Back in the "Dark Ages" it was believed that disease was the result of possession by evil spirits. Another, more modern, health belief, which science is proving to be based in ignorance, is the notion that overweight and obesity is simply caused by gluttony and laziness. The common belief has been that if one just increases their activity level and reduces their caloric intake then the perfect body can't help but manifest. It is time we moved beyond this "flat earth" theory of weight loss, which approaches the human body as if it were simply an engine. People are complex, living, physical, mental, emotional, and spiritual beings. All of these factor in to weight loss.

The number of calories a person eats is an important issue, and exercise is probably the single most important thing you can do for weight loss. However, not everyone who restricts calories and exercises more will lose weight. What's more, not everyone can control his or her appetite; and it's not just a matter of willpower.

Most people are aware of the fact that an underactive thyroid can make weight loss difficult or impossible. However, it's not just the thyroid. The fact is that there are a multitude of other biological factors that interfere with weight loss.

An individual's body composition (amount of body fat and muscle mass) is primarily controlled by the interplay of a myriad of chemical messaging substances produced by the body. The balance of these chemical messengers will dictate whether we are hungry and have food cravings or are satisfied, whether we are burning or storing body fat, and whether we are building or breaking down lean healthy muscle tissue. Some biochemicals, like cortisol, produce hunger, break down muscle and store fat. Others, like leptin, reduce appetite and burn fat. It's the overall balance of the various messaging molecules that determines if a given individual will be lean and fit with a normal appetite or fat and flabby with uncontrollable food cravings.

Excess body fat is a sign of impaired metabolism. When the body is not functioning properly, signs and symptoms develop. These can be things like fatigue, pain, depression, high cholesterol, or…obesity.  I approach overweight and obesity in the same way I approach any other symptom, condition or disease. I use a systematic functional medicine approach. Functional medicine is the field of health care that seeks to understand and improve the body's function in order to prevent illness and promote health. Functional medicine begins by gaining a thorough understanding of the individual's signs and symptoms. From these, an educated guess is made regarding what aspect of the body's metabolism is out of balance. This is then investigated with laboratory tests. Finally, we search for the factors that have caused the metabolic imbalances. Based on the results of this in-depth evaluation, tailored natural therapies are used to restore balance and improve the body's function.

What's of great importance is that the activity of the body's various messaging agents is the result of an interplay of genetics and lifestyle/ environmental factors. The lifestyle/environmental factors are, by and large, things that are within our conscious control and that we can change. These factors, which are the real causes of all disease and poor health, include stress, toxicity, inflammation, nutrient insufficiencies, food sensitivity reactions, insufficient exercise, insufficient rest, emotional factors, hormonal imbalances, various metabolic dysfunctions, and a number of different dietary factors. Yes, things like stress and inadequate rest can make you fat.

Let's take a hypothetical example to better understand all of this. "Mary" is an overweight 35 year old with most of her fat around the midsection. According to the "flat earth" approach of calories in-calories out, Mary needs to cut out the ice cream and start exercising. I agree. However, Mary's body composition problem is more complex than that. Mary may also be experiencing other symptoms, which will clue us in to the type of metabolic imbalance she is suffering from. Perhaps she has depression, anxiety, anger, irritability, headaches, insomnia, fibromyalgia, irritable bowel syndrome and carbohydrate cravings. Upon laboratory testing we discover that Mary has impaired serotonin metabolism. Insufficient serotonin will produce all these symptoms and is associated with excess fat around the midsection. Now, the conventional medicine approach is to give a drug to interfere with serotonin breakdown so it remains in the brain longer. A better approach is to get to the cause of the problem. With further testing we may find that Mary has low levels of the amino acid tryptophan, which is what the body makes serotonin from. Supplementing Mary with tryptophan makes sense but we can probably investigate further and get to a deeper cause of the problem. Tryptophan levels can be low from not eating enough protein. So, Mary's diet needs to be examined. Even if the diet contains enough protein, one could still be deficient in tryptophan if the protein is not being properly digested or absorbed. For this we can do a laboratory test to assess digestion and absorption. If cortisol levels are high, the body will convert less tryptophan into serotonin. Cortisol is one of the body's important stress hormones, which also has the negative effect of interfering with serotonin at the cell receptor level. We can do a lab test for cortisol levels. Other factors can also impair serotonin metabolism. Magnesium and B vitamins are necessary for conversion of tryptophan into serotonin. Dietary inadequacy and various metabolic factors can cause insufficient levels of these nutrients. DHA, an omega 3 fatty acid, must be present in proper concentration in the nerve cell membrane in order for serotonin to properly bind to the cell and have an effect. All of these nutrients can be measured from blood samples. Finally, toxins can interfere with serotonin metabolism. These toxins include environmental chemicals like mercury, poisons from bacteria living within our intestinal tracts, and even certain medications. All of these possibilities can also be evaluated.

Another important reason why people wind up with serotonin imbalances and its associated carbohydrate cravings and weight gain, is overeating of refined carbohydrates. Refined carbohydrates are sugars and easily digested starches found in foods like bagels, muffins, pasta, cookies, crackers, breads, cakes, chips, soda, and candy. Eating these foods causes a rapid rise in blood sugar levels. The body responds by secreting a lot of the hormone insulin, which transports sugar into the cells. The insulin also has the effect of delivering more tryptophan to the brain for conversion to serotonin and serotonin levels do go up. That's a good thing. However, when the effect from this abnormal spike in serotonin wears off, you crave more carbohydrate, eat more sugar and again spike serotonin levels.  When this process is played out over and over again, trouble starts. When serotonin receptors are continuously stimulated, there is a compensation that occurs. The number of serotonin receptors on the cell is reduced. So then it takes more serotonin to get the same effect. And how do you get more serotonin? By eating more refined carbohydrates. Then you get further reduction in serotonin receptors and again experience anxiety, depression, anger, irritability, and carbohydrate cravings, and increased body fat. You wind up eating even more carbohydrates to get the same effect. It's a vicious cycle.

Insulin is another piece of this puzzle that is also a major contributor to weight gain. Excess insulin has several biochemical effects that contribute to obesity. Insulin directly stimulates production and storage of body fat. It also directly interferes with breakdown, transport and burning of body fat. As if that were not enough, chronic secretion of excess insulin has an adverse effect on other hormones, like cortisol and growth hormone, with the result being increased appetite, increased body fat and decreased muscle mass.

Inflammation can also contribute to obesity. Inflammation activates the stress response and cortisol levels. It also impairs insulin metabolism and increases activity of the enzyme, aromatase, which converts testosterone to estrogen. In men, this results in increased fat around the midsection, loss of muscle mass, and possibly breast development. In women, excess estrogen can impair thyroid hormone metabolism resulting in slow fat burning. 

Inflammation also has an adverse effect on the action of the hormone called leptin. Leptin reduces appetite and increases metabolic rate. Inflammation can be triggered and perpetuated by infections, stress, food sensitivities, nutrient deficiencies, and toxin exposure. Excessive intake of refined carbohydrates, excessively heated cooking oils, and foods rich in arachidonic acid (beef, pork, lamb, dairy fat, egg yolks, shellfish) have an inflammatory effect. The gastrointestinal tract is a site of a lot of inflammation due to consumption of problematic foods and the presence of trillions of bacteria, yeast and even parasites.

Toxicity can impair weight loss by interfering with many different aspects of metabolism. Brain function, sex hormone metabolism, thyroid function and adrenal hormone output can all be negatively impacted by toxins and result in weight gain. Energy production within the mitochondria of cells can be poisoned. We are exposed to toxins in air, food, and water. Additionally, organisms residing within our intestinal tracts produce toxins, which can poison our systems. Obese individuals appear to have a different mix of intestinal bacteria than their lean counterparts. Based on animal studies, intestinal bacteria influence how many calories we extract from our food and undoubtedly modify other weight-related metabolic functions, as well. 

If we take a "bigger" look at the issue of obesity, we start with predisposing factors, which include genetics. Our genes are not usually deterministic. They allow for susceptibilities or predispositions but the ultimate manifestation of their possibilities is determined by environmental factors; things like nutrition, exercise, thoughts, and toxins can turn genes on or turn them off. Development of obesity is also influenced by things we are exposed to in the womb. A pregnant mother can predispose her unborn child to obesity by not being adequately nourished, by being stressed out, and by being exposed to toxins. Pregnancy also has the potential to foster poor food choices in the offspring as research has shown that a person's taste preferences begin to develop before birth based upon what the mother is eating. Postnatal factors also predispose to obesity. Not being breast-fed has been linked to greater likelihood of becoming obese. Loss of a parent and poor parental care taking in childhood is also a contributing factor to hormonal imbalances, which will predispose to obesity, among other symptoms.

One of the hormonal imbalances that can persist from in-utero into adulthood is excess cortisol. Cortisol is the body's long acting stress hormone. It is secreted in higher concentrations in response to pretty much anything that pulls the body out of balance. Mental-emotional stress, Inflammation and swings in blood sugar are the most common stressors. Cortisol causes biochemical changes that allow the body to adapt to stress but problems begin if cortisol is chronically elevated. Two of the negative consequences of elevated cortisol are increased appetite and deposition of fat in and around the midsection. A study of women with increased abdominal fat found they reported having more chronic stress and, in a laboratory setting, were more easily stressed and more easily secreted cortisol in response to stress.  What's the bottom line? Vulnerability to stress contributes to apple-shaped obesity. Reducing one's reaction to stress is important for weight loss (and health, in general). Another interesting study examined the connection between personality traits and abdominal obesity. Correlations were made between having a fat midsection and cynicism, anxiety, anger and depression. What's the connection? Possibly, these negative mood states are elevating cortisol levels, which in turn causes fat to be deposited in the middle!

To summarize, the "eat less, exercise more" theory of weight loss is incomplete at best. Numerous qualitative dietary factors, stress, toxicity, nutrient insufficiencies, inflammation, food sensitivity reactions, insufficient exercise, insufficient rest, emotional factors, hormonal imbalances, and various metabolic dysfunctions all need to be considered to achieve your goal of ideal body composition.