An Integrative and Functional Nutrition Approach to Obesity and Weight Management

In the USA, 41.9% of adults and 17% of children and adolescents are obese. Obesity is a chronic medical condition comprised of genetic, environmental factors, socioeconomic factors, psychological factors, and lifestyle choices and is associated with many other chronic diseases.

Obesity affects certain groups of people more than others with African American  adults having the highest prevalence of obesity at 49.9%, while Asian adults have the lowest prevalence at 16.1%. Age is also a significant factor in obesity, with the highest prevalence between 40-49 years old. It also has been noted that men and women with college degrees had lower obesity prevalence than those with less education.

Most notable is the relationship between obesity and food insecurity (typically seen in those experiencing poverty), which is a situation of being unable to get enough food due to insufficient resources or money. Many communities in the USA experience a "food desert" where no full-service supermarkets are readily available, making fast food and processed food the only affordable food options.

If obesity and weight management are something that you are struggling with, just know that there are many more risk factors at hand, other than diet and exercise, and many of which you can adjust when you have all of the integrative tools. Even a modest weight loss of 5-10% of your body weight is enough to reduce the risk factors of many other chronic diseases.

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What is Obesity?

Obesity is a common disease measured by excess body fat and weight. The most concerning issue of obesity is that it is a significant risk factor for many other diseases and health conditions, such as cardiovascular diseases, diabetes/metabolic diseases, high blood pressure, and even certain cancers.

Body Mass Index (BMI) is the standard measurement that healthcare practitioners use to screen for obesity in adults. BMI is a calculation based on a person's height and weight. See below for classifications:

The major issue with BMI is that it does not differentiate between lean body mass (i.e., muscle mass) and body fat mass. So, it is possible to have a high BMI yet a low body fat mass and vice versa.

One way to mitigate this issue is by measuring a person's waist circumference. Men with a waist circumference over 40 inches (102 centimeters) and women with a waist circumference over 35 inches (89 centimeters) have a higher risk of weight-related health problems, which is why health practitioners typically measure both BMI and waist circumference.

What Causes Obesity & Weight Gain?

In general, obesity and weight gain are caused by a combination of overeating and under-exercising. The energy that food gives us is measured in "calories." So, when too many calories are eaten and not enough calories are burned off, the resulting energy is stored as fat.

The conventional view is to stick within a daily caloric range, calculated by adding all the food calories and subtracting the calories burned via exercise. However, a more integrative viewpoint also ensures that the food's quality (i.e., nutritional value) is considered for overall health promotion rather than just the caloric number. For example, research shows that ultra-processed foods in the diet have more of an impact on weight gain than daily consumed calories - basically stating that not all calories are created equal when considering the effect on total health.

Dietary choices are critical when considering the root cause of obesity and weight gain. Poor nutritional choices would include:

• Eating large amounts of processed or fast food
• Drinking too much alcohol
• Drinking too many sugary drinks
• Eating out too much
• Eating larger portions than needed

Another implication of poor dietary choices is that many sugary or processed foods can spike blood sugar, which overtime can lead to insulin resistance, another root cause of weight gain and eventually obesity.

Certain foods also affect our body's robust regulatory pathways for weight gain. Findings from a study provided evidence that foods such as processed foods and soda harm these regulatory pathways leading to weight gain in the long term. However, foods like cheese or milk act neutrally on these regulatory pathways. Foods like vegetables, fruits, nuts, whole grains, and yogurt positively affect these regulatory pathways, resulting in weight loss and maintenance in the long term.

Lack of exercise or daily movement is also a leading cause of obesity. The CDC recommends 150 minutes of moderate-intensity aerobic exercise per week to maintain current weight. But, with 25% of adults in the USA physically inactive, 150 minutes or more per week may seem like a challenging goal for many.

Other Root Causes for Obesity and Weight Gain Include:

• Poor sleep, referring to either an insufficient amount of sleep or lacking quality of sleep. This is associated with difficulty in controlling appetite, which results in obesity. Also, being obese increases the risk of developing sleep disorders like obstructive sleep apnea, which further impairs sleep.
• Research on depression shows that it is predictive of developing obesity, and obesity also increases the risk of depression.
• Certain medical conditions may contribute to weight gain and obesity. Two examples are hypothyroidism (underactive thyroid gland) and Cushing's syndrome (a rare condition where there is an over-production of steroid hormones).
• Some medications, such as corticosteroids, diabetes medications, epilepsy medications, antidepressants, and medications for schizophrenia, can all contribute to weight gain and obesity.
• Genetics plays a crucial role in predisposing individuals to obesity. It may contribute to up to 70% risk for the disease.
• Chemical toxins may also play a role in the obesity epidemic since there is evidence that low concentrations of some chemicals have powerful weight-promoting actions.

Functional Medicine Labs to Test for Root Cause of Obesity and Weight Gain

Since there are many potential root causes of obesity, there are, luckily, several helpful functional medicine labs to help take a closer look at the potential culprits.

The DNA Diet test by dnalife is a genetic test that can help individualize diet and lifestyle recommendations for weight management by assessing specific weight/obesity genes. This test would help evaluate genetics as well as help guide dietary recommendations that work with your genes instead of against them.

Because insulin resistance is a root cause of obesity, it should also be evaluated. Fasting Insulin and Fasting Glucose by Access Med Labs in combination can assess how the body is reacting to blood sugar/glucose, and can indicate if insulin resistance is already occurring. An HbA1c marker, as offered by Ayumetrix, is also useful to evaluate average glucose levels over a period of about 2-3 months.

To assess poor sleep, conventionally, a sleep study would be done to evaluate if there is a sleep problem and what the exact problem is. Occasionally there is a hormonal reason for poor sleep.

Attending annual physical exams and getting routine yearly bloodwork is essential for detecting any underlying medical conditions contributing to weight gain and obesity. This is the best initial step to take. Although hypothyroidism is routinely screened in bloodwork via the TSH marker, it could still be useful to assess the thyroid further since this condition is quite common and a known risk factor for weight gain and obesity.

If chemical toxin exposures are suspected of playing a role in your obesity, the GPL-TOX test by Great Plains Laboratory gives a comprehensive screening for 173 environmental toxins.  

Conventional Treatment for Obesity and Weight Loss

The most common conventional treatments for obesity and weight loss, outside of diet and exercise recommendations, are:

• Weight loss medications, which are intended to be used alongside diet, exercise, and behavior changes, not instead of them. The most commonly prescribed choices are Bupropion-naltrexone (Contrave), Liraglutide (Saxenda), Orlistat (Alli, Xenical), and Phentermine-topiramate (Qsymia). They may not work for everyone, and it is possible to regain much or all of the lost weight after stopping these types of medications.
• Endoscopic procedures can alter and limit the space in the stomach without requiring incisions in the skin. Some examples are an endoscopic sleeve gastroplasty (stitches in the stomach to decrease size) and an intragastric balloon (small water balloon in the stomach to decrease free space).
• Weight loss surgery (bariatric surgery) can limit the amount of food that can comfortably fit in the stomach. However, there is a known risk of nutritional and vitamin deficiencies associated with these procedures.
• Other miscellaneous treatment options include hydrogels (edible capsules that absorb water and enlarge the stomach to help stimulate the sensation of fullness), vagal nerve blockade (an implanted device under the skin that sends intermittent electrical pulses to the vagus nerve to signal to the brain that the stomach is full), and a gastric aspirate (a tube through the abdomen that drains some of the stomach contents after each meal)

An Integrative Approach to Obesity and Weight Loss

An integrative approach to weight loss includes the conventional wisdom of diet and exercise but goes a step further to individualize a custom plan based on many risk factors of obesity.

There are a lot of diet choices out there, and many have been researched in terms of efficacy for long-term weight loss and weight management. Of the studied diets (hypocaloric diet, low-fat, low-carb, Mediterranean Diet, high protein, formula diets, and intermittent diets), research is still unable to identify one diet that works the best for all people. All of the mentioned diets have both pros and cons. However, there are certain dietary principles that can be deduced from this research. A healthy diet with the greatest chance of helping to maintain weight has variety and consists of vegetables, fruits, high-quality proteins, and whole grains. It is also low in added sugar, refined grains, and highly-processed foods.  

Blood sugar stabilization is important to maintain healthy glucose and insulin levels and to reduce the likelihood of insulin resistance. A lower carb whole foods diet is a great way to maintain healthy blood sugar and aligns with the general dietary guidelines for obesity as well.

Results from the DNA Diet test can add an individualized touch regarding diet. While there is no perfect diet for all, there may be an optimal diet for you and your body.

Exercise should also be tailored to your abilities and should take into consideration any other present medical conditions that may interfere with the recommended 150 weekly minutes of aerobic activity.

Sleep optimization is important since poor sleep quality is associated with obesity. Sleep hygiene schedules, proper micronutrient status, and balancing hormone/neurotransmitter imbalances are imperative for healthy sleep.

A gentle detox may be indicated if environmental toxins are playing a role in your obesity. Please use caution when detoxing and work with a knowledgeable practitioner who can guide you on best practices.  

Seeking therapy or counseling is helpful and important in maintaining weight loss in the long term.

If your thyroid is suboptimal, you will want to work with a functional medicine practitioner to optimize thyroid function. A positive side effect of healing your thyroid would be healthy weight loss. If you have other known or suspected medical conditions, a full workup by your physician is indicated.

If you are taking any medications causing weight gain, speak with your prescribing physician about possible alternatives. *Please do not ever stop taking medications without the supervision of your prescribing physician.

Summary

Obesity is a chronic medical condition and a risk factor for several other chronic medical conditions. Diet choices and exercise play a significant role in obesity and weight management and should be at the core of an initial treatment plan. However, many more risk factors play a part, and all of them should be considered when understanding the root cause of obesity and weight gain to treat them best.

Integrative medicine is the best of two worlds - the conventional and complementary/alternative medical worlds. It considers all of the recommendations from conventional medicine and utilizes the benefits of functional medicine labs to dig deeper and assess the root causes at play. Obesity is a national epidemic and a serious health concern. But if diet and exercise alone have not been successful, seek care from a functional medicine or integrative provider who can help.