The Health Index
Being overweight (body mass index/BMI >25) and obesity (BMI >30) are significant contributors to chronic disease. Experts often talk about the “obesity epidemic” that affects not only an ever-increasing population of adults worldwide, but more and more children, too.
Being overweight and obesity play a role in most chronic diseases, most obviously so in heart disease, type 2 diabetes, hypertension and arthritis, but it is also known to contribute to sleep disturbances, liver disease, hormonal imbalances and even cancer. Most recently, excess weight has been listed as a predictor for a negative outcome of COVID-19. In women more than men, the desire to lose weight is often motivated by aesthetic reasons. Yet clearly the health of both sexes would benefit from reaching a healthy (BMI of 19-25) weight. But how to achieve it? The conventional advice is to “eat less and move more”.
Anyone who has ever tried to lose weight knows this and has tried it, but few succeed in the long-term. This is because – like almost everything in the human body – being overweight and obesity are complex conditions. There is more to weight management than a simple “calories in vs calories out” equation. A nutrition practitioner can not only help you identify areas of your diet that might have contributed to your weight, but also explore possible reasons why so far you have not been able to lose weight successfully, for example stress or a contributing health condition or hormone imbalance.
They will be able to develop a customised diet and lifestyle plan that works for you and coach you through its implementation. Unintended weight loss – or being too skinny – is a weight-related issue that is rarely talked about, although it is very common. Not everyone who is very thin chooses to be or has an eating disorder. It may be surprising to many that gaining weight is a lot harder for most than it is to lose it.
What causes weight gain?
Naturally slim people are often quick to judge, blaming the people affected by being overweight and obesity for not having enough willpower. And who can blame them if even in 2020 the WHO still writes on its website: “The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended.” This is what most people – including doctors and those affected – believe.
Yet there is no longer any doubt that the calorie equation does not work and that you cannot outrun a bad diet. Many experts now even believe that we overeat because we are overweight and obese – not the other way around. But why do more and more people become overweight? There is no doubt that there can be a genetic predisposition. However, as with all genes, that does not mean that the gene is expressed. Whether or not it is has a lot to do with what we eat, a child born to an obese mother is at a higher risk of a) having the gene and b) for it to be switched on at birth. Hormones play a significant role in weight. Insulin, cortisol, thyroid hormone, leptin, ghrelin and more all get involved. Insulin, the hormone that enables glucose to access body cells, is even often referred to as the “fat-storage hormone”.
Dietary carbohydrates are broken down into glucose in the process of digestion, i.e. they become sugar. Depending on what kind of carbohydrate food it is and how much of it was consumed, blood sugar levels rise a little or a lot as a result. Sugar in the bloodstream is damaging, so it needs to be removed as soon as possible, and this is what insulin does. Once the cells are saturated and there is no room for more, excess sugar gets converted into fat, which is stored in fat cells in the abdominal area. At the same time, insulin makes sure that fat does not escape from those fat cells. So, if your insulin levels are constantly or frequently high, it will be difficult to lose any fat.
Leptin is a hormone secreted from fat cells. It ought to tell our brain that we have eaten enough and should stop eating. The problem is that, just as cells can become insulin resistant if they are exposed to too much insulin, they can become leptin resistant if there is too much leptin. The message is then no longer received, and we won’t stop eating. As if that wasn’t enough, we live in an obesogenic environment, meaning we are surrounded by junk foods. Ultra-processed foods are designed to be very palatable.
The food industry invests a lot of money into research on how to make their products irresistible. Have you heard of the “bliss point”? That is a formula used by the food industry that uses the right combination of sugar, salt and fat to make junk taste “perfect”. Moreover, sugar, salt and fat trigger the release of dopamine in the brain. It is the same neurotransmitter that is stimulated by addictive substances, such as alcohol, nicotine and cocaine. Is it any wonder that we cannot resist?
With money poured into this kind of research and more again into the marketing of such products, what chance do we have? More recently, it has become apparent that the gut microbiota also affect weight. Although research is still ongoing, it is now known that certain gut bacteria promote weight gain, while others prevent it. Scientists are currently exploring which bacterial species are involved and what the mechanisms are.
Apart from these very good reasons why even formerly healthy people gain more and more weight, there are certain diseases and medical treatments that can lead to weight gain. If you have an underactive thyroid, weight comes on easily, but is hard to get rid of. If you are diabetic and have to inject insulin – the fat-storage hormone – weight gain is inevitable. Weight gain is a side effect of many drugs, including psychiatric medication and anti-depressants.
What causes underweight?
By this we mean underweight in people who have always been slim or even skinny, not people who suddenly lose weight for no reason. If this has happened to you it is important to see your GP as unexplained weight loss can be a symptom of serious illness and should be checked out. Again, genes play a crucial role here. A child born into a slim family is much more likely to remain slim than a child born to obese parents.
Twin studies have shown that even if twins are raised in two different families, their build remains similar to each other. Here, too, hormones, microbes, illness and certain medication affect weight, this time in the opposite way. People suffering from inflammatory bowel disease, irritable bowel syndrome or undiagnosed Coeliac disease cannot absorb nutrients properly and therefore do not gain weight.
How can a nutrition practitioner help?
A nutrition practitioner will ask questions about your overall health and health history, diet, lifestyle and exercise habits. They will look at your food diary to see where there may be room for improvement. Your nutrition practitioner may also recommend functional testing to assess your nutrition and hormone status, perhaps investigate the composition of your microbiome. They will then develop a customised diet, supplement and lifestyle plan for you.