Being overweight has become so prevalent that it's almost more common than not, in the U.S. population. We're now even seeing problems with childhood obesity, which can lead to bullying, depression, anxiety, not to mention physical ailments like diabetes, high blood pressure, etc. Nutrition is a topic that is near and dear to my heart, as a foodie, but also a believer in food as medicine, I know we can do better at addressing this topic.
Traditionally, medicine has made use of the "BMI" or "body mass index" as a tool to categorize people as being underweight, a healthy weight, overweight, or severely/morbidly obese. While it's not perfect, it is what we still commonly use. The BMI is calculated by dividing a person's weight in kilograms by their height in meters squared. A BMI of less than 18.5 is considered underweight, a BMI of 18.5 to <25 is considered a healthy weight, and a BMI of 25 to <30 is considered overweight, while a BMI over 35 is considered obese.
Along with the increase in the prevalence of obesity, we've also seen an increase in the cluster of conditions known as "metabolic syndrome", which increases a person's risk of coronary heart disease, diabetes, stroke and other serious problems. Metabolic syndrome can be diagnosed if you have 3 or more of the following: a large waistline, high blood pressure, high blood sugar levels (impaired fasting glucose), high blood triglycerides, and a low HDL (the "good cholesterol"). While this syndrome is scary, what's important to know is that it can be reversed with certain dietary and lifestyle changes.
One of the features of the metabolic syndrome is insulin resistance, meaning the body does not use insulin efficiently to lower blood glucose and triglyceride levels. While in the past it was thought that obesity could lead to insulin resistance and later diabetes, recent medical research studies suggest that it's possible that insulin resistance may develop early on, even before severe obesity (is it the chicken or the egg?).
In my opinion, we've done everyone a disservice by making it taboo to discuss one's weight, even in a medical setting. It can be a sensitive subject for many, but if we're really going to help our patients achieve wellness, we have to address this head on. We have to be able to communicate with compassion and a goal of reversing this condition. We can empower our patients to take positive steps by educating them and supporting them on their weight loss plan.
I'm not by any means a conspiracy theorist, but I will say I believe the food industry has enabled people to eat poorly, sometimes without even realizing it. They should be held accountable, and promote transparency in food labeling. Food manufacturers have an incentive to create calorie-dense food that is fast and easy to get (e.g. fast food chains, processed prepared foods, etc.). Often, the unhealthy processed foods also cost a lot less than fresh produce, meat, fish, etc. Consuming high-calorie, sugary foods can induce a rise in dopamine levels in the brain, which causes a feeling of well-being, and reinforces the behavior. In many ways, food can become like an addiction. In fact in studies where laboratory rats were offered a choice between sugar-water, or cocaine, they almost invariably would choose the sugar-water. When a consumer goes to shop for food and thinks they will make a healthy salad for dinner, they might be surprised to find out what's in their "light" store-bought salad dressing-- you guessed it, sugar (usually in the form of high-fructose corn syrup). This is intentional to get you to crave that sweet and savory dressing. It's also, IMO, unethical. If you made a dressing at home, would you be adding corn syrup? Probably not. In fact, the food industry knows that if they start kids off eating doughnuts and sugar-coated cereals, they will likely create a customer for life, because these foods are habit-forming.
Most of us grew up learning that the "food pyramid" consisted of a large portion of grains and carbohydrates at its base. We're now rethinking that logic, and there is mounting evidence that our diet should be lower in carbohydrates, and higher in lean proteins and healthy fats.
I could go on and on about the problems with the food industry but let's cut to the chase! Here are some tips to help you get on a program to "beat the bulge":
Don't go at it alone. Have a doctor, PA, or NP who can support you on this effort and follow your lab work etc. to ensure you're doing ok. Before beginning any weight loss plan, it's a good idea to check some basic labs to know where you're starting, and to ensure you have normal thyroid function (if abnormal, it can make weight management harder). You'll want to know your cholesterol and triglyceride levels, fasting blood sugar, and if the blood sugar is elevated, a Hemoglobin A1C (which helps estimate the average of your blood sugars over the last 3 months).
Keep a journal of all the foods you eat for one week (without "dieting"). Make a note of the time of day, the foods, associated activities (e.g. birthday dinner versus a lunch at work), any alcohol consumed, etc. Reviewing this journal will help you find out which foods, drinks, or habits might be hindering your progress. Alcohol is a big source of carbs and calories, but we often don't realize how much we drink if we don't write it down.
Make it a goal to replace calorie-dense foods with nutrient-dense foods. Your mindset needs to be focused on nourishing your body, not just eating. Think about what to include in your diet, not just what to exclude. The more you eat nutrient-dense foods, the less hungry you will feel. Focus on getting protein in every meal, plenty of vegetables, some healthy fats (olive oil, avocado, nuts like walnuts and almonds), and eating some carbohydrates but avoiding sugar and sticking to low-glycemic index foods. The glycemic index is used to classify carbohydrate-containing foods based on their potential to raise your blood sugar and how quickly they can raise your blood sugar. Consuming a lot of high glycemic index carbohydrates can increase your risk of developing insulin resistance and diabetes. Lately there have been some useful apps for your mobile phone that can help you to navigate things and look up the glycemic index of different foods.
Increase your movement: some people call it exercise, but any physical activity is good for you. If you haven't exercised in a while, getting started might be the hardest part. You don't have to join a fancy gym or classes, unless that appeals to you. In fact, studies on weight loss have shown that the most effective long-term exercise program is walking. Yup. People don't need any special equipment for a walking program, and they tend to continue to do it for much longer than other types of exercise programs, contributing to long-term success. Increasing physical activity will help your body to become more effective at secreting and using insulin (it decreases insulin resistance). Find a walking buddy, or adopt a rescue dog that needs daily walks (my favorite walking buddy!).
Other things that can help improve or reverse insulin resistance: -Eating resistant starch. Resistant starch is a carbohydrate that resists digestion in the small intestine and ferments in the large intestine. This means it doesn't significantly raise blood sugar, and it helps feed your healthy gut bacteria, which can aid in blood sugar control. Examples of foods that contain resistant starch are: plantains, green bananas, cooked and cooled rice or potatoes, oats, beans, peas, and lentils. Time-restricted eating or intermittent fasting: time-restricted eating just means that you only eat during certain hours of the day, for example, only from 8 am to 6 pm. Intermittent fasting, which has been trending, can be helpful too, although I do not recommend prolonged fasts (i.e. days), which may lead to disordered eating. Both of these techniques are meant to help train your body to become less insulin resistant over time. Basically our bodies were not designed to be constantly eating and snacking; we were engineered to be able to regulate our blood sugar during times of plentiful food and times when food was less available (i.e. in between hunts etc.). Modern society has made food available all the time, something that has led us to eat even when not hungry.
Practice self-compassion: if you have a bad day, and eat half a tub of Ben & Jerry's, don't give yourself a guilt trip. Just keep moving forward and stay focused on your health and longevity, while nourishing your body. Guilt never helped anyone lose weight.
Fad diets don't work: I think we've learned this lesson, but then a new one pops up and people have to try it. What we know really works, is a long-term commitment to healthy habits that include good nutrition, staying active, and avoiding processed foods when possible (or at least reading the labels to know what you're getting). I'm a fan of the 80/20 rule: you're very conscious about the foods you eat at least 80 percent of the time; and there's going to be a day here and there when you might splurge (20%) on a holiday or birthday. On this road towards a healthy weight, keep in mind your reasons. Keep in mind your goals for the future, and your ability to have more quality time with those you love.
I hope this helps you in your wellness journey. You've got this :)
All the best,
Dr. B
#nutrition #healthyweight #metabolicsyndrome #insulinresistance #lowglycemicindex #resistantstarch #timerestrictedeating #intermittantfasting #wellnessgoals #nourishment
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