The National Health and Nutrition Examination Survey (NHANES) data clearly shows a steady increase in the percentage of overweight and obese Americans. Over half our population was affected (56%) between 1988-1994.
That number is nearly three-quarters of the population (70.7%) according to the 2013-2014 data. As integrative practitioners, we regularly have patients who are looking for help with weight loss plans. In some cases, addressing the foundations of health (e.g., hydration, sleep, exercise, nutrition and stress management) will help patients reach their weight loss goals. However, others may need more individualized recommendations in terms of nutrition and exercise. Although there are a myriad of factors that can impede weight loss, like insufficient thyroid or adrenal function, blood sugar imbalances, high body burden of toxins, etc., the focus of this article is optimizing nutrition and exercise recommendations to facilitate healthy weight loss.
Nutrition
The Standard American Diet (SAD) contributes to the obesity epidemic in our country. Overconsumption and eating highly processed ”food” are the mainstays of the American diet. It would be great if we could tell patients to follow one standardized diet to lose excess body fat. However, it is not that simple and each patient may have slightly different biochemical needs. Individual needs can change over time and what worked well five or 10 years ago may no longer work well for them now.
You may have the time in your practice to teach your patients about nutrition and the basics of cooking. But if you don’t, a good integrative nutritionist or dietician could help your patients implement your dietary recommendations. Consider encouraging them to join a local organic Community Supported Agriculture (CSA) to help them eat in season and diversify their veggie intake. In addition, there has been a rise in the availability of purchasing locally prepared, fresh meals that cater to individuals looking for healthy and organic whole food options. Consider researching and sampling the local organic prepared-meal offerings in your area to have this as an additional resource for your patients. Also, consider creating a handout or short video on eating hygiene: to slow down when eating, thoroughly chew one’s food and be in a relaxed parasympathetic dominant state (rest & digest mode). This will increase digestive tract innervation and ultimately GI function as well as give your brain time to register how much you’re eating and send a timely signal to let you know when you are satiated. When we “inhale” our food, our brain doesn’t have a chance to send signals that we’ve had enough and should stop consuming.
There are a variety of dietary recommendations to consider now from the very basic to the highly individualized. Each patient is unique and we no longer can rely on one dietary recommendation to meet the unique needs of all of our patients. In addition, some specialized diets may not only help your patients lose weight, but may also address underlying hidden obstacles that are impeding their weight loss and contributing to other common symptoms like fatigue, gas and bloating, constipation, brain fog, arthritis, autoimmune conditions—the list goes on and on. When a dietary plan is right for their individual physiology, biochemistry and digestive biome, their gastrointestinal system slowly heals and inflammation decreases. Specialized diets share a common theme to guide the patient toward incorporating unprocessed, nutrient dense foods that are rich in antioxidants and phytonutrients.
Exercise
We know that exercise is essential to weight loss. However, some exercise recommendations are definitely more effective than others when it comes to weight loss. Dr. Keoni Teta, ND, LAc is an expert in the field of helping people lose weight with targeted diet and exercise recommendations. Dr. Teta is a co-author of two books on the subject: Lose Weight Here: The Metabolic Secret to Target Stubborn Fat and Fix your Problem Areas and The Metabolic Effect Diet: Eat More, Work Out Less, and Actually Lose Weight While You Rest. In a brief interview to gain some insights into how to effectively guide patients toward weight loss, he answered the following questions.
Q: What is your prescription for weight loss?
Dr. Teta: Healthy nutrition that is not over-consumed is better than exercise for fat loss. Healthy nutrition helps you lose fat better than exercise, whereas exercise is better for weight maintenance. In addition, any exercise that is done in a sustainable way is better than no exercise. When it comes to fat loss, resistance training tends to be better than stereotypical aerobic moderate intensity exercise (e.g., jogging). General recommendations are 3-4 30-minute resistance-training sessions per week and then 4-7 30-minute sessions of aerobic exercise. This can be anything from walking to running or elliptical or rowing or whatever one likes, etc., or a mix of everything. Aerobic exercise is best for cardiovascular health when compared to conventional weightlifting routines. However, high intensity exercise with big body movements that gets you breathless works aerobic and anaerobic systems.
Q: How can dieting contribute to weight gain?
Dr. Teta: Think of dieting as a prolonged stress on the body. Dieting, or more specifically, long-term energy restriction, contributes to weight gain in the long term because it causes the metabolism (e.g., thyroid and endocrine systems) to slow down. It also causes you to lose muscle at a faster rate than fat. This is a problem because once you come off of the diet, you tend to gain more fat than muscle… and your body wants to get back to its original muscle mass you had before the diet. Muscle acts as a weight thermostat. This means that once you’re back to your original muscle mass, you are padded with more fat, too.
Q: What is the Nutrition Label Rule of the Metabolic Effect Diet?
Dr. Teta: Weight loss is totally different from fat loss. We want our clients to lose fat not weight, especially if that weight is muscle. So for fat loss, the Metabolic Effect Nutrition Label Rule works best to follow for a processed food at one serving size as indicated on the label:
(total grams of carbs) – (total grams of protein) – (total grams of fiber) ≤ 10
Q: What is your favorite weight loss supplement?
Dr. Teta: Favorite weight loss supplement is fiber, specifically powdered fiber mixed in water. A fiber that is unsweetened and a good mix of soluble and insoluble fiber is best.
There are a variety of effective diets to choose from when helping patients lose weight. The Mediterranean Diet is a great staple dietary recommendation that is easy to implement and is supported by extensive research and data. If your patients are not responding well to your initial dietary suggestions, consider utilizing some of the specialized diets mentioned in this article, Tools for Weight Loss, to meet their unique needs. In terms of exercise, be sure to incorporate anaerobic recommendations to help facilitate fat loss and build muscle mass along with your aerobic exercise recommendations.
Supplements
There are three key nutrients that help build a strong foundation when it comes to supporting healthy weight management and optimal health in general—omega-3s, probiotics, and vitamin D. Based on the scientific literature, chances of successful and sustainable weight management begins with these foundational nutrients.
A 2016 review featured in the journal Nutrients confirms what we’ve known for quite some time: too much omega-6 in the diet and not enough may increase risk of weight gain. Studies demonstrate that omega-3 fatty acid intake (usually in the form of fish oil) can help support healthy blood sugar and metabolic balance. A 2013 review in the European Journal of Clinical Nutrition took the weight management aspect one interesting step further. That review paints a clear picture that omega-3 consumption can reduce circulating levels of the weight gain hormones adiponectin and leptin in overweight individuals.
Thanks to the burgeoning field of microbiome research, we now have insight into how weight may be affected by our microbiota. According to a 2017 study featured in the journal Nutrients, may help support characteristics of healthy weight maintenance such as satiety and cognitive control over cravings. That double-blind, randomized, placebo-controlled trial featured 45 men and 70 women who were all overweight. The probiotic intervention was Lactobacillus rhamnosus CGMCC1.3724.
The research regarding and weight management is also gaining momentum. Preliminary studies have shown that there is a correlation between vitamin D deficiency and weight gain. A 2016 meta-analysis featured in the American Journal of Clinical Nutrition confirmed the connection between low vitamin D status and weight gain and adequate vitamin D status and weight loss. New research is looking specifically at vitamin D supplementation in overweight individuals. A 2018 double-blind, randomized, placebo-controlled study published in the International Journal of Preventive Medicine, using a weekly dose of 50,000 IU (1,250 mcg) of vitamin D for six weeks showed a significant decrease in total weight, body mass index, and hip and waist circumference in study participants.
Evidence on the connection between these three foundational nutrients and healthy weight is growing. By starting with this foundation and building a regimen from there, patients may have a better chance of successfully achieving and maintaining their weight goals.