The microbiome refers to all microbiota (micro organisms such as bacteria) living on or inside our body. Fun fact; your body contains more bacteria cells than human cells and they are powerful. Specifically when it comes with it’s association with obesity. They can make digestion more efficient, which leads to an increase in calories consumed. More importantly they can also impact our appetite significantly. We also know our microbiome achieves maturity when we are 3-5 years old. Therefor, some people may be predisposed to develop obesity from a very early stage in life.
Many factors can affect your microbiome’s health right from the moment you are born. We know babies born vaginally and breastfed have a healthier microbiome than caesarian and formula babies. We also know the early usage of antibiotic has a negative impact on gut microbiome. Having a caesarian, using formula and needing antibiotic is often not a choice but a necessity. Sadly these circumstances can increase the chance to develop obesity by up to 50%. Unfortunately we do not currently have a way to fix this issue but more research is being done on this subject.
Due to the significant impact of our microbiome on our health many researchers looked at how it can be improved in our adult life. In fact some research demonstrated how our environment and behavior can have an impact. More research is needed on this subject but it is said that physical activity might also help us achieve a healthier microbiome. Our diet has the biggest impact as the food we eat also feeds our bacteria.
Changing our eating behavior to change our microbiome is not as simple as it sounds. When we change our food choices, the bacteria relying on your old food choices begin to die and be replaced. When this happens the dying bacteria starts to “fight” back. This translate to increase cravings for the food we stopped eating. Which often leads to us eating the food we had previously cut out.
Probiotics (live bacteria) has been available on the market as a supplement designed to boost our microbiome, but does it work? Research does show a significant reduction in weight with the usage of probiotics. More importantly it showed a reduction in waist circumference, fat mass and LDL which are better health indicators. However research done on this subject is limited because of the usage of small sample size and short duration, about 8-24 weeks. We do not have long term research demonstrating the long term effect of taking probiotic supplements. We also don’t know enough about probiotic at this time to have an efficient supplement that can have a significant impact long term.
In conclusion, your microbiome plays an important role in your overall health. It can be challenging to change the microbiota on and in your body with food changes. Probiotics might be able to help you. If you are interested in taking probiotics keep in mind research showed consuming yogurt, kefir or fermented milk is a great option and cost savings as supplements can be pricy. Supplementations whether through capsule, sachet, powder or food must be done on a daily basis. We currently do not have research demonstrating the long term benefit of taking probiotics.
Pharmacotherapy, the use of prescribed medication, has been a treatment option for people living with obesity since the 1940’s. There are currently 4 drugs approved by the FDA being prescribed today and many more are being researched. Unlike popular beliefs these drug are not meant to induce extreme weight loss. Research on all obesity drugs aim to achieve at least a 5% weight reduction which is the FDA requirement for approval. This type of treatment is to improve the health of individuals who are living with obesity and associated comorbidities. Pharmacotherapy is not a magic pill, it is a form of treatment. Many people experience stigma and shame when seeking this option. The stigma associated with treatment comes from people not fully acknowledging obesity as a chronic disease. After all, no one judges someone for receiving medical treatment for other chronic illnesses.
Would you judge someone for taking insulin…
All four drugs currently approved; phentermine/topiramate CR, liraglutide, naltrexone ER/bupropion ER and orlistat come with associated risk. If you’re considering starting treatment make sure to be informed of the side effects. Prescription of these drugs should be accompanied by nutrition, behavioral and physical counseling to improve overall health. The effect on weight will plateau with time, however the use of pharmacotherapy should be initiated with the intent of lifelong usage. If the drugs are discontinued weight regain will happen, especially if they were started without any other counseling.
It is agreed in the medical community that the first line of obesity intervention should be via nutrition, physical and behavioral counseling. We also know long term weight loss retention is not a reliable option. A focus should be placed on health outcomes rather than weight. For people who are suffering from obesity related chronic illness and have already had the first line of intervention, pharmacotherapy can help.
Many people report being able to eat balanced meals during the day but struggle with snacking at night. This is fairly common and can happen for a various of reason. Being aware of why we do certain habits can help us stop it.
Not eating enough during the day; if you restrict yourself too much during the day it will be very hard to shake off the hunger at night. Try eating more balanced meals containing fiber and protein. Also make sure you’re satisfied after eating your meals.
Screen time; watching television containing commercials might be making you hungry. Commercials are often food centered, changing to a system that does not have commercial or has the option to skip them might help you. Another tip is to try to keep your hands busy while watching. You could also consider playing video games instead of television that way you avoid commercials and your hands are busy.
Tiredness; you might be eating simply because you are tired and your body is trying to get energy from food. Try to get more or better sleep at night. This one is hard but research shows how coffee negatively affects our sleep even if we only drink it in the morning. If you struggle with falling asleep try cutting back on caffeine or switching to decaffeinated.
Boredom or habit; you might also be hungry at night because you’ve always ate at that time. Your body is simply used to it. You can try to eat dinner later and make sure to include protein and fiber in your meal which will help you stay full longer. If you think it’s out of boredom try picking up a new hobby that would occupy you at night. It could be as simply as reading a book or joining a book club.
A lot of pressure is placed on people living with obesity to lose weight. Few people outside the obesity community realize weight loss isn’t the issue. Many people living with obesity have successfully lost weight, weather it’s 20 or 100 pounds, keeping it off is another story. Our body has not evolved to lose weight and actually fights weight loss through a series of physical adaptation.
To start, hormonal changes happen; ghrelin “the hunger hormone” increases. While leptin “the fullness hormone” decreases. This leaves us feeling more hungry and less full every time we eat. Science also shows the adaptation of these hormone levels don’t go back to their baseline after weight has been regained. This is part of the explanation why some people regain all of the weight loss and more after dieting.
We also see muscle efficiency increase, while this sounds great it means our muscle are using less calories to perform the same task. The result is we end up spending less calorie without making any changes to our activity level. This adaptation is usually what people refer to when they say dieting decreases your metabolism.
Even our microbiome influences weight regain. The bacteria colonizing our gut (microbiome), varies from one person to the next. However we see very minimal changes in the different type of bacteria found in one person past the age of 3-5 years old. When we change our diet drastically, we also change the nutrition we provide to our gut. Due to this change, the bacteria in our gut starts to change. This change causes the “old bacteria” to send signals to our brain making us crave the food they want. Keep in mind we have more bacterial cells in our body then human, they have a lot of influence.
This is only a simple explanation of some of the physical adaptation that occur after weight loss. These adaptation happen at different times and at different level of intensity for everyone. Always remember the ability to lose weight and maintain it does not depend on someone’s will power.
Our environment can be broadly described as which state we live in, what city or even where we work. You might not have thought much about how choosing your environment can affect your chances of developing obesity. However research demonstrate it plays a big role.
When thinking about where you want to live, take in consideration how many restaurant or fast food there is close by. Proximity to restaurant and fast food increases your chances to develop obesity. You see and smell them constantly, they are very convenient and affordable. So when you’re driving home from a frustrating day, tired, stressed and hungry they become irresistible. When choosing a home consider not only your commute time but what will you be passing by. On the other spectrum, if we live in an area where no affordable grocery stores are available at a reasonable distance obesity rates increase by 30%.
Where you are makes a difference
Our environment can increase obesity rates by having poor infrastructure. Think about neighborhoods walkability and availability of walking trails and parks. If you are within a 15 minute walk to the grocery store and only need a few things, you might walk. For many this is not an option, grocery shopping can easily mean a 45 minutes drive, which takes away opportunity for easy exercise and time. Being far away from parks and walking trail affect us in a similar way. If you’re up for a quick walk but there’s no sidewalk near your house it can be discouraging. If any form of exercise weather it’s walking, biking, running or going to a gym means a 20 minute drive or more, it affects us negatively. This happens because it takes extra time and effort. Many people don’t have a lot of time to themselves.
Walking is the simplest and greatest form of exercise
Environment can also mean something much closer to us such as our home or our work. Both influence our every day lives greatly. Someone living in an unsafe neighborhood might live with constant stress and/or fear. Our work environment can also be stressful or even create fear in us. There’s many supporting evidence demonstrating the link between negative emotions such as stress and it’s impact on obesity prevalence.
If you think your environment is impacting you negatively, make a change!
Has anyone in your life mentioned or recommended bariatric surgery to you? It can be quite overwhelming to decide if surgery is the right choice. Surgery can be a great option; for example someone who’s disease state is severely impacting their health and emotional well being. Always keep in mind it is a lifelong commitment and not a quick solution. It requires behavioral modifications, emotional counseling, nutrition counseling and more. It can also put you at risk for other health issues such as alcoholism. In fact, after surgery alcohol will affect you differently and you can become intoxicated after only 1 drink. Having surgery does not guarantee long term weight loss, many people do regain weight 5-10 years after surgery and sometimes earlier. On the other side bariatric surgery can help improve many chronic health conditions associated with obesity such as sleep apnea, depression, type 2 diabetes, chronic pain, hypertension, heart disease and more. It can be life changing for people who are unable to live happy lives or fear to lose their life’s because of their chronic disease(s).
Postsurgical weight measurements are highly variable and have a nonlinear trend
A multitude of research has been done on weight loss after bariatric surgery; they all show the majority of people lose a significant amount of weight. It also shows weight loss varies greatly from one individual to the next, as shown in the graph above. As previously mentioned weight regain is very common.
A common myth is that after surgery you will not feel hungry, this might be true. Again the experience is different for everyone, some people will continue to feel hungry and this can become very emotionally challenging. Specifically, surgery does not take away emotional or head hunger. When you are considering surgery try finding the root cause of your day to day hunger and find out if emotional hunger is an issue for you.
Using this technique some people are able to eat very large amounts of food in one sitting, such as a large pizza.
People often believe they will not be able to eat large amount of food after surgery. This might be correct until you are able to tolerate solid food again. After which the behavior of not eating and drinking at the same time becomes crucial. Otherwise when you drink you will empty your pouch or new stomach and you will now be able to fill it up again.
Literature also explores the psychological well being of life after bariatric surgery. Results indicate surgery will not automatically remove depression or body image issues. In fact, bariatric surgery can worsen or play a role in the development of eating disorders. Bariatric centers should encourage and provide resources for you to heal from a psychological perspective before getting surgery.
In conclusion, bariatric surgery is a serious life altering journey which can be good or bad. Make an informed decision, take the time to do research not only on the surgery itself but on the clinic you are considering using. Having all the resources available to you such as but not limited to dietitian, physical therapist, psychiatrist and behavioral therapist is vital to your success. This post does not include all aspect of consideration to be taken prior to making an informed decision about surgery. The commitment to taking lifelong daily vitamins has not been discussed and much more. Finally the decision to have bariatric surgery must be discussed with your medical doctor. You can always be the one to start the conversation or be the one to refuse having it. Your life is your journey.
I first heard of the poodle science when I was an Intern at the Weight Management Clinic in Ottawa. If you aren’t familiar with it please take a few minutes to watch it below.
This message made so much sense to me and helped me finally accept my body.
In the picture below you see my two babies (and me opening Christmas presents). They are clearly very different sizes. However I promise you that they get the exact same amount of exercise and on top of that they eat the exact same amount of food. I think they are both perfect just the way they are.
Obesity is a complex chronic disease that develops with an excessive accumulation of body fat. The accumulation of fat, specifically when the fat accumulation is around vital organs such as the liver MAY impact someone’s health. As a chronic disease we do not have a cure for it and it must be treated through a health care professional team. The treatment for obesity might include medical nutrition therapy, psychological intervention, physical activity, pharmacotherapy and surgery. Obesity is diagnosed using BMI, which is limited because it does not indicate how someone’s health is affected.
New research shows obesity should be looked at using BMI and waist circumference; which better predicts health outcomes. In 2020 Canada released new practice guidelines which proposes a 5 stage system to help healthcare professionals identify if medical management is needed. Recent research also recommended for the focus of obesity treatment to be on improving health outcomes rather than weight loss. In the Canadian new practice guidelines they say “At the individual level, complications occur because of excess adiposity, location and distribution of adiposity and many other factors, including environmental, genetic, biologic and socioeconomic factors”. Weight alone does not cause obesity complications, it is only a factor. Weight loss is not sustainable long term because of various body adaptation.
The nutrition approach should be holistic and take in consideration the persons value and health desire. Behavioral changes should be maintainable as a life long change; they can lead to a 3-5% weight reduction. The percentage of weight loss will vary greatly on an individual basis depending on multiple factors such as but not limited to genetics and socioeconomics. The inability to lose weight is not indicative of an individuals personal efforts. In all cases the implementation of balanced meals through behavioral changes decrease the chances of developing or aggravating obesity related co-morbidities.