Weight management: no quick useless hacks, but the real hard science into practice!

One of the courses I completed last month was “Weight Management: Beyond Balancing Calories“, provided by Emory University through Coursera. It’s a course I recommend to everyone. It’s incredible that all the things that Prof. Sharon Horesh Bergquist, MD explained are unknown by most of us, even after 20 years wasted spent in the school.

I’ll try to summarise the main points, but please invest your time in this course: less than 20 hours and every single minute is well spent.

Facts and functioning

• In 1985, less than 15% of Americans were obese; by 2014, 38% of obese people. If trend continues, this will be the 1st generation to live, on average, less than their parents.
• NIH found that after a diet metabolism slows, there’s a metabolic adaptation: loss of muscles and, even after re-gaining same muscles, body can’t have soon same metabolism again, even 6 years later!

But how we work in relation to food?

• Brain keep receiving and signaling need for food
  • Hindbrain (the “metabolic brain”), without thinking, responds to the feeling sent by stomach, so “real needs” of amount and quality of nutrients
  • Cortico-limbic system (“cognitive and emotional brain”) acquire and keep memory of taste and associated emotions, it reasons independently from calories
  • Hypothalamus combines both to regulate appetite and food intake, but cortico-limbic signals can override the sense of full (note: this explains the “space for sweets” we have even if we don’t have “space”, let’s say, for vegetables)

• Appetite & weight regulating system controls your calorie intake & metabolism to maintain the set point
  • by sensing food intake in the short term & fat stores, or adipose tissue, over the long term
  • reason why it’s hard to mantain low weight
  • we’re “manipulating” our set point to be “normal” to be overweight
• There’s no One-Size-Fits-All Approach to Losing Weight
  • Different genes mix
    • Associated to food pleasure
    • Associated to speed to signal to the brain we’re full
  • We can act on our environment
• Restricting calories is not beneficial for long-term weight loss because:
  • Weight loss causes hunger to go into overdrive;
  • Your body will crave fat and sugar;
  • Metabolistic adaptation is even stronger than the expected metabolistic slowing due to the loss of muscles. Once you reach (and go under) the set point, it’s extremely difficult to remain under. Moreover, obesity change/disrupt levels associated to normal/physiologic set point.
• Emotional brain (actually cortico-limbic system) acquire and maintain in memory the thoughts, emotions, tastes and feelings associated to the different kind of food. The worst part is that its signals, in the hypothalamus, can override the ones associated to the “real” stomach feelings (from the hindbrain), so we can desire some kind of food even when we’re full.
• The hormones that cause appetite/hunger and wieght gain increases after the weight loss and remains at high levels even one year later and even if the subject has re-gained the weight!
• In some cases, genes plays a bad role, e.g. genes that code from hormone leptin and some receptors (including the one associated to leptine, but also others). Some studies like the ones related to the FTO gene and the ones on the melanocortin-4 receptor gene, showed that there can be more than one variant, but usually it’s a mix/combination, not only one mutation of a single gene. Most important: genes are not our full destiny: the environment is key!

Processed food (or: not all the calories are the same)

• Americans increased from 2K calories per day in 1970 to 2,5K
  • Industrial processes produced refined carb and oils, more salt, so we assume and retain more calories, but less nutrients
  • We consume less fibers, so we feel less full when eating
  • We over-stimulate the pleasure response, craving for more and more fat, sugars and salt (spoiling our systems, used to search for them in scarsity)
  • USDA report found that US citizens eat:
    • less than recommended fruit, vegetables, dairy;
    • more than recommended grains, protein foods, added sugar, added fats/oils
  • Study of 44 551 French adults 45 years or older, a 10% increase in the proportion of ultraprocessed food consumption was statistically significantly associated with a 14% higher risk of all-cause mortality
  • Food additives: according to a study, thickeners, preservatives, and artificial sweeteners may affect immune function, and contribute to metabolic diseases, such as obesity and type 2 diabetes.
• Whole foods can be (generally) eaten until we feel full
  • Also full of phytonutrients including antioxidants and anti-inflammatory compounds
  • The opposite of some processed food like industrial mayonnaise that contains compounds that kill some of our microbiota

• After sensibilization, people focused on low-fat, but didn’t pay attention to food that replaced fat with lots of carbs.
  • The key takeaways from a large Harvard 2009 study is that:
    • The quality of fat, carbs and protein matters MOST regarding our health
      • Fats: mono or poly unsaturated better than saturated or trans
      • Carbs with fibers are better (again: choose whole foods)
    • The only sustainable diet is the one that contains our favorite food
    • Increased consumption of unhealthy energy-rich diets that are high in fat and sugars results in oxidative stress and inflammation leading to hypothalamic dysfunction, which has been linked with these diseases. Conversely, diets rich in polyphenols, which are phytochemicals known for their antioxidant and anti-inflammatory properties, are associated with a reduced risk for developing metabolic diseases (Diet-induced hypothalamic dysfunction and metabolic disease, and the therapeutic potential of polyphenols)
    • After some review, even if we can there’s no “one size fits all” diet (one can only try), it was found that in general some effective healthy diets share the same point: not too much food and mostly plants:

Stress, exercise, sleep

• It’s not only/always “weight loss = calories in – calories out”
  • Other several factors in the equation

Stress

• Chronic stress is unpleasant, so we crave for comfort junk food
• Under stress, brain release hormones via hypothalamus pituitary adrenal pathway, that make adrenal glandes to release cortisol (stress hormone) + adrenaline and noradrenaline (that chronically harm heart leading to hypertension and plaques in arteria)
  • It drives to flight or fight, so we search for “ready fuel”
  • Comfort food turns down the mechanism
• When eating too much, we accumulate visceral fat, that is like a living organ:
  • It releases hormones and chemicals that cause inflammation and insulin resistance
  • Promote more fat accumulation
• Learn how to deal with stress
  • Meditate
  • Gratitude
  • Find purpose
  • In general, balance and good lifestyle
• Emotional eating
  • upset/stressed -> feel urge to eat -> overeat -> guilty and powerless on food -> (repeat)
  • Often suddenly, mindless, craving for comfort food
  • Analyze if it’s stress, social-influenced, childhood habit, boredom
  • Take a moment to think about and to journal/diary it
  • Limit/manage stress

Physical exercise

• Burn calories and build muscle (that consume more calories than fat)
• Lower cortisol and reduce inflammation
• Myokines (produced by contracting muscles) influence metabolism and prevent/reduce 40 medical conditions
  • We need a mix of myokines, by aerobic 30min/day + strenght resistance 2 sessions per week
• When sit for more than 1h, muscles stops and metabolisms slow down
  • blood sugar and triglycerides and weight rise
  • simply standing 1min every hour can reactivate muscles

Sleep (see Why we Sleep (and how to do it better))

• Sleeping less than 7h per night:
  • raises ghrelin (hunger hormone)
  • lower leptine (feeling of full hormone)
  • increase appetite for hugh carbs food
  • cortisol raise also in the afternoon
  • higher insuline level after meal
    • so, more fat accumulation

Habits

• Habit + design your environment to fight subconscious forces
• Cue -> anticipate reward -> action
• Plan ahead
• Incorporate ritual
• Mindfulness and consciousness are keys
• Create a vision of what you want to accomplish
• Disrupt the chain from cue to action
• Change your environment

First steps

• Set realistic weight loss goals
  • 5 to 10% of loss, in normal cases, can be enough
  • It’s extremely rare to move from eccessive obesity to normal weight
• Remember that genes are different for everyone, so different:
  • Sense of appetite and full
  • Reward after carbs and sugars
• Override your biology: despite your genes, focus on:
  • Change diet, not only on cutting calories
  • Add high-nutrients
  • Change one thing at time
  • In some cases, consider medication to regulate your set point
• Remember that most diseases (like also anxiety and depressions) requires patiences and attempts, overweight and obesity aren’t exceptions
• Create a microenvironment that supports success
  • Meal planning
  • Create healthy food environment
  • Build surrounding that support healthy habits (including sleep, exercise, …)

Next post (coming soon): glucose and us, stay tuned!