An integrative approach to weight loss

By Mercedes Hernandez, Family Medicine Residency, UTMB and Sagar Kamprath, MD, Assistant Professor of Family Medicine, University of Texas Medical Branch

Unfortunately, obesity is a problem that many Americans struggle with and the effects of obesity on one’s health are overwhelmingly negative. Therefore, addressing ways to combat obesity is essential.

Setting SMART goals is arguably the most important first step. SMART goals are goals that aim to be: “specific, measurable, attainable, relevant, and time-oriented.”  As an example, one may consider decreasing the body weight by 5-7%… In fact, many experts believe that a 5-7% weight loss is an appropriate initial weight loss goal, as goals higher than this are often unreasonable and difficult to maintain.^{1, 3}

Creating a daily caloric deficit is also a crucial part of weight loss. There are several online resources and phone applications that can help estimate reasonable caloric goals. Something to keep in mind is to encourage patients to set a caloric deficit that they can adhere to. The next question most patients will ask is, “What should I eat?” There are many popular diets, including the Mediterranean Diet, DASH diet, low carb/keto, low fat, and intermittent fasting all of which appear to produce similar weight loss results.^{1, 3} Therefore, similar to choosing a caloric deficit, the diet that is optimal for individuals is the one that they can most easily adhere to. It is worth noting a few considerations of each diet. The Mediterranean and DASH diets are notable for not only results in weight loss but also in reducing other morbidities (Mediterranean: reduction in cardiovascular disease and diabetes risk; DASH: reduction in risk for colorectal cancer, cardiovascular disease, premature mortality).² Therefore, these may guide decision-making if in patients with respective risk factors.

There are several tools to assist in making behavioral changes. These include: keeping a food/activity journal (hard copies or online/phone applications), engaging in individual/group behavioral therapy or support groups (face to face or online), and seeking regular support from Primary Care Physicians and other Providers. Ultimately, the accessibility, financial limitations, and patient preference will determine the utilization of some of these options.

It is essential for patients to find a physical activity that they, again, enjoy. Once the patient becomes accustomed to moving daily, they should aim for 30 minutes/day, 5-7 days of the week.³ It is worth noting that exercise interventions are typically less potent than dietary changes regarding weight loss. However, regular exercise is a strong predictor of weight maintenance and improves overall cardiovascular health.¹ A combination of aerobic and resistance training should be sought, as the combination provides optimal results. For example, in improving, glycemic control and insulin sensitivity, aerobic and resistance training combined were more efficacious than either alone.¹

Other integrative approaches clinicians may consider advising are: Pre-meal water loading, Omega-3, Vitamin D/Calcium, Green Tea, and Mind-Body Therapy. Pre-meal water loading is a simple strategy that involves drinking 500ml of water prior to a meal. If patients are interested in taking this method one step further, they may try adding soluble fiber to the water, which in theory should enhance the water’s satiety effects.³ Soluble fiber examples include psyllium, oat bran, guar gum, ground flaxseed, or methylcellulose.

Although Omega-3 has no evidence showing its aid in weight loss, it has been found to positively affect cardiovascular health, a potent risk associated with obesity. 1-3g daily is recommended, unless the patient already has high triglycerides, at which 2-4g is ideal.³

Obese individuals are likely to have lower levels of vitamin D due to increased adiposity. It is estimated that obese patients require 2-3x more vitamin D than non-obese patients. Therefore, clinicians should evaluate patient’s serum 25-hydroxyvitamin D and vitamin D and replace them as necessary.³

Some small studies suggest possible fat-burning, weight loss, and cholesterol-lowering effects of green tea extracts.³ As a result, clinicians may consider recommending 2-3 cups of green tea per day (240-320 polyphenols). Given the well-known associations between cortisol and obesity/metabolic derangements, clinicians should consider recommending mind-body therapies such as mindfulness and mindful eating, if patients are open to it.

In a nutshell, weight loss is complicated. However, there are many evidence-based strategies that can aid a patient in their weight loss journey. If pressed for time, or if seeking a simplified recommendation, you might offer: 1) Find a physical activity you enjoy, 2) “Eat real food. Not too much. Mostly plants” – Michael Pollan.

References

1. Perreault L, Apovian C. (2020). Obesity in adults: Overview of management. In UptoDate. Literature review current through March 2021.
2. Perreault L, Delahanty LM. (2021). Obesity in adults: Dietary therapy. In UptoDate. Literature review current through March 2021
3. Rakel, David. 2018. Integrative medicine. Ch. 37: An Integrative Approach to Obesity. 4th ed. Philadelphia, PA: Elsevier Saunders.