Given this time of year, it seems like we tend to associate the New Year with new opportunities and new personal goals. One of the goals that often finds its way to the top of that list is weight loss. As a result, I wanted to take an opportunity to review how to make this goal more achievable. Getting our body to a healthier weight can have tremendous benefits. Let’s discuss some of the fundamental principles on how to make this possible.
Weight Loss Drugs: What Do We Know
Recently there has been a significant focus on weight loss drugs, mainly in the form of weight loss injections, known as GLP-1 (Glucagon-like peptide 1) agonists. GLP-1 is a hormone that we produce naturally in our small intestine (a portion of our digestive tract). These drugs work as an agonist to this hormone, meaning that they mimic the action of the GLP-1 hormone. In other words, they cause the same actions as the naturally occurring substance. These same drugs are used to treat type II diabetes and were actually approved for this use, prior to being used for weight loss. The action of these drugs include helping to improve sugar (glucose) metabolism and increase how full you feel after eating by slowing stomach emptying and stimulating areas of your brain that process hunger and satiety (fullness). GLP-1 agonists such as Ozempic, Trulicity, Victoza, and Mounjaro, have been shown to be effective with weight loss. However, I think in addition to understanding how these drugs work and how they may be beneficial in helping one to lose weight, we also need to understand that these drugs do not come without some significant concerns. First and foremost, these drugs are relatively new and the long-term effects of these medications is not yet known as they have not been around or used long enough to understand the true potential adverse events that can occur with these medications. This is known as pharmacovigilance which is the term used for understanding and detecting adverse effects or any other drug-related problem. Per the World Health Organization: “All medicines and vaccines undergo rigorous testing for safety and efficacy through clinical trials before they are authorized for use. However, the clinical trial process involves studying these products in a relatively small number of selected individuals for a short period of time. Certain side effects may only emerge once these products have been used by a heterogenous population, including people with other concurrent diseases, and over a long period of time”. Meaning in other words, those who are taking the medications once they have been cleared by the FDA are actually the guinea pigs for those medications to determine the long-term potential side effects or consequences of taking that medication. Some side effects of these medications have already been discovered, including: gastrointestinal (stomach and intestine) disturbance (vomiting, diarrhea), pancreatitis (inflammation of the pancreas), intestinal blockage, kidney injury (nephritis, or inflammation of the kidneys), and thyroid cancer. As always, it is best to consider the risk to benefit of any medical intervention prior to considering it use.
Some other things that need to be considered with these medications, is that it appears that in order to maintain weight loss with these medications there must be ongoing use, which likely significantly increases the risk for undesired or side effects associated with their use.
Furthermore, research has shown that the weight that is lost through the use of these medications is approximately 40% lean tissue or muscle. Whenever we lose weight there will always be a portion of that weight that comes from the loss of lean tissue or muscle. However, this percentage can be decreased through simultaneously performing resistance-based exercise that helps to stimulate and improve muscle gain. The big issue with losing this amount of lean tissue is that lean tissue is largely responsible for increasing our metabolism and overall caloric expenditure. In other words, we will increase our overall energy expenditure even at rest when we have higher percentages of lean tissue. When we lose lean tissue, we slow down our metabolism and overall energy expenditure. This is a big problem as without changing our eating habits we will be causing a relative caloric excess, which can result in weight gain and limits our ability to maintain the weight that we have lost. In addition, when we put the weight back on, we will be replacing the lean tissue that we lost with adipose (or fat) tissue, which results in a permanent reduction of our caloric expenditure, which becomes very problematic in trying to maintain a healthy weight. Certainly, improving body composition by increasing our percentage of lean mass can occur with resistance-based exercise, which is extremely important to maintaining a healthy weight and improving our ability to burn the calories that we consume. We will discuss more on this later.
The above discussion on weight loss medications is not to say that they can not be helpful for some and the benefits can outweigh the risks, however just as with any decision it is always better to make an informed one and have a true understanding of the effects of those decisions. I do think the unknowns related to side effects and consequences of the long-term use of these medications are concerning, especially when there are other options to losing and stabilizing weight. The other thing that I think is a concern with these medications is that if we do not change the habits for the reasons as to why we are possibly taking them in the first place, how are we truly making lasting change? Weight is not a result of being deficient in GLP-1 agonists.
Let’s know discuss some of the habits that have an excellent chance of helping to not only lose weight, but to help maintain it along with lowering the potential side effects and consequences associated with other forms of weight loss:
- A Focused Nutritional Plan
- Increasing Lean Mass
- Move Your Body
- Proper Hydration
- Proper Rest
A Focused Nutritional Plan
It is no secret that losing weight is highly related to the food choices that we make and the foods that we consume. This is also potentially the part that is the biggest struggle for most of us. Understand that you are not alone in this struggle. A big part of this struggle is related to our toxic American diet that is heavily concentrated in processed and refined foods that are high in white sugar and white flour. These foods tend to be very low in nutritional content, but very high in calories. In other words, they provide us with a significant number of “empty” calories. In addition, we are only able to store approximately 400 grams of sugar in our muscles and liver. Any additional sugar gets converted to fat and is stored as adipose (fat) tissue. In addition, consuming high amounts of processed foods that are high in white sugar and white flour creates metabolic dysregulation that further promotes weight gain by creating insulin resistance (insulin is our storage hormone that is responsible for lowering blood sugar by taking sugar from the blood into our body, or cells) as a result we begin to need more insulin to regulate our blood sugar. This increase of insulin results in us holding onto more as we are being signaled to store more, as insulin is our storage hormone, and this results in gaining excess weight. The ability to help with reducing insulin and insulin resistance are some of the factors utilized by the GLP-1 agonist medications. The problem is that these medications are not getting to the source of the problem, which is the foods that we are consuming. This is not to say that we should never consume any processed foods, but rather try to focus our food intake on foods that are not ultra-processed and rather those that are minimally processed or whole, non-processed foods.
The best foods for us to consume relative to assisting our body in losing weight are protein, fiber, and healthy fats. Yes, eating healthy fat can help us actually lose weight. To learn more about fat’s role in our diet, check out our previous blog post on eating fats. Protein is helpful to losing weight as there is a high thermogenic effect (thermogenesis is a fancy way of saying “burn calories”) with protein, meaning that we actually burn more calories digesting protein than any other nutrient source. In addition, protein helps us to maintain our lean mass and when used in conjunction with resistance-training can help us to increase our lean mass. Fiber helps to lower our resistance to insulin and helps with the health of our digestive tract as it is a primary fuel source for the good bacteria, known as flora, in our gut.
Weight Loss absolutely requires a calorie deficit (calories are the energy units of food). You must consume less calories than you are burning in a day. Whole, non-processed foods and minimally processed foods typically have a higher nutrient content to caloric content ratio, which helps to satisfy this rule when consuming them. Whereas, ultra-processed foods have a low nutrient content to caloric content ratio, which makes accomplishing this rule almost impossible.
Other ways to help to satisfy this rule are increasing movement throughout your day and increasing your lean mass, both of which will increase your caloric expenditure. Let’s discuss these two factors in a little more detail.
Increasing Lean Mass
Increasing your lean, or muscle mass is an extremely important factor to helping with weight management. Lean mass, because of it being working tissue, burns more calories than adipose, or fat tissue, even at rest. In technical terms, it increases our basal metabolic rate, which is how many calories we burn at rest. As explained above, a calorie deficit is a must to lose weight. Therefore, an increase in lean tissue mass is a significant benefit to losing and maintaining a healthy weight as we can eat relatively more calories as we will be burning more as a result of this change of body composition.
Resistance-based exercise is the key to increasing lean mass. It is recommended that you perform resistance-based exercises, 3x/week to help increase lean mass. The act of doing resistance-based exercises will increase your caloric expenditure relative to exercising in the short-term and will help you to maintain an increase of caloric expenditure over time with the increase of lean mass relative to consistently performing resistance-based exercises. The other way to help with increasing caloric expenditure is to simply add movement into your day.
Move Your Body
The act of movement requires energy to help activate our muscles to move our body. It is recommended that we perform 150 minutes of movement-based activity per week, which breaks down to approximately 20-30 minutes per day. This activity can come in the form of walking (a dedicated walk and not just the walking that you would do in a typical day), rowing, running, cycling, dancing, or playing a recreational sport amongst many other things. In addition to dedicated movement, just our ability to keep our body moving throughout the day is highly related to stabilizing our weight. This is called non-exercise activity thermogenesis (NEAT). Remember, thermogenesis is another term for burning calories. In today’s world of technology and occupations, it is more difficult than ever to reduce our time sitting. Focusing on achieving a minimum of 7,000 steps per day can be a great start to incorporating movement into your day. Even just focusing on spending more time of your day standing is likely to get you to move more as it is not easy to stand still for too long.
In addition, to burning additional calories at the time of doing these activities, these activities also help to increase mitochondrial density in our cells. Mitochondria are the “powerhouses” of our cells and an increase of their density is also another route to increasing our basal metabolic rate just like increasing our lean mass. In addition, increasing mitochondrial density has also been researched to improve longevity and healthy aging related to decreasing chronic inflammation, which also is highly related to weight gain and obesity. To learn more about the connection between chronic inflammation and weight gain, check out our previous blog post on inflammation. Now, let’s review the final two factors that can have a significant impact on weight loss, hydration and sleep.
Proper Hydration
Proper hydration through water intake has multiple roles in helping us to lose weight and maintain a healthy weight. One of the easiest ways to weight gain and metabolic dysregulation is the over consumption of sugary, high calorie beverages. These types of beverages including soda, juice, and sweetened coffee beverages have a very low nutritional content to calorie content ratio, meaning that they are extremely high in “empty” calories. They are extremely high in sugar and can result in weight gain as a result of the excess calories from their consumption along with their effects on increasing insulin (remember insulin is our storage hormone) and the increased risk of insulin resistance associated with long-term use of these beverages. In addition, these beverages, particularly soda and coffee, are diuretics and result in a net loss of water relative to their caffeine content.
On the contrary, water has the best nutrient content to calorie content ratio. It has no calories and is extremely important to our overall health. Considering that we are 70% water, we should drink a minimum of 80 ounces of water per day. Water intake also helps to reduce hunger as it helps us to feel fuller throughout the day, decreases our intake of “empty” calories from other beverages, and helps us to remove waste effectively, which is obviously an important factor to losing weight.
The other factor that needs to be discussed with hydration is the consumption of alcoholic beverages. Alcohol in moderation will not typically have a significant impact on weight. However, excess consumption of alcohol can have significant negative impacts on our ability to lose weight. First, alcohol typically is very high in calories that do not offer us much nutrition (in other words, it is low in the nutrition content to calorie content). Second, it enhances our appetite and we often do not make the best food choices while consuming alcohol, which leads to more calories. Third, it suppresses our metabolism which leads to an increased risk of weight gain. Another factor that is affected with alcohol consumption is that it has a negative impact on our sleep quality, which is the final factor in weight loss.
Proper Rest
Sleep and rest have been shown to be correlated with weight gain as a result of a few factors related to poor sleep and improper recovery. It is recommended that we should be getting 7-9 hours of sleep per night and just as important is when we are getting our sleep. We should focus on being consistent with our sleep and wake times. This is all related to the fact that our bodies work on a circadian rhythm, which highly involves sleep. The ability to allow our bodies to get into deep sleep is important as it is during these phases of sleep that certain hormones, including growth hormone are released to help our body properly recover from the day. Improper or inconsistent sleep patterns have been shown to result in elevated cortisol levels. Cortisol is often referred to as the “stress hormone” as it is released in response to stress. Lack of sleep is seen as a stress to our body, resulting in increased release of cortisol. Cortisol is involved with sugar metabolism, it has opposite effects to that of insulin as it releases sugar into our blood stream, therefore with elevated levels of cortisol we can have similar effects to eating too much sugar, which overtime can create metabolic dysregulation and insulin resistance in the same way as consuming too much sugar. Cortisol is also an appetite stimulant. Chronic stress can have the same effects related to cortisol with weight gain. As a side note, regular exercise also helps to reduce our cortisol levels. In addition to the cortisol effects from poor sleep, it has also been shown to reduce insulin sensitivity (which may be in response to the elevated cortisol, as they have opposite effects as mentioned above), and poor sleep also increases our sugar cravings, which typically results in us consuming more sugar relative to poor sleep. This is likely as a result of our body looking for rapid energy to overcome tiredness that sugar can provide, however it does not help with weight loss as explained throughout this post.
Where to Start
The most important thing is finding the path that works for you. It is best to consider what changes you feel you could more easily make in your current life situation. Perhaps, it would be easiest for you to focus on increasing your water intake initially and while doing that you could start to become more aware of your caloric intake by tracking the food that you are consuming and in discovering your intake, could determine what dietary changes are possible for you to make. If you do not currently have the time or ability to add dedicated exercise into your life, try to focus on adding some additional steps into your day. There are no quick fixes when it comes to weight loss and maintaining a healthy weight over the long term, however it certainly is feasible and can be done in a manner that does not have to feel like punishment.
If you have attempted to lose weight in your past and have struggled to find your path or you would like to have someone who can help you on your path, consider a nutritional coach. Currently, we are offering our First Step Nutritional Coaching Strategy Session at no charge. The only cost to you is 30 minutes of your time to determine if we may be able to be of assistance on your journey. Let’s look to make new habits that will get you on the right path this year instead of making resolutions that are unlikely to last or be sustainable.
Happy New Year!
….Till Next Time!
