Weight, and efforts to lose weight, have become an epidemic over the past many decades, as the once simple advice of “diet and exercise” or “try this diet or cleanse for a few weeks” have failed to wholly stop this trend. Even if their routine now seems more than adequate, weight and, commonly together, its imbalance of hormones, can cause a myriad of other symptoms, or vice versa if someone has endocrine or other concerns and now weight becomes an issue. Plus, medications, life stressors (e.g. family, relationships, finances), and trauma may be contributing factors not only to what’s happening physically, but also potentially unhealthy outlets that inadvertently lead to even weight fluctuations. If we can educate and focus on what people can do or try differently, perhaps they too will be curious about recreating their plan.
In 1948, the World Health Organization (WHO) first recognized (in theory) obesity as a disease. However, before the conventional medical profession disregarded it in the 1980s, the Body Mass Index score (a loosely based combination of measurements accounting for the person’s form, weight and age) raised its “normal” value to now account for a literal growing population. Then in the mid-1990s, the WHO found significance in obesity as a disease, recognizing it as something to address.1
Simply put, weight loss requires change. Whether it’s a change to our typical routine, or a change to our mindset and belief that we really can make positive changes to our body, requires a type of presence and ability to overcome hurdles that are not necessarily celebrated in a society that reveres “how fast” and “how fast can I get to the end result to finally feel good.” Fortunately, what will be addressed during the treatment part, is that there is a way to “feel like you’re on a grand adventure, excited not just by the destination, but by what lies in front of you.” This excitement may also bring in a new supportive community, friends and even a shift in a once prior more negative voice.2
While we are mostly addressing weight, post-industrial revolution we are also considering factors like more air pollution, an increasingly stressful way of life and events as portrayed on the news, important minerals depleted by the soil, hormone disrupting chemicals in our beauty and environmental products, and a plethora of preservatives and pesticides in our food that most countries have since banned. In this case, more than likely there will be other concerns to consider, and perhaps not so ironically the adipocyte (fat cell) is already helping us understand who/what else could be involved. The adipocyte has around 10 different receptors that include inflammation, thyroid, sex hormones, stress, appetite and blood sugar,3 for example, also metaphorically speaking that we need more “balance” over a “quick fix.” Additionally, when we gain weight, we develop new fat cells—they don’t go away, they only shrink when we lose weight, so it’s like having/dealing with more signals (especially if things aren’t in balance).
More specifically, concerns like elevated estrogen (common now in both men and women) can be an issue, as estrogen itself is considered a growth hormone, and it can also inhibit the thyroid hormone, responsible for metabolic processes in the body. In fact, one of these processes is detoxification and gut health, where it’s important for everything to be metabolized and excreted through the body so it doesn’t stay there and recirculate (causing additional inflammation, weight gain, etc.).
Diet is certainly important when it comes to weight, though we are what we absorb. Our 4 pounds of gut bacteria can easily be disrupted by a variety of internal and external factors, as well as our ability to make hydrochloric acid and digestive enzymes to truly break everything down. In fact, research has also shown that a higher firmicutes (bad gut bacteria) to bacteroidetes (good gut bacteria) ratio can be a significant contributing factor to weight gain.4 Similarly, most of our serotonin (happy hormone) is made in the gut (as well as melatonin, our sleep hormone), so chances are how we feel about ourselves, and our sleep patterns, respectively, can also be affected when there are gut-related issues. Further, people may also be predisposed to having mood concerns (e.g. anxiety, depression), where it could be either a contributing factor or potential cause by not feeling comfortable or like themselves in their own body. One example is that depression has recently been found to be inflammatory (i.e. release of cytokines),5 and inflammation is a type of stress on the body that can lead to weight gain, hormone imbalance and other concerns. Lastly, depending on the person, additional neurotransmitters like dopamine (our motivation and reward hormone) may also be affected with various types of internal or external stress, which may impact someone’s confidence and ability to truly feel better.
In blood work, I recommend the basic CBC and CMP, hemoglobin A1c (sugar levels over time), iron panel, cholesterol panel, vitamin D3, vitamin B12 (i.e. energy), homocysteine (i.e. detox pathways), full thyroid panel (TSH, free T3, free T4, total T4, anti-TPO; can consider reverse T3 if high stress picture), hs-CRP (inflammation), and prolactin in women (if additional menstrual issues). Leptin and ghrelin levels, our satiety and hunger hormones, respectively, may be helpful, but not always necessary. I tend to do most sex hormone testing via saliva and urine for more accurate results (especially with estrogen and cortisol done over a period of time), though depending on the case request ones like testosterone (free and total), DHEA-S and sex hormone binding globulin via blood. Additional specialized tests include neurotransmitters, stool, food allergy and genetic testing (especially if strong history of hormone and/or mood disorders) for consideration.
When it comes to long-term weight loss, it is important to address consistency and adaptation of habits and mindset into a daily routine. An adequate amount of water (i.e. half their body weight in ounces) tells the body to “drop fat” as the adipocyte fills with water before shrinking. Getting creative, experiencing joy with oneself and in relationships are also important aspects of health in boosting feel-good chemicals to help us relax. Add in about seven to nine hours of sleep with bedtime ideally before 11 p.m. (before our second wind) to further help us give our body proper rest and rejuvenation.
Nutritionally, chewing food thoroughly helps give our body time to create proper digestive enzymes and acid for optimal absorption. The Mediterranean diet, filled with vegetables, quality protein, healthy fats and generally lower carbohydrates, has been beneficial in keeping weight off long-term.6 Intermittent fasting is another great way too to help boost metabolism and give the body proper digestive rest, beginning at least 12 hours between dinner and breakfast, and three to four hours between meals. However, while generally men can tolerate this better than women, it’s cautioned if there’s pregnancy, anorexia, a more severe illness and more severe fatigue (adrenal) issues.
Numerous studies have shown that weight lifting has many benefits, as muscle can increase metabolism over the long-term, and adding in high intensity interval training (HIIT) exercises to your workout helps not only add muscle as well, but also improves overall cardiorespiratory fitness compared to a more moderate-intensity continuous training.7
While generally healthy weight loss can be about 1 to 2 pounds per week, this depends on the person’s weight, size, and how much there is to lose. Some may experience 5 pounds in the first week, though whatever the amount, your “why” can help keep you going. Studies have shown that “intrinsic motivation,” when we do something for our own satisfaction, has much longer lasting results than “extrinsic motivation,” rewards based on tangible items or even making other people happy.8
When it comes to supplements, it may be best to work with a professional to also provide insight into what you as the individual needs, as well as to address any herb, drug or nutrient interaction. Studies have shown that vitamin D is important, as overweight individuals tend to have lower amounts [and this also helps with mood].9 Magnesium is “nature’s relaxer,” so this with trace minerals are great as caffeine, stress and alcohol deplete these, and they commonly serve as important cofactors in the making and metabolizing of hormones. Fish oil is a great anti-inflammatory and helps to both quell cytokines and reduce general metabolic disease related markers commonly associated with weight. Probiotics with Lactobacillus rhamnosis GG can help shift the aforementioned ratio.10 The herb eleutherococcous can not only help with adrenal/ stress related issues, but blood sugar and gut health as well.
Practitioners need to address the root cause—in looking at and getting a sense of both physiological systems and their day to day habits, think of what stands out as their biggest obstacle to cure. Then we can expand outward and begin employing foundational nutritional, lifestyle, and mindfulness related support that they enjoy (very important!) and feel good about, and getting some quick wins. However, quick wins can mean they found a way to create even five minutes in the middle of their day to figure out where to get a more healthful, satisfying meal versus wondering when they can fit back into those coveted pants.
1 James, W P T. WHO recognition of the global obesity epidemic. International Journal of Obesity (2005) vol. 32 Suppl 7 (2008): S120-6. doi:10.1038/ijo.2008.247. https://pubmed.ncbi.nlm.nih.gov/19136980/.
2 Livingston, G. Permanent weight loss motivation: What it takes. Psychology Today (2019). Retrieved May 5th, 2023. www.psychologytoday.com/us/blog/never-binge-again/201912/permanent-weight-loss-motivation-what-it-takes.
3 Hauner, Hans. Secretory Factors from Human Adipose Tissue and Their Functional Role. Proceedings of the Nutrition Society, vol. 64, no. 2, 2005, pp. 163–169., doi:10.1079/PNS2005428.
4 Magne, Fabien et al. The Firmicutes/Bacteroidetes Ratio: A Relevant Marker of Gut Dysbiosis in Obese Patients?. Nutrients vol. 12,5 1474. 19 May. 2020, doi:10.3390/nu12051474.
5 Berk, Michael et al. So depression is an inflammatory disease, but where does the inflammation come from?. BMC Medicine vol. 11 200. 12 Sep. 2013, doi:10.1186/1741-7015-11-200.
6 Poulimeneas, Dimitrios, et al. Exploring the Relationship between the Mediterranean Diet and Weight Loss Maintenance: the MedWeight Study. British Journal of Nutrition, vol. 124, no. 8, 2020, pp. 874–880., doi:10.1017/S0007114520001798.
7 D’Amuri, Andrea et al. Effectiveness of high-intensity interval training for weight loss in adults with obesity: a randomised controlled non-inferiority trial. BMJ Open Sport & Exercise Medicine vol. 7,3 e001021. 20 Jul. 2021, doi:10.1136/bmjsem-2020-001021.
8 Livingston, G. Permanent weight loss motivation: What it takes. Psychology Today (2019). Retrieved May 5th, 2023. www.psychologytoday.com/us/blog/never-binge-again/201912/permanent-weight-loss-motivation-what-it-takes.
9 Slusher, A.L., McAllister, M.J. & Huang, CJ. A therapeutic role for vitamin D on obesity-associated inflammation and weight-loss intervention. Inflamm. Res. 64, 565–575 (2015). https://doi.org/10.1007/s00011-015-0847-4.
10 Magne, Fabien et al. The Firmicutes/Bacteroidetes Ratio: A Relevant Marker of Gut Dysbiosis in Obese Patients?. Nutrients vol. 12,5 1474. 19 May. 2020, doi:10.3390/nu12051474.
Dr. Serena Goldstein is a naturopathic doctor in South Florida (in-person, and virtual world-wide available), who helps guide patients to trust and understand their body’s signs and signals so they can expand their knowledge and become partners on their health journeys. Dr. Goldstein utilizes conventional and natural medicine, psychology and intuitive healing to help patients achieve long-term weight loss, hormone balance, mood concerns, gut health and thyroid issues so they can bring order to chaos in wanting to feel more deeply connected to their health. Additionally, she treats all concerns with an individualized plan that her patients find fun, a source of motivation and a unique opportunity to learn more about their body than ever before.