How to achieve sustained weight loss

Matt Whitaker – Researcher and Trainer in Public Health/3 January 2017

I hope everyone enjoyed Christmas and had a fantastic New Year!

Following the festive season, many of you may have set a New Year’s resolution, often these are around weight loss (hence why gym membership sales sky rocket at this time of year!). Losing weight can be easy, although maintaining the weight loss can be extremely challenging. This week’s blog will be bringing together the ‘Energy Balance Theory Limitations’ and ‘Insulin: The cause of, and solution to, all of life’s problems?’ blogs. Hopefully it will put you in a place of better understanding of how to keep those lost pounds off so all that hard work pays off!

Firstly if you haven’t read the above blogs, I strongly recommend you doing so….

Let’s briefly re-cap, calories in versus calories out (energy balance theory) does not work, but why? Intake and expenditure of calories are not independent of each other and calories are not equal once ingested and to cap it off when we eat in an energy deficit our basal metabolic rate drops to match the deficit (1). Obesity is a hormonal condition driven by what causes hunger, satiety and what decides the fate of nutrients once consumed (2).

I can imagine what a lot of you may be thinking… If ‘eat less, move more’ doesn’t work, why do I know someone who did exactly that and lost weight!? I won’t dispute that in the SHORT TERM any diet can work, any can lead to a few pounds or even stones in weight loss, but I would question was that weight loss maintained at three months down the line? How about six months… a year? Most likely not. Unless you’re just looking to trim down for a holiday and are not bothered about weight re-gain I suggest considering how to maintain this weight loss permanently. This won’t be easy, once someone has been overweight/obese for a while a range of biological changes emerge to maintain or increase their fat storage and the brains reward mechanisms for food change (3). Don’t be disheartened though it is still absolutely do-able, you just need to understand how to avoid the harsh cycle illustrated below:

Firstly what causes obesity? Simple, having a high body weight set point, this is arguably governed by insulin (for more information and references, see my previous blog). As was concluded in the previous blog, if insulin levels are reduced, the amount of time your body spends utilising fat as energy will outweigh the amount of time it is storing energy as fat (4). This will lead to overweight cells and eventually obesity (5).

Secondly what is the treatment for obesity? Simple, reduce the high body weight set point, how? Reduce insulin! To achieve this we must understand what increases insulin? The main drivers are: carbohydrate consumption (6), frequently eating (snacking) (7) and high cortisol levels (8). The solution to the first two are obvious, reduce carbohydrate intake (particularly refined carbohydrates) and only eat at meal times. High cortisol levels go hand in hand with high stress levels and poor sleep quality (9) so managing stress and ensuring a consistent, healthy sleep pattern will ensure cortisol levels remain reduced.

Thirdly, are there other considerations? Yes, exercising can help achieve most health goals, although when its outcomes are focussed solely on weight management the results are questionable. Exercise alone never leads to its predicted weight loss (10) however when combined with an improved diet exercise can be a very useful tool for improving health so should NOT be neglected (11). The next consideration is the gut microbiota which has been covered previously, with the take away message suggesting if you consume a varied diet you will have a varied gut microbiome which in-turn will aid in digestion, extract vitamins from foods and may aid in weight loss (12). Finally consumption of fibre rich foods may help in weight management by: increasing chewing time, increasing satiety following a meal and by potentially reducing carbohydrate absorption and digestion (having a knock-on-effect on the reduction of blood glucose and thus insulin).

Here are some practical tips to help sustained weight loss, by reducing your body weight set point:

* Pick a dietary approach that is maintainable – There is no point in opting for something you can’t stick to permanently. Think of it as a lifestyle change as opposed to a ‘diet’ which implies an inevitable end date.

* Consider barriers you may face – Set short-term, achievable goals for these barriers, addressing one at a time

* Consume a varied diet to maximise gut microbiome variety

* Increase fibre content – Opt for foods such as green vegetables, nuts, beans and unprocessed carbohydrates

* Reduce intake of processed foods

* Reduce carbohydrate consumption (particularly refined options)

* Try an intermittent fasting protocol – To maximise ‘fat burning’ times

Next week, Sean will be writing a blog exploring ‘good cholesterol, bad cholesterol’

Any questions, feedback and/or suggestions would be most welcomed, please email me at

Matthew.Whitaker@xperthealth.org.uk

References

1. Leibel RL, Rosenbaum M, Hirsch J. Changes in Energy Expenditure Resulting from Altered Body Weight. NEJM. 1995;332(10):621-8.

2. Sumithran P, Prendergast L, Delbridge E, Purcell K, Shulkes A, Kriketos A, et al. Long-Term Persistence of Hormonal Adaptations to Weight Loss. NEJM. 2011;365:1597-604.

3. Ochneremail CN, Tsai AG, Kushner RF, Wadden TA. Treating obesity seriously: when recommendations for lifestyle change confront biological adaptations. Diabetes & Endocrinology. 2015;3(4):232-4.

4. Sanders F.W., Griffin J.L. De novo lipogenesis in the liver in health and disease: more than just a shunting yard for glucose. Biological Reviews. 2015;doi: 10.1111/brv.12178. [Epub ahead of print].

5. Bigornia SJ, Lichtenstein AH, Harris WS, Tucker KL. Associations of erythrocyte fatty acid patterns with insulin resistance. Am J Clin Nutr. 2016.

6. Bao J, de Jong V, Atkinson F, Petocz P, Brand-Miller JC. Food insulin index: physiologic basis for predicting insulin demand evoked by composite meals. Am J Clin Nutr. 2009;90(4):986-92.

7. McAuley K, Mann J. Nutritional determinants of insulin resistance. Journal of Lipid Research. 2006;47(8):1668-76.

8. JA W, PM W, MA B, P C. Hyperinsulinemia Is Not a Cause of Cortisol-Induced Hypertension. American journal of hypertension. 1994;7(6):562-5.

9. Broussard J, Chapotot F, Abraham V, Day A, Delebecque F, Whitmore H, et al. Sleep restriction increases free fatty acids in healthy men. Diabetologia. 2015;58(4):791-8.

9. Hall KD, Sacks G, Chandramohan D, Chow CC, Wang C, Gortmaker SL, et al. Quantification of the effect of energy imbalance on bodyweight. Lancet. 2011;378(9793).

10. Shaw K, Gennat H, O’Rourke P, Del Mar C. Exercise for overweight or obesity. The Cochrane database of systematic reviews. 2006(4):CD003817.

11. Bik EM. The Hoops, Hopes and Hypes of Human Microbiome Research. The Yale journal of biology and medicine. 2016;89:363-73.

 

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