Maintaining a Good Weight with Age
This month and next month, our VitaLifeMD posts focusing on health span and anti-aging will address the importance of maintaining a good weight as we get older, with the goal of avoiding the health risks linked to insulin resistance and/or leptin resistance.
This month we talk about education and patient homework.
Next month we will talk about the doctor’s prescriptions to help you achieve your goal, and we will present some of our success stories.
Before we discuss the topic in detail, let’s have a look at a few statistics. The maps below from the CDC that reveal obesity in the U.S. over time speak for themselves. Obesity is defined as having a body mass index over 30. In 2022 the percentage of adults over 20 who were obese was 41.9%.
In 1995 the map for obesity in the US was still in the green shades in most states.
And here we are in 2022.
Click HERE to watch animated data.
Being overweight is described as having a BMI between 25 and 30. In 2022 the percentage of people in the U.S. who were overweight was around 32%.
Waist circumference is a marker for various health risks; women's waists on average grew more than 2 inches from 36.3 inches in 1999-2000 to 38.6 inches in 2015-2016, while men's waists on average grew more than an inch from 39 inches in 1999-2000 to 40.2 inches in 2015-2016. More recent data would probably show an even higher increase in both sexes.
All of us have heard about diet and exercise being the clues to successful weight loss. If it were so easy to lose weight, then, why are so many people suffering from weight issues in the U.S.? I will not explore the problem of disparities, something which remains a major issue in our country, as this is a bigger economic and political debate that we will not be able to address in this newsletter.
At VitaLifeMD, then, what do we do to help as patients lose weight and focus on getting healthier?
Our first goal is to educate our patients so that they can fully understand what being overweight means in terms of metabolic changes. We focus on the notion of insulin resistance and leptin resistance that most overweight patients will develop.
Insulin helps glucose (or “sugar”) to be used as fuel by any cell in our body to function, particularly in our muscles and brain. Insulin is a hormone that acts like a “key” to open the glucose receptors located on the surface of our muscle cells and to let the glucose enter the cells to be burned as calories. When we put weight on, often as a consequence of eating too much food and overloading our blood with sugar or carbs (glucose), the receptors become saturated and develop what we call “insulin resistance.” The sugar accumulates in the blood and cannot penetrate the cells easily. This can be measured by blood tests such as fasting glucose or, even better, the HbA1C (Hemoglobin A1c) which reveals the average blood sugar level over the past three months.
What happens next is easy to understand. The pancreas first starts to produce more insulin to try to counteract the resistance occurring at the receptors. However, as the receptors on the muscle are already saturated, the sugar finds an easier way to get absorbed by some tissues in which not much effort is needed to stock the excess… and – guess what? – it is the adipose tissue – what Dr. Read calls the “belly fat” – that is going to store the sugar in the form of more fat that we call triglycerides. The vicious cycle has started: more weight, higher sugar in the blood, more insulin resistance, more storage of fat in the belly, and so on…. At one point the pancreas will be exhausted, and we will then reach the stage of diabetes.
And, as if that were not enough, you need to add to the initial insulin metabolic disturbance the fact that the insulin will be helped at some point by its friend and ally, leptin – and this actually makes the situation even worse! Leptin is a hormone that is released from the fat cells in the adipose tissue. It helps the body maintain a normal weight on a long-term basis as it sends signals to the brain to provide a sensation of satiety. Its role is crucial to the regulating of hunger. When weight goes up, especially if abdominal fat is involved, leptin goes up as well, and the brain itself becomes saturated and insensitive to the signals of satiety. This is called leptin resistance; the body feels hungry all the time.
With these explanations, it is easy to find the way to be successful if you are trying to lose weight: we need to decrease the insulin resistance (make the receptors become more sensitive) and at the same time reset the signals of satiety in the brain.
The patient homework list:
A few lifestyle changes that will help with insulin/leptin resistance.
Make better food choices:
Fewer carbs and more protein in your diet. Protein has a much higher thermic effect than fat or carbs — 20–35% compared to 5–15%. High protein intake has been shown to significantly boost metabolism and increase the number of calories you burn. This can amount to 80–100 more calories burned each day. Protein can suppress appetite as it takes longer to digest than carbohydrates and it is much harder to convert into fat and to store. The more protein you consume, the longer the effect may last. This could be helpful for people who fight afternoon or late-night cravings.
A recent Harvard study showed that participants who consumed extra protein at breakfast (over 25 grams) had lower blood sugar levels and reduced appetite later in the day compared with those consuming less protein. Enough protein in your diet is also going to protect against the risk inherent to weight loss such as hair loss or skin wrinkling.
Add more veggies and fibers. They can add volume to your plate but with few calories, making you feel fuller and helping with bowel transit.
Drink a lot of water as it helps with the flushing of toxins from your body and keeps your tissues well-hydrated, something that helps protect the skin from aging.
And of course, what everybody already knows: look at portion sizes, avoid fast food, and be careful with nuts or nut butters that contain a lot of calories. The same is true for cheese and fatty meats such as bacon and sausage. Avoid bananas and grapes which have a high glycemic index. Limit alcohol to 3 to 4 drinks a week; and, if you “drink your carbs” in the form of alcohol at dinner, do not eat any carbs that night.
Boost your exercise:
Aerobic exercise is the best when it comes to weight loss as it does help improve insulin sensitivity and increases insulin-stimulated glucose uptake in skeletal muscle but not in the adipose tissue. Walking, swimming, and running provide identical benefits, so chose the one you like and try to do it 5 days for at least 30 minutes per week.
Adding a day or two per week of interval training or strength training exercise will help preserve your muscle mass during the weight loss program—but do not forget that your protein intake is even more important to avoid losing muscle mass.
Work on your sleep and stress management:
Go to bed at a decent hour. Avoid writing e-mails or looking at social media at night.
Avoid people around you who send stressful messages and negative feedback to you. Practice positive thinking.
Find a reason to smile or laugh at least once daily. This will have an immediate benefit on your neurotransmitters and will make you feel happier and more relaxed. And, believe me, this will be contagious to others, too.
Try to focus on your positive decision to work on your weight and improve your health as a whole, and follow your doctor’s recommendations one day at a time.
These preliminary ideas can help guide you to successful weight loss.
Next month I will present to you the help we as providers can give you to reverse the status of insulin/ leptin resistance. In a discussion of metabolic and hormonal balancing, we will present all the new tools and medications that can be prescribed safely to our patients who can benefit from these treatments.