Energy Overconsumption

Contributors & Causes: Humans derive energy from the food that they consume. Food is required to grow, recover, fuel organs, provide energy for bodily functions, gain weight and maintain weight; therefore it is essential to life.   However, humans do not always eat for survival. Often humans are driven to eat based by the taste of food, the pleasure of food, the convenience or availability of food and eating in a social setting. In today’s convenient food environment, food often is very calorie dense, promotes low satiety and extremely palatable. This makes consuming too much food very easy. Simply put, when you consume more energy than you use, your body will store the excess energy as fat.   

*Source: Adapted from AACE/ACE Obesity Resource Center

Treatment Plan:

  • Lifestyle Intervention: A regular moderate intensity exercise program – 30 to 60 minutes per day at least 5 days a week to establish energy balance and use more stored energy.
  • Structured Meal Plan: Using a meal planning software like Evolution Nutrition I would then provide the patient with a meal plan that creates a small energy deficit and is higher in protein and fiber to promote satiety. For example:

Education:

A large part of success with treating over consumption is education, helping the patient develop a food frame of reference, and developing a stronger understanding of what is in the food they are consuming.  However, this can be overwhelming and confusing when trying to address too much at once. Therefore, I have developed a heuristic to help us prioritize:

This pyramid is a frame of reference. The goal is to prioritize and master the basics; as the patient becomes more competent, you can move up the pyramid. We are talking about long term success, not short cut fad diets. While following the meal plan the patient will begin to develop awareness about their calorie consumption, portion control and energy density in food.  A meal plan forces a patient to do a few very important things: weighing and measuring food, preparing meals, eating at home and developing awareness of the food that they are putting in their mouth, awareness of total number of calories they are consuming and the way that they feel. Plus, a meal plan limits their options significantly, in order to prevent overeating and put them in to a calorie deficit needed to lose weight.

Satiety/Hunger

Contributors & Causes: The feeling of being hungry or full is derived from a variety of hormones in the body. When the body no longer responds to those hormones properly, the result is inappropriate nutrition partitioning and/or inappropriate hunger signaling.  

Treatment Plan:

  • Prioritize foods that incite increased levels of satiety – i.e. a higher protein, Higher fat, lower carbohydrate diet.
  • Small calorie deficit to induce a negative energy balance.

Education:

As the body gains more weight, there is an impairment in the regulation of hormones that control appetite and energy balance.  Essentially, your body wants to maintain its set point of weight. The longer you stay at a certain weight, the more your body wants to maintain that balance.   This means that it can be harder to lose weight, and your body may increase hunger, as you begin to lose body fat. This is why slow, consistent approach to weight loss is more likely result in permanent change.

*Source: Adapted from AACE/ACE Obesity Resource Center

Fructose/Sugar

Contributors & Causes: It has been hypothesized that sugar is at the core of our obesity problems, mainly for its role in Diabetes and insulin resistance.   Sugar is not only highly palatable, but it is also addictive, insulin stimulating and low in satiety. The combination of these three factors can lead to overconsumption and result in weight gain and insulin insensitivity.

Treatment Plan:

  • Prioritize foods that incite increased levels of satiety and improve insulin sensitivity- i.e. a higher protein, higher fat, high fiber, low processed carbohydrates, moderate complex carbohydrate diet.
  • Small calorie deficit to induce a negative energy balance.
  • Lifestyle Intervention: A regular moderate intensity exercise program – 30 to 60 minutes per day at least 5 days a week to establish energy balance and improve insulin sensitivity.

Education: 

Beyond sugar consumption, there are a variety of other contributing factors to consider.  However, if over consumption of sugar is suspected, this is a very controllable factor. By improving your overall diet, and simply reducing your sugar intake your body should respond.   In today’s food environment sugar is often hidden in foods that we do not suspect. Examples: include breads, cereals, health bars. This is not to say that those foods are bad per say, but when we are only feeding our body those foods, our body is not going to be happy.   That being said, the most common question asked in regards to sugar is, “Doesn’t fruit have fructose sugar?”. And the answers is yes! But fruit also includes fiber. Fiber is the key to mitigating the body’s response to fructose. Not only does fiber speed up digestion, but it also blunts the body insulin response; which is important important to part of mitigating obesity.

Diet Composition

Contributors & Causes: At the end of the day, a calorie is a calorie and we can derive calories from a variety of food sources. Ultimately there are 3 different macronutrients that all play vital roles in your body: Protein, Carbs, Fats.  In the absence of sufficient nutrition, your body will have an inappropriate response in the form of body composition and metabolism.

Treatment Plan:

  • Prioritize a balanced meal plan that prioritizes basic macronutrient requirements and is most likely moderate in protein, higher in fat and lower in carbohydrates.  This ensures nutrition to fuel the metabolic processes, and calorie needs.
  • Small calorie deficit to induce a negative energy balance.

Education:

Macronutrients give us energy and they make up the bulk of our calorie intake; like Protein, Carbohydrates and Fats. They provide the body with energy or calories.

To review:

  • Carbohydrates provide the body with 4 cal/g
  • Protein provides the body with 4 cal/g
  • Fats provide the body with 9 cal/g.

Each macronutrient plays a specific function in the body; meaning that the body will utilize each of these macronutrients to accomplish different things. Neglecting a certain macronutrient or not having a balance of all the macros can potentially limit and harm your metabolic processes yourself.

Proteins

Commonly found in animal products, nuts and legumes, protein is responsible for tissue structures like: organs,  tendons, ligaments,muscle, skin, bones and hair. Not only does protein aid in fueling muscle mass growth but it also plays a role in your immune system, it makes you feel fuller and  it speeds up your metabolism due to its greater thermic effect.

Carbohydrates

Carbohydrates serve as the major source of energy to fuel our daily activities. Commonly, carbohydrates are found in starchy foods, grains and veggies.   Some of the carbohydrate we consume are used immediately for energy, the rest are converted into a type of stored carbohydrate called glycogen. Glycogen is stored in the liver and muscles for later use. We need carbohydrates to fuel our physical activity, brain and organs, as well as provide energy to cells, spare muscle protein and fuel our nervous system.   We also need insoluble carbohydrates (fiber) to aid in our digestion.

Fats

Fats are commonly found in other foods we eat.  For example: meats, eggs, olives, coconuts, nuts and seeds and they serve to Provide energy, aid in the absorption of the fat soluble vitamins like A, D, E, & K, play a role in body tissue, crucial to producing and regulating hormones, and they also help us feel full.

Types of Fat:

  • Unsaturated: Omega 3-fatty acids,  are liquid at room temp. Reduce inflammation,  promote development, growth and support brain function.
  • Saturated :Solid at room temperature commonly found in animal meat.
  • Trans:– Present in margarine, shortening, and other solid fats. Should be avoided as much as possible (less than 1% of calories)
  • Cholesterol: Naturally found in animal foods and partially synthesized in our bodies

Pharmaceuticals

Contributors & Causes:  Ted Kyle RPh, MBA & Bonnie Kuehl, PhD, state drugs themself can often cause weight gain; alternatively you could be experiencing a side effect. Those side effects can be changes in your nutrition partitioning, increase in hunger, changes to glucose metabolism and insulin hormone, slower metabolism, shortness of breath or fatigue resulting in decrease activity and/or water retention.

Treatment Plan:

  • Work with doctor to optimize medication dosages
  • Adjust calorie and macronutrient intake to accommodate changes in metabolism and macronutrient utilization.
  • Moderate exercise

Education:

Here is a list of common drugs that can cause weight gain.  This information is adopted from Obesityaction.org

Maternal/Fetal programming

Contributors & Causes:  There is a hypothesis known as the barker hypothesis which was proposed in 1990 by the British epidemiologist David Barker (b. 1939) and states that “intrauterine growth retardation, low birth weight, and premature birth have a causal relationship to the origins of hypertension, coronary heart disease, and non-insulin-dependent diabetes, in middle age.”

Intrauterine, malnutrition, overnutrition, and undernutrition has been shown to play an impact on fetal programming, which set the stage for life long neuroendocrine and metabolic changes in adulthood.  The impact on adult metabolic disease and the implications for the prevention are complex. Fetal overnutrition due to an an overweight and overfed mother has a strong impact on the metabolic phenotype later in that child’s life.

Everything from your mother’s diet composition, her health, the pharmaceutical drugs that she consumed, to her hormones can influence a child’s genes and play a role in the life long

Treatment Plan:

  • Understanding the patient’s predisposition will aid in making changes to accomodate the patient’s personal genetics.  However, changing someone’s genetics is not yet possible. But through personalized nutrition, we may be able sway the body to do what we want.

Hormones

Contributors & Causes:  Hormone imbalances can occur for a variety of reasons which span across: physical abnormalities, drug interactions, sleep, stress, body fat, genetics.

Treatment Plan:

  • Hormone test
  • Doctor supervised hormone therapy
  • Nutrition plan that accommodates hampered metabolism
  • Create a calorie deficit. Moderate exercise program to increase calorie expenditure

Education:

At the end of the day, your hormones ultimately decide what happens to food once it hits your stomach.  Increase levels of stress, excess body fat , imbalances in the hypo pituitary axis and birth control are some of the reasons that we may need an exogenous intervention to re-establish a healthy metabolism.  Clinical research suggest that men with Metabolic Syndrome suffer from lower testosterone levels. Although the main role of stored fat is energy and insulation, fat tissues also produces hormones like leptin, estrogen, resisten and the cytokine TNFα. There is an inverse relationship between estrogen and testosterone.  Chronically elevated estrogen levels, lead to suppressed testosterone levels. Therefore, high levels of adipose tissue have an estrogenic effect; in both men and women. In women this can mean cancer risk, lower libido, autoimmunity ect. While in men this can mean lower libido, and a gamete of chronic disease. The problem is that metabolic syndrome is compounding, meaning the more fat you have the lower and lower your testosterone levels become.   Therefore, using Testosterone supplementation as a tool in both men and women can aid in regulating hormones and rebalancing of testosterone levels which aids in body fat loss, improves insulin sensitivity through muscle (anabolic) and elevates the metabolism.

Viruses

Contributors & Causes: There is growing data and research that supports a virus can change your body’s metabolism and nutritional partitioning.  The Adenovirus-36 (Adv36), a common cold virus, has be linked to obesity.   

Treatment Plan:

  • Test for the virus
  • If the patient is infected with Adv36, creating accommodating nutrition plan will be in order
  • Moderate exercise plan to increase calorie expenditure.

Education:

In 1995 researchers at the University of Wisconsin began experimenting with Adv36.  After introducing the virus to chickens and mice, they saw their body fat rise 50-150 percent. The researcher then replicated the study in monkeys and test obese humans for the disease. In every case, the monkey gain weight and became obese. And 30% of the 500 tested human obese subjects carried the virus.

Genetic Variants

Contributors & Causes:  Over the last 15 years we have mapped the human genome fully and come to understand that although genes play a role, their are not guarantees that you will become obese.  Choquet and Meyre (2011) stated in their research, “ recent discoveries in genetics have found that people differ in their perceptions of hunger and satiety on a genetic basis and that predisposed subgroups of the population may be particularly vulnerable to obesity in “obesogenic” societies with unlimited access to food.”

Treatment Plan:

  • Genetic Obesity testing
  • You cannot treat genes, but you can accommodate and adapt your diet, exercise and nutrition to accommodate genetic predispositions.

Education:

Genes provide core programming for our bodies.  Studies have compared populations of obese and non-obese people discovering that there are clear genetic differences such as someone’s desire to eat, activity, hunger and metabolism. Although genes play some role, they do not guarantee that you will become obese because obesity is a complex and multifaceted disease. Obesity involves both genetic and environmental causes.  Therefore, the best that you can do is understand your genes to the best of your ability and leverage that knowledge to optimize your diet for you personally.

 

In Strength, 

Samson Jagoras

References:

  1. Barker Hypothesis (2018)  Retrieved from: http://www.oxfordreference.com/view/10.1093/oi/authority.20110803095447459
  2. Behavior, environment, and genetic factors all have a role in causing people to be overweight and obese (August, 22, 2018) Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/genomics/resources/diseases/obesity/index.htm
  3. Ted Kyle, RPh, MBA, and Bonnie Kuehl, PhD (2018)Prescription Medications & Weight Gain. Retrieved from: https://www.obesityaction.org/community/article-library/prescription-medications-weight-gain
  4. Macronutrients (2018) Retrieved from: https://www.sciencelearn.org.nz/resources/534-macronutrients
  5. Richard Atkinson, MD (2018) Obesity Due to a Virus: How this changes the Game. Retrieved from: https://www.obesityaction.org/community/article-library/obesity-due-to-a-virus-how-this-changes-the-game/
  6. Week 3 Energy Balance Lecture (2018) Retrieved from: https://logan.instructure.com/courses/5387/files/670367?module_item_id=115640
  7. Week 4 Regulation Food Intake and Body Weight Lecture (2018) Retrieved from: https://logan.instructure.com/courses/5387/files/670370/download?wrap=1