After the recent New York Times article discussing The Biggest Loser contestants regaining much, if not all of their weight loss, I have had many of my patients asking why. First, the circumstances of the weight loss were unnatural. It consisted of extreme exercise, calorie restriction, and behind-the-scenes water restriction leading to extreme weight loss. Also, there was not much focus on why the participants had gained the weight in the first place.
Once ready and committed to a weight-loss goal, the next step is to properly understand the cause of the weight gain. For some, it may be straightforward lifestyle choices, and for others, it may be a bit more complicated, with hormonal and emotional imbalances or digestive issues.
Our metabolism is regulated by a long list of hormones that try to maintain balance in energy, heat generation, fuel, and stress. Both deficient and excess hormones can cause imbalances in our system that can lead to weight gain and other deleterious side effects.
The adrenal glands are considered to be the central gland. Sitting on top of the kidneys, they work with the thyroid, gonads, kidneys, and pancreas to modulate metabolism, blood sugar, blood pressure, sleep, and stress. The adrenal glands release a hormone called cortisol in response to stress. When chronically stressed, this hormone causes people to be stuck in a state called fight or flight. When in fight or flight, the body holds onto fat. This state can lead to imbalances with other associated organs.
We are emotional creatures. When we are happy, we celebrate with food. When we are sad, we grieve with food. Someone could have the best lifestyle program in the world, but if emotions take ahold, the program becomes extremely difficult to adhere to. This is where a holistic approach involving practices like meditation, exercise, and eating psychology coaching proves to be more successful. This element is probably the least emphasized and the most important.
Depression can be associated with low amounts of our happy neurotransmitter, serotonin. Typically, patients with low serotonin levels are more inclined to evening sugar cravings. Many do not even consider themselves depressed — some have chronic pain or sleep issues as signs of feeling low. The body needs serotonin to relax and rest at night, so the sugar cravings are its short-term compensation for a low serotonin level.
Chronic stress can also affect our digestion because it halts our body’s capacity to break down food into nutrients. When in a state of fight or flight, digestion takes a back seat to our getting out of harm’s way (even if the “harm” is simply our day-to-day concerns). We are what we eat, but even more so, we are what we absorb. If our body has an impaired ability to absorb nutrition from our food, we will get hunger signals. This is common in my patients with elevated appetites.
LACK OF STRUCTURE
The top red flag is when I ask patients to walk me through what they typically eat each day, and their response is, “it varies.” “It varies” is usually code for “I don’t really know what I eat.” As humans, we do really well with habit and structure. Our bodies depend on us for proper fuel at regular intervals throughout the day and they actually do better with a certain amount of monotony. This affords stability so we can focus on other areas of our lives. Depending on our goals, this structure doesn’t have to be absolutely strict, but there should be some boundaries.
As someone begins to lose weight and is on the endorphin high of the results, I frequently check in about other measurements of progress, including energy, athletic performance, pain, sleep, skin, digestion, and mood. We work together to understand the effect of food mentally, emotionally, and physically. Patients will actually notice these internal changes before noticing a weight change on the scale. By becoming connected with their internal states, they are far more likely to maintain the external representation of how they feel.
The single most important element a successful weight-loss regimen should offer is the ability to understand where you veered off track. Once you have a better understanding of that, you can self correct to avoid drifting further away from your weight-loss goals.