The incidence of obesity is rising in this country. Obesity is due in large part to overnutrition, disturbing the body’s energy balance by ingesting more calories than we burn. Contributing factors include genetic, cultural, and socioeconomic factors.
Many people find it difficult to avoid food cravings, especially in times of emotional stress.
Appetite is influenced by an array of different hormones and peptides. Ghrelin is a hormone that increases appetite. Studies have shown that insufficient sleep often increases the level of ghrelin. Therefore, insufficient or poor-quality sleep increases appetite.
Leptin is a hormone released by fat cells. Leptin binds to an appetite center in the brain called the hypothalamus to induce satiety. With obesity, the hypothalamus can become resistant to the signal of leptin, causing ghrelin to be unopposed, with the consequence of increased appetite. Leptin resistance can persist for 6 months after weight loss, which can make it difficult to maintain weight loss.
Lifestyle changes can be helpful to promote weight loss. These include:
Being more mindful of your eating habits. Choose your food carefully when shopping.
Consuming only two meals daily to lower total calorie consumption. I recommend consuming only lunch and dinner. Protein is satiating and is not usually rich in calories. If you Crave a snack, I suggest protein.
Reducing carbohydrate consumption, including starchy foods such as bread, pasta, pizza, rice, and noodles. Avoid processed food stripped of fiber. Avoid sweet drinks, including soda. Avoid products containing high fructose corn syrup, which causes increased production of fat molecules and provokes insulin resistance.
Performing zone 2 cardio exercise at least most days of the week. Zone 2 cardio exercise is best for burning fat. If you are in zone 2, you should be huffing and puffing but still be able to speak to your exercise partner or sing a song. When you are Zone 2 you should be at 60 to 70% of maximum predicted heart rate. Your maximum predicted heart rate is 220 minus your age.
If you are unable to maintain weight loss with lifestyle measures alone, medication is available to help you lose weight by reducing appetite.
GLP-1 is a hormone made in the small intestine and colon following a meal. GLP-1 has the following effects:
- reduces hunger
- slows stomach emptying after a meal
- increases insulin secretion
- reduces glucagon (a hormone which counters the effect of insulin) secretion
There are multiple drugs that mimic the effect of GLP-1 in the body. Examples include:
- Ozempic
- Wegovy
- Mounjaro
- Zepbound
The above medications are taken by injection once a week.
Compounding pharmacies can prepare a tincture of sublingual drops containing the same medication found in Ozempic and Wegovy. The tincture is available for people who are averse to needles or who wish to avoid bringing needles when travelling.
The medication is started at the lowest dose and titrated upward every month until either intolerable side effects occur, or the goal weight loss of 2 pounds weekly is achieved. It is not necessary to increase the medication to the maximum dosage in every patient.
Common side effects include:
- esophageal reflux (heartburn)
- nausea
- constipation
- paradoxically, diarrhea
You should not take these medications if you have a family or personal history of medullary thyroid cancer.
One concern I have about this class of medications is that sometimes patients have such a reduction in appetite that they develop protein malnutrition, causing muscular atrophy.
Muscle strength is important for many reasons:
- soaks up glucose from the bloodstream, lowering blood glucose
- muscle helps us to stay upright and reduces the risk of falls
- causes bones to remodel and strengthen
I recommend consuming at least one gram of protein per kilogram body weight per day. I also recommend resistance exercises, such as stretch bands, machine weights, or free weights. Body composition analysis using DEXA scan can help to evaluate muscle mass and adipose tissue while taking weight loss medication. My goal weight loss is 2 pounds per week.