The Power of Sleep

Consider this story, Anna is in her mid 40’s and has been living with obesity for most of her adult life. Her weight has however been stable for about 10 years and she is very happy where she’s at. One day Anna wakes up in the middle of the night in a panic, she dreamed she stopped breathing and it felt very real. The next day the same thing happens and it continues to happen frequently. Anna starts losing sleep, even being afraid of falling asleep which causes immense stress. When she wakes up in the middle of the night stressed and panicked she decides to make herself feel better by eating a snack, usually a bowl of chip or ice cream. After about 1 year of this Anna has gained 30 pounds. Some of you might have guessed, Anna has developed sleep apnea.

This story happens often and demonstrate the power of sleep and stress on our weight. To focus on how sleep affects our behavior towards food here is another story; Peter was diagnosed with sleep apnea about 1 year ago but does not wear the machine at night because it’s uncomfortable. He does not wake up in the middle of the night to eat like Anna did and is not stressed about his disease. He is however very tired because despite not being stressed he still wakes up often during his sleep cycles which leads to overall poor sleep. During the day Peter notices he craves calorie dense foods more and more. He also finds he just can’t resist eating the highly palatable items when they are offered to him or will seek them out a lot more frequently. Prior to his issues with sleep his weight had also been stable but he now has gained 40 pounds in 6 months.

Lack of sleep increases your chances of weight gain.

Both Anna and Peter’s story are fictional but based off true event. The drastic weight gain that can happens with poor sleep is real. The weight gain will be more pronounced if you go from being a good sleeper to a very bad one. You might not notice it as much if you’ve always been a bad sleeper, meaning you’ve lived off very few hours of sleep most of your life. However developing good sleep habits might help you lose weight. Why is sleep so influential on our waist line? Lack of sleep in our brain translate to seeking out more high fat, high sugar items. It acts in a similar way as when we go in starvation mode (although the exact mechanism is different). It is also harder for us to think long term and stick with our health goals. We feel tired and we don’t want to fight with ourselves or our instant want, translating to saying yes to unhealthy food more often.

It’s important to note there is no one size fits all when it comes to sleep, some people need slightly less than others. However the average is around 8 hours of sleep per night, when we go at 6 or below is when we start seeing impacts. It can be challenging to get enough sleep in today’s world with all our technology and light. The light from our devices like TV and cell phone trick our brain in thinking it’s day time, making us stay up longer. If possible try limiting the amount of device you have in your bedroom. You can also download blue light filter apps, that way the light emitted doesn’t mimic the sun’s light. Another thing to consider is your caffeine intake, caffeine can have a devastating effect on our sleep quality especially if consumed later in the day. If you find yourself laying in bed unable to sleep, try meditating. When were unable to sleep at night it’s often linked with stress which meditating can help with. If you’re not quite sure how to meditate try an app or even a yoga class. Many night time yoga classes are more calming and include more meditation, look for a yin yoga class.

The Set Point Theory

The set point theory refers to the idea of our weight being predetermined by our body. In other words our body has it’s own weight it tries to achieve and maintain regardless of our own personal goals. More research is needed to fully understand how our body determines it’s set point. However most agree it is a mix of genetics and environmental factors.

Our set point is also much better at increasing than decreasing, which is why it is greatly influenced by our environment. In the America of today we are surrounded by delicious calorie dense items, driving down almost any road we will either see multiple restaurant/fast food or see advertising signs for them. The interaction of our genetically acquired want of calorie dense foods and our environment makes a deadly combination. Research does show we protect ourselves against weight gain to some extent, for example feeling of fullness after eating. What our body did not evolve to protect us against is our brains reaction to highly palatable (high sugar, high fat items). The result; when we eat highly palatable food we activate circuits in our brain making us want to overeat which often leads to ignoring our feeling of fullness.

After overeating our bodies will generally respond by making us feel fuller for longer, trying to protect the set point. This reaction varies from one person to the next depending on your genetics. Therefor, once again we become at the mercy of our genetics and environment. How many times have we eaten something despite being overly full and using phrases like “I’m so full I think I’m gonna bust”. The mechanism we developed to protect against weight gain are not strong enough to fight the ones we developed to protect weight loss. Mainly because for millions of years weight gain was not an issue, unless genetic mutations were present.

As mentioned above our set point increases as we gain weight. When the holiday season starts at thanksgiving followed by Christmas and we attend multiple family dinners overeating at most of them, we are increasing our set points. We often tell ourselves “I’ll work it off after the holidays” but the set point theory makes sustainable weight loss challenging. There is even research indicating most of the weight people gain yearly is around the holiday season. The lower we get from our setpoint (the more weight we lose) the more our brain will try to make us want highly palatable food on top of the ever present want. There’s an analogy that says “trying to maintain drastic weight loss is like trying to hold your breath, eventually your body will take over and you will have to breath”.

This all sounds pretty discouraging, there is some actions we can take to decrease our set point. However the results vary from one person to the next, there is no one size fits all. Research has demonstrated a less palatable diet might help to decrease our set point. A less palatable diet does not mean bad or bland, it refers to keeping your food choices simple. Eating meat without adding butter or salt but rather herbs. Doing the same with fruits, vegetables, nuts and legumes. Eating a sufficient amount of fiber has also been linked to a decrease in set point as well as exercise. That being said if you eat at a fast food or restaurant daily and try to cook with no salt at all you might not find it very tasty. The trick is to be patient with yourself and your taste buds, they will adjust to the less intense flavors over time. These suggestions are not one size fits all and may not help you avoid weight regain. Despite of weight, eating simple high fiber meals and exercising will improve your health. Which is why when thinking about losing weight or making lifestyle changes we should primarily focus on our health.

Food Addiction or Food Craving

Food addiction remains a controversial subject amongst scientist. After all, how can we be addicted to something essential to our survival. Some research does show it is possible for some of us to become addicted to food. This is most likely possible because the food we eat today is highly processed and packed with sugar or fat in amounts we could not consume when our body evolved. However most of us don’t become addicted to food, we do crave calorie dense products because those items used to be hard to come by.

The neuroscientist Stephan J Guyenet Ph.D. in his book The Hungry Brain explains how decisions in regards to food are done nonconsciously via reward circuits in our brain. When our body evolved, one of our biggest threat was starvation therefor we are programed to seek out calorie dense foods such as high sugar or high fat. When we do find and eat those items we get highly rewarded, it makes us feel good. That reward is what makes us go back to those items even when we know they are bad for our health. We also don’t get rewarded for eating nutrient dense foods like broccoli. Our ancestors had a diverse diet and nutrient deficiencies were not a common occurrence. There wasn’t a need to reward nutrient intake. The decision to seek out food starts nonconsciously, we get hungry, we need to eat. Via reward circuits our brain has to decide what is the best course of action to satisfy the hunger. Yes the balanced home made meal would be better for our health but our nonconscious circuits doesn’t think rationally. They respond to reward and the calorie dense meal will offer the best reward so our brain pushes us to make that decision.

Most of you have experienced the fight with yourself described above. You want to make home made meals but there are too many steps to get there. You would have to go do groceries, prepare everything and then cook it. When you fight against hunger and your cravings, you’re fighting the evolution process not yourself personally. There’s no cure for cravings or hunger, but being aware of the process our brain goes through can help us understand them better. When we get intense cravings it’s usually because we let ourselves get too hungry, maybe by cutting back on our calories too drastically or skipping out on a meal. This is why a little planning can go a long way. Make sure the right foods are easily available and ready when you need them so your brain doesn’t think the restaurant down the street is the best option. Try not to skip meals so you don’t get overly hungry. Avoid triggers like smells, when taking a walk try to avoid passing bakeries or any other favorite restaurant of yours. All in all, when you do feel intense cravings, don’t blame yourself. Enjoy your meal and when you’re done think about how you can avoid having those intense cravings tomorrow.

Obesity Stigma and bias

We live in an obesogenic environment, the CDC report from 2017-2018 indicated 42.5% of adult Americans live with obesity. If we include adults who are overweight and living with obesity, we are at 73.6% of the population. Yet when looking around at our world, things like airplane seats, waiting room chairs, desk job or cubicle areas, they are all designed for small people. Almost half of Americans require or would be more comfortable in larger chairs, larger cubicles, larger sidewalks. Why doesn’t our environment reflect our needs? Obesity bias as defined by the OAC is negative attitudes, beliefs, judgement, stereotypes and discriminatory acts aimed at people because of their weight.

We don’t always see or recognize the subtle bias but it affects us regardless. Imagine your perfect job, suppose this job is in the downtown of a very large city. All the surrounding apartments and houses are out of your price range. The job does not come with parking, your parking option is a parking garage that charges 40$ daily. Another option is public transport and is much more affordable. The problem? Public transport is not built for larger bodies. It can be very uncomfortable and a source of stress, especially if the bus or train is packed and other passenger express hurtful comments because you’re taking up “too much room”. When this happens too often we blame ourselves, we think it’s our fault.

Public Transports are not built for larger bodies.

We should not take responsibility for the lack of adaptation from our environment. After all every year they make bigger and bigger cars, why can’t they adapt the rest? Obesity stigma is a big issue, every time we feel the world isn’t made for us because of our size is an example of it. The fastest way to stop it is by speaking up, demand to get what you need to be comfortable. Having obesity is not your fault, nobody would blame someone for developing cancer, they should not blame you for developing obesity. Don’t feel like you’re on your own, remember back in 2018 42.5% of American were living with obesity and we know it’s trending upwards. If you’re looking for support and a community check out the obesity action coalition!

Diets Don’t Work

About 45 million Americans start a new diet each year, for 95% of them the diet will fail. If you’re one of the 42 million in this situation understand you did not fail but the diet itself failed you. Most diet promises rapid weight loss using drastic measures. In our motivation we often fail to see how the drastic approach of the diet requirements are unrealistic for most of us. More importantly, it does not account for our bodies adaptation to weight loss. Evidently, the average time someone follows their new diet is about 1-3 months. This is also the time it takes most of our bodies weight loss adaptation to truly kick in. Diets fail people because they have a one size fits all approach, which does not work for the complexity of obesity. It was recently said “we always praise the miracle of a diet when it works but when it fails it somehow becomes our fault”. I found this statement very insightful, if we glorify a diet when it works we should also shame it when it fails, not ourselves. The other danger of dieting is the harm it can cause, most people have heard of the effects of yo-yo dieting.

When someone goes from one restrictive diet to the next it really damages our metabolism. In the end the person will require very little calories to maintain their current weight and be very hungry due to hormonal changes. When our body thinks we’re starving (with drastic weight loss) it will increase the production of ghrelin making you more hungry. It will also decrease the production of leptin, making you feel less full. These changes in hormones don’t go back to normal after you stop the diet. Your body will also become more efficient, your muscle will learn to utilize less calories to perform the same tasks. In the end, if you go back to how you were eating before the diet, you will be more hungry and more efficient. This has the potential to cause weight gain past your original starting point.

Now it’s not all doom and gloom, there is a way to better our health and lose some weight. It will not however happen overnight or in a few months. Sustainable weight loss is achieved through life long behavior and food habit changes. It is very hard and challenging, food is such an integral part of our life and it’s everywhere. The key word is lifelong, any change you make must be permanent for the health benefit such as weight loss to be maintained. To be completely honest, for some who’s body adaptation to weight loss might be very strong, you may transform yourself and have amazing eating habits and exercise regime but will never achieve your desired weight goal. Research indicates sustainable long term weight loss via food and behavior change alone is about 3-5% of the person’s original body weight. Keep in mind most people as they implement change will lose more weight, but in the long run they will most likely gain some back. You might feel 3-5% seems like a very low number, this represents how multi factorial obesity is, it is not about eating less and moving more.

Focusing on health is such a crucial approach, you should be proud of every change you make. Even small changes make big impact on our health, research indicates 5-10% weight loss has amazing health benefits. Always celebrate your victories, even if you make changes and don’t lose weight or only lose a few pounds that’s still an accomplishment. You still improved your health via behavior change; you might be feeling more energized or you might be sleeping better. Also look back at the past years, had you been slowly gaining weight? In that case weight maintenance is a step in the right direction. Most of us seek rapid result, the sad truth is weight loss and health improvement does not work that way. Look back on your life, you’ll see that all great things are earned through patience. For example; you have to wait months to meet your baby and that’s if you got pregnant right away! Most of us search for decades to find our husband/wife. Approach health with that same mentality, it will be hard, there will be heartache, it’ll be worth it in the end. Most of all if you rush into it you might end up with some regrets.

Treatment for obesity such as pharmacotherapy or bariatric surgery are often seen as an easy solution. This is wrong, both those approach are very difficult and still require lifelong lifestyle changes. Both come with many side effects that can be life threatening but they can also be life saving. If you feel you’ve done all you can with behavior and food habit changes but are still concern for your health. These might be great options for you, ask your doctor about it. Don’t be ashamed, you did not fail, obesity is a complex chronic disease and you should be proud to have the courage to seek out treatment to improve your health.

Will a Dog Help Me Exercise?

Dogs are great pets but they also come with a lot of responsibility. Often people think having a dog will encourage them to go out for a walk. For some this might work, after all you will need to walk your dog especially if you have no backyard. Unfortunately, the people this usually works for, are the people who already enjoy walking. A dog will not change who you are, if you don’t enjoy walking you probably wont end up walking your dog everyday. This situation can even become sad, either the dog might develop obesity or you will resent your dog for all the responsibility it comes with.

If you do like walking and a dog might be the little extra motivation you need, try babysitting one. Dogs are very popular pets and many dog owners would love to have someone offer to watch their babies over the weekend or even for a full week. This will give them an opportunity for a trip without having to worry about boarding or babysitting costs, after all you’d be offering to watch for free. It would also allow you to see how dogs can demand a lot more out of us than what we might originally think. Another great way to find out if a dog is right for you is by fostering. Shelters are always looking for more people to foster pets before they find their forever home. You can even foster dogs for months before they get adopted, this would really allow you to get the feeling of what it’s like to care for a fur baby without the full commitment.

“Best friends are earned not bought”

Puppies are definitely hard to resist, especially if you’re looking at shelters, we all want to adopt them all. They also require the most work and attention, did you know most puppies are not able to hold their bladder for more than 3 hours. This can be challenging while working a full time job. They also require to be socialized to prevent unwanted behavior issues later on in life, have you looked for a dog park in your area? Most puppies will also go through a chewing phase also known as teething. In many ways a brand new puppy is just like having a small child. They will need to be thought how to use the bathroom (asking for the door), they will need to be fed multiples times a day and they will demand lots of attention. Keep in mind leaving a bowl of food filled up at all times does not work for every dog. This action can lead to your dog developing obesity. If this sounds overwhelming but you would still love a fur baby, consider adopting an older dog. Even a 1 year old would most likely already be housed trained and done with the teething phase, although some dogs are never quite done.

During covid-19 many decided to adopt a dog craving companionship while isolated. Dogs are great companions, treat them with love and respect, you will have a best friend. They can comfort us when we’re feeling lonely. They also require nurturing and respect, they are probably not your solution to commit to exercising but they may fill you up with joy. Before making the big decision, make sure you want a pet for the right reasons and make sure you will be able to give it the life it deserves.

Do I Have to be Sweating?

No, no and no! Too often we associate exercising with the image of being miserable running on a treadmill or any other cardio machine of our nightmares. I’ve often heard I don’t mind exercising I just hate sweating, especially in public places like a gym. The answer is simple, if gyms or other traditional workout place make you uncomfortable, don’t go. Exercising does not mean you have to be dripping sweat, you don’t even have to sweat at all.

The important thing when you’re considering incorporating exercise into your life is to keep yourself in mind. It’s easy to get extra motivated about a new resolution you’ve just made and want to jump all in. Just make sure when the excitement of the new fades you will still be happy with what exercise you’ve chosen and able to keep it up. Instead of jumping 100% in, take a step back and think about your life. Specifically think about how much time you have to dedicate, what do you enjoy doing, what will feel like your just doing an activity that makes you feel good vs a chore you feel you have to do.

Staying true to yourself is challenging but 100% worth it.

Most of us has tried an exercise regime in the past, if it failed explore why? If you enjoy going to a gym was it because you had a hard time motivating yourself or weren’t quite sure what to do? Try hiring help like a physical therapist or a personal trainer. If you were having a hard time getting to the gym try finding a YouTube channel offering home workout videos. If it failed because you were not enjoying the activity than try something completely different. It could even be a new sport you’ve never tried before. The most important is to find an activity you will look forward to. If you have a dog, but don’t enjoy walking, try taking him/her to a dog park and play fetch. This might not seem like much but it is exercise, you will have to bend down, throw the ball and yes sometimes walk to the ball when your best friend forgets to bring it back.

Never forget to take time in consideration, it is probably the number 1 reason why most of us fail to exercise. One comment that comes back is “I’m not a morning person and working out at night wakes me up too much I have a hard time falling asleep afterwards”. If this is you an exercise plan that’s less intense might be the solution. Something like yoga can be very calming, there are many different types of yoga, make sure to do your research before signing up for a class. If you have a hectic schedule and really have no time, how about a short walk on your lunch break at work? Walking is a great way to calm our mind and exercise without sweating a drop, unless it’s boiling hot outside!

Whatever it is, only you can figure this one out! Before jumping in 100% think back about why past attempts failed. This reason might not be obvious at first but dig deep. After you’ve figured out what doesn’t work, it will be much easier to eliminate some activities and find out what will. Most of all don’t be afraid to try something new!

I’m Living with Obesity, Should I Lose Weight?

This might not appear to be so at first but it is a very personal question. The obesity epidemic has made it to easy for health care professionals to talk about someone’s weight. We have to remember, not every one wants to or is ready to lose weight. Being told by someone else how to manage our body can be very stressful and frustrating. Stress has been linked to cause an increase in weight gain, therefor by imposing our treatment ideas on people we might be making the problem worse. As a patient, someone should always ask your permission before discussing your weight.

The idea of weight loss in itself can cause anxiety, some people try their whole teenage and adult life to lose weight with minimal or no success. When someone in this situation gets told to lose weight it becomes very disheartening especially if it’s introduced as their way to improve their health. If you’re in this situation and are interested in weight loss; instead of focusing on weight loss itself focus on why you are exploring the idea. If it’s out of concern for you’re health focus on that instead. For example, if you were newly diagnosed with type 2 diabetes, discover how you can manage your diabetes with food or behavior changes. Chances are by making some changes to improve your diabetes management you will end up losing some weight. By changing the focus of things we sometimes make it easier. You might also end up not losing weight, which is also okay because you will still have improved your health by improving your diabetes management. If you never wanted to explore weight loss, make it known you’re not interested to who ever suggested the idea. Change is hard, it’s hardest when it’s not wanted.

If you’re considering losing weight for health benefit remember a weight reduction of 5-10% of your body weight is sufficient. Research has proven it multiple times over, no drastic weight loss is needed. In fact, considering what we know about our body adaptation and weight regain a small weight loss could be the best option. For you, weight loss might even be just not gaining any weight. If you’re currently in a phase where you’ve been consistently gaining, a great approach could be to try to maintain. The motivation and want to lose weight should come from yourself, nobody should tell you how to manage your body.

Most of all, remember you’re not alone! If you’re unsure about what to do to better your health, reach out to a healthcare provider whether it be a dietitian, doctor, behaviorist or any one else. There is a growing community dedicated to helping people who are living with obesity, take advantage of it!

Should I make a smoothie?

Smoothies come in and out of popularity throughout the years and are known to be healthy. Many companies such as Jamba Juice or Smoothie King specializes in making delicious variations of flavors. Most often smoothies are a healthy choice, however there are things to consider especially if you’re not making it yourself.

When buying a smoothie make sure to pay attention to the calorie and portion size. Some of the smoothies offered at places like Smoothie King have over 1000 calories per serving. Sometimes the calories might seem reasonable but the portion size is very small. Always keep in mind, smoothies are liquid and will be digested faster than whole foods. This means you will start feeling hungry again earlier in the day.

Consider your appetite and eating habit, for example if you’re someone who is always hungry smoothies might not leave you satisfy. This will vary depending on what you put in it but generally speaking because of it’s liquid form it will be digested faster. On the other hand, if you’re someone who struggles to eat breakfast because you don’t have time or don’t feel very hungry in the morning, smoothies might be ideal for you. They can also make great snacks, again be careful not to overload them with calories. To help guide you in making healthy smoothies ask yourself this; would I eat everything I’m putting in the blender in one sitting? If the answer is yes than you’re good, if no rethink your ingredients. Most smoothies will have at least 250 calories per portion, they should be considered a meal or a snack not as a beverage to go with a meal.

The ingredients you use to make your smoothie are also very important. One thing often missing is protein which will also help keep you full. An easy way to add protein is to use greek or skyr yogurt, add a scoop of protein powder or natural nut butter. If using nut butter pay attention to the calories as some can be calorie dense. To add extra nutrients try adding some greens with the fruits like spinach or kale. Some green smoothies can be intimidating for people who don’t really like vegetables but if done right you will only taste the fruits. Try the recipe below:

Spinach Mango Banana Smoothie:

Using a magic bullet (or equivalent) single serve cup, fill it up with spinach and just enough water to liquify the leaves.

Once the leaves have become a green liquid, it should be a small amount at the bottom, add 1 small frozen banana or half of a large banana. Blend until it becomes a creamy consistency, you might need to add a bit of extra water, be careful not to add too much.

Once you have a creamy consistency add a small handful of frozen mango pieces. Blend until smooth.

Enjoy as a snack or breakfast with some nuts or yogurt on the side for protein.

Can Fiber Save Your Life

It might! For decades now we have learned about the importance of fiber for our health. Fiber comes from plants and is a form of carbohydrate, it gets digested by our gut microbiome. When we consume fiber we not only feed ourselves but we also feed the beneficial bacteria in our gut. The most commonly known fact about dietary fiber is that it helps us stay regular by preventing constipation. It also helps us stay full faster and longer as it slows down digestion.

A recent systematic research review has shown fiber adds much more to our health than previously thought. In fact, a 35% mortality risk reduction was found when people consumed 35 gm of fiber daily. It also resulted in a decrease in waist circumference, LDL, A1c, triglyceride levels and blood pressure. Of note the participants in the review were all living with pre-diabetes or diabetes type 1 and 2. The review also pointed out the participants had a decrease in their A1c despite making no other changes in their eating behaviors. In other words, adding fiber alone helped improve their A1c levels, which was actually an increase in their total carbohydrate intake.

As mentioned above consuming fiber feeds our gut microbiome. Although the full extent of the effect of fiber on the gut microbiome remains uncertain we know it increases it’s diversity. The increase in diversity favors our “good” bacteria leading to a decrease in total body inflammation and a decrease risk of developing metabolic disease. These changes in the gut microbiome have been observed by increasing fiber alone. As we know changing our gut microbiome by making food changes can be challenging adding fiber might be the secret weapon!

In summary, fiber has vast health impacts both in our immediate and long term health. The average American does not consume enough fiber in a day. It can be difficult to get enough, especially if you don’t regularly consume fruits and vegetables. Other great source of fiber are nuts, beans and whole grains. A quick trick might be to add bran cereal in your yogurt or mixed in with another cereal you like. If you feel you really can’t get your daily fiber needs via food alone, consider a supplement.