5 Ideas That Will Change The Way You Approach Weight Loss, From A Doctor
Every year, “lose the weight” is the #1 resolution for Americans. But many never reach that goal, and the obesity rate continues to rise in the U.S. So what’s wrong? How can we treat weight mangagement affordably and sustainably?
1. Obesity is a disease, and it’s not your sole responsibility.
With the already-high rate of obesity continuing to grow within the U.S., we have to take a look at the way our healthcare system approaches weight management. And at this point, it’s pretty clear we’re not doing a great job at it.
One study addressed the barriers to weight management—from the physician’s side and the patient’s side. The thing that struck me the most from that data was that 65% of patients that were obese thought that obesity was a disease, but of those patients, 82% thought it was their sole responsibility to solve.
So, patients know it’s disease, but they think it’s their own problem. But what other chronic disease do people feel like they have to solve all on their own? If those 65% of people were diagnosed with cancer, would they feel it was their own responsibility? Would they be Googling blogs and asking their neighbor how to treat their cancer? Of course not.
That just goes to show that somehow there’s a disconnect. And I hope that this post is at least a start in the right direction for that 82% to start seeking care and find the best place and way to do so.
Dr. Cassandra Wertz
Obesity Medicine Physician
Inquire with Dr. Wertz—Houston-based physcian offering in-person and virtual services for a fixed monthly membership fee. From individuals to businesses, find a memership that works for you at First Primary Care.
2. Obesity is more than just “eat less and exercise more”
Obesity is chronic, replapsing disease (like hypertension or diabetes), but we haven’t treated it as such. We know it is associated with big health risks like diabetes, hypertension, liver disease, cancers, and increased mortality. All the bad stuff
But what happens typically when patients have gone and asked for help from the healthcare provider? They get told to “lose weight.” And if somebody is bold enough to say “how?” They get told to maybe eat less and exercise more.
Surely, I would understand being frustrated if you were told that. I got frustrated as the physician when I didn’t know what else to tell people. I knew how important it was that people lost weight to avoid all those bad health consequences. So I went off to get some more education, and thank goodness there is more that we know and can do.
Here’s what we know:
- Obesity is disease
- It’s chronic
- It’s progressive. Most adults are gaining weight every year.
- The brain likes to hold onto weight
- Multifactorial disease (meaning it comes from a lot of places)
“The mantra is: “calories in, calories out,” but it’s not that simple. The human body doesn’t just boil down to one single math equation.”
– DR. WERTZ
What does obesity actually boil down to?
- What you eat
- How much you eat
- How you eat
- When you eat
- Physcial Activity
- How active you are
- What activity you do
- Environmental Factors
- Things that happen during pregnancy and early childhood
There are many different factors that can be impacting someone’s weight, and as you can see from the partial list above, there are many things that are outside a person’s control. So now that we understand that obesity is not just a behavioral disease, how we can treat the factors outside of our control?
3. When fighting your brain and gut, be strategic. Work smarter, not harder.
Let’s envision a game of tug-of-war. You’re on one side of the rope; your brain and your gut are on the other side. You have decided that you want to lose weight, so you’re gonna cut calories and start going to the gym. You’ve got your calculator or app where you’re logging calories and activities, and it tells you how much weight you should be losing.
When you’re first playing this game, you’re losing the weight and you’re happy. Then all of sudden, you’re not losing weight anymore. What’s happening? But you keep doing the same thing, and now the number on the scale is going up. The insanity!
Well, you’re losing the tug-of-war. Your brain and your gut are defeating you. And that is called metabolic adaptation.
As your system senses the calorie intake going down, it revolts. It decides that it’s going to do everything it can to try to power up to bring more calories in
This causes your gut hormones to change. Your hunger hormone goes up. Validation—you really do feel more hungry when you’re on that diet. Your satiety and satiation hormones, the hormones that say you’re full, go down. And then your resting metabolic rate goes down. So there’s the calories we can control, like when we go to the gym, but all of us burn calories at rest so that our bodies can do the normal things they’re supposed to do. Those calories are controlled by your brain.
When your brain senses you’re losing calories and weight, it thinks it’s going to starve to death. So it shuts some of that down, causing you to no longer lose weight even though you’re doing everything right. So what do you do? Cut the calories a little bit more? Hit the gym a little harder? Sooner or later, that becomes unsustainable and frustrating.
We have to be clever and work hard in different ways to try and overcome this metabolic adaptation. So, go back to the list—are you thinking of everything on there? It’s not just calories, it’s all of nutrition. And it’s not just that you’re putting out calories by being on the treadmill. How are you sleeping? Is there a mood disorder to consider?
Talking to your doctor can help you pinpoint what you’re missing from the list, how to fix it, and when to consider medication.
4. Weight loss drugs can’t fix you, but they sure can be necessary
Some people are immediately put off when we start to talk about anti-obesity medicine. And it’s probably not for a fair reason.
There’s a lot of criticism surrounding anti-obesity medicine, but my favorite is “They don’t really work. Once you stop taking them, you’ll regain your weight.”
While that might be true for some scenerios, I still ask—what other chronic conditions do the pills fix you? If you have hypertension, another chronic condition, the pills you take don’t fix you. They just control the disease.
If someone is diagnosed with high blood pressure, and lifestyle changes are working, we prescribe medicine. Then, when the patient comes back in and the blood pressure is controlled, do we say ‘Oh, great, it’s better. Stop the medicine. You’ll be okay”? No! We say “it’s controlled. Keep taking your medicine. It’s working.”
With weight loss medicines it’s the same thing. If the medicines are helping you, they’re doing what they’re supposed to do. It’s the same thing; we just treat it differently. We have this different mindset when it comes to obesity medicines—it’s just bias.
We have different classes for obesity medicine:
- Ones that help with hunger
- Ones that help with different eating issues (like emotional eating)
- Ones that help with satiety
The medicines are good, but of course all medicines have risk. So it’s important that you have a conversation with your doctor and think about those things. There are contraindications where one medicine may not be good for a patient based on their medical history. But overall, the medicines are helpful.
We only need a relatively small percentage of weight loss (5-10%) to make a big difference, in terms of medical issues.
Considering that, the medicines can definitely be helpful in getting there.
5. Get a doctor you can have consistent, direct communication with
The First Primary Care model is a quite a bit different than you’re used to (in all the best ways, trust me).
Typically, the first visit is a long one. And no, none of that time is waiting around for your doctor to show up. The visit entirely spent having one-on-one time establishing a relationship with your care team. You’ll talk everything from medical history, habits, hobbies, family, and treatment plans.
From there, you and your care team will make a plan personalized to your specific health needs, wants, and nutrition/fitness goals.
When the visit ends, the care doesn’t. There will be frequent follow-ups to ensure you’re getting all your questions answered. You are not in this alone! First Primary Care utilizes a secure app to make messaging, calling, and scheduling as easy as possible.
Most importantly, at FPC we focus on your longterm health. We’ll adjust as we go, try medications as needed, help you through all the stages of life from pregnancy to emergencies to just everyday concerns.
It’s like nothing you’ve experienced before. Let’s get you started at the link below.