Throughout  history, humans  have been  faced with many challenges. One of the biggest challenges  was starvation. Having no food is a very difficult way to survive. Our bodies are designed and refined to overcome challenges such as starvation.  This makes us very efficient at taking in and storing calories. Today we have material abundance and are not as concerned with ingesting enough calories to survive.

For many of us the bigger problem we face today is not starvation but weight gain. Controlling that weight gain is important to preventing health problems such as diabetes, hypertension, stroke, heart disease and cancer. Weight control and loss can take many forms. In our previous  article, I discussed some of the medical problems that one should be screened for. These need to be treated for health and wellness. Hypothyroidism is a common condition. Low thyroid hormone levels decrease our metabolic rate and our rate of using calories. Thyroid replacement increases our metabolic rate and calorie use.

When thinking about dieting and weight control, we need to think long term. Many diet programs can get us to lose weight. The successful weight loss regimen is one that allows you to change your lifestyle and behavior for the long term.   I like to think of weight loss in terms of a ledger. We add calories to our ledger with our choices when eating. We deduct calories with exercise and activity. Any weight loss program can work if you burn off more calories than you consume. It sounds simple but most things are. 

Leptin is a protein hormone that helps your body regulate your weight. Leptin is produced in fat cells. It circulates in your blood stream and the level in your blood tells your brain if we have enough energy stored in our bodies. As you lose weight or are under stress, your leptin level can go down and can tell your brain you do not have enough fat stored. This can stimulate you to eat. Each person has their individual leptin level and sets a weight floor under which the leptin mechanism becomes active. Your brain not sense your leptin level and regulate you to a different weight point. Leptin resistance can occur where you have high leptin levels but your brain receptors are insensitive to it. This can make you feel hungry when you really have eaten enough calories or have enough fat stores.  Leptin supplements are sold but because they are proteins they are ineffective if taken by mouth.  Reducing your insulin and triglycerides is the best strategy to breaking this cycle of losing weight and having your leptin go down and your appetite is increased.

Steps to reduce leptin resistance include

• Reducing stress
• Adequate sleep
• Low refined carbohydrate, higher protein diets avoiding fructose
• Eating breakfast with whole grains such as oatmeal, peanut butter or high protein foods
• Taking periods of time where you do not eat for at least 4 hours

These changes can help reduce the hunger feelings that leptin resistance can create. A careful exercise program that reduces stress such as weight training is also helpful. An exercise program that  relies on aerobic activity to burn calories can reset your leptin level and make it more difficult to lose weight. Varying your exercise program can also help.

Medical weight loss can include medicines or surgery. There are two types of medications that are used for weight loss.  Orlistat is a medication that interferes with the absorption of fats. It also goes by the name of Xenical. Side effects include bowel movement problems including oily stool, gas and bloating, cramps and malabsorption of fat soluble vitamins like A, D,,E and K.  Lowering the fat in your diet can reduce the gas and cramps and timing the use of vitamin supplements can avoid the vitamin deficiency.

The other class of medications  include appetite suppressants including phenteramine, Belviq, and Qsymia which is a combination of phenteramine and another drug, topiramate. Phenteramine  is an amphetamine and can only  be used for  short period of time. These medicines are amphetamines and can have serious side effects including dizziness, GI upset, headache, abnormal heartbeat and mood changes. These medications need to  be used under close medical supervision to observe for these and other side effects.

These are short term approaches that can get you started on the road to weight loss but will not make the lifestyle changes that will give long term weight loss that is most beneficial to your health.  For those who have extreme obesity problems that are not improving with diet and exercise, surgical weight loss is an option to lose weight. Body mass index uses height and weight to assess the level of obesity a person may have. Surgery is usually reserved for those with a body mass index greater than 40 or BMI of 35 with significant health problems, such as sleep apnea, diabetes, or heart disease. There are many different procedures available to aid with weight loss. Patients must be motivated to live a different lifestyle after their surgery or they can regain the weight they lose. That commitment is critical in these people. Surgery has many risks and some can be life threatening.

Our next installment of this series will discuss various diet programs for weight control and loss.

About the author:

Dr Schutz was born in Newport News, VA and grew up in Flemington, NJ. He attended Rutgers University and New Jersey Medical School where he graduated in 1985. He was selected as a “Top Doc” in NJ Monthly Magazine and is the former President of the Medical Staff at Shore Memorial Hospital. He is married and has 3 children. He is active in religious and youth activities.