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By Andrea Cannas

DATE

October 5, 2023

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What Really Matters for Your Weight: Beyond Caloric Counting

Feeling stuck with your weight goals?

You may have tried countless of celebrity weight loss diets,  prescribed diet plans or promising ‘fat burner’ products. Unfortunately, current approaches favour quantity over quality and focus on short-term rather than long-term sustainable change.  But why are you struggling to lose weight even if you are eating less calories than you are burning (i.e. in a hypocaloric state)?


Top 10 factors that are preventing you from responding to interventions 

  1. You are “stressed out”

A combination of different biological, lifestyle or social factors can increase our ‘stress load’.  Some lifestyle or social factors that can increase our stress load include:

  • Working long hours
  • Psychological distress
  • Restrictive eating
  • Drinking caffeine or artificially sweetened drinks in excess
  • Smoking or vaping
  • Alcohol and substance abuse
  • Under- and overexercising
  • Excess screen exposure
  • Frequent illnesses or infections
  • Lack of restorative sleep

Cortisol acts on the brain to increase appetite.

A high stress load causes the autonomic nervous system to become hyperreactive. Biochemically, this manifests as a sustained activity of cortisol which can bring about weight fluctuations. Cortisol dysregulation can trigger increases in blood sugar and insulin concentrations and interfere with appetite hormones, thyroid function, sleep quality or energy balance.

Having chronic stress also activates our sympathetic nervous system, interfering with your ability to relax, focus and digest. In the long-term, it can lead to an undesirable state of exhaustion and frustration. As a result, you may not be able to cope with diet or lifestyle changes because you are physically and mentally exhausted. 

  1. Your metabolism is slower than the average healthy individual

Thyroid hormones, namely thyroxine (T4) and triiodothyronine (T3), play a key role in weight regulation, energy production and body temperature regulation. A drop of just 30% in T4 can reduce the body’s basal metabolic rate by , often seen in patients with an underactive thyroid. As a result of this, hypothyroid patients experience a sluggish metabolism, weight gain, water retention, constipation or “brain fog”. In those with an overactive thyroid, the opposite is seen, with patients experiencing unintentional weight loss. It is important to evaluate a Full Thyroid Profile by including free T3 and reverse T3 levels. Unfortunately, this is not part of routine screening and must be done privately. Therefore, patients belonging in this category may benefit from optimising thyroid function in complement to a weight intervention by assessing their micronutrient status and lifestyle. 

  1. You have gut symptoms you are neglecting

Appetite signals are produced within your gut. Also, the efficiency of our metabolism is not only determined by our thyroid health but also by the metabolic potential of the gut microbiome. Scientists have shown that a poor Westernised diet can negatively influence bacterial diversity in our gut. An overgrowth of unfriendly gut bacteria in the gut (dysbiosis) can lead to weight gain, insulin resistance and adiposity. In cases of small intestine bacterial overgrowth (SIBO), malnutrition and poor absorption of nutrients from food is common. In total, dysbiosis or SIBO can be counterproductive to the benefits of a dietary and exercise programme if left untreated.

  1. You have uncontrollable cravings

Food intolerances or sensitivities can increase inflammation in the body, typically manifesting as water retention, a permeable gut barrier and dysregulated lipid profile. People often crave the very foods they are allergic to. The reason for cravings is that some foods, such as gluten or dairy, when partially-digested release addiction-prone chemical substances called exorphins. Exorphins may bind regions of the brain that trigger ‘addiction’ behaviour and overeating.

Undoubtedly, women experiencing hormone imbalances during the reproductive years or in transition to menopause can also experience erratic eating behaviours.

  1. You are undereating

Primary research and patient experience support some fasting methods as effective for weight loss in normal and overweight adults. However, there are questions around possible weight regain and how sustainable the weight loss if fasting is continued for more than 3-6 months.

It is a cultural norm in Cyprus to further fast in addition to an overnight fast of 12-16 hours. It is commonly witnessed to skip breakfast by having an iced black coffee (therefore extending the fast) until lunch time.

Did you know there are specific groups for which fasting may not be suitable for?
  • Women with PCOS / Menopausal women
  • Insomnia and chronic stress
  • Patients with chronic disease or metabolic-related conditions including advanced diabetes
  • Those who self-medicate with antidiabetic or antihypertensive medication including diuretics and SGLT-2 inhibitors
  • Vulnerable groups: pregnant or lactating women, young children, history of eating disorders, immunocompromised patients, older adults who are frail, individuals in post-operative recovery and those with a history of traumatic brain injury
  1. You get your calories from pro-inflammatory and insulinemic foods

A pro-inflammatory diet; in other words, a highly processed diet that is excessively high in calories, starch, sugar and vegetable oils, can trigger an abnormally high insulin release. High insulin levels can cause the body to store fat instead of break it down, commonly in the abdominal area. Fat around the middle can contribute to insulin resistance and inflammation which can interfere with the body’s ability to regulate blood sugar. This can hinder your ability to lose or gain weight.

  1. You are feeling unmotivated and/ or have a low mood

If you are experiencing low mood, it is important to seek support to help achieve your weight goals. Research has linked depression to inflammation in the brain and neurochemical imbalances. In support of this, depression can coincide with carbohydrate cravings, which may occur as an unconscious attempt to correct a deficiency in serotonin.  Compulsive eating of sugar and carbohydrate-rich foods can make us feel good as they trigger the release of your happy hormone and reward signals in the brain called serotonin, dopamine and endorphins. This reinforces sugar-consuming behaviour which over time can reduce your brain’s sensitivity to overeating, causing cravings and withdrawal effects if the bingeing is stopped.

  1. You are sleep deprived

Individuals who are tired and wired or find it hard to switch off at night have more trouble losing or gaining weight due to dramatic appetite changes. Sleep deprivation may occur due to sleep apnoea, chronic stress or night shift working. As a result, hormone and neurochemical imbalances occur that are responsible for regulating our appetite, stress response and sleep-wake cycle.

  1. You are taking medication that directly increases appetite and fluid retention or interferes with your metabolism

  • Antidepressant, antipsychotic or mood-stabilising medicines

Treatment with antidepressants, including the selective serotonin reuptake inhibitors (SSRIs), influences energy balance and is associated with increased risk of weight regain over 10 years follow up. Moreover, some psychiatric drugs can also increase weight gain risk. Weight gain can happen indirectly as the side effects that come along with treatment such as sedation and dry mouth can make it less likely for the individual to exercise and more likely to depend on sweetened drinks to quench the thirst.

  • Corticosteroids
  • Antihistamines
  • Beta-blockers
  • Insulin / Sulfonylureas


Having acknowledged the side effects, this does not mean you should avoid efforts to limit your carbohydrate intake and blame your medication for any noticeable increase in weight.

  1. You have an acute illness or medical diagnosis that is hijacking your metabolism and requires personalised attention


Summary

It would be unrealistic to expect lasting benefits from a diet and exercise plan without adequately addressing all the above factors. In conclusion, it is important to find a health professional who will help identify your underlying factors, guide you with appropriate testing and direct you with therapeutic interventions that will influence your weight in a favourable way. A nutritional therapist can help provide you with guidance on the most appropriate plant-based foods or supplements including lifestyle and stress management to include for better mental health and sustainable weight change.

Disclaimer

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Medication should always be discussed with your doctor and you may benefit from nutrition counselling to optimise your medical treatment.


References
  1. Geiker, N.R. et al. (2017) ‘Does stress influence sleep patterns, food intake, weight gain, abdominal obesity and weight loss interventions and vice versa?’, Obesity Reviews, 19(1), pp. 81–97.
  2. Xu, R., Huang, F., Zhang, S. et al.(2019) Thyroid function, body mass index, and metabolic risk markers in euthyroid adults: a cohort study. BMC Endocr Disord 19, 58.
  3. McEwen BS. (2005) Stressed or stressed out: what is the difference? J Psychiatry Neurosci., 30(5):315-8.
  4. Cleveland Clinic (2015). “Intermittent fasting has benefits beyond weight loss. Available at: https://health.clevelandclinic.org/interested-fasting-health-get-facts-first/ Published October 23, 2015.
  5. Olansky L. (2016) “Strategies for management of intermittent fasting in patients with diabetes”, Cleve Clin J Med 84(5):357-8.
  6. Grajower, M. and Horne, B. (2019) Clinical Management of Intermittent Fasting in Patients with Diabetes Mellitus, Nutrients, 11(4), p.873. doi: 10.3390/nu1104087
  7. May, C. et al. (2020) Dietary sugar inhibits satiation by decreasing the central processing of sweet taste. eLife 9: e54530.
  8. Meyer JH, et al. (2006) Elevated monoamine oxidase a levels in the brain: an explanation for the monoamine imbalance of major depression. Arch Gen Psychiatry, 63:1209-1216.
  9. Nedeltcheva AV, Kilkus JM, Imperial J, Schoeller DA, Penev PD. (2010) Insufficient sleep undermines dietary efforts to reduce adiposity. Ann Intern Med, 5;153(7):435-41.
  10. van Galen KA, Ter Horst KW, Serlie MJ. (2021) Serotonin, food intake, and obesity. Obes Rev, 22(7):e13210.
  11. Gafoor R, Booth HP, Gulliford MC. (2018) Antidepressant utilisation and incidence of weight gain during 10 years’ follow‐up: population based cohort study. BMJ. 2018;361(k1951):1‐9.
  12. Richard DM, et al. (2009) L-Tryptophan: Basic Metabolic Functions, Behavioral Research and Therapeutic Indications. Int J Tryptophan Res, 23;2:45-60.
  13. Höglund, E., Øverli, Ø. and Winberg, S. (2019) Tryptophan metabolic pathways and Brain Serotonergic Activity: A comparative review, Frontiers. Available at: https://www.frontiersin.org/articles/10.3389/fendo.2019.00158/full (Accessed: 05 September 2023).
  14. Tondo, L. and Baldessarini, R.J. (2022) ‘Psychotropic medicines: Increased appetite rather than weight gain’, The Lancet Psychiatry, 9(2).
  15. Mazereel, V. et al. (2020) ‘Impact of psychotropic medication effects on obesity and the metabolic syndrome in people with serious mental illness’, Frontiers in Endocrinology, 11.
  16.  

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