One of my biggest interests – and one of the most common goals patients have – is weight loss. It’s also a common area of frustration. After all, it SHOULD be a simple thing. Change your diet and move more, right? What could be easier than that? And yet, millions of Americans try this approach every year, and most of the time it fails them. Why?
The problem with the “eat less, move more,” mantra (or the “eat less carbs, move more,” or the “don’t’ eat until noon and move more” mantra, or whatever other strategy you want to try) is not that it isn’t true, but that it’s a very incomplete truth. Which is to say that it is literally true that if you ate less and exercised more, you would lose weight, but that for most people it is almost impossible to do so on a long-term basis without first changing a lot of other stuff in their life. This is because hunger is an intense, primal drive.
Moreover, studies repeatedly show that even very educated and well trained people aren’t able to count their calories all that accurately.
In other words, the “eat less, move more” approach to weight loss requires both near impossible will power, and near impossible math skills. Hence, if you’ve tried the “eat less, move more” approach and not lost weight, it’s not that you’ve failed your diet, so much as that your diet was an almost impossible plan to start with.
This is where a more holistic approach to weight loss comes into play. It turns out that there are a lot of habits you can build into your life that, applied consistently over time, will lead you to eat less and move more. And not all of them have to do with food or exercise.
I think of this sort of like a house. If you build a wonderful looking kitchen, bathroom, and living room, but forget to pay much attention to the foundation, you will have a beautiful looking house for a short time – and then it will collapse into ruin. On the flip side, if you take the time to build the correct foundation, there’s a good chance that long after you are gone from this world, your grandchildren and their grandchildren will still be able to admire all of the beautiful craftsmanship that went into your home.
So it is with diet and exercise plans. If you first lay a correct foundation, your attempts to cut calories and move more are much more likely to succeed in the long term. This is why I believe we need to start approaching weight loss in a much more broad and holistic fashion – and this is what I endeavor to do with my patients.
Here is just a partial list of the things I think about when trying to help patients lose weight. You’ll note that many of them don’t directly relate at all to food or exercise:
Food quality: unprocessed foods that are rich in nutrients, fiber, and protein, tend to be much more filling than the processed foods that come in packages and now make up about 60% of the typical American diet. If you simply increase the amount of these foods in your diet, caloric restriction – without hunger – often follows as a natural side effect.
Meal timing and circadian rhythm: I’ll have a lot more to say about this in future posts, but increasing amounts of research show that eating on a regular, fixed schedule, can lead to much greater metabolic efficiency and an easier time regulating your appetite.
Stress Management: stress raises levels of the hormone cortisol, and cortisol makes it very easy to store fat. Stress also increases the odds that you will eat junk food.
Good sleep: sleep has multiple impacts on weight, including on levels of a key hormone called Leptin, which helps to regulate appetite. This is why you tend to be hungrier when you are very tired. Getting into good sleep habits can be a huge benefit for weight loss. Fortunately, helping patients improve their sleep is another big interest and passion of mine about which I will say more in a future post.
Gut microbiome – our gastrointestinal tract is teeming with approximately 40 trillion bacteria, most of which are either harmless or in fact beneficial. Emerging research shows that thin people have much more diverse and healthy gut microbiomes than overweight people, and that frequent antibiotic use (which wipes out many of these beneficial microbes) can make your gut microbiome worse and increase your risk of obesity. This is a good reason to avoid antibiotics as much as possible. There are many steps that can be taken to improve your gut microbiome over time, and adopting lifestyle measures that support a healthier gut microbiome is always part of my treatment for overweight patients.
Medications – many of the medications that people commonly take can make it easy to pack on extra pounds. Trying to reduce or eliminate unnecessary pills can be very helpful in this area.
Pollution – this is a story that is still being worked out, but more and more studies show that various pollutants in our environment can disrupt hormones in an “obesogenic” way (“obesogenic” is medicalese for “causes weight gain”). While you can’t control your exposure to everything in the environment, two things that can be helpful are to limit your exposure to pesticides by buying organic foods where possible, and limiting your exposure to plastic. One place to start is to stop drinking water bottled in plastic, as this tends to have a lot of plastic residue in it.
Blood Glucose – two people can have radically different blood glucose fluctuations to the same food. These big rises and dips in blood glucose can have major impacts on mood and appetite. Sometimes I use continuous glucose monitors for a few weeks to help patients get a sense of how they respond to different meals and which ones work best for them.
Supplements – there are a few supplements that have been shown to have modest benefit in weight loss, and while these should never replace the above measures, they can help to complement them.
There are other factors too, and more are being discovered all the time.
If you try to cut calories and move more (or some other strategy such as low carb, keto, plant based, or whatever else is out there) to induce weight loss, but you aren’t working on optimizing the above variables, you might only be getting at part of the problem.
