Table of Contents Show
Our conversation was with Irina Kumysheva, an endocrinologist and dietitian. During the discussion, we covered various topics such as the link between hormones and excess weight, the potential consequences of obesity, the ethical implications of doctors encouraging patients to lose weight, and strategies for healthy weight loss that minimize the risk of further health complications.
The following are some of the topics covered in this material:
- The correlation between excess weight and hormonal problems
- Genetic predisposition to obesity
- The impact of sweet cravings on weight
- The effect of sleep deprivation on hormonal balance and weight gain
- The definition and occurrence of metabolic syndrome with obesity
- The link between excess weight and related health conditions
- The concept of prediabetes
- The relationship between excess weight and insulin resistance, including the need for hormone testing
- The possible connection between excess weight and elevated prolactin levels
- The effectiveness and potential risks of restrictive diets
- The role of calorie counting in preventing overeating
- The optimal amount of weight loss per month
- Situations where healthy eating and exercise alone are insufficient for weight loss
- The necessity of weight loss for all individuals with excess weight according to medical advice
- Strategies for maintaining a healthy weight.
Is it true that excess weight is almost always associated with hormonal problems?
The idea that hormonal disorders are responsible for obesity is a common misconception among patients. In reality, consuming too many calories and living a sedentary lifestyle are the main culprits in about 95% of cases. Only about 3-5% of cases of weight gain can be attributed to endocrine disorders, which have distinct characteristics.
For instance, Cushing’s disease can result in weight gain due to overproduction of cortisol by the adrenal glands, but this is typically accompanied by other symptoms such as muscle weakness, menstrual cycle disturbances, decreased libido, erectile dysfunction, and stretch marks that appear throughout the body. Additionally, fat is usually deposited in the abdomen and neck, while the arms and legs remain relatively thin.
Patients who are overweight and inquire about testing their adrenal function are frequently advised against it since this is a rare condition with obvious symptoms that are hard to overlook.
The second reason for weight gain that patients often attribute to a particular organ is the thyroid gland. You can read on the internet that a disruption of its function leads to weight gain. But in this case, a person gains not 10-30 kg, but rather 3-5 kg due to swelling in the body, as a result of hypothyroidism- a decrease in thyroid function.
Patients with hypothyroidism often lead a sedentary lifestyle due to symptoms such as weakness, increased fatigue, and drowsiness. Although they may continue to eat as before, their reduced activity levels may result in some weight gain, but the idea of gaining 10-20 kg is a misconception.
Nevertheless, since hypothyroidism is a prevalent condition, it is advisable to have thyroid hormone levels checked. Polycystic ovary syndrome is another endocrine disorder linked to weight gain in women. The excess production of testosterone due to this condition can lead to menstrual cycle disturbances and ovulation issues.
It is uncertain which condition is the root cause in this scenario – whether polycystic ovary syndrome is brought on by excess weight, or if the condition itself leads to weight gain. Given the complex relationship between the two, it’s challenging to determine which is the primary factor. However, this distinction is not critical, as weight loss is always a crucial part of treating polycystic ovary syndrome. The same weight loss strategies apply to patients with or without this condition.
Moreover, while polycystic ovary syndrome does elevate the likelihood of obesity, there are numerous women with a healthy weight who also have the condition. It should be noted that polycystic ovary syndrome does not necessarily result in weight gain in all cases.
In conclusion, individuals who are overweight should undergo TSH level testing to evaluate thyroid function, as it is a frequent ailment, and a vitamin D test, as its deficiency is often present in obesity. Other hormone examinations are not mandatory for everyone.
Is there a genetic predisposition to obesity?
As I already mentioned, the main causes of obesity are an excessively high-calorie diet and a sedentary lifestyle. Due to the decrease in physical activity among the population, the number of patients with obesity and related diseases is increasing catastrophically.
There are people with a genetic predisposition to weight gain, but it doesn’t manifest itself on its own. To activate these genes, again, a sedentary lifestyle and high-calorie diet are needed. In other words, one needs to overeat and expend fewer calories.
Is it true that some people have a stronger craving for sweets, and does it affect weight?
The desire for sweets is often a learned behavior, such as snacking on a chocolate bar while watching TV after a long day or using sweets as a way to cope with stress. Weight gain is not necessarily caused by sweets if the daily calorie intake is not exceeded.
However, when reviewing patients’ food journals, it is apparent that many individuals consume more than a single piece of chocolate or candy. Instead, they often consume excessive amounts of sweets and do not restrict their intake of other foods. As a result, people who consume a large amount of sweets in their diet are more likely to be at risk for obesity.
Furthermore, consuming more sweets can lead to an increased desire to eat. This is due to the quick rise and fall of blood glucose levels, which can cause the person to feel hungry more frequently and eat more than necessary.
Moreover, a diet high in sweets may lead to the displacement of more nutritious foods, such as fiber and complex carbohydrates, which provide not only energy but also essential vitamins and minerals.
There is no scientific evidence suggesting that a craving for sweets arises from a deficiency of any specific micronutrients. Women may experience cyclicality in their cravings for sweets and flour, which could be linked to hormonal fluctuations. Additionally, patients with iron deficiency may also report a desire for sweets. This could be because the body is attempting to compensate for the lack of energy with fast-acting carbohydrates.
How much sugar can you eat per day?
| To Whom | How much sugar | Clearer |
|---|---|---|
| Children aged 2-4 years old | Not recommended to give products with added sugar and other natural sweeteners like maple syrup, even if they are designed for children. | Early introduction to sweet foods increases the risk of developing tooth decay, obesity, and other problems. |
| Children aged 4-6 years old | No more than 19 grams of sugar per day, which is approximately 3 full teaspoons. | This is the amount of sugar in 2 bottles of kids yogurt drinks, each 90 ml. |
| Children aged 7-10 years old | No more than 24 grams of sugar per day, which is approximately 4 full teaspoons. | This is the same amount of sugar found in half a bar of dark chocolate. |
| Adults | No more than 30 grams of sugar per day, but according to other recommendations, men should not exceed 35 grams per day and women should not exceed 25 grams per day. On average, this means no more than 5-6 full teaspoons per day. | One can of cola already contains 35 grams of sugar. |
Is it true that lack of sleep disrupts hormonal balance and leads to excess weight?
Healthy sleep is important for preventing weight gain. If a person sleeps poorly, they experience weakness and fatigue. This can increase the risk of overeating, as the person compensates for their weakness by consuming carbohydrates. In the long term, this can lead to excess weight.
What is metabolic syndrome? When does it occur in obesity?
Metabolic syndrome is a cluster of symptoms that occur when obesity is accompanied by an increase in glucose, blood pressure, cholesterol, and uric acid. In other words, when obesity disrupts metabolic processes, diseases develop in a chain reaction that are often linked to each other and can often be treated by reducing body weight.
Some patients require medication, but for many, their condition can be normalized simply through diet and lifestyle adjustments.
Does excess weight always lead to accompanying illnesses? Is obesity ever without consequences for health?
Some patients with obesity may not have metabolic syndrome, indicating that they do not experience any lipid or carbohydrate metabolism disturbances, and their blood pressure is within the normal range. Genetic predisposition is an important factor to consider, and the higher the degree of obesity, the greater the risks involved.
Abdominal obesity is a type of obesity in which fat accumulates primarily in the abdominal region. Hence, it is crucial to consider not only the body mass index but also the waist circumference. Studies suggest that if the waist circumference is more than 80 cm in women and 94 cm in men, the risk of metabolic syndrome is higher.
On the other hand, lower-body obesity involves fat deposits primarily on the buttocks and thighs, which poses a lower risk because the waist circumference usually remains normal.
I have encountered several patients with severe obesity who did not experience carbohydrate metabolism disorders until old age. Therefore, having excess weight does not necessarily mean a 100% chance of developing diabetes.
The current scientific consensus suggests that obesity always has consequences, even if a specific disease has not yet manifested in a patient. Any type of obesity carries a certain level of risk, which may materialize in the future. Therefore, it is crucial to address the problem of obesity as soon as possible.
What is prediabetes?
In America, a normal glucose level on an empty stomach is up to 5.7 mmol/L. When the glucose level exceeds 7 mmol/L, it indicates diabetes. Prediabetes occurs when the glucose level is not yet at the diabetes range, but still not considered normal, indicating disturbances in carbohydrate metabolism.
The development of type 2 diabetes is gradual, with episodes of elevated blood glucose occurring over 3-5 years. Some individuals may experience impaired glucose tolerance, where their blood glucose level stays high after eating but remains normal on an empty stomach. Others may see an increase in blood glucose levels even on an empty stomach, but it returns to normal within two hours after eating.
It is crucial to begin treating patients at the prediabetes stage as soon as possible. Often, a simple change in lifestyle and diet can be effective. With the patient’s cooperation, it is possible to normalize carbohydrate metabolism and delay the onset of diabetes, or reduce the risk of developing it in the future.
If prediabetes is not diagnosed early, and lifestyle and body weight are not modified, it can progress to diabetes.
To diagnose prediabetes, individuals who have risk factors and blood glucose levels at the upper limit of normal are given a glucose tolerance test. This involves checking the blood sugar level on an empty stomach, drinking a special glucose solution, and then performing a repeat analysis after two hours. If the test is normal, the patient is released and advised to have their blood glucose tested again after six months.
In some cases, doctors may look at the level of glycated hemoglobin, which indicates the average level of blood sugar over three months. The normal range for glycated hemoglobin is up to 6%. However, individuals with excess body weight can be diagnosed with prediabetes if their glycated hemoglobin level is 5.7% or higher.
Insulin serves as a glucose transporter that enables glucose to enter cells after a person consumes carbohydrate-containing foods. The pancreas produces insulin as a key that unlocks the way for glucose to enter the cells, which subsequently break down glucose to provide energy.
However, individuals with obesity experience a change in cell structure that impedes insulin from assisting glucose entry into cells. This results in insufficient glucose supply to the cells, causing them to starve and leading to a rise in blood sugar levels. Despite having eaten, glucose fails to reach its destination due to insulin resistance. This, in turn, prompts the pancreas to produce more insulin, which exacerbates the situation as the cells continue to starve.
Although some experts suggest that insulin resistance triggers weight gain, it is the opposite: insulin resistance develops due to excess weight and aggravates the progression of obesity.
Insulin resistance may trigger an increase in appetite, leading to persistent weight gain. However, it is crucial to note that insulin resistance alone does not cause obesity and does not warrant medication. Instead, weight loss is necessary to tackle the condition effectively.
Furthermore, undergoing an insulin test is not a reliable way to diagnose insulin resistance. This is because insulin is an unstable molecule that lasts only for about seven minutes in the bloodstream, and its level depends heavily on the patient’s dietary intake. For instance, if a patient avoids carbohydrates two to three days before the test, insulin levels may appear normal. On the other hand, consuming carbohydrates before the test may elevate insulin levels, making it an unreliable indicator of insulin resistance.
Thus, it is essential to educate patients about the need to address their weight issues, as it is the most effective way to stabilize insulin levels.
Is it true that excess weight can be linked to an excess of prolactin?
When a patient experiences symptoms like an irregular menstrual cycle, breast discharge, among others, a doctor may recommend a prolactin test. However, performing a prolactin test without a valid reason is not recommended.
It is worth noting that high prolactin levels do not cause weight gain. Nonetheless, excessive body weight may indirectly lead to elevated prolactin levels, resulting in associated health issues.
Do restrictive diets work, and what harm do they cause?
Losing weight is relatively easy, as evidenced by the countless diets available on the internet that promise results. However, the real challenge lies in maintaining the achieved weight loss. Extreme weight loss methods increase the likelihood of regaining the lost weight and even gaining additional kilograms, typically ranging from 5 to 15 kg.
This is because the body compensates for strict calorie restriction by storing extra fat to conserve energy in case of future starvation. Therefore, it is crucial to adopt a gradual and gentle approach to weight loss. Rapid weight loss poses a higher risk of relapse and regain, and the body may struggle to sustain the achieved weight loss.
Encouraging patients to adopt a healthy diet, rather than a diet solely focused on weight loss, is the optimal approach. When individuals prioritize their health, their body weight gradually reduces without any adverse effects.
On the other hand, extreme weight loss methods can result in several health complications, including gallstones, osteoporosis, kidney problems, and deficiencies in protein, minerals, and vitamins, such as iron deficiency anemia and B vitamin deficiency. Such weight loss often leaves a lasting impact on the body.
By adhering to adequate dietary guidelines, individuals can gradually attain their optimal body weight, in line with their physiological requirements.
Should you count calories to avoid overeating?
Counting calories can be helpful in the beginning stages of understanding how much food to consume, but it is not a sustainable long-term solution. This method can quickly become tedious and may even lead to the development of eating disorders. As a result, relying solely on calorie counting is not a healthy way to achieve weight loss goals.
Instead, after a person has gained an understanding of their food needs, it is advisable to transition to alternative methods such as the palm rule or plate rule. This involves using a plate the size of one’s palm divided into three sections, with half filled with vegetables and the other half with whole grains and protein.
Furthermore, dietitians assess each patient’s diet individually, taking into account factors such as age, existing medical conditions, and dietary habits. This personalized approach is necessary to ensure optimal health outcomes.
Is it worth reducing the calorie content of your diet to your individual norm right away?
To begin with, dietitians typically request that patients maintain a food diary for a period of time. This involves taking photos of their meals, weighing or measuring the amount of food consumed, and recording other relevant information. Many individuals who struggle with weight issues often claim that they eat very little yet still gain weight, or that they have not seen any progress despite consuming minimal amounts of food. However, after reviewing the food diary, it often becomes clear that this is not the case.
Through careful examination of the food diary, the doctor can evaluate the patient’s diet in terms of the quantities of fiber, protein, carbohydrates, and other nutrients present. This process helps to identify any major dietary mistakes and enables the doctor to work collaboratively with the patient to address them.
For instance, if a person has consumed a large amount of meat, such as a kilogram in a single meal, the dietitian will not recommend that they immediately reduce their intake to 300 grams the following day. Such a drastic change is usually unsustainable, and the individual may eventually revert to their previous eating habits.
As an illustration, I recently had a patient who consumed very few solid foods but drank a considerable amount of coffee – around 24 cups per day – with four spoons of sugar each time. Additionally, they engaged in minimal physical activity, leading to a surplus of calories. However, instructing them to cut out coffee with sugar altogether would not be an effective strategy.
Instead, a gradual approach that is comfortable for the patient is necessary. For instance, advising them to reduce the amount of sugar in each cup of coffee by one spoon initially, and then gradually decreasing it every three to four days.
The same gradual approach applies to food portions. The dietitian reviews the food diary to determine what and how much the patient has consumed, and may recommend introducing more fiber or protein, replacing certain items with healthier options, and so on. The focus is on improving the quality of food, but we do so gently and gradually, even when dealing with patients with diabetes.
How many kilograms per month should you lose weight?
The rate at which one can comfortably lose weight depends on various factors, such as initial weight, gender, and any underlying health conditions. For some individuals, a weight loss of 6 kg per month may be achievable without discomfort, whereas others may only be able to lose 2 kg in the same period.
It’s important to remember that any amount of weight loss should be considered a significant achievement, and there is no single “normal” rate of weight loss. In some cases, changes in body shape and size may be more noticeable than changes in overall weight, such as a reduction in waist and hip circumference. Similarly, an individual who participates in regular exercise may experience a growth in muscle mass and reduction in body fat, leading to a change in body composition that may not be reflected by changes in weight alone, but can be measured using bioimpedance scales.
In what cases is healthy eating and physical activity not enough for weight loss?
In instances of severe obesity, where the body mass index (BMI) exceeds 39.9 kg/m², surgical intervention may be deemed necessary. Furthermore, there are situations where medication therapy may be required, such as cases where a patient is experiencing first or second degree obesity, or where their BMI is at the upper end of the normal range, but they have failed to achieve desired results despite following multiple dietary and fitness regimes.
In such cases, I assess their progress with respect to weight loss, and if everything appears to have been executed appropriately, I may suggest the use of specialized medication. The goal of medication therapy is to promote gradual weight reduction and minimize weight regain. However, it is important to note that medication alone is not a magic solution for weight loss maintenance. It must be complemented by a healthy diet and regular physical activity, as discontinuing medication without implementing lifestyle changes will likely lead to weight regain. It is currently not possible to completely cure obesity without a modification in lifestyle.
Should a doctor insist on weight loss for all overweight patients?
The majority of my patients approach me seeking assistance with weight loss. They desire to achieve a healthy weight and require medication therapy or dietary adjustments to do so.
Occasionally, a patient may visit me after being referred by a cardiologist due to high blood pressure, despite feeling content with their weight. In these instances, I recommend tests to rule out any issues with carbohydrate or lipid metabolism. If the results are favorable, I suggest that they visit an endocrinologist for regular check-ups every six months.
I am cautious not to make overweight individuals feel unwell or convince them that they will inevitably develop diabetes. Such an approach may lead to the development of negative feelings and eating disorders. I instead focus on providing supportive care and encourage them to avoid harmful fad diets found on the internet.
When a patient is in good health during the consultation, it is advisable to gently suggest dietary changes and weight control. However, when a patient specifically requests weight loss assistance, it is important to address their concerns.
Working with patients who have excess body weight can be challenging from a psychological perspective. It is crucial to approach them with sensitivity and flexibility to prevent the development of potential disorders or aggression.
Unfortunately, some patients have had negative experiences with doctors who have made insensitive comments such as, “What do you expect? You weigh 100 kg. You need to lose weight” or “You will definitely have diabetes with your excess body weight.” Such comments can be hurtful and counterproductive. During the medical history evaluation, I aim to understand how best to communicate with the patient, what to emphasize, and what to avoid.
In general, an individualized approach should be employed for each patient. For some individuals, it may be unnecessary to focus on the consequences of obesity, while for others, it is essential to explain the potential health risks.
If a patient has diabetes but does not understand the need to lose weight as they are not currently experiencing any symptoms, I can explain the possible complications associated with the condition. Additionally, I may prescribe sugar-lowering medications that can also assist with weight loss.
What do you do to maintain a normal weight?
I have a diverse diet, including sweets, and my colleagues at work often look surprised when they see me enjoying a tea with candy. I follow the plate rule, which means that I aim to have at least two balanced meals each day. I also only eat when I feel hungry; if I am hungry three times a day, I eat three times, but if I only feel like eating once, I eat once.
While I do not obsess over food, I make a conscious effort to include a wide range of vegetables in my diet. However, if I did not eat vegetables on a particular day, it is not a big deal. I always keep them in my fridge and make it a habit to wash and consume them regularly.
My approach to eating well is not solely focused on controlling body weight but rather on promoting good health and bodily functions.
Furthermore, if I realize that I have not been very active during the week, I try to incorporate more physical activity into my routine, such as walking or using public transport instead of driving.
Remember
- In 95% of cases, obesity is associated with improper nutrition and a sedentary lifestyle.
- There is a genetic predisposition to obesity, but it is realized only under certain conditions: overeating and lack of physical activity.
- Consuming sweets can lead to weight gain if it exceeds the calorie norm.
- Obesity can lead to the development of metabolic syndrome and related diseases: hypertension, diabetes, lipid metabolism disorders, but this does not happen in 100% of cases.
- Before the development of type 2 diabetes, a person may have prediabetes for several years. This is a reversible condition – if treated in time, diabetes can be prevented.
- Insulin resistance is a consequence, not a cause of obesity. It should be treated by reducing body weight, and there is no need to take insulin tests.
- Prolactin does not cause obesity but may be elevated in some overweight people. If there are symptoms, the doctor will prescribe an analysis.
- Restrictive diets lead to rapid weight regain, and body weight becomes several kilograms more than before.
- Constantly counting calories can be harmful, increasing the risk of eating disorders.
- The diet should be changed gently and gradually, otherwise, the person will quickly return to the old eating habits.
- Drug therapy is needed for people who have tried several times to lose weight by proper methods but have not succeeded. It has side effects, so not everyone is prescribed such drugs.
Responses