Positive Health Online

Overview
Obesity figures in the US show that 68% of adults are overweight,[1] while data from the UK shows a similar situation, 66% of men and 57% of women are overweight.[2] There is certainly no lack of fad diets promising fast results, but many such diets often limit your nutritional intake, can be unhealthy, and tend to fail in the long run. It's really all about adopting a lifestyle that includes a healthy diet, regular exercise, and a sensible balance between a variety of other contributing factors, discussed below.

One out of three women and one out of four men are on a diet at any given time. Two-thirds of dieters regain the lost weight within one year and virtually all regain it within five years. A naturopathic approach to a healthy weight focuses on nutrition, exercise and other lifestyle changes for lasting, sustainable benefits. Instead of focusing on diet or exercise, healthy weight loss becomes more readily achievable and weight maintenance becomes easier with a comprehensive, balanced approach that utilizes all reasonable resources.

Considerations
It is virtually impossible for overweight individuals, especially the obese, to return to a normal body weight without experiencing measurable health improvement.[3, 4] Here are the important considerations when attempting to lose weight:

1. Genetics;
2. Diet/nutrition;
3. Exercise;
4. Psychological condition;
5. Hormones;
6. Pharmaceutical/surgery.

Note: no attempt has been made to rank these six elements in order of importance since that order will be determined by individual need. Let's take a look at them one at a time.

Genetics
Mapping out your road to a successful weight loss plan starts with understanding the role of genetics. Research does not demonstrate a significant cause-and-effect relationship between genetics and obesity. Researchers frequently use words like a genetic susceptibility, tendency and predisposition, to hedge their bets, but these words are not the same thing as a cause. We all have certain genetic predispositions, but most genes can only express themselves if they are provided with the proper environment.

Many non-genetic factors, such as environment, work in conjunction with a genetic predisposition for weight gain. The fact is developed societies have an environment favouring weight gain rather than weight stabilization because of an abundance of food, often high calorie food, and a lack of exercise. "In most humans, genes do not directly cause obesity, but they predispose to becoming obese in the changed environment of the modern world."[5]

The solution to losing weight is far simpler than having to figure out the complexities of your genetic makeup and trying to make some sort of correction. By determining which environmental conditions have the greatest impact on the problem e.g. excess caloric intake, inadequate exercise, a hormonal imbalance, a psychological disturbance, etc., and taking appropriate steps to alter them, you can make major improvement in your weight status. Experts maintain, "the most likely environmental factor contributing to the current obesity epidemic is a continuing decline in daily energy expenditure that is not matched by an equivalent reduction in energy intake."[6]

Diet/Nutrition
The 21st century diet is dramatically different from that of our ancestors. In addition to the abundance of food and snacks available today, the macronutrient composition of our food has changed. Not all of these changes are good, for example:

• Our carbohydrate intake has increased at the expense of protein;[7]
• The carbohydrate composition, which used to come primarily from wild plants, fruits and vegetables,[8] is now comprised of many processed and refined products e.g. corn flakes, pancakes and fried potatoes;
• The composition of our fat intake has changed substantially:
  o Omega-6 fatty acid intake has increased dramatically at the expense of omega-3 fatty acid, because:
       * Modern diets contain little fish, which is high in omega-3;
       * Modern diets contain more oils from corn, sunflower, safflower, cottonseed and soy, all of which are high in omega-6;
       * The fat composition of meat often reflects an abnormal animal diet.[9]
  o Our intake of trans fats and altered fats is increasing at an astonishing rate, which may be because "high-fat, more calorie-dense diets promote over eating and overweight."[10]

Everything we eat and drink has calories, except for pure water. Some things have few calories, like lettuce, and some have many calories, like ice cream. During any given day, if you take in more calories than your body uses, you have a positive calorie/energy balance, which the body stores as fat. If you keep this process up long enough you can gain a tremendous amount of weight. Instead, once you've reached the weight you desire the obvious way to maintain your weight is to consume approximately the same number of calories each day that your body needs to function. For optimal health, you should also make certain those calories provide you with balanced nutrition.

Dieting has more than one downside. Here are some of the more significant failures of dieting:

• Today there are many fad diets masquerading as good, sound, balanced weight-loss plans, and one of the greatest hazards of these diets is that they are often nutritionally inadequate;[11]
• Dieting tends to coexist with a number of other health risk behaviours;
• Dieters rely on dietary restriction as their primary strategy, which can backfire if the dieter becomes preoccupied with food or begins eating in the absence of hunger, which can throw the body into starvation mode;

Although, what I am about to show you is conceptually easy to understand and implement, because you don't have to have any knowledge of nutrition, you will still need a bit of self determination. I have developed what I call the Rule of Thirds.

Source: Sustainable Weight Loss: The Definitive Guide to Maintaining a Healthy Body Weight,
by D Lee Waller JD ND

As you can see the Rule of Thirds contains three vertical columns.

• Phase 1: When you sit down to eat look at what you're about to eat. You should see two-thirds fruit and vegetables, and one-third meat, whole grains, dairy, seeds and nuts. Stay on phase 1 until you are consistently eating this way;
• Phase 2: Once you have determined you are consistent with the phase 1 food plan, it's now time to try to improve on it. The important thing about phase 2 is it involves breaking the phase 1 fruit and vegetable group into two-thirds vegetables and one-third raw fruit. What this means is you will need to make two slight adjustments from the phase 1 plan. First, concentrate on eating two-thirds vegetables and one-third fruit from the fruit and vegetable group of phase 1. Second, the fruit you eat will be raw fruit not canned, cooked or in some other way processed;
• Phase 3: The Phase 3 adjustment is in the vegetables you eat. Move toward more raw vegetables instead of cooked or processed. The goal is to achieve two-thirds raw vegetables to one-third cooked. I know this may be a tough adjustment, but by cooking your vegetables you kill the enzymes your body needs to properly digest them, and you damage many of the other nutrients. Although you may never fully get phase 3 down perfect, it is still a good goal.

By looking to the right of the third column you can see the percentage each food group consists of.

Exercise
No weight loss program should be without an exercise regime, aggressive if possible. There is however a lot of misconception over what a real exercise program should look like. Here is what you might see if you watch the vast majority of ill-informed, overweight people at most fitness centres. Somewhere along the line they have been led to believe by engaging in some of what I call 'pinch and tickle' physical activities, like: 1) stretching ad infinitum; 2) leisurely walking on the treadmill or casually riding a stationary bike; 3) performing a few wimpy resistance exercises, they will lose weight. Guess what, they won't!

The only changes they will experience are that they: 1) get very frustrated, and 2) continue to gain weight. Don't be lulled into a false sense of security by thinking that a leisurely walk around the park, shopping mall or golf course meets the requirements of an aggressive exercise regime. It doesn't and it will not get you the result you want.

In addition to weight loss, exercise can help you with:

• Fat oxidation;
• Chronic disease prevention and/or abatement, including:
  • Heart disease;
  • Cancer;
  • Diabetes;
  • Brain function e.g. dementia, Alzheimer's, Parkinson's);
  • Bone density;
  • Inflammation;
• Accrued psychological benefits e.g. mood elevation, minimized depression.

In attempting to create an exercise plan, here are the questions you must answer:

• Exercise Type -
  • Do you want aerobic or anaerobic exercise?
  • What specific exercises?
• Exercise Duration - How long will your exercise sessions be?
• Exercise Frequency - How many exercise sessions per week will you have?
• Exercise Intensity - How hard should you exercise e.g. percent of VO2max?

Select exercises that you like and will return to consistently, being certain they: 1) elevate your heart rate sufficiently for cardio-respiratory health, and 2) stress your muscles sufficiently for muscle strength and tone.

Psychological Condition
The psychological underpinnings of sensible and effective weight management are so pervasive and intertwined they are seldom understood or satisfactorily explored by health, exercise and nutrition professionals. If left unaddressed, psychological issues can retard your weight loss progress.

Stress is a fact of life in today's developed societies and it can wreak havoc with the body in a number of ways, including unhealthy weight gain. Research data suggests properly applied stress reduction techniques could be a friend of many people trying to lose weight. Studies report, "adults with current depression or a lifetime diagnosis of depression or anxiety were significantly more likely than those without each diagnosis to smoke, to be obese, to be physically inactive, to binge drink and drink heavily."[12]

Working hand-in-hand with the physical act of changing the body is the psychological principle of behaviour change. If you want to change your weight status you need to adopt new behaviours. It has been suggested, "obesity is not a problem of defective physiological regulation, but is an environmental and societal problem and therefore, must be approached through environmental and social solutions."[13] Most everything we do to control our weight will ultimately rest upon the foundation of behaviour change.

Don't be misled into believing if you find a weakness in some psychological aspect of your life and fix it, your weight problem will go away. Focusing on a single weight loss strategy alone often results in disappointment. The important point here is if you believe an emotional disorder could be contributing to your over-weight condition, you need to address that issue in order to optimize your chances of success with your overall weight loss program.

Hormones
One of the most overlooked aspects of weight loss is the role the body's hormones play. Hormones are "chemical substance[s] produced in the body by an organ, cells of an organ or scattered cells having a specific regulatory effect on the activity of an organ or organs."[14] In plain words hormones are chemical messengers produced in one part of the body, transported via the bloodstream, and ultimately used to regulate the activities of a different part of the body. "Numerous circulating peptides and steroids produced in the body influence appetite through their actions on the hypothalamus, the brainstem and the autonomic nervous system."[15]

We have all heard the statement that weight loss is simply the expending of more calories than we consume. While that principle still has truth today, there are a lot of people who find this concept frustrating. Many people continue to gain weight even while they are reducing their caloric intake and doing more exercise. "This unfortunate process takes place largely due to the hormonal changes that occur with age."[16]

Two of the more significant hormones involved in the process of body weight stabilization are ghrelin and leptin.

• Ghrelin is principally created in the intestinal track and it signals the brain that the body needs more energy, in effect telling the brain that it is time to eat;
• Leptin is primarily created in the fat cells and signals the brain that the body has plenty of stored energy, in the form of fat, therefore making eating unnecessary.

Dysregulation of these, as well as others, can create a problem.

Pharmaceutical/Surgery
For morbidly obese individuals, pharmacotherapy may be added if lifestyle interventions alone don't solve the weight problem and bariatric surgery combined with long-term lifestyle modifications may also be considered.[17] But understand, lifestyle changes are often sufficient to achieve favourable results without drugs or surgery. In plain words, drug therapy or bariatric surgery should not be attempted until all possible lifestyle changes have been proven ineffective.

The basic rules for the use of prescription weight loss medications are that:

• They should only be used by patients who are at increased medical risk because of their weight;
• They should not be used for the purpose of cosmetic weight loss;
• They should only be used after extensive lifestyle interventions have been exhausted;[18]
• From a safety standpoint, obesity treatment products need special consideration before their use because, "few other diseases have such a poor pharmaceutical safety record,"[19] and this poor safety record is frequently expressed as unacceptable side effects.[20]

The most extreme obesity treatment is obviously bariatric surgery. Since this group of procedures is fraught with so many negatives, it must be selected as the treatment of choice with the utmost of caution. Some researchers claim that bariatric surgery is neither practical nor desirable as a treatment for obesity, since this intervention has not produced consistently effective long-term weight loss.[21] Not only does it result in unsatisfactory weight loss, it has been shown to have no beneficial effect on mortality.[22] Another major drawback to bariatric surgery is that the patient frequently suffers from nutritional malabsorption also know as malnutrition.[23] To me. bariatric surgery makes about as much sense as deciding that you can save gas by putting less in your car's tank.

Application
The naturopathic roadmap to weight loss and weight maintenance replaces the one-size fits all approach, with a broad based endeavour that utilizes all of the best available options. The important question is how to apply this information. Here are the critical success factors:

• Despite the people you see on television, who are losing large amounts of weight rapidly, experts tell us the optimum rate of weight loss is between 1 and 2 pounds per week;[24]
• "To lose one pound of body fat, you must burn an extra 3,500 calories beyond those you are consuming;"[25]
• To experience successful weight loss followed by satisfactory weight maintenance, I strongly suggest you begin with a detailed plan. The plan needs to: 1) be written, 2) provide a place for you to document your results, 3) be reviewed frequently, and 4) be adjusted as often as necessary;
• For easy, effective calorie control follow the Rule of Thirds, as further explained in Sustainable Weight Loss.

Although there will be times that are invariably tough, and you'll experience setbacks and lapses, if you remain determined and motivated, you will win the weight loss battle. Don't forget this effort is all about you, and your success, so don't let anybody or anything stand in the way of reaching your goal and holding onto it.

References
1. Centers for Disease Control and Prevention, "Obesity and Overweight," www.cdc.gov/nchs/fastats/overwt.htm 2011.
2. The Health and Social Care Information Centre, "Statistics on Obesity, Physical Activity and Diet: England 2011." www.ic.nhs.uk/webfiles/publications/003_Health_Lifestyles/opad11/Statistics_on_Obesity_Physical_Activity_and_Diet_England_2011_revised_Aug11.pdf 2011.
3. J Tuomilehto, J Lindstrom, JG Eriksson, TT Valle, H Hamalainen, P Ilanne-Parikka, S Keinanen-Kiukaanniemi, M Laakso, A Louheranta, M Rastas, V Salminen, M Uusitupa; Finnish Diabetes Prevention Study Group, "Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose intolerance," N Engl J Med 344: 1343-1350. 2001.
4. Diabetes Prevention Program Research Group, "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin," N Engl J Med 346: 393-403. 2002.
5. HR Berthoud, C Morrison, "The brain, appetite, and obesity," Ann Rev Psych 59: 55-92. 2008.
6. A Marti, MJ Moreno-Aliaga, J Hebebrand, JA Martinez, "Genes, lifestyles and obesity," Int'l J Obes 28: S29-S36. 2004.
7. L Madsen, B Liaset, K Kristiansen, "Macronutrients and obesity: views, news and reviews," Future Lipidol 3: 43-74. 2008.
8. Ibid.
9. Ibid.
10. C Davis, RD Levitan, P Muglia, C Bewell, JL Kennedy, "Decision-making deficits and overeating: a risk model for obesity," Obes Res 12: 929-935. 2004.
11. "Lifestyle and weight management consultant manual-American Council on Exercise," San Diego, CA: American Council on Exercise: 101. 2005.
12. TW Strine, AH Mokdad, SR Dude, LS Balluz, O Gonzalez, JT Berry, R Manderscheid, K Kroenke, "The association of depression and anxiety with obesity and unhealthy behaviors among community dwelling US adults," Gen Hosp Psych 30: 127-137. 2008.
13. M.R. Lowe, "Self-regulation of energy intake in the prevention and treatment of obesity: is it feasible?" Obes Res 11: 44S-59S. 2003.
14. "Hormone," Dorland's Illustrated Medical Dictionary, 30th ed: 862.
15. AP Coli, IS Farooqi, S O'Rahilly, "The hormonal control of food intake," Cell 129: 251-262. 2007.
16. J Jamieson, LE Dorman, V Marriott, "Growth hormone: reversing human aging naturally," 7nd ed, St. Louis, MO: Jamieson: 77. 1997.
17. CP Cannon, A Kumar, "Treatment of overweight and obesity: lifestyle, pharmacologic, and surgical options," Clin Cornerstone 9: 55-71. 2009.
18. Weight-Control Information Network - The National Institute of Diabetes and Digestive and Kidney Diseases NIDDK) in conjunction with the National Institute of Health, "Bariatric Surgery for Severe Obesity," http://win.niddk.nih.gov/publications/gastric.htm
19. EG Jackson, "Eating order: a 13-week trust model class for dieting casualties," J Nutr Ed Behav 40: 43-48. 2008.
20. D Cooke, S Bloom, "The obesity pipeline: current strategies in the development of anti-obesity drugs," Nat Rev Drug Discovery 5: 919-931. 2006.
21. RS Padwal, S.R. Majumdar, "Drug treatments for obesity: orlistat, sibutramine, and rimonabant," Lancet 369: 71-77. 2007.
22. AJ Walley, AIF Blakemore, P Froguel, "Genetics of obesity and the prediction of risk for health," Hum Mole Gen 15: R124-R130. 2006.
23. SP Davison, MW Clemens. "Safety first: precautions for the massive weight loss patient," Clin Plastic Surgery 35: 173-183. 2008.
24. WSC Poston, ML Hyder, KK O'Byrne, JP Foreyt, "Where do diets, exercise and behavior modification fit in the treatment of obesity," Endocrine 13: 187-192. 2000.
25. "Lifestyle and weight management consultant manual-American Council on Exercise," San Diego, CA: American Council on Exercise: 196. 2005.