How do you manage obesity?

Obesity is not always, or not only, a question of diet

It's a fairly complex pathology, requiring treatment by a nutritional therapist (who will refer the person to a doctor if necessary, or work in collaboration with one).

Here's what I can say and recommend:

Weight alone is not enough to diagnose obesity. We also need to look at body mass index, which takes into account the ratio between weight and height; waist circumference; body composition in terms of fat, muscle and water; location of fat (the most problematic is abdominal, epicardial and perivascular fat, and the least problematic is subcutaneous fat); and even the color of fat (brown fat, which contains a lot of mitochondria and is used for heat production, is less problematic than white fat).

The causes of obesity include, of course, a bad diet, but also illnesses such as hypothyroidism, hyperinsulinism, hypercortisolism, and lack of growth hormones. There may also be a genetic cause, such as the mother herself being obese as a result of a bad diet, as changes in diet can lead to genetic changes that can be passed on to offspring. Other causes include fetal malnutrition, which leads to the development of a thrifty genotype that burns little fat. Endocrine disruptors can also alter metabolism.

In terms of risks, obesity can lead to cardiovascular disease, hypertension, diabetes (itself a risk factor for degenerative diseases), polycystic ovary syndrome and hence infertility, senile dementia, weakened immunity, etc. Clearly, we must try to treat it.

To treat obesity, I don't recommend a low-calorie diet, unless there's too much food intake. I talk about the difficulties and risks of such a diet in another article.

What I recommend is a series of measures that start with correcting the diet, towards a natural and diversified diet. When it comes to diet, I also recommend to:

  1. Ensure a high intake of fiber (vegetables, fruit, wholegrain cereals, etc.), as they play a fundamental role in regulating appetite (faster satiety), act as a prebiotic if soluble or fight constipation if insoluble, provide vitamins and minerals and produce short-chain fatty acids in the intestines, which increase insulin sensitivity. Watch out, if you come from a diet containing little or no fiber, you should increase your intake gradually to avoid bloating and flatulence.

  2. Care for the intestinal microbiota by consuming enough pre- and probiotics. The intestinal microbiota should also be restored (see the chapter on digestion) in cases of dysbiosis, after antibiotic treatment, diarrhea, or intestinal enema, particularly prior to colonoscopy[1]. Indeed, an unbalanced intestinal microbiota encourages weight gain and makes weight loss more difficult.

  3. Avoid fructose, except that naturally present in fruit, as it overloads the liver, reinforces insulin resistance, and is suspected of playing a role in intestinal calorie extraction. It is found in agave syrup, honey, sodas, and other processed foods.

  4. Not chase after dietary cholesterol, which has little influence on blood cholesterol, for all the reasons we've already discussed. What's more, recent studies have highlighted yet more positive roles for cholesterol (most of which is synthesized by our bodies, so let's forget about dietary cholesterol once and for all), notably in immunity, the formation of myelin sheaths surrounding the axons of neurons, and the functioning of serotonin receptors. It is increasingly recognized that the hunt for dietary cholesterol is counter-productive, as is the use of drugs that reduce its synthesis, such as statins. The only exceptions are in cases of excess oxidized cholesterol that is not treated by diet and lifestyle, and in cases of hypercholesterolemia of genetic origin.

  5. Fight inflammation, which in principle will be achieved by correcting the diet. Remember the anti-inflammatory properties of omega 3 and vitamin D. One also needs to avoid as far as possible all toxic substances, both in food and in other areas (textiles, cosmetics, cleaning products, air pollution, etc.).

  6. Avoid micronutrient deficiencies, which in principle will also be achieved by correcting the diet. Particularly unfavorable are deficiencies in vitamins B and D, iron, iodine, magnesium, and zinc, due to their contribution to various metabolic processes.

  7. Moderate glycemic indexes, for the reasons already explained and by following the advice given in the sections on carbohydrates and diabetes.

  8. Optimize serotonin production to avoid compulsive eating, by ensuring adequate intake or supplementation of vitamin B3 (which is otherwise synthesized by the body from tryptophan to the detriment of serotonin synthesis) and by eating a carbohydrate snack around 5 p.m. Inflammation is also detrimental to serotonin synthesis and should be reduced (avoid an inflammatory diet, aggressive cooking, chronic stress, etc.).

  9. Correct any recalcitrant hypothyroidism after correcting the diet.

  10. Reduce salt drastically, which in principle will be achieved by correcting the diet, because in addition to being inflammatory, salt increases intestinal glucose absorption.

  11. Adopt healthy eating habits:

    • ­ Chew well, eat calmly and with full awareness of your sensations. This will help you to perceive and take account of satiety, among other effects.

    • ­ Eat when you're hungry, and meet your other needs (break boredom, comfort yourself, etc.) in other ways. Of course, this is much easier said than done, and may require support from a nutritional therapist or psychotherapist.

The non-food measures I recommend are:

  1. ­ Physical exercise, which increases insulin sensitivity, browns white adipocytes, and reduces the production of cortisol (which increases appetite).

  2. ­ Stress management, as chronic stress increases cortisol production.

  3. ­ Avoidance of chronic sleep deprivation, as it also increases cortisol and insulin resistance, and increases the production of ghrelin, the hunger hormone.

To find out more, read these articles:

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