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Weight loss: Understanding the process and developing an individualized plan.

Today, people in the US struggle more with unintentional weight gain and obesity than ever before. There is, however, an abundance of weight loss information available to Americans based on various diets and exercise recommendations. A more comprehensive approach to sustainable weight loss often also requires nutritional education, behavioral counseling, anti-obesity medications, and surgical therapies.

According to the Obesity Medicine Association, diet and calorie restriction have a far more significant impact on successful weight loss than exercise. However, we cannot underestimate the importance of exercise for weight preservation and maintenance of muscle mass. In addition, people who experience gradual weight loss are more successful long term than those with rapid weight loss programs (US Centers for Disease Control). There are multiple genetic, biological, behavioral, and environmental factors contributing to abnormal weight and obesity. Possible obstacles to successful weight loss include a lack of sleep, FAD diets, consumption of alcohol, sweet beverages, stress, and an abnormal microbiome (flora in stool). Therefore, an individualized weight loss program in combination with a behavioral change, is considered to be the most successful and sustainable approach.

Low carbohydrate diets have been most beneficial in improving metabolic risk factors and maintaining healthy weight long term. In addition, low carbohydrate diets will produce modestly higher weight loss results than fat restriction diets during the first six months. Hunger control will be a challenge in the first eight weeks and can be overcome with appetite suppressing medications.

A very low-calorie regimen produces rapid weight loss, but it is difficult to follow long-term. Intermittent fasting diets (fasting for 8-24 hours between meals) are gaining popularity and are considered by some patients easier to follow. High-fat diets such as Adkins should be used with caution as saturated fats (margarine, shortening, processed red meat) are not required for nutritional balance and may contribute to worsening metabolic risk factors.

In any diet that restricts calories, it is crucial that the essential ingredients are included to preserve metabolic balance. Omega 3 and Omega 6 polyunsaturated fatty acids are essential for heart health, mental health, and the weight loss process. The source of Omega 3 acids comes from fatty fish, algae, and several high-fat plant foods. Omega 6 fatty acids are obtained from poultry, eggs, nuts, vegetable oils, and grains. The recommended consumption ratio of Omega 3/6 is 4 to 1. The typical American diet, however, has the ratio of 20 to 1 with an insufficient Omega 3 consumption. It is also imperative to include the six essential amino acids in the diet since we cannot synthesize them: histidine, lysine, cysteine, tryptophan, isoleucine, valine, methionine, tryptophan. Lysine is often deficient in a vegetarian diet and should be substituted regularly in weight loss programs based on a vegetarian diet.

We often recommend a multivitamin, vitamin D, and calcium supplementation along with an exercise regimen for muscle mass improvement and reduction of body fat percentage. Exercise recommendations by the Department of Health and Human Services are 150 minutes of moderate intensity exercise, split over three days a week. There should be no more than two consecutive days without exercise, and there should be resistance training two days a week. It is also essential to reduce a sedentary lifestyle by limiting sitting to no more than 90 minutes at a time.

Other weight loss interventions include spending more time in nature, getting enough sleep, avoiding sweet beverages, and using sweeteners with caution as there is no clear data on their role in weight loss treatment. As more research is done on the topic of obesity and abnormal weight gain, new treatments and options are emerging. As we develop a deeper understanding of factors contributing to abnormal weight gain and obesity, we can provide better tools and strategies to educate and treat our patients.

Dr. Inna Yaskin, DO Board certified Internal Medicine

Board certified Obesity Medicine

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