedly shown that it is very difficult for overweight individuals to lose weight without some help with appetite control. While there are several prescription medications to help with behavioral lifestyle interventions, that can provide an additional 5%-10% weight loss, less than 5% of eligible individuals use them. These physician prescribed medications, along with the physician developed weight loss supplement Attenuate, can make a significant difference in helping the weight loss process. Because weight loss that results from using diet and exercise alone is usually accompanied by an increase in weight regulating hormones, like Ghrelin and Leptin which are associated with increased appetite and weight gain, these medications can help promote weight loss and prevent and/or limit weight regain. Physician prescribed FDA approved weight loss medications are not addicting, and when used appropriately are generally considered safe and effective.
Because obesity is one of the most important common, costly, and chronically destructive disease that burden Americans, as well as other citizens in the world. Today more 65% of American adults, and over 18% of youths, are overweight or obese. This is more than a social-cosmetic concern since being overweight significantly increases the risk for co-morbid medical disease conditions such as type 2 diabetes, heart disease, hypertension, degenerative osteoarthritis, obstetric and gynecological complications, gallbladder disease, obstructive sleep apnea, asthma, and certain cancers. There is also a heavy and significant psychological burden to being overweight in a relentlessly social conscious society. Being overweight is not a trivial or unimportant concern for one's health, comfort and quality of life.
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