You’ve heard it before: all you need to do to lose weight is diet and exercise, right? Well, as it turns out, it isn’t always that easy because sometimes your own biology is working against you.
Researchers from Icahn School of Medicine at Mount Sinai in New York published a paper in The Lancet Diabetes & Endocrinology advising doctors to move away from making standard recommendations of diet and exercise to obese patients.
The reason, explained lead author Christopher Ochner, an assistant professor of pediatrics and psychiatry, is because without treating the biological responses to dieting, most people eventually put back on the weight they lose.
In order for weight loss to be successful, surgery and medication is often needed in combination with lifestyle changes for obese patients.
“In people who have been obese for many years,”Ochner explained to Live Science, “body weight seems to become biologically ‘stamped in’ and defended. We don’t have enough treatments to address our underlying biology [of obesity]. We would like to see other, safer, more widely available treatments.”
It all has to do with what happens in the body when diet becomes restricted.
According to Ochner and other experts, dieting doesn’t just restrict calories while the body maintains the same operating levels it always did. When food to the body is suddenly cut, the body thinks it is starving and burns fewer calories in an attempt to conserve fat. Changes in the brain during dieting also generate a craving for high calorie foods.
Even though someone who is 400lbs wouldn’t be starving by modern standards if they cut food back, their body is so used to being at 400lbs it will generate this panic response to calorie reduction. This is why more than 80 percent of obese individuals gain back weight they have lost through traditional diet and exercise.
For obese individuals, medication or surgery to intervene in this natural starvation response are the best options. Unfortunately, these treatments are often expensive and have a long list of potential side-effects. Bariatric surgery, a procedure that involves restricting the amount of food the stomach can hold, is the only proven long-term treatment for obesity, but it comes with undesirable risks such as the need for re-opperation, nutrient deficiencies and long-term medical care.
According to The American Society for Metabolic and Bariatric Surgery, bariatric procedures also often cause hormonal changes and can sometimes result in irreversible damage to the gastrointestinal system in the long run.
For patients who don’t want to take the surgical step, there are current weight loss medications on the market to help the dieting/ exercise regime, but these medications have yet to prove themselves in the long-term.
“We recommend the use of lifestyle modification to treat individuals with sustained obesity, but it should be only one component of a multimodal treatment strategy,” Ochner and colleagues wrote.
The uncertainty related to medication and surgical intervention should not stop individuals from attempting to lose weight or making lifestyle adjustments, they added. Even if weight loss fails, a healthy diet and exercise program will ultimately improve quality of life.