Weight Loss - The Never-ending Story -The Stigma. The Struggle. The Shame.

The simple truth is, energy in should equate to energy out. But it is not that simple, we are beginning to see the shades of grey behind this never-ending story of weight loss. What propels this desire to eat more than our bodies require? Why are some people able to maintain this energy equilibrium with such ease and others fail miserably with blame and regret.

The predisposition to gain weight is influenced by several factors like genetics, hormone imbalances, medications, medical conditions, environmental factors…..and the list goes on. Obesity in urban settings is largely related to two environmental factors. The first is the vast abundance of unhealthy food options available especially foods with trans-fatty acids and refined sugars. The second “is a significant shift in the structure of employment, that relies far less on physical activity” as noted in a study by Barry M Popkin, Ph.D., and Colleen M. Doak, M.A. This translates to an imbalance of energy in and out of the body. 

Energy intake is controlled by the brain, mainly by the hypothalamus. A metabolic set point allows this area of the brain to regulate the intake of food for energy. Once this requirement is fulfilled, the individual reaches satiety and stops eating. However, this set point differs amongst individuals due to genetics and can further experience alterations due to external environmental factors leading to weight gain.

Add to the mix, the impact of the hedonic system. Historically, human beings had to hunt and forage for food to survive. The consumption thereof was met with reward. Today, with the ease of availability of food, this reward system still exists and munching down on that dessert after dinner is purely for pleasure. This pleasure stimulates the release of dopamine, endocannabinoids and opiates ensuring the persistence of the hunger signals of the hypothalamus and satiety is subdued. The urge to continue eating persists and food is consumed despite the already fulfilled need for energy.

Understanding the complexities of weight gain, affords me, your health professional (GP) an armamentarium to not just assist with weight loss but to sustain and maintain weight over long periods. This is by far the most challenging component of weight loss management. Adopting a nutritious diet and healthy lifestyle which includes moderate exercise and activity, good sleep patterns, improved mental health, reduced stress levels, cessation of smoking and reduced alcohol intake ensures the sustainability of weight loss. All too often preached but not practiced.

So, as much as we can blame our biological makeup for the unwanted weight gain, the onus lies within the individual. Taking the first step of identifying there is a problem. A problem not just related to aesthetics – to how you look in a bikini or gym shorts but also to the negative impact it has on the individual’s quality of life and development of comorbid conditions like diabetes and hypertension, strokes and heart attacks, and even mortality. The next step would be seeking out your medical doctor (GP) with the ability to help on this weight loss journey. For it is a journey – a lifelong journey. Unbiased, non-judgmental attitudes with the knowledge to advise with authority is what is needed. This comes from not only the health professional. It takes a village. Enlisting the advice and assistance of family and friends, psychologists and life coaches, dieticians and nutritionists, gym trainers, physiotherapists and bio-kineticists. Everyone has their role to play on this journey.

Despite all these endeavors, modern medicine does play a significant role in treating weight gain and obesity when the afore-mentioned measures fail. Compelling data confirms however, that modern medical interventions are merely adjuncts to these lifestyle changes and adaptations. They all fit together like puzzle pieces to solve this conundrum of weight management.

Drug therapy are so varied, ranging from appetite suppressants, lipase inhibitors (fat blockers) and the latest diabetic drugs which are used to control insulin release and regulates glucose levels. As with all medication, initiation of these drugs is done slowly and controlled under close medical supervision with recurrent blood tests to monitor the effect on organ systems like the liver, pancreas and kidneys. Treatment periods varies too depending on the side effect profile and long-term complications associated with these drugs. Often drugs like psychotropics, diuretics, thyroid medication, and others are used for their side effect of weight loss. When used appropriately in individuals with the pre-existing condition it is licensed to treat, these drugs are beneficial. However, strong caution is raised in the misuse of such drugs for the mere effect of weight loss. Polypharmacy is also advised against due to side effects, drug interactions and high complication risk.

Bariatric surgery, once frowned upon, is now accepted as a safe and effective therapy for sustained weight loss in obesity. And again, sustained lifestyle changes both pre- and post-surgery is emphasized. Technological advances now also afford us the benefit of treating localized fat. Perfecting the human form with cinched in waists and clearly visible abs, there are safe options such as cryo-lipolysis, injection lipolysis, radiofrequency, high-intensity focused ultrasound, liposuction with tumescent technique. Each has its limitations, side effects, complications and results are highly dependent on the individual and the health professional performing the procedure. With all these treatment modalities however, informed consent with an adequate understanding of the plan, possible hurdles and costs between patient and doctor on all fronts is essential in attaining optimal treatment outcomes.

There is a huge hiatus between the reality of people becoming more and more obese and the theory of how this epidemic should be stopped. To take the lead in solving this problem, we have to acknowledge that the healthcare professional and modern medicine can only be part of a broader approach in addressing weight gain issues. With healthier lifestyle choices, this burden of disease can be lifted for optimal individual quality of life and I am here to hold your hand through this journey.