I know some of you are still saying it: I’m fat and it’s all my fault. I want to begin by briefly explaining the underlying pathophysiology of weight gain and weight loss.

There are many hormones that control hunger, satiety, fat storage and breakdown. Many of these hormones become dysfunctional due to different reasons. Let’s start with ghrelin. Part of its role is to control the physical feeling of hunger. The problem is this peptide becomes dysfunctional in obesity. For example, in someone who is obese, ghrelin levels don’t decline after eating. Additionally, secretion of ghrelin increases with weight loss…the more weight we lose, the hungrier we get. We just can’t catch a break here! So, how do we overcome this? Our body is setting us up for failure, right?

Wrong! We are going to work on retraining our brain. Begin to practice assessing your hunger on a scale of one to ten when you sit down to your plate. Ask yourself, “how hungry am I?” Take note of how hungry you are and stop eating just before you feel full. This too, is going to take practice and patience!

Let’s talk about Glucagon-like peptide-1 (GLP-1). This peptide acts as our satiety hormone. Currently, there are drugs on the market that act as a GLP-1 agonist, meaning they promote satiety, decrease blood sugar levels and can even promote weight loss. These drugs are currently approved for the management of diabetes. The FDA just approved one for weight management, which is set to hit the market next month. This is a very exciting time for medical providers. We are gaining a deeper understanding of obesity as a disease. More drugs are being approved to help individuals manage their struggle with excess weight. We’re learning this can be a very difficult battle and treatment protocols must address obesity as a medical condition. In other words, we need to manage your weight medically, just as we would high blood pressure or elevated cholesterol levels.

Another very important point I would like to make revolves around your metabolism. Did you know as your weight decreases, your metabolism follows suit? What this means is to maintain your new lower weight, you need to eat even less and exercise more…just to maintain! Let me lay out some tangible numbers illustrated in a study done in 2011 by Schwartz A., et al. Your resting metabolism slows by 15 calories per day for every 2.2 pounds you lose. So, if you lose just 11 pounds, your metabolism will slow 75 calories per day. Because of this fact, I stress the importance of testing resting metabolic rates to my patients, especially at the end of the initial weight loss stage. Armed with the knowledge of your exact caloric need will help you succeed in maintaining your new weight and help guard against weight regain.

Remember: Be positive about yourself, practice your new skills, and be patient!

~Megan Vardeman, MPAS, PA-C

Photo Credit: Nueng Audok, 123RF