What’s the right approach for weight loss? It depends…

Are you still keeping track of your new year resolutions? While almost half of us will make new years resolutions, with the majority of those regarding health, there is new data showing that most of these resolutions are abandoned by the end of January.  Strava, an online fitness app that tracks over 800 million users logged activities, has shown that most people abandon their new year’s plans by the third Thursday of January. This is the perfect time for WellHealth to say “Congratulations, you made it!” 

Losing weight is one of the most common new year resolutions and it’s one of the most difficult to maintain and achieve. There is a public crisis of being overweight (having a BMI between 25.0 and 29.9 kg/m2), or obese (having a BMI greater than 30.0 kg/m 2).  Among U.S. adults, the prevalence of obesity is 39.8% and affected about 93.3 million in 2015-2016.  Rates have increased in all ages and both sexes, irrespective of geographical locality, ethnicity or socioeconomic status. 

Just as alarming are the effects of being overweight.  Obesity is associated with an increased risk of death, by 20% to 40% in overweight patients and by 2- to 3-fold in obese compared with normal-weight patients.  There is increasing evidence suggests that abdominal obesity, rather than total body fat, is also a useful, independent predictor of several cardiovascular- and cancer-related outcomes

Obesity is caused by a complex interaction between the environment, genetic predisposition, and human behavior.  Understanding this allows for specific interventions for each factor leading to weight loss and wellness.  The experts at WellHealth took a look at some interventions that are commonly used, and describe the benefits and shortcomings of each.

Medications for weight loss

Doctors often prescribe weight-loss medication to support healthy eating and physical activity programs for patients with a BMI of 30 or more or a BMI of 27 or more and with weight-related health problems, such as high blood pressure or type 2 diabetes.  There are many U.S. Food and Drug Administration (FDA) approved weight-loss medications, but these are only for adults. Most programs identify specific deficits based on your medical history, blood and genetic makeup and prior diet and fitness experiences to decide which medications will be best.

Examples of medications include Topiramate, an anti-seizure medicine that blunts your appetite and interferes with your taste buds.  Another is Phentermine, a stimulant that releases adrenaline, also blunting your appetite and increasing your energy expenditure.

It is important to note that medications don’t replace physical activity or healthy eating habits as a way to lose weight.  Each medication will have side effects and warnings. For example, Topiramate might kill the enjoyment of your favorite food while Phentermine is addictive and worsens coronary artery disease.  Sadly, you will probably regain some weight after you stop taking weight-loss medication.

Diets for Weight Loss

Truthfully, there is no one size fits all diet plan for everyone.  A healthy diet for weight loss should be one that is sustainable over time, and what works for one person won’t work for the next.  Instead of listing the best diet you should do, we’ve compiled a list of popular diets and identifed the pro’s and con’s of each.

Basic Caloric Restriction. 

This is the oldest diet strategy in the book.  This involves finding your basic metabolic rate (BMR), the number of calories you need to sustain your current weight.  Then, the diet is based on subtracting 500 calories from you BMR. There are many commercially available plans: Weight Watchers, for example, gives you a balanced bank of calories but you count food in points.  Jenny Craig is also based on caloric restriction but it comes with prepackaged meals. You can also track your calories on a tracking app such as Lose It or My Fitness Pal. The Obesity Medicine Association recommends tracking your intake through one of these apps as your first step toward weight loss.

Pros: The benefit of these plans are they allow you to eat any food as long as you stay under your calorie goal, so you do not feel restricted.  They also allow you to eat more if you exercise as long as there is a calorie deficit. Weight Watchers has switched its focus from strictly weight loss to a wellness focus and is starting to look towards healthy food choices with calories.

Cons: There is increasing evidence that the calories in vs calories out is just not the only aspect of weight loss.  Weight loss and gain is driven by hormones and the longer you restrict calories eventually your hunger hormones increase.  Also, if you are going off of calories alone you may not be getting enough of important macronutrients that drive weight loss (proteins) and too many macronutrients that increase your insulin and weight (carbohydrates). Commercial Diet Plans can be expensive and processed food replacement has a lot of chemicals and isn’t a long term solution. 

Intermittent Fasting:

Gaining increasing popularity, this is not so much a diet in terms of what you eat but rather when you eat.  Evidence is accumulating that eating in a 6-hour period and fasting for 18 hours can trigger a metabolic switch from glucose-based to ketone-based energy.  During fasting, cells activate pathways that enhance intrinsic defenses against oxidative and metabolic stress and those that remove or repair damaged molecules.  This is cellular detox. During the feeding period, cells engage in tissue-specific processes of growth and plasticity. This is cellular regrowth. 

Periodic flipping of the metabolic switch not only provides the ketones that are necessary to fuel cells during the fasting period but also elicits highly orchestrated systemic and cellular responses that carry over into the fed state to bolster mental and physical performance, as well as disease resistance.

Pros: It is sustainable because you don’t really have to restrict food groups and it takes less meal planning.   As it is gaining in popularity, there is tremendous research to support it. Studies in animals and humans have shown how intermittent fasting affects general health indicators and slows or reverses aging and several disease processes:

  •   OBESITY AND DIABETES MELLITUS – On the island of Okinawa, the traditional population typically maintains a regimen of intermittent fasting and has low rates of obesity and diabetes mellitus, as well as extreme longevity.
  •   CARDIOVASCULAR DISEASE – Intermittent fasting improves multiple indicators of cardiovascular health in animals and humans, including blood pressure; resting heart rate; levels of high-density and low-density lipoprotein (HDL and LDL) cholesterol, triglycerides, glucose, and insulin; and insulin resistance
  •   CANCER – intermittent fasting is thought to impair energy metabolism in cancer cells, inhibiting their growth and rendering them susceptible to clinical treatments
  •   NEURODEGENERATIVE DISORDERS – There is strong preclinical evidence that alternate-day fasting can delay the onset and progression of the disease processes in animal models of Alzheimer’s disease and Parkinson’s disease.
  •   ASTHMA, MULTIPLE SCLEROSIS, AND ARTHRITIS – A reduction in symptoms was associated with significant reductions in serum levels of markers of inflammation and oxidative stress.
  •   SURGICAL AND ISCHEMIC TISSUE INJURY – Intermittent-fasting regimens reduce tissue damage and improve functional outcomes of traumatic and ischemic tissue injury

Cons: It needs to be done correctly.  Some people will use the eating window time as a free-for-all to eat anything and everything because they are hungry.  While the caloric deficit is not all you need for weight loss it is still important. If you have any chronic illness, especially blood sugar issues or diabetes you need to be carefully monitored by your healthcare provider. 

HCG Diet:

The hCG diet combines the use of hormone supplements and severe calorie restriction to support weight loss. 

Pros: The diet does result in quick, large amounts of weight reduction. 

Cons: However, there is no research to support this diet as being either safe or effective.   While people following the hCG diet may initially lose weight, this appears to be entirely due to the severe calorie restriction, rather than the effects of the hormone. Eating just 500 calories a day is neither healthy nor sustainable, and it can cause serious adverse effects.   Also, it is not an FDA approved use of HCG. 

Low Carb

There is a range of diets that use carbohydrate restriction.  Adkins, South Beach, and Keto are all low carbohydrate diets. Adkins encourages high fat and high protein.  Keto encourages high fat moderate protein and very low carbohydrate and South Beach encourages low carbohydrates high protein and moderate healthy fat.  All are based on the principle that when you cut carbohydrates your body uses your fat for energy rather than glucose. Keto has become the most prevalent of these.

Pros: This is a great diet for people who are insulin resistant.  Fat and protein are more satiating so you are not always hungry and you don’t have to count calories so much.  People typically achieve weightloss quickly through any of these diets- but a lot of this weight is water because carbohydrates cause water retention.   As Keto has become more prevalent, there is more research regarding its health benefits:

  •       One study found that people on a ketogenic diet lost 2.2 times more weight than those on a calorie-restricted low-fat diet. Triglyceride and HDL cholesterol levels also improved
  •       Heart disease: The ketogenic diet can improve risk factors like body fat, HDL cholesterol levels, blood pressure and blood sugar
  •       Cancer: The diet is currently being used to treat several types of cancer and slow tumor growth
  •       Alzheimer’s disease: The keto diet may reduce symptoms of Alzheimer’s disease and slow its progression
  •       Epilepsy: Research has shown that the ketogenic diet can cause massive reductions in seizures in epileptic children
  •       Parkinson’s disease: One study found that the diet helped improve symptoms of Parkinson’s disease
  •       Polycystic ovary syndrome: The ketogenic diet can help reduce insulin levels, which may play a key role in polycystic ovary syndrome
  •       Brain injuries: One animal study found that the diet can reduce concussions and aid recovery after brain injury
  •       Acne: Lower insulin levels and eating less sugar or processed foods may help improve acne

Cons: This diet is difficult to sustain, and people have a hard time transitioning off of this diet, and if they do not do it correctly will gain weight back quickly.  If you have a genetic predisposition to high cholesterol keep an eye on your cholesterol if you do this diet. Extreme keto dieters will avoid many vegetables and rob themselves of essential micronutrients for the sake of staying in ketosis.  If you are trying to build muscle, carbohydrates are not always a bad thing. 

Paleo

This is based on a eating style that mimics the hunter gatherer type diets prior to the times when agriculture was inherent.  On this diet, you eat mostly whole foods that are not processed and avoid most grains, processed sugars, dairy and legumes. 

Pros:  this diet encourages healthy meats and vegetables.  You get all the essential micro and macronutrients that you need.  People with chronic inflammation tend to lose the most weight as they are avoiding processed foods that increase inflammation. 

Cons- The biggest con to this diet is that it is very difficult to sustain.  You can miss out on essential nutrients and fiber from avoiding legumes and whole grains, which have evidence that they can reduce the risk of heart disease. 

Whole 30

This is the Paleo Diet to the extreme.  It is not advertised as a weight loss diet, although most people do lose weight on it.  It is more of an elimination diet of the most common food groups that cause food intolerance for 30 days.  It focuses on improving gut health through eliminating foods that could be causing inflammation. After 30 days you slowly reintroduce food groups one by one to test for intolerance. 

Pros: Many people with gut health issues and chronic inflammation can benefit from an ellimination diet. By eliminating the foods and other toxins that could be disrupting the gut flora and out first line protection, people often find relief from inflammatory symptoms such as migraines, autoimmune disease, mood or energy. 

Cons: This elimination diet is intended to be short term to identify triggers, not necessarily for weight loss, however many people choose to continue this diet long term. It is very restrictive and hard to sustain.  People may eliminate essential foods that they have no intolerance to at all. It may be better to test for food allergies to eliminate specific foods rather than an umbrella of guess work. This diet also claims to be the cure for almost any chronic disease and while it can help, anything that says it can cure everything should be met with skeptisism. 

Macronutrient Tracking

This method involves eating within the confines of a caloric deficit but rather than eliminating or restricting any of the three essential macronutrients- carbohydrates, fat, and protien, it is a balance of all three.  It involves keeping track of everything you intake and calculating all of your macronutrients and staying within the bank, which is actually not difficult with the use of fitness tracker like My Fitness Pal. If your goal is to lose weight you will consume a lower percentage of carbohydrates such as 20%, If your goal is to gain muscle you would consume a higher percentage of carbohydrates.

Pros: You do not restrict any macronutrients, and you can, in general, eat what you want within the confines of your allowable macros. This makes this diet pretty sustainable because you don’t feel as restricted.  Counting macronutrients does involve tracking but again there are several apps that make this super easy.

Cons: This can be done unhealthily if you aren’t still focusing on getting healthy micronutrients through vegetables.  It can get cumbersome constantly tracking everything. 

As we mentioned earlier, obesity is caused by a complex interaction between the environment, genetic predisposition, and human behavior.  Successful, long-lasting weight loss requires the correct identification and management of each of these factors. This is our approach at WellHealth

Our goal is to understand your resolution, transform it to an obtainable goal and maintain this as a wellness lifestyle.  First, our medical providers will consult with you and review your medical history including previous weight loss experiences.  We will then run a full blood and genetic panel to see what metabolic and genetic deficits you may have. We will then discuss your goals and determine which diet will be the best for long term success.   We utilize engaging technology like Enara, which has a proven track record of medically directed weight loss. They recently published 2 year data of sustained 15% weight loss, achieved through behavioral change.  We have also partnered with MapMeals, which allows you to coordinate delivery of WellHealth approved meals to your work, home or any of our clinic locations.

Learn more about Enara at weightloss.wellhealthdfw.com. There is no obligation, sign up is easy, and after you sign-up you will then be assigned a personal care team to help you through the weight loss program. Did we mention it’s covered by insurance?

Learn more about the delicious and nutritional meal delivery service, MapMeals, at mapmeals.com

Good luck on your new year resolutions and your weight loss journey. We’re always here to help!

WellHealth Medical Team