The real reason you may have more trouble losing weight than others do

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If you have excess body weight, the standard advice is to eat less and move more. Of course, we all know this is easier said than done.

For one thing, it takes a lot of work to change deeply ingrained habits and behavior patterns. It’s hard to move more when our workplaces are designed for sitting and our neighborhoods are designed for driving. It’s hard to eat less when you’re surrounded constantly by hyper-palatable food. It’s also challenging to eat less when you’ve learned to use food to cope with stress or soothe your emotions.

These are all issues that a good behavior modification program can help with. But It’s also really hard to eat less when your brain is sending you the wrong signals about whether you’ve had enough to eat.

If you have excess body weight, the standard advice is to eat less and move more. Of course, we all know this is easier said than done.

Hunger (the urge to eat or to seek food) and satiation (the feeling that you’re full and don’t want more food) are regulated in the hypothalamus, the most primitive part of the brain. The hypothalamus responds to hormonal signals being sent from different organs of the body via various chemical messengers. When this system works as it should, our hunger increases when our body needs energy and decreases when it doesn’t. The result is a stable body weight.

But sometimes, the system goes awry. Dr. Gabriel Smolarz is an endocrinologist specializing in the treatment of obesity. Here’s how he explains it:

“The hypothalamus is receiving all of these different inputs and processing the situation to then say: Should we eat? Should we not eat? Should we stop eating? We conclude that there’s dysregulation when the gas tank is full, but the hypothalamus is indicating an empty tank.”

If your brain is getting the wrong signals about whether you need food, this is obviously going to make it much more difficult for you to eat less.

Are genetics to blame for obesity?

Dysregulation of appetite signals can be due to genetics — similar to the way you might inherit a dysfunction in your body’s ability to regulate your cholesterol levels or blood pressure. This may be at least part of the reason that obesity, like high cholesterol, runs in families.

Of course, our genetics haven’t changed that much in the past 100 years, while the incidence of obesity has skyrocketed. But genes aren’t always destiny. Sometimes they need an environmental trigger to unfold. What’s changed in the past 100 years is not our genetics but the environmental triggers.

We are more sedentary than previous generations. And at the same time, our food supply has gotten cheaper, more convenient, and it’s processed in ways that make it more tempting. The combination of dysregulated appetite signals with cheap and abundant high-calorie, hyper-palatable food is clearly a recipe for disaster.

This situation can be compounded by something referred to as metabolic adaptation, in which the body responds to caloric restriction by burning fewer calories and amping up the urge to eat. Here’s Smolarz again:

“If you are fortunate enough to achieve a meaningful weight loss, it’s really hard to keep that weight off. It’s basically the body saying, Oh, no, this is not good. Higher weight is better, safer, and more conducive to reproduction and survival. So after the weight loss, you’re hungrier than you were before, because of this hormonal part of metabolic adaptation.

“And then the second half of this story has to do with how much energy you burn at rest. The body says, We’re now going to conserve as many calories as we can by burning less. So if it took you a hundred calories to walk around the block, your body says, Well, we can now do this in 80 calories.

“So you’ve increased your efficiency. And if you want to continue to lose weight, you need to consume even less than you did just a few weeks ago, because now your resting energy expenditure is lower than it was before.”

One of the reasons I advocate a slower pace of weight loss than is commonly prescribed is to minimize the unwanted metabolic adaptation. Those with a long history of crash or yo-yo dieting may have lasting effects that make weight loss increasingly difficult, though.

So while it’s true that if you eat less you will lose weight, it’s not an even playing field. One person might be able to lose a couple of pounds by cutting out a dessert here and there and taking a walk after dinner. Some people have to eat a lot less (or go around feeling hungry all the time) to lose a pound or maintain a lower body weight.

Is there any way to fix appetite dysregulation?

There are a variety of medications that work in the hypothalamus to regulate appetite signals. For those suffering from a dysregulation of appetite, where the hunger signals are out of sync with what their bodies actually need, these medications can make it easier to eat less and lose weight.

Several drugs have been approved by the Food and Drug Administration for the treatment of obesity. Some of these are similar to drugs that have been approved for the treatment of other conditions, such as Type 2 diabetes, but have been found in clinical trials to be effective in the treatment of obesity as well. (The conditions frequently occur together.)

In the past few months, there’s been a lot of buzz about a Type 2 diabetes drug called semaglutide, which appears to be even more effective at promoting weight loss than some of the drugs approved to treat obesity.

In the most recent study, participants got intensive behavioral counseling along with a weekly injection of semaglutide or a placebo. Those getting the behavioral counseling and a placebo succeeded in losing an average of 5% of their body weight … which is no small accomplishment.  Those who combined intensive behavior modification with the medication lost over 15% on average.

Disclosure: In addition to his work as a clinician and on the clinical teaching faculty of Rutgers Medical School, Smolarz serves as medical director for Novo Nordisk, the company that developed semaglutide.

Why are these medications so underutilized?

When you consider the prevalence of obesity and its enormous costs to individuals and society, you might think that these drugs would be more widely used.

If a person develops high blood pressure, high cholesterol, or high blood sugar, their doctor will probably suggest that they make some changes to their diet and get more exercise. And for some people, lifestyle change is sufficient to solve the problem. For others, often those with a genetic predisposition, even the most diligent efforts with diet and lifestyle don’t fix it. At that point, the doctor will likely prescribe a medication to help modulate whatever aspect of their metabolism is out of whack.

Similarly, when a person has excess body weight, their doctor (if they mention it at all) will usually suggest that they eat less and move more. But if they are unable to get their weight down, rarely are medications discussed.

As pharmacist and obesity advocate Ted Kyle points out, 88% of people with Type 2 diabetes are prescribed medication to manage their blood sugar. Yet anti-obesity medications are prescribed to only 3% of those with obesity. (And that’s doubled in the past 10 years.)

I asked Smolarz why he thinks this is.

“I went to an allopathic medical school and a mainstream internal medicine residency program. I did a mainstream endocrinology fellowship. What I like to call essential obesity was not part of any curriculum. This dysregulation of appetite was not taught.

“Obesity is the most prevalent non-communicable disease on the planet. And we learn more about bioterrorism and how to use potassium iodide than how to use medicines in this regard.”

Not everyone who needs to lose weight needs an anti-obesity medication, of course. Smolarz describes how he evaluates patients seeking treatment for obesity.

“You want to look for secondary causes of extra weight first, Are there other medicines that the person is taking that promote weight gain?

“There are also underlying medical conditions that could be causing this. An underactive thyroid can contribute to weight gain and be a cause of an inability to lose weight. So that’s something we would check for. Is this person perhaps an emotional eater or traumatic eater? Maybe it’s a sleep problem.”

In addition to treating underlying conditions that may be contributing to the problem, the first line of treatment is still to modify the diet, increase physical activity, and address behaviors that may be leading to overeating. But that’s not where treatment always ends.

Smolarz:

“There is no blood test that tells me you have an appetite signaling problem. I wish there was something like that. You cross things off the list, and then you say, Well, it’s not this, it’s not that. Okay, I’m left with this. And so let’s approach that.

“The first part of the treatment is to ensure three key pieces: optimal nutrition, increasing physical activity, and behavior modification. I say someone is a candidate for medications when those three elements have been tried or are being currently tried, but we’re not seeing weight come off. “

Even if appetite signals are out of whack, medication alone won’t solve the problem. Nutrition, physical activity, and behavior modification still need to be part of the program.

Smolarz:

“The medications are enabling those fundamentals to be even more successful. The medicines allow you to tolerate a reduced caloric intake. So it’s one thing to say, You need to eat salad twice a day. You may be very hungry at 1,200 or 1,500 calories a day. The medicines that act as appetite suppressants make that feasible.”

Like all medications, the drugs used to treat obesity have a risk of side effects. Patients and doctors need to weigh the costs and benefits of the various medication options and select the one that is the best match for their situation. And this may be another reason that family doctors are reluctant to prescribe anti-obesity medications.

Here’s Smolarz again:

“All the drugs work a little bit differently, so it’s a bit of a challenge to master it all. Then the last piece is [the] fundamental misunderstanding of obesity as just a failure of willpower, that people just need to eat better and they should get a handle on their obesity. That’s just not the clinical reality.”

How to find help

If your health is at risk because of excess body weight and you and your doctor feel you have run out of solutions, you might consider consulting with a practitioner specifically trained in obesity medicine, which involves much more than just writing prescriptions or scheduling bariatric surgery.

The American Board of Obesity Medicine trains and certifies physicians in obesity management. Their website includes a directory where you can find Diplomates by location. The Obesity Medicine Association is another resource that can help you locate clinicians with specific training in obesity medicine.

This article originally appeared on Nutrition Over Easy and was syndicated by MediaFeed.


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Common diet & weight-loss myths that hurt more than help

Common diet & weight-loss myths that hurt more than help

When it comes to diet and nutrition, we all want to find “the answer” that will fix our alleged problems. As a result, we often latch onto crazy diet ideas that, in the moment, sound like the perfect solution. But these too-good-to-be-true “solutions” can hurt more than help us in our attempts to achieve weight loss and gain healthy habits.

Here are some of the most common diet myths exposed.

Related: How to eat healthier, even at the drive-thru

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The protein-pushing keto craze sure makes it seem like carbs should be avoided at all costs. But do grains deserve their bad reputation?

“People often say that carbs are fattening,” says Kristin Kirkpatrick, MS, RD, LD. “But complex carbohydrates, like whole grains, are not ‘fattening’ foods.’”

In other words, avoid refined carbohydrates like white bread, rice and processed snacks, but keep those whole grains for a healthy balance.

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While diet sodas may be a better alternative than their full-sugar counterparts, medical studies are starting to show that the artificial sweeteners may actually cause us to eat more calories later in the day. If you want to keep the fizz and ditch the artificial sweetener, try flavored carbonated water instead.

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Like carbs, the type of fats we eat makes a difference. That, in combination with how many calories we eat each day, determines our body weight. Trans fats, typically found in many fried foods, can cause cardiovascular disease. However, saturated fats do not have the same effect and can, in fact, help keep us satisfied longer, leading to fewer calories consumed.

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Maybe you’ve only been eating the egg whites to avoid raising your cholesterol. Well, maybe you don’t have to anymore.

“Unless you are genetically predisposed to high cholesterol or cardiovascular disease, eating the eggs AND yolks can actually help you,” says Darin Hulslander, CEO and owner of DNS Performance and Nutrition. “For one, yolks are high in antioxidants, vitamins, and minerals. Egg yolks also elevate high-density lipoproteins, which are the ‘good’ proteins that can help remove plaque from the arteries.”

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If you count calories, you might think losing weight is as simple as staying under a certain number every day. Unfortunately, this is not necessarily true. You can eat 200 calories of lean protein or 200 calories of chocolate, but the body processes each differently. Depending on what you eat, your body can store or burn more calories. So, use those calories wisely!

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Reading headlines such as “red meat could lead to cancer” is frightening. And while some studies indicate there is an association with red meat consumption and cancer, it’s important to note that this doesn’t mean it causes cancer. Eating red meat in moderation is not dangerous.

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The American Heart Association recommends that people consume less than 1,500 milligrams of sodium (salt) each day. Excessive sodium can lead to high blood pressure. However, this doesn’t mean we have to eat bland food. Use salt in moderation and, if you have high blood pressure, talk with your doctor on the best guidelines for your individual needs.

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Sure, peanut butter is a good source of protein and fat. However, you need to be careful about what kind you put in your pantry. Many national brands of peanut butter are filled with extra sugar, fats and preservatives that counteract any health benefits. Check the label and pick up a jar with as few ingredients as possible to get the healthiest version of this favorite snack.

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Calories can’t tell time. The time of day of when you eat only matters if you tend to overindulge at the end of the day and eat too many calories. If you happen to eat a late dinner or snack but stay within your normal calorie range for the day, it should all even out in the long run. However, many people mindlessly eat at night because they are bored or tired, and this is what leads to weight gain.

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This is the one case where all calories are pretty much alike. Multiple studies show that eating the same amount of calories in either a few larger meals or more frequent smaller ones have the same outcome on the body. In other words, this is a case where 1,000 calories in a day are the same, no matter how often you eat during the day.

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With labels like “Lean Cuisine” and “Healthy Choice,” it’s easy to think that pre-packaged frozen meals are not only convenient but also a better choice to help us in our diet goals. This isn’t always the case. Many of these pre-packaged meals contain too much sodium, which can lead to water retention and bloat. Also, many offer too few calories, which can lead to hunger later on in the day. Check the labels carefully and make sure you’re making the best choice.

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When looking to avoid processed carbohydrates, many people reach for wheat or multigrain bread over white. But be careful! Make sure you’re picking up 100% wheat or whole grain bread. Otherwise, you could be just be getting mostly white bread with a little wheat flour mixed in — or even just food coloring to make it look brown!

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This nutrition myth has been around forever, but it’s just not true for most people. Medical studies show that among extremely active people such as marathon runners and skiers, taking at least 200 milligrams of vitamin C every day can possibly cut the risk of getting a cold in half. But for most people, taking daily vitamin C did not seem to actually reduce the risk of getting a cold.

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Wouldn’t it be great if there were such a thing as a negative-calorie food? You know, the kind that burns more calories when we eat it than it has? Sadly, there is no such thing, even when it comes to something as healthy as a piece of celery.

“Regardless of the [calories] in the food, you’re always going to be able to get something out of it,” says Stephen Secor, a professor of biological sciences at the University of Alabama.

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Organic is simply how ingredients are grown, usually pesticide-, herbicide- and insecticide-free. An organic label does not mean it’s healthier than non-organic foods. Even things like sugar, granola bars and boxed mashed potatoes can be organic. So, don’t rely on an organic label to tell you if something is automatically better for your diet.

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While cutting out gluten from your diet can help if you have celiac disease, it isn’t really a factor in weight loss.

“Unless you suffer from celiac disease, there’s not much scientific support to back the claim that eating gluten-free is healthier or a smart strategy for weight loss,” says Ashvini Mashru MA, RD, LDN. “Cutting gluten out of your diet most often leads to a reduction in overall calories, simply due to the sheer amount of grain-based foods that we eat on a regular basis.”

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Fewer calories consumed means weight loss, right? Not so fast!

“In fact, studies have proven it to be the opposite: skipping meals promotes weight gain,” says Cheryl Forberg, RD, nutritionist for “The Biggest Loser.” “When we skip a meal, by the time we eat, we’re so hungry we consume too much, too fast and choose the wrong foods.”

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Foods like asparagus and lemons are known as natural diuretics. And while these kinds of foods may not hurt when it comes to holding onto excess water, eating large amounts of them will not help get rid of belly bloat or weight.

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Your daily cup of coffee may give you a good dose of caffeine, which is a stimulant to your body. However, that caffeine jolt does not boost your metabolism enough to be a weight loss cure-all. Also, depending on what you add to your coffee (cream, flavorings, sugar), you could be adding extra calories to your day. So if you love a cup of joe, keep it basic and black, if possible.

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This is a short-term fix with many long-term problems. By severely cutting daily calories for extended periods of time, your entire metabolism can change to actually hold onto weight! Also, your body needs adequate nutrition to stay healthy. If you want to lose weight and keep it off forever, you need a modest calorie restriction plan that you simply continue and never stop.

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You cannot outrun a bad diet. It’s as simple as that. Exercise is great for our cardiovascular health and for building good muscle tone. And yes, it does help regulate our weight. But the amount of exercise you have to do to counteract a few extra slices of pizza isn’t sustainable or reasonable. So work in a healthy diet plan along with your regular workouts for optimal results.

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In a pinch, these convenience items are helpful in maintaining a healthy diet. But things like shakes and nutrition bars are not meant to be long-term replacements for healthy meals. Check the ingredients for artificial sweeteners if you buy these items. Your best bet: Make these at home and use them occasionally.

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Yes, some people should probably cut back on sugar in order to make their diet healthier. But naturally sweet foods such as fruits are sources of important vitamins and minerals. The sweets to avoid are those with added sugars and syrups.

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Good news! While fresh vegetables are always a healthy option, so are most frozen varieties. Over time, fresh vegetables can lose nutrients, while frozen ones can retain them longer. Make sure you pick up frozen vegetables without added sauces, cheese or sodium to keep them as close to fresh as possible.

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Can you imagine life without ice cream, cookies or cake? You don’t have to in order to follow a healthy eating plan. In fact, planning to have some of your favorite treats occasionally can ensure you don’t feel deprived and end up splurging later on.

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This article originally appeared on TheDelite.com and was syndicated by MediaFeed.org.

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