What causes obesity?

We are suffering from a first world obesity epidemic in America today. But, what is driving this epidemic? While genetic abnormalities are known to cause approximately 2% obesity, the vast majority of people who struggle with obesity have another driving factor. Some other associations associated factors include epigenetic, microbiome, macronutrient disorders, micronutrient deficiency, hormonal, metabolic, and behavioral drivers.

Behavioral drivers. There are many behavioral or mental health sources for obesity such as depression, binge eating, and coping disorders. When a behavioral disorder is present this must be effectively treated before any meaningful therapy can be rendered.

Macronutrient disorders. The abundance, relatively low cost, and addictive nature of high calorie, low fiber, processed foods in first world countries is a primary driving force behind the obesity epidemic.

Hormonal disorders. Hypothyroidism, excess cortisol, pregnancy, menopause, and other abnormal sex steroid conditions have all been linked to the development of obesity. 

Metabolic disorders. Obesity often does not occur in isolation but often exists in a more complex setting of metabolic derangements both can be initiated by obesity and serve to amplify obesity in feed forward fashion. Some of these metabolic disorders include Type II Diabetes and PCOS. 

Environmental. Certain medications and environmental toxins have been implicated as causes for obesity.

Epigenetic. in utero DNA imprinting can increase or decrease the expression of specific genes responsible for obesity.

Childhood obesity. Children suffering from obesity are at least twice as likely to become obese adults.

Microbiome. Abnormal intestinal microbial flora ratios may be associated with obesity.

Micronutrient deficiencies. The western diet is deficient in the more than 5,000 key micronutrients that our bodies need. Deficiencies may contribute to drive obesity for some individuals. More information is still needed in this area.

What role does nutrition play in obesity? 

Inappropriate nutrition plays a major role in the development of obesity. When nutrition becomes dysregulated by either inappropriate food selection or by lack of availability of nutritious food choices, the body begins to suffer accelerated and synergistic disease burden based on obesity. Nutritional choices that are highly processed contribute calorically dense foods that are easily absorbed and lead to hormonal and metabolic distortions (increased insulin production, insulin resistance, and leptin resistance) that drive obesity in children and adults. These foods also produce changes in the intestinal microbiome, can introduce toxins, and carry epigenetic impact.

Furthermore, due to the addictive nature of artificial flavor enhancers, highly processed food sources are actually addictive and produce food selection behavioral abnormalities. Finally, refined nutritional choices lack actual micronutrient nutrition. Although they are “vitamin and mineral fortified” this covers only a small fraction of the more than 5,000 essential micronutrients that our bodies need to function normally and prevent chronic diseases. Poor nutrition disrupts weight and metabolism on a multi-dimensional level. 

What are dietary or nutritional options for weight loss?

Even a quick google search will turn up many different and often conflicting dietary approaches that all claim to promote weight loss and metabolic health. However, the key question is, “is there evidence to support that specific dietary philosophy?”

Calorie control v. portion control v. content control

Many dieticians will recommend using a conceptual method for limiting the daily intake of calories. The most measurable and direct method is to calorie counting, or count all calories consumed every day with a specific caloric goal in mind. This has traditionally been somewhat complicated for the average person to maintain, the emergence of several apps such as myfitnesspal and loseit can make this a bit more manageable. While this method is still difficult and the body does adjust within as little as 7 days to fight ongoing weight loss, dynamic adjustments to calorie control can be an effective method for weight loss. Portion control is second less direct method for limiting the amount of calories consumed. Using this method a predefined portion size is selected for each meal. While less direct in terms of measuring caloric intake, portion control has an advantage in that it is much easier to use and sustain than calorie control. For this reason, it can be an effective weight loss concept. The third concept is dietary content control in which certain food sources or macronutrient balances are selected or eliminated. Content control can also be combined with other methods.

Elimination of processed foods

Most dietary specialists do agree that the elimination of processed foods the single most important first step. Processed foods include refined sugar, refined grains (eg. Flour), refined oils, liquid calories (even juice), and artificial flavorants. Processed foods are present in restaurant foods, most of the middle section of the grocery store, and in virtually all snack foods as well as in breads, pastas, and cereals. While in principle this may sound simple, in practice this can be challenging. Eliminating processed foods not only requires saying no to almost all restaurant food, but also all snack foods, breads, pastas, fried foods, boxed foods, frozen dinners, and many more items that have unfortunately become food staples of our culture.

Processed foods cause your body several problems. First of all, even though these foods often times say “sugar free” or “zero calorie” on the labels, foods containing artificial sweatners such as sorbitol or erythritol as well as other artificial flavor enhancers such as aspartame, MSG, and “natural flavor” actually work to stimulate our appetites and drive us toward higher overall calorie intakes. Most artificial flavorants also carry a side effect profile and some are even neurotoxins.

Secondly, processed foods by definition have removed the complex food and fiber structure and this causes two issues: 1) all of the calories are usually completely absorbed at a very rapid pace (high glycemic index), 2) this rapid absorption of calories often stimulates a spike in your insulin levels. So rather than giving you a sustained release of energy, the calories from these foods are rapidly driven into your cells favoring fat storage and leaving you rapidly depleted of energy.

Lastly, processed foods usually have had many of the natural nutrients stripped out of the food during the refining process. While they are then vitamin fortified all of the necessary micronutrients essential to your body cannot possibly be added back. There are more than 5,000 essential nutrients that we should be getting in unrefined plants that cannot be added back to food. This leaves our bodies in a constant state of micronutrient depletion in which our bodies are literally starving for missing nutrients. For these reasons most dietary experts do agree that an elimination of processed foods is an important first step.

Keto (low carb) diet

The Keto diet focuses on reducing carbohydrates to very low levels by increasing dietary fat content. This does shift your body’s energy metabolism from carbohydrates to fat. A byproduct of fat metabolism is ketones which most of your body organs can use instead of sugar. A keto diet can be effective for weight loss, and one additional advantage of a keto diet may include a reduction in the sensation of hunger. However, the high ketone levels also result in excessive water loss and therefore some of the initial weight loss is actually body water loss.

For most people the body will eventually get used to a keto diet and once this happens ongoing weight loss can be difficult. Some significant disadvantages of a keto diet include possible damage to your kidneys, liver, and heart if this diet is continued beyond a short one month timeframe. Therefore, at LiveNew we do not recommend using a keto diet long-term as it can compromise your health. If you choose to use a keto diet we strongly recommend closely following up with your doctor at least monthly intervals to assess your organ function.

High protein (low carb) diets

The two most common high protein and low carbohydrate diets are Paleo and Atkin’s diets. Proponents of high protein low carbohydrate diets cite population data such as the Maasai and Inuit people groups as indicators of weight loss success. However, both of these populations also have significantly decreased life expectancy compared with the average US citizen. Additionally, several studies have recently indicated a direct reduction in lifespan with high animal protein low carbohydrate diets.

An Atkins diet attempts to eliminate all carbs by increasing animal protein and fat intake using foods such as meat, eggs, and cheese. Similar to a keto diet this diet can be effective for weight loss but does present significant health concerns if utilized long-term with potential for end-organ damage and decreased lifespan. 

A paleo diet, also called a caveman diet by some, also is a high protein diet mostly consisting of animal protein and an elimination of grains. Many of the benefits of this diet center on the elimination of many processed foods. This diet can also be effective for weight loss and is somewhat healthier than the Atkin’s diet in that it incorporates vegetables. However, the long-term effects of high protein and low carb remain for this diet. 

Mediterranean diet

The Mediterranean diet is designed to emulate the food eaten in Italy and Greece. In the 1960s researchers noted that this diet rich in vegetables, fruits, nuts, seeds, olives, and limited in red meat and grains did produce weight loss and better metabolic health than the average US diet.

Plant based whole foods diet

A plant based whole foods diet, also known as a plant forward diet, is a diet that is vegan (eliminates all animal sources of food such as meat, eggs, and dairy). However, a vegan diet could still be unhealthy if large amounts of sugar and processed foods were used. So, a plant based whole foods diet also eliminates all processed foods as well. The main disadvantage of this diet is that it represents the most significant change from the average US diet and therefore for many people is the most difficult diet to follow. However, this diet can be very effective for weight loss and is a rich source of micronutrients. It also is associated with prevention and reversal of many chronic disease states such as heart disease, diabetes, and cancer as well as up to an 11 year survival advantage. Because this diet is naturally lower in protein, careful planning is needed to ensure adequate protein intake. However, this diet has been thoroughly researched in the China study and the Adventist Health Studies by researchers Dean Ornish, Caldwell Esselstyn, and T. Collin Campbell. 

Intermittent fasting and meal frequency modification

Meal frequency has been hotly debated in recent years with recommended meal frequencies ranging from 2 to 6. Many well-known athletes have adopted diets that utilize up to 6 meals per day. The idea is that these high meal number diets trick the body into increasing metabolic rate. However, metabolic rate is largely variable from one person to another and is controlled physiologically by activity level and thyroid hormone not by meal number. In fact, research has never indicated that on average increasing meal number improves weight loss. For some individuals high meal number may help them to gain control of unbalanced hunger signals and consume 6 very small meals daily. But this is true only when the total calorie intake is lower as a result. However, population studies from around the world generally indicate that people groups that consume more than 3 meals daily are overweight.   

Conversely, on the other end of the spectrum intermittent fasting is accomplished by clustering all meals of the day (often 2) into a 6 to 8 hour window and then not eating for 16 to 18 hours (the intermittent fast). Studies have actually shown an association with weight loss and also improved metabolic health using this approach. Also, during the fasting portion insulin levels fall preventing weight and fat gain. While more data is probably needed to understand its exact role, intermittent fasting may be the better approach for non-athletes and especially for those with insulin resistance. However, diabetics should notify their doctor and may need more frequent follow-up if using this approach. 

What diet or nutritional plan is recommended for weight loss?

Studies have shown that all of the above diets can produce effective weight loss. The most consistent factor that produced weight loss was compliance with the diet of choice. However, the better question is not only which diet will yield weight loss, but also which diet will also lead to the best long-term health?

What diet or nutritional plan is recommended for best health?

The clear choice for the weight loss diet that will also result in the best long-term health is a plant based whole foods diet. Many professional athletes in sports ranging from football, to bodybuilding and UFC have even used this dietary approach effectively indicating that careful planning can mitigate concerns over adequate protein intake even for athletes. Additionally, due to the high fiber content and naturally decreased caloric content, patients will usually not need to count calories if maintaining this dietary philosophy carefully. A plant based whole foods diet is the best diet to reverse metabolic and chronic disease states that accompany obesity. For patients with severe metabolic disease such as diabetes and high cholesterol adding an intermittent fasting approach may render additional benefit.

If you need a thorough metabolic assessment and individualized nutritional prescription to support weight loss, come LiveNew today!

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